advice please - failure to thrive in newborn

[pmgkt]

My 3 week old has only just got back to his birth weight, having only gain 2 oz in the last week. Hv is happy to give us another week before referring us for failure to thrive. He has 2 bottles a day and bf every 3 ish hours during the day. At night after the bottle he goes 5 hours then 3 hourly again. He does lots if wee and poo, and although he sleeps a lot like any newborn he does have awake time, is strong in his arms and legs and screams loads having his nappy changed. Any advice or experience to share please. I an happy to ff rather than bf,, if that is what it takes

[Loislane78]

I'm no expert and you should phone one of the helplines but in the first instance it seems like you should try feeding more. Only feeding twice in 8 hours (overnight) for a 3 week old isn't v much, whilst we'd all be grateful for the sleep :)

Are you mix feeding, bottle and breast? Do you feed on demand?

Babymoon on the sofa or in bed for a few days. TV remote, snacks, drinks and keep baby on you and just keep offering.

Best of luck to you and little one :)

[tiktok]

Sorry you're having a hard time, pmgkt.

I can understand your HV's concern. Has she suggested anything other than 'wait and see'? She should have shared some ideas with you.

Loislane makes some good points. Sounds to me your baby is bf maybe 5-6 times in 24 hours, with a long gap after the bottles? It's not very often for a 3 week old and not sufficient for most mothers to build up and maintain a good milk supply. Try to call helplines and talk about feeding much more often, using at least both breasts each time...hope you get good help. Talk to hV about reducing formula when it's ok to do so.

[Purplelooby]

We weighed DS on kitchen scales before and after BFing to check whether he was getting a sensible amount of milk during each feed - it helped us to be more scientific about what his issues were.

[tiktok]

Hmmmm...not a good idea, sorry, purplelooby. How would you know what a 'sensible' amount was? And what do you do if the amount is not 'sensible"? And what about the fact that babies take widely differing amounts each time?

Nothing wrong with this, if you can be bothered, with a healthy baby who's growing well anyway....but it isn't scientific :)

[pmgkt]

Thanks Lois. Babymoon sounds like a nice plan but with a 2 and half year old that isn't possible I'm afraid. Yes mix feeding. Bottle about 7 in the morning then feeding 10 1 4 7 then bottle at half 9. I do top him up if he wants a bit more in between too. Overnight he for a til between 2 & 3 then at 5 ish depending on when he wakes.

Tik she did suggest maybe adding another formula feed at lunch time so that I could monitor intake better. I'm looking to switch to ff over the next few weeks anyway cos its more practical with childcare and ds1 needing my attention too. Hv was happier with me just feeding one side to make sure he was getting the hind milk needed rather than just the foremilk. It's all so confusing this time, I ebf ds1 for 6 months with the odd bottle to get him used to it. Both hv and others have said its harder when you have a 2nd one as you don't sit down and relax between feeds in the same way.

[tiktok]

:( :( :( Very poor info from the HV....adding a further bottle of formula and only offering one side is a pretty quick way of moving to fully formula feeding, plus her suggestion you need to relax (bf usually goes better 2nd time round - women tend to have a better milk supply).

She's got the wrong idea about foremilk/hindmilk.

It'll help you make up your mind about what you want to do, I think, if you call one of the helplines. If you are planning to switch to formula then what you are doing now is going to make it happen, and maybe this is what you prefer....your choice! But if you want to keep bf going longer, even partially, you will need to change what you are doing.

Hope you find the solution that's right for you.

[pmgkt]

Thank tik. He has fed on and off all evening tonight and seemed a bit frustrated, when he had his bottle, he also ate all of that and then seemed really happy and full.

I think the hv advice was based on the knowledge that I wasn't going to feed much longer anyway and I offered it as a solution, if I had said I wanted to carry on then her advice would have been different.

[Purplelooby]

tik my friend went to a lactation specialist and it's exactly what she did, only with more precise scales! It means that, over a 24 hour period, you can monitor the volume that they take, which is exactly what the hospital will want to know if he has to go in. Which I know because DS got sent in.

[JiltedJohnsJulie]

Dc1 won't necessarily get more attention in the long run either. You've got to add in shopping time for the formula and other feeding equipment, sterilising bottles, making up feeds, transporting feeds if you are going out and feeding. It's not a criticsm, just saying that dc1 isn't necessarily a reason to stop feeding dc2.

Agree with tiktok, ringing one of the bfing helplines should help you work out how you want to go on and then what to do. Try the National Breastfeeding Helpline

[tiktok]

purple, I have heard of some lactation consultants (more commonly in the US - hardly ever hear of it being done in the UK) doing a 'test weigh' like this. I am not saying no one does it....but what can I say? It has no good evidence for it as a clinical tool (although I accept that coupled with expert help, follow up and understanding, some LCs find it useful). It has lots of evidence against it. It may be useful when treating very high risk babies or very pre-term babies. There is nothing in the lit. I have seen that supports its use for healthy, term babies. If it's done at all, scales need to be accurate, natch, and not the kitchen scales you suggested, sorry.

Even doing it for every feed over 24 hours you are still getting a snapshot, not a big picture.

Who's to say how much milk is a 'sensible' amount at any one time, on any one day? If you want to know more, read this www.ncbi.nlm.nih.gov/pubmed/16510619 which shows the volume of milk taken by healthy term babies at any one feed varied from 0 ml (zero, that is :) to 240 mls. Clearly, healthy babies vary, and it would be very hard to say that a test weigh would reveal anything.....other more reliable signs of milk intake in a newborn are nappies, weight gain, behaviour and observation of the baby at the breast.

[Purplelooby]

tik I have serious respect for the fact that you've cited a paper so I am well and truly bowing to your superiour knowledge (plus, I'm about to post a breastfeeding question and having seen your post above, I am now very much hoping that you are one of the people who will reply )

[JiltedJohnsJulie]

purple if I was still bfing and had a problem, I'd be actively seeking out tiktok

[pmgkt]

Just an update. I switched to formula yesterday morning and ds seems happier already, taking a good amount each feed. I did wonder how my boobs would cope and my plan was to Express when they felt full to ensure that I didn't get mastitis. It wasn't until 24 hours later that they felt full, and when I expressed I only got 120ml in total from both sides. I know babies are more efficient but that makes me think that for whatever reason I wasn't making enough for him to thrive. Of course he us having what I Express so will still have some breastmilk for a bit longer. His nappies have also been significantly wetter. He has been showing hunger signs earlier which I think is a good sign that he isn't too sleepy due to no energy, The real test will be on Monday when he is weighed.

[JiltedJohnsJulie]

Glad you've made a decision that makes you happier, I just wanted to add though, for any lurkers, that the amount you can express is absolutely no indication of how much milk you are producing. I fed my DS who was a right chunky monkey but could hardly ever express a drop.

[pmgkt]

I would agree with that jilted, ds1 was breastfed for 6 months and was always 90th+ centile, but I could Express for 40 min and be lucky to get 20ml. But my boobs would feel big in time for the next feed which I haven't had this time.

[tiktok]

purple I will check tomorrow :)

pmgkt, glad you are happy with your decision.

(Could well be that at present you are not/were not making sufficient milk - he's had a lot of formula and this would certainly have had an effect on supply.)