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My 2 week old baby girl is not nursing well. At each nursing, she eats 1 to 1.5 ounces in about 50 to 60 minutes. She often falls asleep immediately afterwards. If we let her, she will sleep for 3+ hours between feedings. We typically wake her up so that she nurses every 2.5-3 hours to make sure she gets 8 feedings a day.

At this rate she will only be getting 12-18 ounces of breast milk a day when she needs to be getting closer to 24 ounces a day.

Her pediatrician has recommended pumping and giving her a bottle to supplement to make sure she gets the 3 ounces he recommends based on her birth weight. We did that so she will start gaining weight, which she has. However, when I nurse her she is back at taking in about an ounce over 60 minutes.

How can I help my baby girl nurse more effectively?

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3 Answers 3

Agh. Supplementing is such bad advice (regardless of f the advice is to give additional breast milk or formula), it really upsets me that pediatricians (who should know better!) still tell people to do this, especially in the case of slow weight gain.

Advice concerning slow weight gain (or weight loss) is very tricky, as there are so many different factors to consider, and rarely just one cause. Slow weight gain may be a sign of underlying problems in the child (but the most common cause is still problems with the breastfeeding technique). To routinely advise supplementation without finding the underlying cause of the slow weight gain or weight loss can, in the worst case, conceal sickness in the child.

It is important to understand that more than 95% of the newborns lose weight after birth because of natural fluid loss, combined with the naturally low volume of colostrum the baby ingests the first few days. Around 12% of babies lose 10% or more in weight, ans only 5% increase in weight the first three days [January Riordan, Breastfeeding and human lactation, 2010]. Hence, it's completely normal for the child to lose weight after birth.

One should also keep in mind that weight is not the only measure of growth. Measuring height and head circumference may be just as important (if not more). Just because a child is gaining weight does not mean she is growing, and rapid weight gain is not always something worth striving for.

In Sweden, recommendations to breastfeeding counselors is to not advice to start supplementing unless the child has lost more than 10% of its birth weight. Hence it's perfectly okay for a child to lose up to 10% after birth, without the need for supplementation.

At a 5-7% weight loss the pediatrician should focus on supporting the mother and the baby with their breastfeeding technique, make sure the child has as good a latch as possible, helping to reduce and ease any redress or pain, and talking about how the mother can increase her milk production (basic anatomy, how milk production goes to, etc.). Instructing the mother to supplement is known to be connected with low self-esteem of the mother in regard to breastfeeding and can cause problems with milk production.

Another problem is that your baby will get used to drinking out of a bottle, which can lead to nipple confusion and make breastfeeding even harder for the pair of you. I would stop doing this immediately, and focus on getting the breastfeeding to work instead. Your baby will not starve, you need to trust her on this.

Contact a lactation consultant ASAP to get help with your breastfeeding. Good luck!

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I don't know how you're determining how much milk she is getting, but rather than focussing on input at this age I would be looking at output - she should be having 6-8 properly wet nappies, and 1-2 dirty ones, per day at this stage. This, in combination with checks on her body weight, will tell you whether she's heading in the right direction or not.

If she's short on output that's an early warning sign that she's not getting enough milk; wake her up more frequently to feed - for 48 hours, don't go more than 2 hours from the START of one feed to the START of the next. If you possibly can spend those 48 hours with her, in bed, both of you wearing as little as possible so you get lots of skin to skin contact, then that will help get things better established. If you do this make sure someone brings you frequent drinks of water and food you can eat one-handed. (Also, make sure you are getting LOTS of water to drink and calorific food to eat no matter what.)

This happened with my daughter - she just wasn't very efficient at feeding at first, and it is a vicious circle where not enough milk -> sleepy -> unlikely to feed -> not enough milk. The 48 hours thing is a complete pain at the time, but it sets up a basis for a much better breastfeeding relationship which makes things easier down the road.

If the 48 hours thing doesn't seem to improve things then I would consult a qualified lactation consultant to check on her latch. She may have something like a minor tongue-tie which makes it hard to feed efficiently and this can be easily corrected.

I definitely think that supplementing with a bottle is bad advice at this stage (as long as she's not actually dehydrated - if she is, then it becomes more of a case of getting it into her by whatever means possible, although spoon or syringe feeding is still better than bottle feeding at this point).

Good luck. I know this is a really difficult time and you want to be doing your best for her but it's not clear what the best actually is, which is terribly stressful.

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I second this advice. If baby is not urinating, then she could get dehydrated. Any signs of dehydration, and you should take her to the doctor right away. –  MJ6 Apr 18 '13 at 21:23
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My daughter had overwhelming trouble nursing - very similar to what you are describing. I cannot give you a hard and fast answer, but I have a few thoughts from my experiences.

First, breastfeeding is the hardest thing I have ever done. It was emotionally difficult, as well as physically difficult with my daughter. It is also my most proud accomplishment that we made it a year. Keep at it. I found it was worth the struggle, which for us lasted 4 months.

Second, be careful pumping too much - it is not as good as breastfeeding for your milk supply production.

Third, as long as she is growing, it is good. Babies will not starve themselves. I was told this over and over by multiple pediatricians. Do not let anyone talk you out of breastfeeding if that is the path that you are committed to as a mother.

Finally, I found that it took an overwhelming amount of dedication to get through the difficult patch. She eventually got on board. She has always been a great sleeper and hated being woken up to eat. I used to strip her down to her diaper to keep her awake to eat, which helped. I also found with her establishing a routine was helpful - Daddy would get her up, change her diaper and strip her down then I would feed her and re-dress her - she came to know what we were doing.

My daughter finally started making significant weight gains when we added solid foods to her diet. She was very tiny for a very long time - below the 15th percentile. This week we went for her 2 year check up and she is now in the 75th percentile for her weight. Stick with it. Listen to your instincts and listen to your baby. As long as she is growing and hitting benchmarks, trust that you are doing well.

As a side note, my second child, a boy never had a moment of difficulty nursing, so do not assume that this difficulty will happen with every child.

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