8 week old ebf baby diagnosed failure to thrive

(46 Posts)
Woolybob Tue 04-Dec-12 17:36:19

Help needed! Am ebf my DD and initially everything went very well (born 8lb 1, lost 6% at day 5 and back up to bw at day 10). However when she was weighed at 6 weeks she'd gained very minimally and dropped a centile. HV not concerned at this point as felt was catch down growth but a week later she'd only gained a further 3oz so dropped a second centile (now between 25th and 9th). At this point hv suggested bottle of formula after last feed of evening 'if we wanted'. Over this week dh & I had had vomiting and diarrhea and were fairly certain dd had too (vomited twice and not normally sticky baby plus a couple of watery poos). So we felt had good reason for slow gain plus dd happy smiley baby who seems satisfied after feeds and plenty of wet nappies etc. So basically we carried on as normal.

Saw gp today for new baby checks and first jabs and gp weighed again - weight stayed at 9lb 6 over last week and a half. So basically they've now said this is FTT and are referring us to the children's hospital. He also recommended starting to give formula but suggested doing it before a feed.

I should add that the world and his wife have checked my latch and noone has found a problem, I do get blocked ducts fairly regularly - can this effect supply? I've tried expressing but am rubbish, get virtually nothing after a feed and only 1/2-1oz if I express one side while feeding the other. I'm not keen on the formula as don't want to start on the slippery slope to ending bf but I'm starting to see it as my only option. Has anyone got any other ideas? When is the 'safest' time to top up and if I start will I ever be able to go back to ebf?

Thanks in advance.

tiktok Tue 04-Dec-12 18:24:54

Wooly, sorry to hear you are worried. Not enough info in your post, though.

How many times in 24 hours does your baby feed? have you done anything to increase intake and production of breastmilk eg feeding at least both sides each time, breast compression, switch nursing, increasing freq esp at night?

Did GP or HV suggest any ways to increase intake and production?

Maybe try some of these ways of doing so, if you have not done so, and ask HV if you could have some time doing this before referral to paed?

Woolybob Tue 04-Dec-12 18:56:36

Hi tictok. Thanks for replying so quick. In the day I'm feeding every 90 mins to 2hrs (and feeds last at least 45 mins & always involve both breasts). There's quite often a longer gap at some point in the afternoon when I take her out in the pram and she sleeps but still only 3 hours max. Then feeds become almost constant in the evenings from about 5pm till 11 when she finally conks out and sleeps 4-5 hours, up to feed for an hour or more then back down for 2-3 hours. She's very fussy in the evenings, pulls at the breast etc but I understand this is normal and doesn't mean she's not getting milk? Have been doing breast compressions. No chance of delaying paeds ref - gp is making it by phone and wants us seen in 48 hours. How often should I swop for switch nursing?

aamia Tue 04-Dec-12 19:42:02

Has anyone checked for tongue tie?

PolterGoose Tue 04-Dec-12 19:53:50

Did the GP use different scales?

Welovecouscous Tue 04-Dec-12 19:59:31

I swap every time baby comes off until they won't take the breast - sometimes only 2 sides, but sometimes 4 or 5.

ecuse Tue 04-Dec-12 20:02:13

Had a very similar situation with my DD at 5wks and it was tongue tie. Everyone kept telling me latch was fine but I knew it wasn't.

I started mix feeding at the FTT diagnosis at 5 weeks (although slightly more severe as my DD was actually losing weight rather than just not gaining).

I never got back to EBF - took a further 5 weeks to get TT appointment and the snip and my supply never recovered. But then I did partially BF her until she was 1 so it wasn't quite the slippery slope to the end of BF either.

jojane Tue 04-Dec-12 20:04:55

I had similar problems with all 3 of mine
ds1 lost a lot of weight initially so more than the 14% average but in order to have an average some have to be more or less than the average figure. We got referred to pead at hospital who checked him over and said he was fine. Dd was the same although didn't lose quite as much, again referred into hospital, checked over and declared fit and healthy, by the time ds2 lost too much weight and midwife expressed concern I put my foot down and said he was just like the others and would gain weight soon
Eat ad drink lots of dairy, biscuits etc etc as well as making sure you drink lots of fluid to keep the quality of your milk up as well as your energy.
Feed from one breast for as long as possible to ensure that baby is getting enough of the fatty hind milk, if you swop noobs during a feed there is the danger that try only get the water thirst quenching mill from both breasts but not thick calorie rich stuff which takes a while to come through.
Just feed on demand but try to encourage more feeds for the moment.

I ended up exclusively feeding all three of mine until they were all 12p the or so so it can be done, I resisted the suggestions of topping up with formula and they all gained weight soon enough.

Woolybob Tue 04-Dec-12 21:33:02

Yes GP used different scales, the amounts involved seem so small it must surely make a difference if she's pooed or not that day! And no, noone's checked for tongue tie though she seems able to stick it out fine. Will ask them to check at the hospital. I still think maybe she's supposed to be tall and thin, me and dh are and it seems to us she's getting longer and outgrowing stuff but maybe this is wishful thinking on my part.

Welovecouscous Tue 04-Dec-12 21:37:25

What about expressing and feeding your ebm as top up?

Mumlar Tue 04-Dec-12 21:55:45

I had a similar situation when dc3 was a little bit younger. I was left to my own devices as I had already had two others. There was a gap of about a week between weighings and she had been feeding almost continually, or so it felt. I took her to the clinic and her weight had remained completely static. I was devastated, I was absolutely exhausted and the HV made me feel like a criminal.

I had to top her up after every feed with 2oz of formula, something I absolutely hated doing, but slowly she started to gain weight. I had to take her to the clinic every two days to be checked. I continued breastfeeding on demand too and somehow my milk production increased. I then began to wean her off formula until at nine weeks she was fully breastfed again. I fed her until just after her third birthday, so it doesn't have to be a slippery slope.

My advice would be to check your latch, (ask a breastfeeding counsellor to do this), and make sure that you are resting as much as you can. Even spend a couple of days in bed with your baby and sleep when she does. Get someone else to do everything else for you and tell them that you are increasing your supply. Good luck.

blonderthanred Tue 04-Dec-12 22:40:06

Hi, I'm in a similar boat although have been battling this since birth. My DS lost 11-12% of his birth weight on days 5 & 7, I had so much pressure on me to start giving formula top-ups but I said I wanted to give bf a chance so was given a reprieve of 2 days. I contacted LLL who sent a very long, detailed and helpful reply with info about increasing supply, breast compressions etc as well as about the effect of C Sections on weight loss & regain which was relevant to us. It felt great to have the support as I didn't really know if I was doing the right thing.

2 days later we had an increase of 20g and crucially a more positive mw who said that bf babies don't increase in a steady line but instead in steps, so one week there might be an increase and another nothing at all. It was more important that he looked healthy and was developing in other ways.

DS is now 5w4d and still not back to birthweight but has increased each week, last week just 80g which was disappointing but I reminded myself of what the mw had said. We have a weigh in tomorrow so fingers xed for a bigger increase. As you say it could be the difference between whether he does a big poo beforehand or there are different scales.

Anyway just wanted to share my experience and say in my view you should hang on in there if possible. I know how hard it is to be put under pressure to top up but I worry it will decrease supply. Having said that it is good to read the experience of others who have mixed or returned to ebf successfully. If we don't get back to birthweight tomorrow I think I will be under even more pressure to do the same.

tiktok Tue 04-Dec-12 23:05:42

jojane, you say "Eat ad drink lots of dairy, biscuits etc etc as well as making sure you drink lots of fluid to keep the quality of your milk up as well as your energy."

None of that will make any difference to milk ( might make some difference to OP's energy, possibly).

"Feed from one breast for as long as possible to ensure that baby is getting enough of the fatty hind milk, if you swop noobs during a feed there is the danger that try only get the water thirst quenching mill from both breasts but not thick calorie rich stuff which takes a while to come through."

This is not right, sorry. The way to increase production and intake if needed is to 'switch nurse' - swapping from breast to breast. Worries about not getting hindmilk are not necessary.

tiktok Tue 04-Dec-12 23:08:42

Wooly, the diff. scales may be misleading.

It certainly sounds that you are doing the right things.

I do think it's sensible to keep an eye on his weight - see what the paed has to say.

TheSecondComing Tue 04-Dec-12 23:12:34

Message withdrawn at poster's request.

Debs75 Tue 04-Dec-12 23:19:06

Tiktok you say ther is no 'hindmilk' as such but on my breastfeeding peer support course today we were talking about hindmilk and how the milk does get fattier towards the end of the feed. I know there is a fair bit of different opinion on breastmilk and feeding patterns. We are told to drain the breast so that the FIL hormone knows to make that much milk again for the next feed. (not wanting to start a bunfight here just wondering why dvice is so different. Our support trainer is a trained midwife as well as a LLL trainer)

OP Could you try using the expressed milk as a top up? The bonus would be all that pumping will help boost your supply

catkind Tue 04-Dec-12 23:21:37

It's sad that the HCP's first response is to top up with formula, not to help support you in bf-ing.

You're feeding lots, that's great. Blocked ducts is a little worrying, particularly with such frequent feeds. Could indicate baby isn't draining the breast properly, maybe tongue tie? Can you get access to a lactation consultant to double check for latch, tongue tie etc? They might also be able to help you with the expressing, I think you should be able to use a bit of massage to help prevent blocked ducts and increase expressed amounts but I'm not an expert. Then you could top up with breastmilk.

I'd personally think that if baby's had D&V then maintaining weight is doing okay. I think the GPs do have to play safe and if baby hasn't gained weight refer on. The paeds may be able to take a bigger view of the situation, happy baby, feeding well, and the D&V thing.

jojane Wed 05-Dec-12 00:22:57

Ask you wealth visitor if there is a breast feeding clinic nearby that you can attend. With ds1 it was one of the things my midwife referred me to, spent a couple
Of hours there and the breasts feeding counsoler helped show me different positions etc and I found it really helps as a first timer

In response to tiktok - eating dairy and oats helps with your supply was what I was told by midwife, even if it doesn't improve your milk keeping energy up helps you to keep milk supply plentiful
I have been told by numerous health people - midwives, health visitors and doctors about making sure baby gets the hindmilk. When expressing you can actually see the milk being creamier as you go on - for example if I pumped 2 pots full from one breast the second pot would be creamier than the first

oscarwilde Wed 05-Dec-12 00:35:14

Or you could stoo beating yourself uo and take the advice given as they have your child's best interests at heart and give 1-2 formula feeds a day?

Narked Wed 05-Dec-12 00:35:54

I've heard of oats being used as a galactagogue. There are obviously some drugs that work to increase supply. I've never seen any evidence for dairy products increasing supply. It comes from the twisted logic of drink milk to make milk. Cows eat grass. They do ok.

Tiktok speaks sense, as usual.

ChippingInLovesAutumn Wed 05-Dec-12 00:36:38

If it were me, I'd call the Dr in the morning and tell him that you don't want the referral just yet (remember, this is your baby), tell him you will take DD back to see him next week and he can weigh her on the same scales. When you are talking about such tiny amounts, deciding it is FTT whilst using different scales is daft. In the meantime, do the things that have been suggested. If DD is still having a lot of wet nappies, I really wouldn't panic <easier said than done I know x>

willitbe Wed 05-Dec-12 00:37:09

If the baby is having frequent wet nappies this is more important than weighing at this stage. Different scales and the fact that enf babies gain weight slower than ff babies should be taken into account. I too found better weight gain with less switching and more hind milk, one breast each feed.

Narked Wed 05-Dec-12 00:40:58

I wouldn't avoid the referral. If there are any issues that aren't to do with feeding, the hospital will pick them up.

tara277 Wed 05-Dec-12 00:56:03

Woolybob - I tried to PM you but couldn't for some reason. I'm a LLL leader and would be happy to help you if you want me to. The referral to the paedicatrician shouldn't be like being sent to the headmaster's office. Hopefully they will be fully supportive of the great efforts you're going to to breastfeed your baby and I would be very concerned if they weren't fully aware of the risks associated with artifical feeding. The paediatrician will hopefully reassure you that your baby is fine and then you can look at milk supply issues if that seems to be the problem. In a very small number of cases there may be conditions that are rare but important to be picked up on or indeed ruled out and hopfully your mind will be put at ease and you will be supported. It may be worth getting them to check for tongue tie (do you think your baby might have this?). It sounds as though the GP has been a little swift in the diagnosis of FTT - there is a broad criteria for this a slow weightgain alone would not constitute a diagnosis of FTT.
If possible I would suggest the best thing to do might be to cancel what you can and spend as much time as possible cuddled in bed with your baby allowing free access to milk and cuddles which I feel will do you both good.
Please PM me if you would like me to support you.

demisemiquaver Wed 05-Dec-12 01:15:36

sl similar exp myself...Centiles are baseed on bottle-fed babies weight gain pattns...dead annoying how fixated HVs can be on this,esp when see all the fat babes and wee kids around..(I wonder why ?)..lots of tea (to help the 'let-down reflex),relaxation and GOOD PROTEIN in diet...an HV told me my millk may have been like 'skimmed' and to make it richer thru my own diet

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