Mismanaged Breastfeeding

Navigating poor weight gain

Perhaps the most common cause of slow weight gain is related to mismanaged breastfeeding. The following are some tips for navigating poor weight gain:

  • Watch for signs from your baby that he or she wants to feed. Your baby should wake and "cue" to breastfeed about eight to 12 times in 24 hours by rooting, making licking or sucking motions, bobbing his or her head or bringing his or her hand to the face or mouth. It is important for you to recognize these feeding cues and put your baby to your breast when he or she cues. Don't wait for your baby to cry. Crying is a late feeding cue. Usually a baby latches and breastfeeds better if he or she does not have to wait until he or she is crying, frustrated, or too tired to feed. Putting a baby off to try to get the baby to go longer between feedings and frequently offering a pacifier instead of the breast when a baby demonstrates feeding cues are often linked to poor weight gain.

  • Many mothers find milk production increases and babies' weight gains improve if they and their babies let chores and activities go for two or three days, so they can breastfeed, more or less, around the clock. When a baby is not breastfeeding, the mother holds him or her skin-to-skin on her chest, which often helps her become more sensitive to the baby's feeding cues.

  • If your baby is a "sleepy" baby who does not cue to feed at least eight times in 24 hours, you will have to wake the baby to feed frequently--about every two hours during the daytime and evening hours and at least every three to four hours at night until weight gain improves.

  • Be sure your baby is mainly uncovered during breastfeeding. A baby that is bundled papoose-style seems to get much too warm and comfy, and he or she is more likely to doze off too quickly during feedings. If there is a chill in the air, drape a sheet or light blanket over you and the baby, as needed.

  • If your baby falls asleep within minutes of latching on, massage your breast as he or she nurses. This can provide a burst of milk and re-trigger sucking. You can do this by stroking downward and inward on the breast.

Illustration of breastfeeding, massage technique

  • Make sure your baby is latching on correctly. The latch should be comfortable to you. Your baby's lips should be flanged outward like "fish lips." The tongue should be under your breast. A large amount of your breast tissue should be in the baby's mouth. 

  • In general, avoid "switch nursing." That is, breastfeeding at one breast for a few minutes, then the other, and then back again. This may interfere with your baby getting enough of the calorie-rich hindmilk, which your baby gets more of as a feeding continues on one breast. However, the "switch" strategy sometimes stimulates the "sleepy" baby so he or she wakes up and begins sucking again.

  • Offer a supplement during, or after, breastfeeding (when prescribed) to provide additional calories. Use your own expressed milk first for any alternative feedings if any supplementary feedings are recommended.

  • Use an alternative feeding method recommended by a certified lactation consultant (IBCLC). There are many alternative feeding options, so let her know if a recommendation does not "feel right" for you. Alternative feeding methods include:

    • Cup feeding

    • A tube system with a special feeding tube taped to the breast or a finger

    • Syringe feeding

    • An eyedropper

    • Spoon-feeding

    • Bottle-feeding

    Several methods require assistance from a professional, such as a certified lactation consultant (IBCLC) so you can use them correctly. Depending on your baby and the cause of the problem, some methods may work better than others. Also, discuss bottle nipple type with the IBCLC if you bottle-feed any supplement. Some types of bottle nipples are less likely to interfere with breastfeeding than others.

  • Pump your breasts after as many daily breastfeedings as possible, especially if you are uncertain whether your baby is effectively removing milk during breastfeeding. Pumping will remove milk effectively, so your breasts will know to produce more milk. Pumping will also express supplemental milk for feeds. Milk can be removed from the breast by manual hand expression, a hand pump, a battery-powered pump, or an electric breast pump. If frequent and prolonged pumping is anticipated, a hospital-grade, electric pump can be very helpful. 

  • Your baby should be weighed on a frequent and regular basis until he/she is gaining weight at a satisfactory rate. Digital scales are available that allow a health care provider or a certified lactation consultant (IBCLC) to get precise pre- and post-feeding weights in order to measure how much milk a baby takes in during a particular breastfeeding. Although this can be helpful, babies take in different amounts at different feedings throughout a 24-hour period. Therefore, a professional may recommend that parents rent this type of scale so a baby can be weighed before and after different feedings. They also may suggest recording only a daily or weekly weight, depending on the situation.

If breastfeeding is properly managed, yet the baby still is not gaining adequate weight, it is likely that some other factor is affecting milk production or the baby's ability to breastfeed effectively. Always consult your doctor in this case.