Help please with slow weight gain and a lot of sicking

[kateab]

Wonder if anyone can give me a perspective on this for me. My daughter is 16 weeks old, was 9lbs 3oz at birth so a good weight, but is only now 12lbs 2oz - given that she's a long baby, that's quite small.

I have breastfed her from birth, barring a couple of days when she had formula or EBM early on to help me recover from a cracked/blistered nipple. Since the start of August, when she was about 3/4 weeks old, she's been feeding 4 hourly in the day and once, occasionally twice at night. At first her weight gain was OK but quickly slowed and then at her first assessment at 9 weeks, she had only put on 6.5oz in 3 weeks so everyone said to keep an eye on it. I responded by trying to encourage her to feed for longer and to offer both breasts at each feed. (I rarely did this with my son but he fed much more often!) Two weeks later, she'd put on 12.5 oz - so far, so good. Two weeks after that, she'd only put on 3.5oz and I started to get worried and I was finding she was less inclined to spend time at the breast, she would pull off and i would try to wind her which she would resist.

I figured this would be OK if it was a one-off, esp as she was starting to bring back substantial amounts of her feeds and my son and husband both had sickness bugs around then. I needed her to have a bottle again at the start of October so she was tried with a bottle twice in the week, but on the day I needed her to take a bottle, she refused it and I had to dash home from what I was doing and feed her - after not feeding for 8 hours! Two days later, I managed to get her to take a bottle after a breastfeed.

We decided after that that we would consider giving her a bottle regularly, if not daily. I tried expressing but I couldn't get enough but formula it had to be. I weighed her again (I've got my own scale and it's been compared to a HVs' and it's correct) only to find she'd lost an ounce in a week. We started a bottle at our bedtime even though she didn't normally feed then. After a week of this, the HV came to weigh her and she'd put on 6 oz. However, we have found that she's continued to sick up a lot - but only when breastfeeding. After 2 weeks of having a bottle which started at 6oz and rising to 8oz in the last couple of days, she has not once sicked up after a bottle, which is some going considering she's winded and then laid back down.

Monday was the low point for me; not only did she sick up a fair amount of all her breastfeeds that day, after one feed, she sicked up 7 times in one hour and surely can't have had any breastmilk left in her tummy.

The HV has been again this morning and she's gained another 6oz to reach her current weight. She's advised me to get her checked by a GP in case there is something wrong with her. Developmentally, she's fine and a contented baby - she is very smiley, she has rolled over but is not doing it all the time, she can hold herself up well if I sit her on my knee and I can even let her sit on my knee by herself for a few seconds.

I have not drastically changed my diet or anything and I make sure she sits up on my lap or in a bouncy chair after each feed before she is laid down on the floor but this doesn't seem to make any differnce. I do wind her but she doesn't always like it and I find that she does bob on and off a lot after a while - could this be a factor?

Anyone got any advice for me as I was hoping to go to 6 months but at the moment, it's like she doesn't react well to my milk. At this rate, I will get to 4 months (end of next week) and consider swopping over to bottles over the following few weeks. I feel guilty about that but it's so disheartening when I do my best for her, but it doesn't seem to work out.

tia ladies

kateab

[sallyrosie]

I don't think its likely that there is anything 'wrong' with her if she takes formula feeds ok and isn't sick, is developing normally and is putting on weight. Formula contains cows milk protein and lactose etc so I guess unlikely to be an intolerance. I'm no BF expert - but maybe she is swallowing more air when BFing if she is pulling on and off. Could it be worth getting advice from a BFing counsellor?
Don't really know what to suggest - maybe try infacol to help her bring up her wind? more burping post BF?
At the end of the day though you've fed her for 4 months which is fab anyway, so if you have to give up now at least she's had that long.

[liquidclocks]

If she was being scik a lot, desperately unhappy and not gaining weight I'd consider reflux but the fact you say she happy... confusing!

There is such thing as a 'happy spitter' - a baby who's sick a lot but doesn't seem to be bothered by it. Perhaps your DD is one of these.

As long as she is developmentally ok and 'thriving' don't work yourself up over it too much but do go see your GP. A friend of mine had a baby who was very small (0-3 clothes at 12 months) but she's absolutely fine - just naturally small.

Has yo HV/GP suggested trying to give her some infant gaviscon with her BF to help keep it down? Unless she obviously allergic to something in your breast milk (don't even know if that can happen) then surely helping her keep the breast milk down is preferable to switching to formula if you're not ready to change yet (though obvioulsy if you've had enough of BF then it's an option).

The only thing I can think is that formula can sit heavier in the stomach so perhaps it's easier to keep down?

Good luck - try visiting kellymom for info on spitting up - there's a link on that page about forceful let-down that might be helpful and anti-sickness strategies.

[Mum2FunkyDude]

Kateab,

If her weight gain is following the curve in the back of the redbook you can rest assured that she is fine. Is it possible that you've eaten something or started eating something that can affect the taste of your milk?

You might find that she is starting to prefer tastes and it could be that she likes the taste of the formula better, maybe you should try and ebm for her again, but giving it in a bottle.

Who know this might not be the right advice, and be sure to have her checked by GP if the HV thinks there is something to have checked out.

[purplemonkeydishwasher]

kateab - my ds was a sicky baby. and like your dd he was a content baby, he just spit up A LOT. I had a really fast and forceful let down and I'm pretty sure that had a lot to do with it. Eventually it just settled down and he was sick less and less.
i wouldn't worry about weight too much. just as there are different shaped adults there are different shaped babies. if she's contented and has lots of wet nappies then she's doing ok.

[Kaloo20]

Feelings of guilt and that there is something wrong because your baby isn't coping on breastmilk is not helping you. I went through very similar BF'ing issues and being your own harsh critic isn't good. Please go easy on yourself, add bottles and cut down on BF's over the next week and see if she starts to gain weight again. In 14 days reassess the situation. a) is she gaining weight, b) are you feeling more positive because she is feeding and gaining weight.

What you prefer is not always best for baby (as I found out only once I'd hit rock bottom)

Good luck

[tiktok]

I can understand your concern, Kate, but your baby sounds fine. Some babies do sick up breastmilk - it doesn't mean anything.

My only concern is that she has not fed very often - 3-4 hourly from 3-4 weeks old with a slow weight gain could mean you would benefit from more frequent feeds to counteract the infrequency.

[fizzbuzz]

Has she got reflux? my dd has it, but has never sicked up after every single feed, just some. She would often throw up entire feed twice in a row.

[Stonard]

I have a similar history with my baby, who is also breastfed (with an occasional bottle of formula). He was born weighing 10lb 9oz and while he kept to "his" curve for the first couple of weeks, since then his growth has slowed right down so that he is now an "average" weight baby. He is now 19 weeks and, like your baby, tall for his age.

There have also been a few bouts of sickness where it seems as though all the milk he is taking in is coming back up again, but the health visitors and doctors have said that this is likely to be due to little bugs that babies get now and again.

To be sure that everything is normal, we tested my baby's urine a couple of weeks ago at the dictor's suggestion and it came back showing an infection. As a result, we visited the paediatrician yesterday but she was not at all concerned. The infection reading was probably a false positive and she suggested that my baby was just settling into his genetic weight pattern - both my husband and I are tall and slim and so my baby is likely to be too.

It is worth getting your baby checked out by your doctor, but if he is feeding well and seems happy in himself, there is probably nothing at all to worry about.

[manitz]

hi i had probs with both my dd's. dd1 was 7lb at birth by 3m she was 8.5lbs. was v paniced and sent to dietician who didn't turn up so gave her formula and it was extremely clear she had a cows milk allergy (obvious exorcist style vomiting and nettle rash where it touched). Eventually after trying expressing I mix fed with nutramigen and then at 6m went to full formula (nutramigen). dd2 had good weight gain but stopped gaining at all from 8-16wks. They rushed me to peadiatrician and tested for cf and other things. ultimately they diagnosed reflux (though no symptoms) and gave us neocate (new type of dairy free formula) Again I mix fed till 6m and then only formula. It has since transpired that she didn't have a dairy allergy and she now eats dairy.

I have now concluded that I need to force the next child (ttc at mo) to feed every two hours rather than every three as part of the problem has been supply. I would also suggest that bf babies follow different curves and in hindsight of my two dd1 had a problem (visible spine and ribs and skull very clearly visible) whereas with dd2 it was simply a matter of increasing feeding with a small amount of (possible) reflux - one poss symptom is where they 'chew' following feeding.

I know this is just banging on about me and mine but i hope it helps to realise that many children - even from the same family - have many different reasons for not following weight curves and that hvs can panic sometimes. Do you feel that your dd looks ill? trust your own judgement I believe.

for dd1 you can still see her bones and they've decided she's just made that way. Makes me feel a bit silly for all that worry...

[fizzbuzz]

Stonard, throwing up sounds like reflux. Did the milk just come straight back up? How can it be an infection if it is lasting more than 24 hours When they have reflux, they can bring an entire feed up in one go. Sometimes it can be straight away, and sometimes it can be partly digested, but it doesn't always happen at every feed. My dd would do it after a couple of feeds for a few days, then she might be ok for a day or so, then it would happen again. Infant gaviscon is the suff you might need. You can buy it over counter, but not cheap. Why didn't hv suggest this? I sometimes wonder what HV get paid for. Hope this helps

[fizzbuzz]

Sorry have to rant.. cannot believe doctors and hv think it is due to "little bugs...!" What little bugs? My two have never had "little bugs" and I don't know any other babies who have either! "Little bugs" I ask you..!. Have re read your message and it sounds even more like reflux. It can run in families, so if either you or dh get acid or indegestion, or wind(!), or any other relos then you have your answer.

[Stonard]

Fizzbuzz, thanks for that.

I'm not at all sure my ds has reflux. He is hardly ever sick at all, and never has been since birth. But at around 14-17 weeks, there were a few days here and there where it seemed as though very little was staying down. Even a few hours after a feed there was quite a lot coming back up.

Fortunately, at the moment, everything seems fine with him. I thought that reflux was far more frequent and persistent bringing up of milk than my ds seems to have shown?? HV's certainly haven't even mentioned that reflux may be a possibility.

[sallyrosie]

stonard FWIW I think you're right - my LO had reflux and it was all the time, and settled when stopped dairy. My second LO had a cold last week and brought up quite a few feeds, but didn't before or after they got better. I don't think that not automatically assuming that any spitting up in a baby is due to reflux necessarily means that the HV/Dr don't know what they are doing. 'Little bugs' to me sounds like a euphemism for ' minor viral infection/common cold' which sounds about right to me.