8 week old ebf baby diagnosed failure to thrive

(46 Posts)
Woolybob Tue 04-Dec-12 17:36:19

Help needed! Am ebf my DD and initially everything went very well (born 8lb 1, lost 6% at day 5 and back up to bw at day 10). However when she was weighed at 6 weeks she'd gained very minimally and dropped a centile. HV not concerned at this point as felt was catch down growth but a week later she'd only gained a further 3oz so dropped a second centile (now between 25th and 9th). At this point hv suggested bottle of formula after last feed of evening 'if we wanted'. Over this week dh & I had had vomiting and diarrhea and were fairly certain dd had too (vomited twice and not normally sticky baby plus a couple of watery poos). So we felt had good reason for slow gain plus dd happy smiley baby who seems satisfied after feeds and plenty of wet nappies etc. So basically we carried on as normal.

Saw gp today for new baby checks and first jabs and gp weighed again - weight stayed at 9lb 6 over last week and a half. So basically they've now said this is FTT and are referring us to the children's hospital. He also recommended starting to give formula but suggested doing it before a feed.

I should add that the world and his wife have checked my latch and noone has found a problem, I do get blocked ducts fairly regularly - can this effect supply? I've tried expressing but am rubbish, get virtually nothing after a feed and only 1/2-1oz if I express one side while feeding the other. I'm not keen on the formula as don't want to start on the slippery slope to ending bf but I'm starting to see it as my only option. Has anyone got any other ideas? When is the 'safest' time to top up and if I start will I ever be able to go back to ebf?

Thanks in advance.

tiktok Tue 04-Dec-12 18:24:54

Wooly, sorry to hear you are worried. Not enough info in your post, though.

How many times in 24 hours does your baby feed? have you done anything to increase intake and production of breastmilk eg feeding at least both sides each time, breast compression, switch nursing, increasing freq esp at night?

Did GP or HV suggest any ways to increase intake and production?

Maybe try some of these ways of doing so, if you have not done so, and ask HV if you could have some time doing this before referral to paed?

Woolybob Tue 04-Dec-12 18:56:36

Hi tictok. Thanks for replying so quick. In the day I'm feeding every 90 mins to 2hrs (and feeds last at least 45 mins & always involve both breasts). There's quite often a longer gap at some point in the afternoon when I take her out in the pram and she sleeps but still only 3 hours max. Then feeds become almost constant in the evenings from about 5pm till 11 when she finally conks out and sleeps 4-5 hours, up to feed for an hour or more then back down for 2-3 hours. She's very fussy in the evenings, pulls at the breast etc but I understand this is normal and doesn't mean she's not getting milk? Have been doing breast compressions. No chance of delaying paeds ref - gp is making it by phone and wants us seen in 48 hours. How often should I swop for switch nursing?

aamia Tue 04-Dec-12 19:42:02

Has anyone checked for tongue tie?

PolterGoose Tue 04-Dec-12 19:53:50

Did the GP use different scales?

Welovecouscous Tue 04-Dec-12 19:59:31

I swap every time baby comes off until they won't take the breast - sometimes only 2 sides, but sometimes 4 or 5.

ecuse Tue 04-Dec-12 20:02:13

Had a very similar situation with my DD at 5wks and it was tongue tie. Everyone kept telling me latch was fine but I knew it wasn't.

I started mix feeding at the FTT diagnosis at 5 weeks (although slightly more severe as my DD was actually losing weight rather than just not gaining).

I never got back to EBF - took a further 5 weeks to get TT appointment and the snip and my supply never recovered. But then I did partially BF her until she was 1 so it wasn't quite the slippery slope to the end of BF either.

jojane Tue 04-Dec-12 20:04:55

I had similar problems with all 3 of mine
ds1 lost a lot of weight initially so more than the 14% average but in order to have an average some have to be more or less than the average figure. We got referred to pead at hospital who checked him over and said he was fine. Dd was the same although didn't lose quite as much, again referred into hospital, checked over and declared fit and healthy, by the time ds2 lost too much weight and midwife expressed concern I put my foot down and said he was just like the others and would gain weight soon
Eat ad drink lots of dairy, biscuits etc etc as well as making sure you drink lots of fluid to keep the quality of your milk up as well as your energy.
Feed from one breast for as long as possible to ensure that baby is getting enough of the fatty hind milk, if you swop noobs during a feed there is the danger that try only get the water thirst quenching mill from both breasts but not thick calorie rich stuff which takes a while to come through.
Just feed on demand but try to encourage more feeds for the moment.

I ended up exclusively feeding all three of mine until they were all 12p the or so so it can be done, I resisted the suggestions of topping up with formula and they all gained weight soon enough.

Woolybob Tue 04-Dec-12 21:33:02

Yes GP used different scales, the amounts involved seem so small it must surely make a difference if she's pooed or not that day! And no, noone's checked for tongue tie though she seems able to stick it out fine. Will ask them to check at the hospital. I still think maybe she's supposed to be tall and thin, me and dh are and it seems to us she's getting longer and outgrowing stuff but maybe this is wishful thinking on my part.

Welovecouscous Tue 04-Dec-12 21:37:25

What about expressing and feeding your ebm as top up?

Mumlar Tue 04-Dec-12 21:55:45

I had a similar situation when dc3 was a little bit younger. I was left to my own devices as I had already had two others. There was a gap of about a week between weighings and she had been feeding almost continually, or so it felt. I took her to the clinic and her weight had remained completely static. I was devastated, I was absolutely exhausted and the HV made me feel like a criminal.

I had to top her up after every feed with 2oz of formula, something I absolutely hated doing, but slowly she started to gain weight. I had to take her to the clinic every two days to be checked. I continued breastfeeding on demand too and somehow my milk production increased. I then began to wean her off formula until at nine weeks she was fully breastfed again. I fed her until just after her third birthday, so it doesn't have to be a slippery slope.

My advice would be to check your latch, (ask a breastfeeding counsellor to do this), and make sure that you are resting as much as you can. Even spend a couple of days in bed with your baby and sleep when she does. Get someone else to do everything else for you and tell them that you are increasing your supply. Good luck.

blonderthanred Tue 04-Dec-12 22:40:06

Hi, I'm in a similar boat although have been battling this since birth. My DS lost 11-12% of his birth weight on days 5 & 7, I had so much pressure on me to start giving formula top-ups but I said I wanted to give bf a chance so was given a reprieve of 2 days. I contacted LLL who sent a very long, detailed and helpful reply with info about increasing supply, breast compressions etc as well as about the effect of C Sections on weight loss & regain which was relevant to us. It felt great to have the support as I didn't really know if I was doing the right thing.

2 days later we had an increase of 20g and crucially a more positive mw who said that bf babies don't increase in a steady line but instead in steps, so one week there might be an increase and another nothing at all. It was more important that he looked healthy and was developing in other ways.

DS is now 5w4d and still not back to birthweight but has increased each week, last week just 80g which was disappointing but I reminded myself of what the mw had said. We have a weigh in tomorrow so fingers xed for a bigger increase. As you say it could be the difference between whether he does a big poo beforehand or there are different scales.

Anyway just wanted to share my experience and say in my view you should hang on in there if possible. I know how hard it is to be put under pressure to top up but I worry it will decrease supply. Having said that it is good to read the experience of others who have mixed or returned to ebf successfully. If we don't get back to birthweight tomorrow I think I will be under even more pressure to do the same.

tiktok Tue 04-Dec-12 23:05:42

jojane, you say "Eat ad drink lots of dairy, biscuits etc etc as well as making sure you drink lots of fluid to keep the quality of your milk up as well as your energy."

None of that will make any difference to milk ( might make some difference to OP's energy, possibly).

"Feed from one breast for as long as possible to ensure that baby is getting enough of the fatty hind milk, if you swop noobs during a feed there is the danger that try only get the water thirst quenching mill from both breasts but not thick calorie rich stuff which takes a while to come through."

This is not right, sorry. The way to increase production and intake if needed is to 'switch nurse' - swapping from breast to breast. Worries about not getting hindmilk are not necessary.

tiktok Tue 04-Dec-12 23:08:42

Wooly, the diff. scales may be misleading.

It certainly sounds that you are doing the right things.

I do think it's sensible to keep an eye on his weight - see what the paed has to say.

TheSecondComing Tue 04-Dec-12 23:12:34

Message withdrawn at poster's request.

Debs75 Tue 04-Dec-12 23:19:06

Tiktok you say ther is no 'hindmilk' as such but on my breastfeeding peer support course today we were talking about hindmilk and how the milk does get fattier towards the end of the feed. I know there is a fair bit of different opinion on breastmilk and feeding patterns. We are told to drain the breast so that the FIL hormone knows to make that much milk again for the next feed. (not wanting to start a bunfight here just wondering why dvice is so different. Our support trainer is a trained midwife as well as a LLL trainer)

OP Could you try using the expressed milk as a top up? The bonus would be all that pumping will help boost your supply

catkind Tue 04-Dec-12 23:21:37

It's sad that the HCP's first response is to top up with formula, not to help support you in bf-ing.

You're feeding lots, that's great. Blocked ducts is a little worrying, particularly with such frequent feeds. Could indicate baby isn't draining the breast properly, maybe tongue tie? Can you get access to a lactation consultant to double check for latch, tongue tie etc? They might also be able to help you with the expressing, I think you should be able to use a bit of massage to help prevent blocked ducts and increase expressed amounts but I'm not an expert. Then you could top up with breastmilk.

I'd personally think that if baby's had D&V then maintaining weight is doing okay. I think the GPs do have to play safe and if baby hasn't gained weight refer on. The paeds may be able to take a bigger view of the situation, happy baby, feeding well, and the D&V thing.

jojane Wed 05-Dec-12 00:22:57

Ask you wealth visitor if there is a breast feeding clinic nearby that you can attend. With ds1 it was one of the things my midwife referred me to, spent a couple
Of hours there and the breasts feeding counsoler helped show me different positions etc and I found it really helps as a first timer

In response to tiktok - eating dairy and oats helps with your supply was what I was told by midwife, even if it doesn't improve your milk keeping energy up helps you to keep milk supply plentiful
I have been told by numerous health people - midwives, health visitors and doctors about making sure baby gets the hindmilk. When expressing you can actually see the milk being creamier as you go on - for example if I pumped 2 pots full from one breast the second pot would be creamier than the first

oscarwilde Wed 05-Dec-12 00:35:14

Or you could stoo beating yourself uo and take the advice given as they have your child's best interests at heart and give 1-2 formula feeds a day?

Narked Wed 05-Dec-12 00:35:54

I've heard of oats being used as a galactagogue. There are obviously some drugs that work to increase supply. I've never seen any evidence for dairy products increasing supply. It comes from the twisted logic of drink milk to make milk. Cows eat grass. They do ok.

Tiktok speaks sense, as usual.

ChippingInLovesAutumn Wed 05-Dec-12 00:36:38

If it were me, I'd call the Dr in the morning and tell him that you don't want the referral just yet (remember, this is your baby), tell him you will take DD back to see him next week and he can weigh her on the same scales. When you are talking about such tiny amounts, deciding it is FTT whilst using different scales is daft. In the meantime, do the things that have been suggested. If DD is still having a lot of wet nappies, I really wouldn't panic <easier said than done I know x>

willitbe Wed 05-Dec-12 00:37:09

If the baby is having frequent wet nappies this is more important than weighing at this stage. Different scales and the fact that enf babies gain weight slower than ff babies should be taken into account. I too found better weight gain with less switching and more hind milk, one breast each feed.

Narked Wed 05-Dec-12 00:40:58

I wouldn't avoid the referral. If there are any issues that aren't to do with feeding, the hospital will pick them up.

tara277 Wed 05-Dec-12 00:56:03

Woolybob - I tried to PM you but couldn't for some reason. I'm a LLL leader and would be happy to help you if you want me to. The referral to the paedicatrician shouldn't be like being sent to the headmaster's office. Hopefully they will be fully supportive of the great efforts you're going to to breastfeed your baby and I would be very concerned if they weren't fully aware of the risks associated with artifical feeding. The paediatrician will hopefully reassure you that your baby is fine and then you can look at milk supply issues if that seems to be the problem. In a very small number of cases there may be conditions that are rare but important to be picked up on or indeed ruled out and hopfully your mind will be put at ease and you will be supported. It may be worth getting them to check for tongue tie (do you think your baby might have this?). It sounds as though the GP has been a little swift in the diagnosis of FTT - there is a broad criteria for this a slow weightgain alone would not constitute a diagnosis of FTT.
If possible I would suggest the best thing to do might be to cancel what you can and spend as much time as possible cuddled in bed with your baby allowing free access to milk and cuddles which I feel will do you both good.
Please PM me if you would like me to support you.

demisemiquaver Wed 05-Dec-12 01:15:36

sl similar exp myself...Centiles are baseed on bottle-fed babies weight gain pattns...dead annoying how fixated HVs can be on this,esp when see all the fat babes and wee kids around..(I wonder why ?)..lots of tea (to help the 'let-down reflex),relaxation and GOOD PROTEIN in diet...an HV told me my millk may have been like 'skimmed' and to make it richer thru my own diet

PeerieMootsMum Wed 05-Dec-12 04:43:30

Just wanted to say its definitely worth checking out some of the threads on here about tongue tie, particularly on symptoms as sadly it doesn't seem to be very well recognised / diagnosed by the 'experts' yet. I was struggling with a baby dropping centiles, who pulled off lots and was literally continuously feeding but apparently this couldn't be TT related because he could stick tongue out and I wasn't in pain.

MN told me otherwise so I pushed the issue and ended up with a private referral - one small snip of posterior TT and 6 weeks later and we've jumped back up to 75 centile and feeding now only 20-30 mins at a time.

mmmmsleep Wed 05-Dec-12 04:59:48

Centiles are based on bf babies and have been for few yrs. There are things like infections etc that can cause failure to thrive and a quick paeds check could serve to reassure you and give you confidence to carry on i wouldn't delay referral.
Agree with above suggestions for babymoon with lots time in bed with baby with skin to skin. And to get baby checked for tongue tie.
If you do top up i would do at end of feed rather than beginning to reduce effect on your supply.

Best of luck sounds like you are doing the right things

tiktok Wed 05-Dec-12 08:38:01

* Debs* you are misquoting me! I didn't say there is no hindmilk. Read my post smile I said 'worries about not getting hindmilk are not necessary' and that is correct. Yes, of course the milk gets fattier as milk is removed from the breast. This does not mean the baby has to stay on the first side as long as possible. In fact, worries about this are not necessary - there is a good and more detailed explanation here www.nancymohrbacher.com/blog/2010/6/27/worries-about-foremilk-and-hindmilk.html

tiktok Wed 05-Dec-12 08:46:26

Oats and other food items may well have a reputation for helping the mother make more milk - but there is no good evidence that they do. Many cultures have ideas like this, and ours just happens to have oats which is commonly cited. If you go elsewhere in the world you'll find other ideas.

The main driver of milk supply is effective and frequent removal of milk from the breast. Anything else - oats, tea, dairy, chocolate, cake, mars bars, , homoepathy, herbs, keeping your fingers crossed, running three times round the garden before breakfast smile - will have a marginal effect at most, and if they appear to have an effect it is likely to be placebo, coincidence, or actually related to other things the mother is doing.

Keeping your energy up does not make your milk supply more plentiful, either....milk supply doesn't depend on energy levels (apart from certain conditions like anaemia, where the mother may lack energy, but it's the anaemia leading to the milk supply problem, not the lack of energy. And an anaemic mother needs more than dairy and oats smile

Just because a midwife says things does not make it right - and jojane, read the link about foremilk/hindmilk to understand why, as I said, 'worrying about hindmilk is not necessary'. Just because I say something does not make it right either - but I do know my sources and I can back up what I say smile

tiktok Wed 05-Dec-12 08:49:51

I am shocked at the misinformed HV who said that good protein helped milk quality and that a mother was producing 'skimmed'.

That's a disgrace, to undermine a mother in that way.

Diet can change the components of milk - mainly it has an effect on flavour, and on the type of fat. It does not change the quality of the milk. No one in this country needs to worry about protein unless they are on a very strange or restricted diet. Increasing protein quality makes no difference to milk production of quality.

Sorry about all these posts, but there is a lot of stuff here that won't help the OP or anyone else reading it with similar concerns sad

tiktok Wed 05-Dec-12 08:55:31

Blimey, here's another one smile : breastfed babies don't gain weight more slowly than ff babies. BIG MYTH.

If you compare charts based on bf babies (ie the ones in current use today, all over the UK) with charts based on ff babies (the old charts will do - though they were based on babies whose feeding was not differentiated; or you can find ff charts on the web) you will see that bf babies gain slightly faster than ff babies (though the difference is very small). Then from about 5-6 mths on, bf babies' growth rate slows and by the time the babies are aged 1 year, the 'average' bf baby is significantly lighter than the formula fed counterpart.

tiktok Wed 05-Dec-12 09:00:11

Debs - I have no idea why your peer support trainer is saying the breast must be 'drained'. Of course she is right that removing the milk removes the protein known as FIL kellymom.com/bf/got-milk/basics/milkproduction/#fil and that this regulates milk production. But if she is telling you that 'draining' the breast is essential to making sufficient milk she's over-stating it....I suspect she could explain it better.

Welovecouscous Wed 05-Dec-12 09:06:25

Just wanted to add to the voices saying ignore the comments here about diet and feeding from the same side.

In my bf textbook it is very clearly stated that switch nursing - giving the baby the other side until baby satisfied is the best way to increase milk transfer and help weight gain.

The same book also says diet has no impact unless you are actually malnourished as milk is made from your blood - amazing eh! (who knew?!)

blonderthanred Wed 05-Dec-12 10:12:46

This thread is fascinating! I was told by bf counsellor that the hindmilk thing was a red herring and to switch feed, then later the same day was told by mw to keep DS on the same breast to get the hindmilk. I told her what the bfc had said and she replied, oh that's interesting, I always thought the hindmilk thing didn't make sense. So she had been giving advice she didn't believe in!

I was also told by the mw who originally told me I would have to top up that if DS was later referred to a paediatrician and the mw hadn't advised me to top up, she would be in trouble. So it's not always about the best interests of the child, sometimes it's box-ticking.

Woolybob Wed 05-Dec-12 12:08:34

Thanks for all your messages. I contacted our local bf support ppl this morning and a lovely lady came out to have a look. She thinks latch/positioning fine but DD not spending enough time actively feeding. So she's made several suggestions about breast compressions, keeping her awake and switch feeding. Also suggested (as many of you have) skin to skin - she's suggested taking my top off and carrying her round in the sling in just her nappy.

Am not going to put off the referral I'm not totally happy to rule out something else going on. I know they will probably insist on formula - bf lady recommended the medela supplemental nursing system if they do, anyone any experience of this? She went through hand expression as well as thought I might get more that way so will have a go.

aamia Wed 05-Dec-12 13:32:38

I really would give the tongue tie a look. Research posterior ties and normal ones, look at the pics and vids, then have a good look in your baby's mouth. I say this from experience. Both GP and HV also said something that relates strongly to you - if the baby is removing milk efficiently then supply will be good. That was true for us as we went back to ebf after having to top up from four days old!

duchesse Wed 05-Dec-12 13:39:58

I don't know the particular circumstances of your particular baby but will just say that I have experience x 3 of perfectly healthy babies gaining only 2 oz a week from birth, dropping from the 50th centile to the 0.2-9th in the first 4 months just because that's what they were designed to do. Sometimes they don't gain quickly. For the record, DD1 (now 17) and DD2 (now 15) are perfectly beautiful and healthy weights and heights and still growing. Some babies just don't grow fast.

demisemiquaver Wed 05-Dec-12 15:05:44

re 'SKIMMED MILK', Ididn't feel undermined.....just 'allowed to self-indulge' foodwise and enrich my diet a bit more....had been rushing around poss not treat-/feed-ing myself enuf, AND IT HELPED!!!!!!!
Interesting re 'boxticking' at end of "blonderthanred" at 10:12:46 ; can tot believe it

Welovecouscous Wed 05-Dec-12 15:37:44

Demise it's good diet helped you - probably helped you have more energy to deal with a young baby.

Welovecouscous Wed 05-Dec-12 15:39:31

Ps research still shows diet doesn't improve milk, though, unless you are pretty underfed, so no need for anyone reading to worry about that

tiktok Wed 05-Dec-12 15:46:04

demisemi, good that you did not feel undermined.

Other women would certainly have done so. Other women might have found the (ridiculous) idea that their diet was producing semi-skimmed milk to be a criticism (ridiculous analogy, anyway - the fat proportion of breastmilk is dynamic and changes all the time!).

I think HVs should ensure they give information to mothers that is based on good evidence, not myth or misunderstanding and I bet you think that too smile

notfarmingatthemo Wed 05-Dec-12 16:29:51

I have one (my first) ff baby and one bf. Both are girls. I did get hassle from midwife that dd2 wasn't gaining enough weight but as she seams to be having wet nappies ect she left us and came back the next week. The next week I had found my dd1 red book and her weight gain or rather lack of it was the same. I think some of it may be genetic.
Only you know your baby. Listen to all the advice but and the end of the day do what you think is best for you and your baby. Things that aren't going to do any harm are always worth a try ( rest, eat high calorie food, try not to do to much rushing around).
Try and enjoy your baby don't let this spoil your first Christmas with herthanks

blonderthanred Wed 05-Dec-12 16:56:58

Well my baby only put on another 100g/4oz this week meaning he is not yet back at birth weight so we are officially 'failure to thrive' as well. Being referred to paed and have to send off urine sample.

If topping up really is the best thing for him I'll do it. But I don't know if it is. I just feel that if he hadn't lost so much in the early days, he'd be back up to bw by now and there wouldn't be an issue. Although GP said 100g a week is slow.

Sorry for hijacking thread but really miserable now. Thought we'd cracked it this week. What am I doing wrong?

tiktok Wed 05-Dec-12 16:58:35

blonder, start a new thread and put in all the details smile

Debs75 Wed 05-Dec-12 18:04:01

Thanks Tiktok I didn't want to cause aggro and take away from the OP. Staying up till gone 11 means I am missing out words, must get some sleep tonight. On the whole the peer support advice is really good, re the 'draining the breast they talk about giving a full feed(however long that may be depending on the baby) on one side then offering the other if baby wants..

OP I hope I'm glad you got some reallife support. Skin-to-skin is a lovely way to help boost feeding. My dc's loved it then and still do now. Are you sure they will suggest formula top-ups? Why couldn't you give expressed bm?

tiktok Wed 05-Dec-12 18:42:08

Debs, what you are being told sounds fine to me smile

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