Expert: ruth kraft - 2/4/2010

Question
I am asking this on behalf of my sister. Her son is 12 weeks old and currently exclusively breastfed on demand. He did not have the best start in life as he had a lung infection when he was born and was in the neo natal unit for the first 5 days. Consequently his first breastfeed was at 5 days, although he had been tube fed colostrum while in NNU. He lost just under 10% of his birth weight after coming home from hospital at 8 days. When he was 3 weeks my sister's midwife expressed concern at his weight gain - which at that stage was actually not too slow - and recommended formula top ups. My sister very reluctantly agreed to this (although it was more a case of being worn down by her partner's insistance) and baby had one 3oz supplement a day for around 10 days. Baby's weight unsurprisingly increased and the supplements were stopped. Since then his weight gain has been slow but relatively steady. He didn't gain a lot over Christmas (which is to be expected as they were out and about a lot and baby inevitably was not feeding as frequesntly). Two weeks ago he had gained 4oz in a fortnight, last week he had gained 4oz in a week and having been weighed today his weight is unchanged from last week. My sister has been advised again to supplement, which she really does not want to do, however she is concerned about her son's slow gain. Other than this he is a perfectly healthy baby. He is alert and happy, he has grown in length and has plenty of wet nappies daily. My sister is breastfeeding on demand including through the night (she co sleeps) so is giving around 10 - 12+ feeds daily. Her latch is good and baby is swallowing well during feeds. Her health visitor has referred them to a paediatrician but has said that the paediatrician will insist on supplementary feeding before doing any other tests.

Answer
If the baby is 12 weeks and is acting normal other than slow gain, it sounds like he is doing ok. When you say slow gain, here is the US we use growth charts and they expect babies to continue going up and up and up and talk about how they compare to other children. I suggest, watching the baby as an individual. Not compared to other children. If the baby is steadily gaining and developmentally where he needs to be , no supplementing is needed. Breastmilk has more calories and better nutrition than formula. So, if your sister wants to supplement with a few ounces to make her feel better, have her pump and express a few ounces each day to supplement with that.  She can take metamucil if you have that where you are that will help increase milk as well. But he might just be a small slow gaining baby. it doesnt mean anything is wrong it just means that he is growing differently than other kids. This is not a bad thing. Especially if he is developmentally where he needs to be and acting normal.

I hope that helped!