HV has advised me to start ebf 19 week old on baby rice...confused and dont know whats in his best interests

(50 Posts)
YouMaySayImADreamer Fri 14-Jun-13 22:45:07

I have posted a previous post on my ebf baby's slowed weight gain, so apologies if im repeating anything, but there has been further developments...

My ebf 19week old ds's weight gain has stopped. I wanted to ebf him to 6 months as per current guidelines and as per research ive read on the benefits to baby of having nothing but breastmilk until this age. I found bf quite tough to begin with, so its ironic that now that im really enjoying it and finding it a lot easier, that this is happening.

Basically, my ds has only put 2 ounces on in 6 weeks (none in the past 3 weeks). He started life on the 75th percentile and in the 6 weeks has dropped to the 25th.

I have been asked all the usual questions by hv and bf counsellor...he has plenty of wet nappies, one or two dirty nappies a week, he feeds on demand (which is usually every 3 hours), feeds from both sides every time, seems happy and satisifed after feeds. The bf counsellor seems to think my supply is fine, and the hv is at a loss as to why his weight gain has halted, but does say that some bf babies' weight does plateau for a while. She also says that babies can become distracted around this age, but i havent noticed any change in his feeding behaviour. The bf counsellor has given advice on breast compressions, told me to pump between feeds (not sure why if my supply is fine), and told me to wake ds for night feeds.

DS sleeps through most nights from 9pm til 5 or 6am (after an 8pm feed) and has done since a few weeks before the weigh in 6 weeks ago (no encoaragement from me). He never naps in the day though despite my best efforts and im starting to wonder if he is just crashing out through exhaustion and missing his night feeds if this is a likely sceanrio?

The hv wants me to get him weighed next week - a week after his last weigh in and if he still hasnt gained, she has said that we maybe need to start weaning him early onto some baby rice. I'm so confused because he doesnt seem hungry despite his lack of weight gain, so why would it mean he needed weaning? Is there something wrong with the fat content of my milk? Why do they advise so strongly to ebf until 6 months and then give you this advice?

The main health benefits that i am concerned about are that i have read that ebf until 6 months provides a coating on the intestines which plays a part in prevention of digestive disorders and allergies. Introduction of solids or formula before this, i have read, jeopodises this, so if i introduce baby rice, i worry that 4.5 months of ebf will have been of no long term benefit...i dont know what to do for the best for my baby....

mummytime Fri 14-Jun-13 22:49:48

I would ignore the HV and ask to be referred to a paediatrician if she is concerned.
Is she using the latest weight charts for bf babies?
You could also still get support from la leche

pod3030 Fri 14-Jun-13 22:51:21

i am sure i read somewhere that breastmilk is nutritionally and calorifically superior to babyrice.

pod3030 Fri 14-Jun-13 22:56:50

I would concentrate on some night feeds, my dd hardly woke when i did dream feeds, and breastmilk is definitely the best to put on weight.

HumphreyCobbler Fri 14-Jun-13 22:57:27

there are bound to be more calories in milk than in babyrice

it seems strange to want to fill him up with something less calorifically dense.

4.5 months WILL have had long term benefit, I wouldn't worry about that, but I would wait and see if I could get another opinion before rushing to solids.

Your 4.5 months of exclusive breastfeeding have already been of IMMENSE benefit to your baby. You need to be proud of this.
Re: the HV, two things spring to mind.

1. At 4 months, babies start moving a lot more - using abdominal muscles, waving legs, arms etc. - and this tends to correlate with a bit of a weight plateau, as you have seen. As the BF counsellor says, this also correlates with distractability in most cases!
2. Weighing a baby every week (as your HV has suggested you do) is not appropriate at your baby's age because the margin for error in each measurement is comparatively large and will overlap with the level of weight gain you would be looking to see. HVs are told not to weigh babies so frequently, but most ignore this scientifically-based advice.
3. If the only reason you have been advised to introduce rice is weight gain for its own sake, the question you should ask your HV is this: what healthy benefit will extra weight gain, in this situation, bring to my child? Does this anticipated 'gain' outweigh the risks of breaking the exclusivity of breastfeeding?

If you feel that your baby is healthy, happy and developing normally - and it sounds like this is exactly what you think - my candid advice would be to step away from the HV and her scales and focus on enjoying your exclusively breastfed baby. I say this as a mother of 3 who has learned to look at the baby, not the scales, in the absence of any health concern.
A significant proportion of health visitors do not understand the nature of growth charts. Not every baby follows a neat centile line - in fact most don't, since the centile lines are aggregated data rather than trajectories to strictly follow. It would be odd if a baby got through it's first six months without any deviation at all.
By all means add in a few breast compressions or introduce a dream-feed if it will put your mind at rest. Baby rice tends to fill them up and constipate them (and it tastes horrid, all of mine hated it) so if you do decide to go ahead with solids then something like sweet potato is more tummy friendly. But honestly, it has fewer calories than breastmilk - as does baby rice - so I am not clear how your HV thinks it will help! grin

YouMaySayImADreamer Fri 14-Jun-13 23:13:51

Thanks for the replies - knew i would get some better advice on here! The weight chart is the one in the red book which i believe is based on ff babies (?). I thought the baby rice was strange too and really want to avoid.

I am worrying that there is something wrong with my milk. Maybe not supply, but the quality if that is possible?

Loftyjen Fri 14-Jun-13 23:27:39

Even with consideration to the wt charts appropriateness (am sure it's the WHO charts in red books which were revised to be more weighted to BF babies a few years back), a drop from 75th to 25th is significant (imagine plotting the weight on a chart without centile lines & whether you'd consider it ok or not) & as mentioned, review by paediatrician would be advised (?see GP if HV not forthcoming with this). Plus, might be worth keeping a diary if when buns feeds/duration/did he nod off or stay awake well & inc in this his sleeping habits - will give any healthcare pro a more rounded view of how bubs & yourself are doing & may even give you more insight to how things are going/whether bubs really is feeding as well as you think.

YouMaySayImADreamer Fri 14-Jun-13 23:27:47

Sorry frozen, cross posted there. Thank you. You are right on so much of what you have said. DS Is moving alot more and it has coincided closely with this weight situation. He started rolling over and now does it constantly, tries to commando crawl, bounces constantly when being held, waves his arms and lega constantly, barely sleeps through the day because he is too busy taking everything in...he doesnt stop and im sure it uses a lot of calories. He also seems to be growing longer, just not a chubby as he was.

Also youre right that my gut feeling is that he is absolutely fine. He could not be a happier baby. I cant help thinking that if i had never got him weighed so regularly as some people dont, there would be no issue,but now that the issue has come up, i dont know what to do..

SirBoobAlot Fri 14-Jun-13 23:35:21

Ignore the HV. Baby rice is pointless in any situation, and has absolutely nothing in it. Ignore ignore ignore.

If you are concerned, ask for a referral to a pediatrician, but if his weight gain is slowing down, along with him moving more, and getting 'longer' rather than chubbier, taking into consideration the fact that he seems fine in himself... Honestly I wouldn't worry too much. If he's hungry, he will tell you smile

Go along to the next weigh in if you feel the need to, but remember that the HV's opinion is just that; her opinion. You've obviously done your research surrounding breastfeeding, and especially around exclusive breastfeeding for the first six months. Some HV give out very old fashioned advice.

Loftyjen - I am a bit surprised to read that re: the need to refer. Particularly since I am sitting next to a GP who would not consider refering to a paed at this point IF the baby presented as healthy, thriving, hydrated and developing appropriately. Keeping a diary of feeds is not going to be particularly meaningful at 4 months, as most babies are feeding for brief but efficient intervals which vary very widely from one baby to the next. The paediatricians I know have not received formal training in interpreting feeding records from breastfed neonates, let alone interpreting those of a healthy breastfed four month old. The two things that a paed can add at this point seem to me to be a) blood tests to try to detect a physiological problem causing this plateau and b) an enormous dose of self-doubt for the OP.
OP, you sound like a very sensible woman. If you have concerns about your baby's health then you should see a GP, preferably the most sensible and experienced one you can find. In fact, if it will set your mind at rest, you might decide to do this even in the absence of health concerns.

YouMaySayImADreamer Fri 14-Jun-13 23:43:05

Thanks Loftyjen- good idea about keeping a diary, i will give that a go i think.

Thanks sirboobalot, i know and the problem is, with this being my first baby, i rely a lot on the advice of professionals because i dont want to think i know it all when i dont, but it does sometimes conflict with the research ive done. Ironically, a lot of the research ive done is to try and find the justification for the current guidelines, and then i am given advice that seems to contradict it. In all fairness, im not having a go at my hv because i like her and she seems fairly clued up and incredibly supportive/encoaraging of ebf...but this makes her advice even more confusing!

Oops, pressed too soon! I wanted to add that your son sounds adorable and actually rather like my youngest (who never, ever seems to stop moving and is also getting longer rather than chubbier).

YouMaySayImADreamer Fri 14-Jun-13 23:47:25

Sorry, keep cross posting. I dont have concerns from my own gut feeling, but more i am concerned because the hv is comcerned. I dont know an awful lot about bf other than what i have read, or indeed about babies development in general, and with so much conflicting advice re what is normal, its very difficult to make an informed decision about what is best

YouMaySayImADreamer Fri 14-Jun-13 23:52:33

Sorry did it again! Thanks frozen smile he is lovely, we just love him! Thanks very much for all your advice, it is much appreciated

I can sympathise. A lot of HCPs will be giving advice based on anecdote and the perceived need to fully 'cover themselves' to minimise risk. Unfortunately the risks that they weigh up don't frequently include the risks of non-exclusive feeding, but DO include those exceptionally rare cases in which weight faltering is a symptom of a more significant problem.
If your gut feeling is that he's fine, but you still find yourself second-guessing this feeling, is there a compromise that would set your mind at rest to the greatest extent e.g., waiting, say, 2 or 3 more weeks between weigh ins and during that time adding in some compressions and possibly a couple of additional feeds if you can manage? That's just an example obviously.
Sorry for all the long posts; I hope that they have helped rather than hindered.

Okay, now I'm cross-posting! Very glad to hear that you are enjoying him so much - they grow up too fast < eyes 4 year old who starts school shortly > I'd better take myself off to bed! Glad to have helped a little bit smile

LizTerrine Sat 15-Jun-13 07:44:28

Christ, ignore ignore ignore. And stop getting him weighed so often, it's counter-productive.

DS1 dropped from the 25th to the 2nd centile during the first few months and was slow to gain weight. However, he had sufficient wet and dirty nappies and was bright and alert miserable bugger though. I ploughed on with ebf and at about six months he suddenly turned a corner and shot right up to above the 90th! He's still there, a chunky, robust and devilish happy toddler. His was an unusual growth pattern, for sure, but not unheard of, and certainly not a reason to substitute bm with rice!

LizTerrine Sat 15-Jun-13 07:49:14

I had one of the most wonderful HVs ever, but even she gave some dodgy bf advice. Frozen's advice is very sound, but do also seek rl expert support (do you have a local La Leche League?).

PS, sorry if the first bit of my reply above sounded a bit curt, it wasn't supposed to! The amount of rubbish bf advice around is so depressing, especially when it undermines mothers who are doing so well under such adverse circumstances. You are doing fabulously smile.

YouMaySayImADreamer Sat 15-Jun-13 07:53:08

Thanks frozen, yes i l dont think i will get him weighed this week as advised because i think it is too soon. I have been doing the compressions, and he woke last night at 11.30 and 3am for feeds so hopefully he got a few extra calories on board. Id set my alarm for 3am anyway so will continue doing this.

Thanks Liz - i should have said sorry, the hv had asked originally that i get him weighed every 2-3 weeks, and i had been going with every 3 weeks. I wasnt sure why this was as he was originally a big baby, putting weight on well and the red book even said not to weigh more often than monthly. But as he is my first child i didnt think it was my place to start questioning the hv. Your story is very reassuring though, especially as my ds sounds similar in that he is otherwise very alert. Every comments on how alert and happy he is, which is why i am so reluctant to intervene.

YouMaySayImADreamer Sat 15-Jun-13 07:56:32

Sorry cross posted there liz. Dont worry, i didnt take it as being curt! I know, thats it, i find so much more knowledgable people on here! The nhs do need to get their act together in terms of consistency if they want people to successfully bf!

There is LLL in my area but they meet in someones flat and meetings are advertised by an anonymous facebook page which im not entirely comfortable with. Other than that there is very very few support groups around here.

bellablot Sat 15-Jun-13 08:14:25

Hi

I know someone with a solar story to you whose baby had an undetected heart condition whereby a valve that should have closed at birth didn't, resulting in blood being circulated around the body inefficiently, this needs a lot of calories and the baby in question didn't put weight on at all over a course of weeks.

I didn't want to post and worry you, but I hope the info helps, it's always best to get a second opinion.

Good luck!

bellablot Sat 15-Jun-13 08:14:44

Similar story!

Liskey Sat 15-Jun-13 08:24:56

We did see paedtrician after Dd failed to put on weight (& was below any line on the charts!) It was the best thing we did as he was knowledgeable and put our minds at rest. He also said no point weighing every week as children don't grow steadily but in spurts. We had to see him every 6 months moving to a year (to check DD's height rather than weight as it turned out) but all fine in the end. Dd ended up with extra calorie milk supplement to help her as she was just a very lively baby (who crawled young and used up her energy that way rather than growing!).

Recommend seeing paedtrician rather than relying on HV as even weighing ever 3 weeks sounds too often.

LizTerrine Sat 15-Jun-13 08:30:26

Is there a phone number you could ring to chat with someone from the LLL if you're not comfortable just turning up? I would say that LLL meetings do tend to run in people's homes (certainly the one I go to does) because it's a voluntary organisation. Perhaps a friend could go with you? My experience of them has been fabulous (up to and including one of the leaders regularly going out of her way to give me a lift, and visiting me at home with my newborn to help with jaundice issues). Also, as well as being experts with up to date knowledge, they're excellent at the 'softer', less technical aspects of supporting bf'ing mothers - tea, cake and real emotional support.

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