Breast feeding / weight gain issues - advice please?

[JillyBaby]

Hi,
This is Jillybaby's DH here, sorry, but this is going to be a bit long -

My DD is now 13.5 weeks old and weighs 10lb 5oz. She was 7lb 8oz at birth. She is exclusively breast fed up to now. Her weight gain has been erratic, but a bit slow for several weeks now. On a good week she might gain 4 oz or more, other weeks she has gained nothing. She's gradually dropping down on the weight curve the health visitor uses, which in itself doesn't worry me too much as I've been told this is based on formula fed babies who normally gain weight faster.
She is bright and alert and seems generally healthy apart from possibly a bit of diarrhoea a couple of times.
I'm really not sure whether I should be at all concerned about her weight or not, but it's been clear for some time that the HVs are not happy with it.
They (HVs) have suggested visiting breast feeding groups a couple of times to check latching etc which DW has done, as well as seeing an NCT breast feeding counsellor. No real problem has been identified except perhaps there is a certain amount of non nutritive (sp?) feeding.
They told DW to start switch feeding, which she did.
Next they told her to add an extra feed every day, which she did
Next they said she should probably stop switch feeding as DD might not be getting enough hind milk, which she did.

DD's been weighed today, and only gained 1oz this week so HVs are arranging for a home visit to check the latch again and have told DW to express more (she currently expresses in the morning and gives it to DD as a supplement in the evening).

DW is quite upset, worrying that she's not doing the best for DD, depressed at the thought of expressing more, which she finds time consuming and wants to replace a feed with formula to see if that helps.

We'd really welcome some feedback on the above from the breast feeding experts please.

Should we be at all concerned about DD's weight?
Any thoughts on the advice given on the breast feeding?
Might adding some formula help? If so, could it replace a feed or would it have to be in addition to existing feeding?

Thank you very much for reading through to here!

[belgo]

how can breastfeeding be non nutritious?

what is switch feeding?

[bluejelly]

No advice other than to keep offering extra feeds and keep in touch with NCT, they may be able to offer more advice.

[callmeovercautious]

I am sure she is the same as my DD at that age and my HV had no worries....will go and check the book....

Bump for anyone else around?

[belgo]

I don't understand - is she being weighed weekly? A baby's weight gain will vary from week to week according to growth spurts/normal growth patterns.

It's the overall weight gain that's more important.

If she's bright and alert and seems generally healthy as you say, I don't really understand what the problem is, but then I'm not an expert.

[callmeovercautious]

Sorry she was a bit more. Is she small in length? Is DW demand feeding or timed feeding?

[NineUnlikelyTales]

Hi Jillybaby DH

I am sure someone expert will be on here soon but if I were you wife I would stop expressing if it is wearing her out. It is the same milk that your DD will be getting whether your wife goes to the hassle of expressing it and giving it to your DD in a bottle, or if your DD just has it direct from the source IYSWIM.

It's great that your DD is bright, alert and healthy. That is a much better indicator of a well fed baby than her weight.

I can't add much more except that I had a lot of help from a La Leche League leader (a BF counsellor). Your DW may find going to a meeting helpful and supportive generally, not just with BF but with mothering generally (I do).

Best of luck

[JillyBaby]

Nutritive feeding means the baby is actually actively feeding, i.e. sucking and swallowing milk. Non-nutritive feeding is where the baby is on the breast, but not concentrating on taking milk (as I understand it).

Switch feeding means swapping breasts every 5 or 10 minutes.

Sorry for getting technical, but these are the terms the health visitors use!

Thanks for your responses.

[MrsBadger]

by 'non-nutritive feeding' did she mean comfort sucking?

is dw demand feeding? am puzzled by the 'add an extra feed a day' malarkey if she is

if you give formula it would certainly be as an addition rather than a replacement - if the weight gain really is a problem you'd want to get as much milk of any sort into her as possible, so cutting a bf seems counterintuitive.

someone skilled will be along soon, but if it were me I'd be offering the breast every time she squeaks, making sure dd stays awake during feeds and considering a babymoon (ie stay in bed for a whole weekend, with lots of skin-to-skin, feeding as much as she wants)

[belgo]

under what circumstances would a HV advise switch feeding? I thought that was very out of date, like you say, it can hinder the amount of hind milk a baby gets.

What do you mean when you say your baby has had a couple of bouts of diarrhea? Was she ill?

[sazzybee]

If I were you, I'd stop going to have her weighed. I honestly think it makes you a bit paranoid. If she seems well and happy, is growing and feeding well, then it doesn't seem like she's hideously underweight to me.

Does she sleep at night? That's a much better gauge IMO of being hungry - at 13.5 weeks, she isn't young enough to be sleeping when she's not hungry which can be an issue with very little babies. How many feeds is she having a day and how often? Is your wife demand feeding?

I'm no expert but it seems to me that your HV and the constant weighing is making you anxious. Babies don't gain weight in a linear fashion.

[bluejelly]

I think Mrs Badger has some good advice

[belgo]

agree with Mrs Badger regarding the 'babymoon' to increase breast production- although it's the first time I've heard it called that!

[belgo]

I think even comfort supposidly 'non nutritive' feeding will also help stimulate milk production so isn't a bad thing.

[JillyBaby]

She's not small in length.

Yes she's weighed weekly.

I think the idea behind the extra expressing is probably to combat the non-nutritive feeding - i.e. if DD won't concentrate on getting enough milk when she's feeding on the breast then DW extracts it for her and gives it to her via the bottle which is easier for her.

She feeds on a rough schedule - 6 or 7 times a day I think. DW would not cope well with demand feeding, and in any case DD does not cry to say she's hungry.

[NineUnlikelyTales]

My DS was feeding more than 6-7 times a day at this age and beyond, though some babies aren't. It may be worth trying putting your DD to the breast every couple of hours for a week or so to see if her weight gain increases, if it is a concern for you.

[JillyBaby]

DD sleeps well at night. She sleeps from about 8pm to about 10.30pm when we wake her up for a feed. Then she goes to sleep again from about 11.30pm to 6.30am.

The comment about diarrohea was because once or twice she's produced what seemed like very large quantities of very liquid poo. But it's not a regular thing at all.

[sazzybee]

I've never heard of non-nutritive feeding. All babies comfort suck to a degree and that will stimulate your DW's body to produce more milk so it's not a bad thing.

At that age, mine was feeding every 3 hours but spending as much time as he liked on a breast before moving to the other one. AFAIK, switch feeding is very old fashioned and not really recommended any more.

Have you had a look on kellymom? Has some v good advice on there.

[bluejelly]

I would go back to the NCT and explain it all to them and see what they have to say. My dd was feeding more frequently than that at that age, 6-7 times a day doesn't sound quite enough but I am not qualified in any way so don't take my word for it!

Good luck to you all

[MrsBadger]

does 'very liquid' mean actually watery, or runny like [thinks of comparison] paint or yoghurt?
latter is normal and not worrisome

I would offer the breast more often, esp if dd is a 'lazy' feeder and/or easily distracted.
I can almost see where the hv is coming from re switch feeding if dd needs a strong letdown in order to stay interested, but I'm not sure giving expressed milk is helping her to become more efficient at the breast - if anything it seems the opposite may be true...

[JillyBaby]

More like cream than paint or yoghurt (!)

[MrsBadger]

think cream is ok

[JillyBaby]

Not sure if it's important, but each feed lasts an average of about 50 minutes by the way.

[Theclosetpagan]

You need Tiktok's advice - she's great with breastfeeding support. She'll also tell you that the growth charts in use are not based exclusively upon bottlefed babies but on a mixture of breast and bottlefed babies with no adjustments being made for the differences in growth pattern (correct me if I am wrong tiktok ).

Has your DD been seen by a GP at all? Often slow weight gain is due to a feeding problem but it's important to rule out health reasons like reflux etc.

The fact that your DD seems happy and healthy is very reassuring though and it could just be that she's adjusting onto whatever growth curve she will follow still.

[JillyBaby]

She hasn't seen a GP apart from the routine checkup they did at about 8 weeks.

Are GPs really expert enough in this kind of area? Might be a bit unfair, but in general I find they don't know any subject in much depth because they have to cover so much...

[silverfrog]

I'm not an expert, but have a dd who is tiny. she was 7lb 13 at birth, and is around 15lb now (she is 29 weeks).

She was exclusively breastfed until starting weaning a few weeks ago, and despite the hv worrying a little occasionally, is doing very well.

Would you be worried about your dd if she hadn't been weighed? That was the principle I went by, and my instinct told me that if I hadn't known an actual figure for dd's weight I would have been totally satisfied that she was fine. she was (and is) bright and alert, produced lots of wet nappies, and above all was happy. She was fed flexibly (ie some idea of structure but if she was hungry then she was fed) and I think by around 13 weeks she was on about 6 feeds a day.

Do try to go with your instincts - you say your dd seems happy and well, so other than a number on a chart is there anyhting which bothers you? some people are just destined to be small.