Slow weight gain - help

[Bee14]

Where do I start with feeding problems! Have a beautiful 12 week DD, long story short: no/ very low supply, 12% weight loss, bloody nipples, tongue tie, breast refusal, expressing.

At 10 weeks we have, happily been in a combination feeding routine that seemed to work well and after various lactation consultations have been diagnosed with hypoplasia. DD is also not the worlds strongest sucker. After much heartache with all of the above, had generally made peace with it all then the weight issue....

Basically DD weighed a bouncy 4.120 at birth, promptly lost nearly 500g and took 3 1/2 weeks to regain. Month two saw a couple of weeks of throwing up a feed a day, followed by a stomach upset, so we weren't overly concerned when she only put in 400g, but over last month she has only put on 300g with sometimes no weight gain. Fairly sure reason for this is that she doesn't drink enough. We feed 6/7 times a day, 20 minutes plus on breasts (by which time either empty or she is super fussy) and then offer formula at every feed.

We offer 120ml every feed as this is at the bottom of what she should be taking if exclusively formula for her weight (us 700 ml a day)as best guess is that she only gets 15-30 ml per breastfeed. However she rarely gets near this, averaging around 70ml a feed (with one around 120ml and one around 20ml a day) or 450-550 ml a day. Feeding is usually every 3 hours with two 4 hour stretches at night . She is very clear when she doesn't want more and feeds can last two hours as I try to persuade her to take more. This has ok success but usually means the next feeding slips back and we end up with only 6 feeds.

Pooh is 1 to. 2 a day and lots if wet nappies, otherwise healthy and very alert and happy. Dr suggested would need to refer her to a paediatrician if weight gain didn't improve and we are slowly cruising to stoping down three percentile lines.

Any thoughts on why this is happening? My husband takes the view that thus us just 'her' but I am sending myself loopy with worry. Was wondering if BF was part of the problem. Ie slow BF makes her feel full before she really is. Have tried more frequent feeds (and I always feed if she demands) but she isn't interested. Next thought was trying larger gaps, so that she gets genuinely hungry and/or moving to expressing breast milk only, but any ideas or similar experiences greatly received!

[McBaby]

You could have the tongue tie reassessed. They can re grow as scar tissue forms or the tie may not have been fully cut.

With dd1 we had four cuts in total before it was fully cut and healed correctly.

[tiktok]

What a struggle :(

Bf babies usually don't gain a huge amount of weight, and mothers don't make a lot of milk, on six to seven feeds a day. It's at the low end of frequency. However for a few babies this frequency is normal for them and usually these babies are big and bouncy and usually these mothers are super-producers - neither applies to you. So you are doing the right thing in exploring what to do.

You don't say if you have tried switch nursing or breast compressions - both are worth it and worth persisting with.

There will be more times than six to seven times when she may accept a quick bf - try it.

You'll also need a plan to gradually cut down the formula. There's not much room for breastmilk with that volume but this would need to be done very carefully. Have you got the help of a bf specialist/counsellor or equivalent? It may be you can tip the balance by making more milk so she needs less formula.

Hope you find good help soon.

[Philippalc]

What a worry for you. Can you go back to your lactation consultant(s) to talk it through? Or try a new one, there are links at the end of this article to find one in UK or Internationally. A private practice IBCLC, will usually spend several hours with you taking a full history, making a care plan with you and liaising with your health team. Meanwhile getting the referral to a paediatrician underway sooner than later will give you peace of mind to help rule out any underlying medical reasons for low gain e.g. if your little one was anaemic or had some other undetected health issue. Trying smaller amounts much more frequently may help and you could talk to your IBCLC about supplementing at the breast.

[geekaMaxima]

Great advice already. Additionally, I wonder has her length been measured? Is it on a similar centile line to her birth weight or her current weight?

Sometimes, infants are born with quite a high birth weight relative to their length (thanks to a v efficient uterine environment). Once born, they then exhibit "catch-down growth" by gaining weight more slowly than usual, which brings their weight and length closer together. It's one reason why slow weight gain is normal for some babies.

Now your dd obviously had some other things going on that influenced her weight gain and you've been doing great to address them. But if her current weight is within a centile line or so of her current length, then catch-down growth could be a factor as well, which might give you one less thing to worry about.