I get a lot of phone calls about babies not sleeping well. When I take a history I make sure I take a detailed history of their feeding, output i.e. wees and poos, and how much and what exactly the wees and poos look like!

I also make sure I get a history of their weight measurements and plot them on a WHO graph. I use an App for iPhone called Growth that can be bought for free from the App store. Unless you plot measurements it's really hard to assess how a baby is feeding. You can find the app here - Growth: baby & child charts

One baby I saw last week was 8 weeks old

Her birth weight was 2.9kg, her weight at 8 weeks was 3.47kg. Mum had been to the local clinic a few times concerned about her feeding. The nurse whipped out a calculator and worked out that she'd gained 100g a week so she said that was OK. Except it wasn't.

Weight gain at this age should be 150-200g a week. The chart showed a centile at birth of 28%, which means that 28% of babies weigh 2.9kg or less at term. The chart then showed that her current weight was 1%. Eeeek. It was quite obvious just by looking at her that she wasn't gaining weight. You could see her ribs easily and her skin on her arms and legs was loose.

Sometimes it's obvious by observing a feed, looking at the letdown, observing swallowing, looking at the baby's sucking what supply is like. She was suckling well and swallowing. I then asked about nappies and she was having 8 explosive green/yellow nappies a day as well as 5-6 very wet nappies a day. OK.

Then I asked more about the poo. Was it slimy/mucousy or bloody? Yes it was everytime. Here's a blog I've written on baby poo with lots of photos: https://www.nurtureparenting.com.au/whats-normal-for-baby-poo/

Then I looked at family history of atopic disease, asthma, eczema or hay fever and there was a lot of all 3 things in mum, dad and siblings. Aha. It looked very much like a cows milk protein intolerance/allergy and possible malabsorption, Here's a blog I've written on milk allergy and intolerance: https://www.nurtureparenting.com.au/cows-milk-protein-allergy-and-intolerance/

What to look for as an indicator of low milk supply

• Baby not satisfied after a feed, feeding more than 12 times a day and not happy.

• Dry nappies, maybe urates and infrequent poos

• Dry mouth

• Sunken fontanelle

• Skinny looking baby, loose skin folds and ribs showing

• Feeding all day and all night
  
  
• Crying and unsettled

What can you do to help this mum and baby?

• Increase milk supply - see this blog for ideas https://www.nurtureparenting.com.au/how-to-increase-your-breast-milk-supply/

• Elimination diet in case of cows milk protein intolerance/allergy

• Exclude Reflux - https://www.nurtureparenting.com.au/reflux-and-your-baby/

• Breast feeding help - refer to a lactation consultant

• Breast feeding tips - https://www.nurtureparenting.com.au/breast-feeding-and-the-basics/

• Check for tongue tie

• Nipple damage

• Get baby checked with GP to check for organic illness - urinary tract or other infections, heart conditions etc.

• Think about supplementing with Expressed Breast Milk or Infant Formula

• Help and support for mum - review by child & family health nurse and GP
  
  
• Keep an eye on the weight, regular bare weights until back on track