[stacyat]

My friend is EBF'ing her little girl who is now four months old.  In those four months she has gone from 7 lb 2 oz up to 8 lb 3 oz (I think, at least in the 8 range), I don't know her length.  When I saw her today she was alert and happy, though looked very skinny.  She is meeting her developmental milestones as well.

Now, isn't her weight on the extreme low side?  It's below the WHO growth chart standars by a lot.  She doesn't think there is a problem, but it seems like there is one to me.  I suggested she try fenugreek to boost her supply like I had to take when my son was little.  That's the only advice I could think to give her, but I don't know that that would be enough.  Is there any other information that I could provide her with?  What advice would you give to her?   I suggested she call an LC, and can look up a number for her if need be.

Edited to add:  Her pediatrician is recommending supplementing with formula but she is against this as she felt pressured to when her older daughter was two months and she gave in and just switched to all formula.

Thank you in advance!
  

[stacyat]

My friend is EBF'ing her little girl who is now four months old.  In those four months she has gone from 7 lb 2 oz up to 8 lb 3 oz (I think, at least in the 8 range), I don't know her length.  When I saw her today she was alert and happy, though looked very skinny.  She is meeting her developmental milestones as well.

Now, isn't her weight on the extreme low side?  It's below the WHO growth chart standars by a lot.  She doesn't think there is a problem, but it seems like there is one to me.  I suggested she try fenugreek to boost her supply like I had to take when my son was little.  That's the only advice I could think to give her, but I don't know that that would be enough.  Is there any other information that I could provide her with?  What advice would you give to her?   I suggested she call an LC, and can look up a number for her if need be.

Edited to add:  Her pediatrician is recommending supplementing with formula but she is against this as she felt pressured to when her older daughter was two months and she gave in and just switched to all formula.

Thank you in advance!
  

[dietdrpepperfan]

Stacy, to effectively help with this issue, I think we'd need more details, like how many times a day your friend is nursing, how wet diapers are, medication use and so forth. I'm not sure we have any magic words to offer based on just a little information. Is there any way your friend can come post her with more info? If there's concern, your friend can certainly contact an LC for assistance or a La Leche League Leader. Sorry I don't have more to offer but in a situation like this, the first thing I would do is ask a ton of questions to get more particulars.

[stacyat]

She said she has appropriate amounts of wet and dirties (didn't say a number).  Also she usually nurses every 2-3 hours but the past day or two it's been every hour.

I don't think that she would come here and post because she doesn't think that there is a problem so maybe I'll just see if I can play 20 questions with her to get more information.  What other questions should I ask her aside from the ones that you listed?  I'm just worried that she's so set on EBF'ing her baby because it's right for her that she's not looking at the baby and seeing what she's currently doing is not right for baby.  This is coming from me who EBF'd my son till he was 6 months old and still BF'ing him at just past a year with no plans of stopping.  She is meeting her milestones though, so that's a definite positive.

  

[kathywithivillage]

I would agree that 1lb in 4 months is very concerning IMO. A baby should gain more like a pound per month. This baby has only gained about 4oz per month which is at the low end for a weekly gain.

It's a very difficult situation for you as her friend I'm sure. How did she react when you suggested the LC or fenugreek? If someone is unwilling to accept advice it's very difficult to get them to heed it. Sometimes even when a mom seeks advice about breastfeeding she doesn't always follow that advice.

Other than staying close to her and looking for opportunities to offer your help or expertise I honestly don't know what to do. If she seems open to accepting help at any point, the best thing would be to help her find a good LC. Also, if you have an opportunity to offer advice a good way to do that gently is to offer praise first, then the advice, then some praise. Like, "Wow you are working at being such a good mom, I know a really good LC who might be able to help with your baby's weight gaining concerns, What a sweet baby, it's obvious she has a very loving mom!"

If she seems open to help remember, the most important aspect of increasing supply is to take more milk from the breasts. When I work with moms who have a slow gaining baby I often suggest pumping after every feeding and giving the baby anything she is able to pump. I also suggest formula if the weight issue is really severe or mom is not pumping enough to help the baby gain well. Some moms and babies respond well to a supplementor at the breast rather than using bottles. However, all of these ideas are best determined by an LC who has made a careful evaluation of mom and baby.

Go slowly if you overwhelm her with information she may only balk even more. 

One thing she might be willing to try on her own is to rent a special scale like the Medela Baby Weigh, to do pre and post bf weights of all the feedings for 24 to 48 hours. This way she can 'prove' the doctor wrong if the baby is getting enough to drink via the breast. If it turns out the baby is drinking enough milk from mom (usually about 25oz per 24 hours) then it may be a good idea for the doctor to explore why the baby isn't gaining well despite drinking enough milk. She might like this idea better b/c she can do it on her own and 'see' if the baby is drinking enough or not. IF she sees the baby isn't drinking enough she can figure out what she wants to do to increase supply and/or supplement. If the baby is drinking enough but not gaining it's probably good to know that b/c that would warrant a different approach from the doctor, likely some tests to see if there is an underlying problem. 

Maybe explain to her that seeing an LC doesn't mean she'll need to give formula, it may help her to breastfeed in a way that helps her baby to gain weight.

The pediatrician is obligated to report to child protective services if s/he thinks that the mom is doing something that is dangerous for the baby and I have seen many situations where doctors have done that when a baby isn't gaining well and mom is not working on it at all. Some doctors will suggest formula but be satisfied if mom says she's working with an LC or pumping or at least acting in a way that demonstrates mom understands that it's reasonable to be concerned and take action. So she may want to do something even if she won't give formula.

Another thought is you might mention the board here just in a very non-threatening way, like....."Wow have you seen this message board, I love it the information is so good and the mom's are so nice....etc etc." And she may explore information herself. If she comes here it's a way for her to talk to an LC for free. I'm not sure she'll listen to me either though!

Please be sure to keep us posted on what happens and any insight you gain on how to help a friend in a difficult situation like this. I'm sure you aren't the only person here who has experienced something like this. Also, don't feel guilty in anyway if you can't help her. People generally don't accept help unless they seek it out.

Warmly,

Kathy Kuhn IBCLC

iVillage lactation consultant

and Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, and Silas 

[stacyat]

She didn't comment on talking to an LC but she seemed interested in the fenugreek.  She said that no one had suggested that, and all they suggested was to supplement with formula.  No breastfeeding help period.  I'm wondering if WIC might be able to offer her a free LC?  I know she mentioned that she was on WIC and that might be good if cost is a factor for her being able to see one.  

I know that she said she pumps for when she goes to class and gets about 2-3 oz, and her daughter takes that in a bottle.  I'll see if she pumps any other times.  I love that idea about the scale too, that really would prove one way or another if her LO is really getting enough or not.  I bet she could swing a one month rental of one of those.

Thank you so much for all the tips, they are very helpful!  I was going to skip a pot luck over at her house tomorrow because I've got a ton going on already but it might be the perfect opportunity to talk to her a little more at length.  I did lay some of the groundwork for her hopefully accepting some sort of advice or help and told her today that my son was admitted at five days old with severe dehydration and hypernatremia after my milk didn't come in almost at all until the night of his fifth day of life and we missed the signs as did our pediatrician, if there even were any.

I'll definitely keep you posted with how things go!