Expert: Sally Wendkos Olds - 9/18/2010

Question
My son is 17wks (born 5/20/2010).
birth: 9lb6oz (39wks, scheduled c-section)
discharge: 8lb13oz
1 month: 12lb1oz
2 month: 14lb9oz
4 month: 15lb12oz

He was a little fussy this week so we went to see the NP/LC at our ped office. I had not been concerned about his weight until they put him on the scale. In 2 months, he only gained 19oz and dropped from 95th to 75th percentile for weight.  He is a laid back baby...but he is happy.  He slept 9-10hrs/night @ 2 months old and sleeps 11-12hrs/night @ 4 months old. He nurses about every 3 hours during the day. I was only offering 1 breast because I have a history of over-production with my other 2 children and was over-producing with him in the early weeks
Up until the appt this week, he would nurse 1 side for about 20 min and then be alert, happy, playful, cooing until he was ready to nap. Then nap and repeat the eat-play-sleep throughout the day. I feed on demand but his demand seems to be about every 3 hrs...sometimes he has gone even 4hrs. I only took him in to the doc because he seemed to be waking from naps after a short time and was crying...but he didn't necessarily seem hungry when I would pick him up. I would put him in the stroller and he would fall asleep while we were taking a walk.  Now I am confused because I didn't feed him...because he wasn't showing signs of hunger. I assumed that if he fell back to sleep, he is not hungry...just still tired.  When he is hungry, he is sucking on my arm, shoulder, fidgeting in my arms, starting to really get upset.

I am taking fenugreek, drinking mother's milk tea, and offering both sides at each feeding. I started all of this yesterday. I am also pumping at night before I go to bed. I did get an 'extra' feeding in today during the day (6 feeds total) but he seemed to spit up a lot.  He is definitely popping on and off the breast more later in the day as I seem to have less milk and I guess my body will take a few days to adjust to him nursing from both sides at each feeding.  I also felt like I had very little milk for his bedtime feeding. I am also upping my water and trying to make good food choices. I did get my period for the 1st time this week and I know that can affect milk supply to.

He sucks his thumb and the LC said that maybe he is 'going to bed hungry because he is pacifying himself with his thumb'.  He nurses and I put him in his crib awake...and he sucks his thumb and falls asleep (same for naps).  I was surprised by this...didn't think a baby would sleep 12hrs at night if he was hungry! He is wearing 6-9mo clothing...rolls and chubby...seemed to be growing well. But now I am doubting every decision I make with him because I feel like I missed the signs of him needing more. I worry that if I don't feed him more, he will continue to gain slowly. I don't know how to feed him more frequently than his demand.

So, my questions are:
- how long will it take to increase my supply doing what I described above?
- is it possible that i can increase my supply but he will still go every 3hrs? or should i try to feed every 2.5 to get in one more feeding?
- could it be that he is 'leveling out' after having tremendous weight gain in the first 2 months? His length was 75th percentile @ 2 months. they didn't measure his length this week.
- do dream feeds really work? i am worried that I will pick him up, feed, and then he won't go back to sleep.

We have his 4mo appt on 9/28 so they will re-check his weight at that appt.

Thank you.

Answer
Dear Carri,

First, congratulations for giving your children the best start in life by breastfeeding them! As far as your son is concerned, you seem to be doing everything right.

I consulted pediatrician Dr. Laura Marks, coauthor of our book (see below); she says that babies do cross weight percentiles before one year of age, and it is often fine. Continue what you're doing --  feed your son on demand, every 2 1/2 to 3 hours, and continue to offer both breasts. Then don't worry -- and wait for his four-month checkup. At that time you'll have another point on his weight graph, and you can discuss the whole picture with your pediatrician, who can probably help you get a better picture of your son's development.

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Olds & Marks, 4th edition, September 2010, published by Workman Publishing, and soon available in most public libraries, bookstores & La Leche League chapters.