If you’ve been told your breastfed baby isn’t gaining enough weight, you might feel a little heartbroken, defeated, and full of mum guilt. You just want your baby to be ok and doing well. The good news is that there are some things you can do to get your baby’s weight and breastfeeding back on track. However, I want to make it clear that this information is general in nature and doesn’t take into consideration yours or your baby’s individual situations. You will likely find it helpful to work with an International Board Certified Lactation Consultant (IBCLC) to help you work out a plan that works for you and your baby’s individual situation.

There are 3 steps to the process you need to work through:

1. Feed the baby
2. Protect/build supply
3. Find the underlying cause

Feed the baby

It’s important that your baby is getting enough breastmilk to sustain their body and grow while working on supply and any underlying causes. This can be as simple as making changes to your baby’s position and latch so that they are able to breastfeed effectively. You can find out how to tell if your baby is breastfeeding well HERE.

Most babies under 6 months of age will breastfeed AT LEAST 8 times in 24 hours. If your baby isn’t gaining as much weight as expected and they are feeding less than 8 times a day, you can try offering breastfeeds more frequently to increase how much milk they are taking from you. This will also stimulate your breasts to make more milk as supply = demand. Offering both breasts at each breastfeed will help here too.

Breast compressions can help increase the amount of milk your baby is able to transfer from your breasts to their mouth. This helps them gain more weight and also increases your supply (more milk removed = more milk made). To do breast compressions, squeeze and hold the breast gently, up far away from the nipple while your baby is latched. You are looking for your baby to do some more swallows. If they do swallow, keep gently squeezing the breast until they stop. Then let go of your breast and repeat. Continue this until your baby doesn’t respond with any more swallows. If your baby doesn’t do any more swallows when you do a breast compression, you can switch breasts.

Along the same lines, switch feeding helps to trigger a new let down and release more milk to your baby. Switch feeding involves changing sides 3-4 times during a breastfeed. You will find it helpful to watch your baby’s suck pattern when you do this. After they have finished nutritive sucking/swallowing (more on nutritive sucking HERE), change sides and keep doing this until bub has had both sides twice. This also helps stimulate supply because more milk is removed.

If the above techniques do not help your baby to do more nutritive sucking, your baby may need to have some extra milk so that they get what they need while working to increase your supply. There are a few options here:

• Express breastmilk (by hand expressing or breast pump) and feed this to your baby with a cup, breastfeeding supplementer or a bottle (a spoon or a syringe can also be used if the top up amounts are small).
• Source donor breastmilk and feed to your baby using the methods above (find out more about donor milk HERE and HERE).
• Use infant formula via methods above.

Your lactation consultant will be able to advise you on how much and how often. If you use donor breastmilk or formula, expressing after breastfeeds will help to stimulate your supply while you do this.

Protect/build your supply

Breastmilk supply works on a supply and demand basis, so the more milk that is removed from your breasts, the more they will make. It is important for your breasts to be drained often so that they increase milk production, and your baby gets more milk and will then gain more weight. As mentioned in the last section, breastfeeding more often, offering both breasts at every feed, breast compressions, switch feeding and expressing can all help increase your breastmilk supply by removing more milk from your breasts.

If your baby is not draining your breasts well, you may need to express after or in between breastfeeds to increase breastmilk production. Some mums find that they don’t get much milk when they express. It is important to note that the amount you get when you express does not necessarily reflect how much milk your baby is getting at the breast. Babies who are latching well are usually much more efficient at getting breastmilk out than pumps. If you don’t get much milk out when you express, you might like to double check that your breast pump flange (also called breast shield) is the right size for you. This is usually explained in the instructions for the breast pump. Lots of mums also find hands on pumping helpful (more info on this HERE).

If these techniques have not worked well, you can discuss the use of medication that can help boost your supply with your GP/midwife. In Australia, the most common medication used for this is motilium/domperidone. This medication can help together with the above techniques. Many mums eat lactation cookies and take other herbs that are thought to increase supply, but there is no research evidence to say that these things actually work. We do know that the more milk you remove, the more you will make, so this is the most important thing to focus on. You will need to continue working on the other methods of building supply along side the medication to see the best effect.

Find the underlying cause

The most common cause for low weight gains in babies is usually that they’re not getting enough breastmilk. If this is the cause in your situation, all the techniques above will likely start to make a difference. There is a rare condition of the breast called Insufficient Glandular Tissue (IGT) which means there is not enough milk making tissue in the breast. Often, mums with IGT are unable to build a supply enough to meet their baby’s needs and need to supplement with donor milk or formula long term.

If it is found that your baby is getting enough breastmilk and they’re still not gaining enough weight, other causes for this may be allergies/intolerances, medical illness, a problem with gut absorption or a metabolic disorder. You may need support from a team of health professionals to help get to the bottom of what’s going on in this case. A lactation consultant near you may be able to point you in the right direction to those who can help.

If you’re living this story right now, I see how hard and upsetting this is for you. It is super important to surround yourself with support. If you’re not working with an IBCLC yet, it may be helpful for you to find one to guide and support you through the process. You can book a home visit or online consultation with me below.

** Please note that this information is general in nature and doesn’t take into consideration yours or your baby’s individual situations. You will likely find it helpful to work with an International Board Certified Lactation Consultant (IBCLC) to help you work out a plan that works for you and your baby’s individual situation. **