Why Your Baby May Not Be Gaining
He's not nursing frequently enough. Newborns need to eat about every two and a half hours, or roughly eight to 12 times in a 24-hour period. "Some infants, particularly if you had any complications, are really sleepy -- like they haven't woken up after delivery," says Dr. Shu. But it's a vicious cycle: When your little one doesn't nurse frequently enough, your body isn't stimulated to increase supply, which means your baby may not get enough nutrients, leaving him too tired to eat. Instead of letting him drift off too soon on your breast, rub his feet to rouse him so he keeps sucking. If that doesn't work, remove him from the breast to wake him, then latch him back on, says Dr. Wight. A sleepy baby may give you nice stretches at night, but you should wake him to nurse every two and a half hours until your pediatrician says you can stop.
Your latch needs tweaking. Helping Baby latch on correctly takes practice, says Dr. Wight. It may not come as naturally for you as you imagined, but it's important to master for nursing sessions that are satisfying (for your baby) and pain-free (for you). In the maternity ward, have nurses help you and don't be shy about asking your seasoned mom friends to observe your latch.
Your infant has tongue-tie. In about 5 percent of infants, the piece of skin that attaches the tongue to the bottom of the mouth (the lingual frenulum) is abnormally thick or short, and this may restrict the movement of the tip of the tongue, making nursing difficult for your baby. A lactation consultant or your pediatrician should check for tongue-tie if your baby is struggling. One clue: if the tip of his tongue curls under when he cries with his mouth wide open. During an outpatient procedure, your pediatrician or a specialist will clip the frenulum. "Tongue-tie is less of a problem for bottle-fed babies," says Dr. Schanler, since less tongue movement is required to get the milk from the bottle. "But severe tongue-tie needs to be treated, regardless of breast or bottle, to prevent later speech problems," he says.
You aren't mixing formula precisely. "Sometimes parents add extra water because they think formula is constipating their baby or they want to save money," says Dr. Shu. Don't. Diluting formula can be fatal to your infant if she takes in too much water and not enough calories.
You delivered slightly early. Babies born between 34 and 37 weeks, considered "late preterm," may struggle to breastfeed since they aren't as developed as we used to think, says Dr. Wight. "Their brains are smaller at birth, they have an immature nervous system, and they may have low muscle tone or jaundice, or be dehydrated, all of which can affect the ability to suck, swallow, and breathe during nursing." You may have to combine nursing, pumping, and supplementing with formula until your early bird gets the hang of sucking and swallowing. A lactation consultant who specializes in premature babies can help you plan. "I recommend pumping after every feeding until your infant reaches his original due date," says Dr. Wight.
Your baby has reflux or a possible allergy. It's normal for most babies to spit up and fuss after nursing, but too much of either may be caused by excessive reflux. Feeding your baby in an upright position and burping him more frequently can help. Talk strategy with your pediatrician. In rare cases, a prescription antacid might be needed. One reassurance: Most babies outgrow reflux on their own between ages 1 and 18 months.
Extreme fussiness could also signal her tummy hurts from a food allergy (at this age, often to dairy). A baby who can't tolerate cow's milk or soy, either in formula or in your own diet if you're nursing, may have diarrhea, and you might spot blood in her poop, says Dr. Shu. If you're breastfeeding, your doctor may first have you eliminate the suspect food from your diet to confirm the allergy. Or tests may be run. If your child is found to have an allergy, you'll have to stop eating whatever she's allergic to (the top offenders: dairy, soy, eggs, tree nuts, peanuts, fish, shellfish, and wheat). Formula-fed infants should be given a special hydrolyzed formula, in which the proteins they can't tolerate are already broken down.
You have a supply problem. "It can be hard to trust your baby is getting enough from nursing, but as long as he's peeing and pooping, and seems satisfied, you are probably producing sufficient milk," says Dr. Shu. Phew! Your biggest threat: lack of support. "Problems develop when new moms don't have anyone to help them at the beginning and so they don't establish their full supply," says Dr. Wight. Talk to other women or a lactation consultant early and often.