Failure To Thrive / Growth Failure

“Low Intake of milk”, “Failure to thrive”, “Growth failure” and “Slow gain” are all terms used to describe the circumstance in which baby is not receiving enough breast milk to grow and pick up weight healthily.


If your baby is growing well and is generally healthy, then he/she is getting enough milk. Growth can be slow at times, but may still be adequate.

Causes of low intake of milk

Problems in Mom that can cause a low milk supply or cause baby to have difficulty latching on:

-    Hypoplastic breasts.

- Anemia.

-    Sheehan’s syndrome.

- PCOS.

-    Delayed onset of milk.

-    Chronic illness.

-    Hypothyroidism.

- Autoimmune disease.

-    Eating disorder.

-    Breast surgery.

-    Depression.

-    Inverted nipples.

-    Another pregnancy.


Problems in baby that can cause low milk supply, laziness and/or latching difficulty:

-    Anatomical problems such as cleft lip or palate, short frenulum or any tongue problems. There are a list of things that can cause a week latch.

-    Any disease in baby can affect whether baby will drink often enough and effectively enough.

-    A premature baby may have less muscle tone and may be sleepy more of the time.

-    Some babies may have an allergic reaction to something in Mom’s milk.

-    Acid reflux can cause baby a lot of pain and discomfort.

Other causes of low intake of breast milk:

-    Giving baby supplements.

-    Scheduling feeds.

-   Setting time limits for feeds and times for each breast.

-    Poor latching technique

-    The use of pacifiers or artificial nipples

-    Not feeding baby often enough and not breastfeeding through the night.

Signs and Symptoms of Failure to Thrive

-    Not enough urine nappies for baby’s age.

-    Urine is dark and strong smelling.

-    Not enough bowl movements. (first few weeks after birth)

-    Baby is not swallowing enough while breastfeeding.

-    Baby is not gaining weight sufficiently.

Stool and urine requirements of infants per week.

Weight requirements of infants per week and month.


Weight Variations

NORMAL

OF CONCERN

(Get a lactation consultant to assess the breastfeeding relationship)

ABNORMAL

(Get a lactation consultant to assess the breastfeeding relationship)

Weight loss in percentage during the first 5 days after initial birth weight.

7 % or less

10%

More than 10%

Time it takes baby to return to the original birth weight.

2 weeks after birth

After two weeks

After 3 weeks

Daily weight gain after original birth weight was gained back.

Girls – 34g

Boys – 40g

Girls – 20g

Boys – 30g

Girls – less than 20g

Boys – less than 20g

Weight loss after two weeks of age.

None

None

Any amount of weight lost after two weeks of age.

Tips to Avoid or Deal with Failure to Thrive

-    Let baby breastfeed as often as he/she wants without restricting the time.

-    Make sure you have a good latching technique.

-    Try different breastfeeding positions.

-    Know your baby’s hunger signs.

-    Wake a newborn if they sleep longer than three hour stretches at a time. Make sure to breastfeed through the night too.

-    Keep note of how many urine and soiled nappies your baby is having.

-    Skin to skin contact is recommended as often as possible and especially during breastfeeding. Many Moms have found that breastfeeding in the bath can help for maximum relaxation and milk transfer.

-    Using breast compressions while breastfeeding can help the milk flow faster if Mom feels that she has a slow milk let down reflex.

-    Massaging your breasts in-between breastfeeding sessions can help increase fat content of milk.

-    If baby is struggling to pick up weight and Mom has a sufficient milk supply, Mom can pump milk into separate containers, keeping the hind milk and foremilk separate. She can then freeze the foremilk for when baby is a little older. The hindmilk is fattier and more satisfying and will help baby gain weight faster.

-    If Mom is using a breast pump, it is always best to use a hospital grade, electric double pump. Making sure that the flange (part that touches the breast) is the right size.

-    Avoid using pacifiers and artificial nipples. Alternative methods of feeding can be used to avoid the use of these.

-    Mom can investigate different ways of increasing supply, if this is an issue. She can increase supply with acupuncture, herbs, galactogogues, and certain lactogenic foods.

-    Some medications can decrease milk supply, for example some contraceptives.

-    Mom should take care of herself, keep calm and eat well as well as keep herself hydrated by drinking plenty of fluids.

Supplementation

-    If supplementation is necessary, it is recommended to first try human milk fortifier which adds goodness and calories to the breast milk. The second best choice would be to use donor breast milk if safe and available and the last resort would be formula.  

-    Supplementation can be done via a SNS or alternative feeding methods.

-    Mom should pump while supplementing, to increase her own milk supply.


Top of failure to thrive page

Tracy Behr, CBC, CLD (CBI)

Reference: Breastfeeding counselor Course information through childbirthinternational.com on Physiology of breastfeeding / breastfeeding problems / Other issues / failure to thrive.



Other pages on breastfeeding problems in connection with this page on failure to thrive

* Low milk supply

* Suck problems

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