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Poor weight gain in breast fed infants can be caused by a number of problems
resulting in the common pathway of inadequate milk supply.
Infants who have slow weight gain need
to be seen by the child's physician or nurse practitioner
for evaluation of possible causes.
Technique problems are the most common cause of low milk supply.
These include mothers who are not feeding their infant frequently enough
to get their milk supply up,
and infants who have ineffective sucking.
Ineffective suckling can result from sucking only on the nipple
instead of the areola,
from not latching on well or not
sucking for a long enough period of time
to elevate the prolactin levels.
Nipple shields can interfere with nipple stimulation resulting
in low prolactin and oxytocin levels.
Flutter suckling is an abnormal sucking pattern in the infant
characterized by rapid shallow tongue movements that do not
massage the nipple well enough to stimulate prolactin secretion.
Infant health problems such as congenital and acquired infections,
urinary tract infections,
metabolic diseases such as hypothyroidism or other aminoacidopathies,
renal problems,
anomalies of the mouth or the throat causing poor sucking,
congenital heart disease,
cystic fibrosis,
congenital neuromuscular disorders,
and Down's syndrome
can be associated with slow weight gain.
Maternal health problems including inadequate maternal diet or hydration,
fatigue,
anxiety,
stress,
chronic infections,
or endocrine disorders,
can interfere with both milk production and milk ejection.
A retained placenta can
inhibit milk production due to the presence of the placental hormones.
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