Failure to Thrive While Breastfeeding

Failure to Thrive While Breastfeeding

Failure to thrive is a term doctors use that means that a baby is not growing and developing as expected. If a baby is growing slowly but has lots of energy, appears healthy, and is doing all the things babies should do at that age, then that baby may be a slow gainer. Slow weight gain can be normal, particularly if the parents are small. It never hurts to offer the baby more feedings just to make sure he is not hungry. This will help him grow best. For babies to grow well while breastfeeding, it is important to get good help with latch technique. If your baby does need extra food, it is best to use a feeding device at the breast such as a SNS™, Supplemental Nursing System™ in order to stimulate supply and help baby learn to breastfeed better. If breastfeeding is painful or you have latch problems, see an IBCLC as soon as possible, and keep in close touch with your doctor. True failure to thrive can have different causes depending on when it appears. Early failure to thrive is usually due to breastfeeding problems. If babies lose more than 7% of their birth weight or do not gain it back by 2 weeks, it is likely that breastfeeding is not going well. Mothers can have difficulty making enough milk if they have excessive bleeding during and after birth. Previous breast surgery or failure of the breasts to develop properly during adolescence can also cause problems with milk production. A baby can get less milk than he needs if the suck is weak, if there is a tongue-tie , or if the baby has breathing difficulties. Over-scheduling or limiting feedings has resulted in failure to thrive in some young infants. The AAP recommends that babies be fed as soon as they show hunger signs like trying to eat their hands or becoming more active, and certainly they should be fed if they are crying. http://www.aap.org/policy/re9729.htmlAt the first sign of low weight gain or latch problems, or if the baby loses more than 7% of birth weight or has not regained his birth weight by the 2 week checkup, an IBCLC should be consulted to help with breastfeeding. Breastfed babies who are feeding well gain between 5 and 8 ounces a week during their first few months. If a baby older than one month stops growing normally, the doctor will need to examine the baby because the baby may be ill. Some of the illnesses that can cause growth and development to slow down include infections, undiagnosed heart problems, neurological issues, cystic fibrosis, and metabolic disorders. Vitamin B12 deficiency is a rare cause of failure to thrive, but may happen if the mother eats a strict vegan diet or has had intestinal bypass surgery. The baby with failure to thrive will need extra food while you work on building your milk supply. Banked human milk is the best supplement if mother’s own milk is not plentiful enough, but if it is not available, your physician will recommend formula. Banked human milk is especially important if a metabolic disorder is suspected. Some babies with inborn errors of metabolism such as PKU can have some breast milk along with a special formula made just for their condition.Babies who are not developing as expected should be evaluated by a team of early intervention specialists, including occupational, physical, and speech therapists. In the US, these services are free of charge. The early intervention specialists, your baby’s physicians, and your IBCLC should work as a team to maximize your baby’s growth and development.

References:

  • American Academy of Pediatrics Work Group on Breastfeeding Breastfeeding and the Use of Human Milk. Pediatrics 1997 Dec 100(6):1035-9.
  • Glass, RP, Wolf, LS: Incoordination of Sucking, Swallowing and Breathing as an Etiology for Breastfeeding Difficulty; Journal of Human Lactation 10(3):185-189.
  • Grange DK, Finlay JL. Nutritional vitamin B12 deficiency in a breastfed infant following maternal gastric bypass. Pediatr Hematol Oncol. 1994 May-Jun;11(3):311-8.
  • Lukefahr JL. Underlying illness associated with failure to thrive in breastfed infants. Clin Pediatr (Phila). 1990 Aug;29(8):468-70.
  • Morton JA. Ineffective suckling: a possible consequence of obstructive positioning. J Hum Lact. 1992 Jun;8(2):83-5.
  • Neifert MR. Prevention of breastfeeding tragedies. Pediatr Clin North Am. 2001 Apr;48(2):273-97.
  • Powers NG. Slow weight gain and low milk supply in the breastfeeding dyad. Clin Perinatol. 1999 Jun;26(2):399-430.
  • Snyder JB. Bubble palate and failure to thrive: a case report. J Hum Lact. 1997 Jun;13(2):139-43.
  • Wiessinger D, Miller M. Breastfeeding difficulties as a result of tight lingual and labial frena: a case report. J Hum Lact. 1995 Dec;11(4):313-6.
  • Willis CE, Livingstone V. Infant insufficient milk syndrome associated with maternal postpartum hemorrhage. J Hum Lact. 1995 Jun;11(2):123-6.

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