Make yourself comfortable, this post is a doozy...
I've been meaning to write this post for quite awhile to fill in the details surrounding West's slow weight gain. It's a long story but I'd like to go ahead and put it all down on paper the screen for any and all we've talked to about it along the way and for our own record as well.
The plan they developed was to put him on Prevacid, put him back on a schedule feeding him every three hours during the day and 3-4 hours at night for a total of 7-8 feedings during the day, and hold off on feeding him solid foods still. (We get asked a lot why we don't put him on solids, but the reason is that one jar of baby food has the same calories as one ounce of breastmilk and a baby his size won't even finish a jar of baby food, so we'd be filling him up on less caloric food). We were to try that for three weeks and then go back in.
West weighed 8lb 9oz at birth - a big baby but not completely unexpected since he was a whole 7 days past his due date (may not seem like long but for this momma it felt like an eternity!). At his one week check up he weighed 8lb 12oz - we were so proud that not only did he regain his birth weight (which they should do within 2 weeks), but gained even more and was at the 90th percentile! At his one month appointment he weighed 10lb 4oz and was at the 50-75th percentile. At his two month appointment he weighed 12lbs and was at the 50th percentile. His pediatrician didn't seem concerned that he was dropping a bit on the curve; in fact, she didn't even mention it. She said to have him back in two months for his next well baby check-up.
All this time he was exclusively breastfed and it had all gone very smoothly. No problems with latching, supply, mastitis, etc, praise God! After his first week or so he wasn't necessarily a big eater. He rarely, if ever, emptied both breasts or actively ate for 30+ mins. Most feedings would be about 10-15 mins on one side and maybe 5 on the other. When he was 12 weeks old, when I was back at work, I noticed he stopped eating as well when I would nurse him over lunch. He would only eat for 3-4 minutes and then get so distracted he wouldn't eat anymore. He also never took a full feeding from the bottle (of expressed breast milk) - he should've been eating at least 5 oz for his age and weight but he'd usually only eat 3-4 oz. We chalked it up to the change in me being at work and since I quit after 7 days (an entirely different story...) we just hoped we'd get back on track once I was back at home with him. But then the day after my last day of work we traveled for a family Christmas, the next day we traveled down to Springfield, when we got home all 3 of us got sick and my dad was in the hospital for almost a week. Add to that the craziness of our 5 other Christmases, and we didn't get back on track like we were hoping. In fact, most every feeding only lasted 5 minutes if he wasn't sleeping.
I read online that as babies get older they become more efficient nursers so I wondered if maybe he really was filling his belly in that short amount of time. He was happy and content between feedings and had the amount of wet and dirty diapers that well-nourished babies should, so the only way we'd know was actually weighing him. His pediatrician's office weighs babies for free on Tuesdays from 3-4:30 so as soon as I quit work I wanted to take him to make sure his weight was still on track.
I took him on December 20th and we found that he only weighed 12lb 14oz. In 6 weeks he had only gained 14 oz, whereas he should've gained at least 20 oz. It was upsetting, but from that weighing alone we couldn't tell if it was a one-time problem that occurred in the previous 6 weeks (me being at work, him getting sick, etc) or a bigger issue with his eating so we had to just continue on as normal for a week and take him back and see if he gained 3-5 oz like he should or not. We couldn't take him back the next Tuesday because they were closed for Christmas, but thankfully we did get in on the following Thursday for his 4 mo checkup. He weighed in at 13lb 6oz in the exam room and our fears were assuaged - he had gained 8 oz in a week and his doctor and we believed that his poor weight gain the week before must have just been from the craziness of the previous 6 weeks... or so we thought.
I took him back the following Tuesday afternoon to be weighed again just to be sure, and we were devastated to find that he didn't actually weigh 13lb 6oz but 13lb 2oz, due to a difference in how the scales were calibrated (the one in the exam room as a non-digital scale whereas the one in the lactation consultant's room was digital). He had only gained 4 oz in 2 weeks. A bit of panic set in. His pediatrician referred us right on to Children's Mercy's Ready, Set, Grow clinic - a specialty clinic for failure-to-thrive children and infants but we wouldn't be able to get in for 9 days. In the meantime, I talked to a handful of lactation consultants and other breastfeeding friends for tips and encouragement and I focused on extending his feedings however I could, adding an extra feed at night, and making his feedings closer together. The hard work paid off and he gained a whopping 10 oz over the next week! Because of this huge weight gain, we thought we had it under control and his doc cancelled his appt at Children's Mercy. The next week he gained 5 oz - a little lower, but still on the upper end of the 3-5 oz he should gain per week at that age. I was starting to feel more confident, only to find that the third week he hadn't gained an ounce. Of course, the day before that weighing he had spit up way more than usual and then that morning he had a record-breaking blowout diaper (well, at least if there was such a record he'd have been in the running...) so we weren't sure how worried to be. His pediatrician rescheduled the appointment at Children's Mercy Ready, Set, Grow for Feb 9. In the meantime I kept working at extending his feedings; the next week he gained 6 oz.
Now let me elaborate on what "extending his feedings" entailed. Each feeding session would take about an hour and we'd have to sit in his room with no lights, the blinds closed, and no radio or computer. Brad couldn't even be in the room because he was so easily distracted. He would usually eat for a few minutes and then stop to chew on his hand, look around, etc. If I would hold his hands sometimes he would eat for another minute or so, but I'd have to fight to get those precious few minutes. If he still wouldn't settle down we'd have to go sit in the bathroom on the floor because that's the only room in the house that is pitch black. The only time he ate really well was when he was asleep, so I tried feeding him to sleep or right when he woke from naps as much as possible. Feeding him to sleep worked the best but created a slew of other problems as his schedule was thrown out the window and he started to become dependent on nursing in order to fall asleep (something we've been against from day one). Of course we knew those things were secondary to him getting nourishment so I pushed them aside to get the calories in.
In addition to each feeding being a long, tiring ordeal, the stress/wonder/pressure was wearing on us too of whether or not he was going to gain 3-5oz at each upcoming weigh in and what we could try next and if he was going to suffer developmentally because of his slow weight gain. Whereas before we looked at the Children's Mercy appointment with contempt (not sure why really, maybe because we thought it meant we had failed), at this point we were desperate for relief in the form of answers. Thankfully, it was a great experience. We were able to meet with a team of a nurse, nurse practitioner, lactation consultant, and dietitian and they all worked together to figure out what in the world is going on with our little guy. It only took a few minutes of us explaining what it's like when he eats when they zeroed in on silent reflux (more on this and his symptoms of it to come in another post).
Turns out that because of his silent reflux, he'd trained himself to only eat for a few minutes because he knew that if he ate longer the gastric juices would burn his esophagus. That also explained why he ate better when he was sleeping - he couldn't consciously make himself stop eating. So this whole time he wasn't just a terrible nurser who hated food - he was trying to avoid pain! It was such a relief to find that there was a cause of - and more importantly, solution for - his eating issues.
The plan they developed was to put him on Prevacid, put him back on a schedule feeding him every three hours during the day and 3-4 hours at night for a total of 7-8 feedings during the day, and hold off on feeding him solid foods still. (We get asked a lot why we don't put him on solids, but the reason is that one jar of baby food has the same calories as one ounce of breastmilk and a baby his size won't even finish a jar of baby food, so we'd be filling him up on less caloric food). We were to try that for three weeks and then go back in.
Our three weeks ended this last Thursday and we went back in to see how he did. Sadly, he came in just under the goal they set for him, gaining only 13 oz instead of 15-21. He weighed in at 15lb 1oz, which is the 13th percentile. They weren't discouraged, though, because there are three things that they think contributed to it: 1) he got his first ever cold during the three week period and ate terribly for a few days because of it; 2) we went out of town last weekend which meant, despite our best efforts, he had extremely distracted feedings and a thrown off schedule, and 3) we switched from the Prevacid solutabs twice a day to the capsules once a day.
The new plan is to offer half of the capsule twice a day to give a more continued release of the medicine. We hope this works because the solutabs twice a day were working so fantastically and he was eating better than he has in months. Why don't we just continue using the solutabs? Well, because they're $200 a month vs. $20 a month for the capsules, so we're definitely hoping that simply readjusting the timing of the medicine will do the trick. We're going to give it a week and call them and let them know how it's going and reexamine whether or not to switch back to the solutabs. We are also supposed to offer him some expressed breastmilk fortified with a little formula in a sippy cup a could times a day (since he refuses to take a bottle) to get in some "catch up" calories. I asked again about solids and they said they prefer the milk in a cup since it has more calories in it, but that rice cereal is at least a little more caloric than baby fruits and vegetables so we can experiment with that after I feed him if he isn't interested in the cup. We'll work on all that and go back in again in 3-4 weeks.
So that's where we are now. It has been quite the roller coaster and has been quite stressful at times, but we just keep thanking God for our sweet boy and that he is healthy and happy, even if he's a bit on the small side. ;)
