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What does reduction of breast milk consumption in a new born indicate?

Answered by
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Dr. Sumanth Amperayani

Pediatrician, Pulmonology

Practicing since :2003

Answered : 7730 Questions

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Posted on 5 days ago in General Health
Question: Hello doctor, I had contacted you about few weeks back about my baby girl in the UK who had eczema and also sent you pictures. I hope you remember.

Her Eczema has improved after mild steroid use. She is much much better now.

My baby girl is 2 months + 3 days now. She did not take direct breast easily so we are giving her breast milk in a bottle. I have to express the breast milk and give her by bottle. So far we had given her only three time formula milk because we had to take her out.

I am now concerned about her amount of feeding. Until one week ago she was taking about 650ml in 24 hours and that was without much fuss. She was sleeping well as well.

Since last one week she does not take more than 600ml. She also does not finish the bottle quickly as before. She takes about 45 minutes to finish 70-80ml. Before she used to finish 90-100ml in 20-30 minutes.

She had first vaccinations 5 days ago and since her temperature is bit higher than before. She was around 35.8c before vaccines and now about 36.5c after vaccines.

She is weeing about 15-20 times a day and pooing about 1-3 times a day.

She was born at 38 weeks by c-section and birth weight was 2.960kg. At 2 months her weight is 4.100kg.

1> Is her weight gain acceptable or on lower side?

2> Does her current feeding pattern indicate any problem? We have not been to the doctor yet but what could possibly causing her feeding less and taking more time?

3> We have tried different bottles but same thing happens with all bottles. Do you think she does not like breast milk anymore and we should try formula milk?

4> We will weigh her again in next 2-3 days to see whether her weight has gained. I understood that as baby grows she should be eating more but in my case she is eating less. How long should I wait before making hospital appointment for this feeding issue?

5> Do you think her temperature is ok? Will it go down as before ? She used to have 35.8 before the vaccinations.

6> Any suggestions on feeding her? such as changing timings, waiting longer to feed again etc??

7> Is she eating enough according to her age and weight? Some internet stories says their babies eat as much as 1000ml at 2 months.

8> Also we noticed that since last three days she is sleeping less in day time. She remains awake for longer and then sleeps 10 minutes and then wake up again. In night she sleeps about 2-3 hours and then feed and then again 2-3 hours. But day time hardly more than 10 minutes. Why this can be happening?

9> She is peeing a lot. about 20 times a day. may be more. Is this normal?

Awaiting your response.

Thanks & Regards.
doctor
Answered by Dr. Sumanth Amperayani 50 minutes later
Brief Answer:

Suggestions on infant feeding

Detailed Answer:

Hello,

Coming to your questions one by one -

1. Her weight is on the lower limit of normal but nevertheless it is normal.

2. Usually some babies when they grow up they start becoming fuzzy during feeds and they develop aversion towards milk. So it is not a hard and fast rule that as a baby grows up they should be taking more and more milk.

3. Please refrain from using formula feeding as most of the formula fields are tastier than mother's milk and the baby will start preferring formula feeding.

4. Her weight gain is approximately 25 grams per day which is normal according to the XXXXXXX standards. So you can wait another 15 days and recheck her weight and then get back to me so that we can decide what should be done next.

5. No need to worry about the body temperature it is appropriate post vaccination.

6. My only suggestion is if possible revert back to direct breastfeeding rather than bottle feeding.

7. Please do not worry about comparing the internet stories. Not all kids do consume the same amount and have the same weight gain.

8. Sleep pattern also might change as the baby grows up and you need not worry about the sleep if she is sleeping totally around 16 to 18 hours per day.

9. Usually urinating so many times is suggestive of Renal tubular acidosis and this particular condition needs to be ruled out. But as the baby's weight gain is in the normal range we can wait another 15 days and reassess.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Sumanth Amperayani, Pediatrician, Pulmonology
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumanth Amperayani 31 minutes later
Thank you doctor for your reply.

I had tried direct breast feeding many times. I had consulted lactation specialists. I had enough support but its my baby who does not want to latch on for longer. I had also tried nipple shields for baby's convenience but no improvement.

We only give formula in emergency when we do not have breast milk available, such as at doctor appointment etc. Is Formula milk too bad? Here in UK lot of mothers chose to formula feed voluntarily not in compulsion.

My baby starts taking milk on breast but in just 2-3 minutes removes herself from breast. Then starts crying like a hell. Then does not take breast at all. Sometimes I feel after crying she just goes to sleep hungry and tired. I can not see that too often. Therefore I make sure that she eats something before sleeping.

I still try everyday to direct breastfeed but same story everyday.

1> Can you suggest anything to bring her on breast feeding again?

2> She did not sleep 16-18 hours in last three days. I would say total she slept was about 12 hours including night. Is this a problem to look into immediately?

3> I am again concerned by your indication of Renal tubular Acidosis. I searched internet briefly and found it may cause LESS urinating. Is this condition serious or we can wait little to see any changes?

Regards.



Dear doctor,

Thanks for your reply.

We have been to health center today to weigh my baby. According to their records Three weeks ago it was 3.72kg and today after 21 days it is 4.100kg. They put readings on the chart. They said the weight gain in last three weeks is just under her normal curve (percentile) on the chart. They said it is not immediate worry but we should keep an eye on her feeding level and weigh her again after two weeks.

They also suggested to look for oral thrush if baby refuses to feed. They could not see mouth of baby because my baby was hungry and my husband was feeding her bottle while appointment was going on.

We checked baby's mount but could not see white spots in her mouth other than some white patch on tongue only. We will again see tomorrow her mouth and will update you.

This readings today made me more worried. why she has not gained as much as she should? They said she has gained about 180gms less than what the chart suggests but its nothing to worry immediately and baby may catch up weight in 2-3 weeks time.

About urine they said it is normal to have frequent urination and is a sign that baby is feeding well.

I am confused by these somewhat contradicting information.

What do you think I should do at this stage?
doctor
Answered by Dr. Sumanth Amperayani 9 hours later
Brief Answer:

Suggestions on infant feeding and RTA

Detailed Answer:

Hello,

1. I feel that you have done all you can do to bring her back to breast feeding please. You have even consulted lactation specialists.

I suggest that you continue to go on with formula feeding or expressed breast milk, but not with a bottle, but with a spoon or paladey so that, rather than this - the baby may prefer breast.

2. The sleep pattern is something you need not be concerned about immediately. But this has been observed in babies who do not like to spend too much time on breastfeeding, please.

3. More frequent urination and normal quantity of urine every time is the classical history we obtain as pediatricians when we are suspecting a baby with RTA who is failing to thrive.

Here your baby is is just in the lower limit of normal. So we can wait another 15 days and see the weight and then we can take a call on this please.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Sumanth Amperayani, Pediatrician, Pulmonology



Brief Answer:

I also had suggested you wait for 2 weeks, please.

Detailed Answer:

Hi,

I agree with the opinion of the people in the health center as I too had suggested waiting for 15 days, like what they have said today.

Even though the baby is passing urine more times, as her weight is within the normal range I too felt that we should evaluate her after 15 days.

So we can wait for another fortnight and then decide what to do based on weight gain, please.

Hope I have answered your query.

Take care

Regards,
Dr Sumanth Amperayani, Pediatrician, Pulmonology
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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