EBF 9 week old dropping centiles..

[TitaniaP]

Hi - sorry in advance for the mammoth post.

My DS will be 9 weeks on weds and has up until now been exclusively bf. He was 7lb 4oz born, and lost 9.5% by day 4. He didn't feed much at all for the first 48 hours (couldn't wake him up/latch him on). He took nearly 4 weeks to gain his birth weight and since then has gained between 4-5 oz a week. He is now hovering between .4 and 2nd centile and was 8lb 10 last Wednesday (at 8 weeks) (was born at 25th and was at 9th at 2 weeks)

I've been seeing the infant feeding specialist (who is excellent) at our local hospital since he was 2 weeks old and she helped me sort out his latch. I feed on demand upwards of 10 times a day and he doesn't ever go more than 4 hours at night.

He does make a clicking sound when feeding but the world and his wife have checked him for TT and posterior TT). I've seen 3-4 different peer supporters at different support groups plus weekly visits to the support group at the hospital. Everyone says his latch and attachment look OK. Also I'm not sore.

His nappies seem OK (plenty of wet and a couple of dirty per day). I've been talking domperidone for two weeks which doesn't seem to have made much difference. I struggle to express (I realise this is no indication) and never get more than about 20ml and sometimes much less ( I have a medela swing and continue pumping after flow stops to no avail). I never really feel full and my breasts don't leak (and never really have done).

I co-sleep, use a sling, feed in the bath, and do plenty of skin to skin, and breast compressions (as I believe they are all supposed to help increase milk production or transfer). My baby is very unsettled - will spend hours at the breast and cries a lot throughout the day. He often pulls off the breast crying too. I think I'm coming to the conclusion that the unsettled behaviour is due to hunger and that I'm going to need to top him up with formula.

I really don't want to do this. I want to ebf my baby boy and it's really upsetting me the thought of giving him formula. So I guess my questions are:

1. Does anyone have any suggestions on how I can increase his weight gain without giving formula, given that everyone thinks his latch is fine and it's not TT - is there anything else it could be?
   

1. Also if I do give him a top up, will this be the beginning of the end of my bf relationship (had planned to continue to a year at least)?
   

The HVs don't seem worried - but surely this slow gain together with the bouts of screaming aren't right?

Sorry for the mammoth post - and thanks in advance if anyone reads for long enough to reply.

[zdcgbjm]

Could be reflux - is he sick much? Can be silent too though. My Ds has reflux, he's 4 weeks old and lost a lot of weight in the first 2 weeks. Then got him on gaviscon and he's so much more settled. Feeding better and gaining weight, going back up the centiles now.

Just a thought and worth ruling out if nothing else.

If the HVs aren't worried I'd try not to worry too much.

[JetLi]

Hi Titania - to re-iterate what zdcgbjm has said if the HV isn't worried then that is a good sign. Well done for getting so far and for getting help.
Keep getting support & going to groups - keep talking to the hospital. Getting plenty of wet & dirty nappies is also a very good indicator that all is well.
When he pulls off crying is he generally happy to go back on?

[HarperSeven]

Just wanted to repeat something back to you - you are coming to the conclusion that your baby is hungry and that you should top up with formula.

Then do it!! There's no point whatsoever in leaving your baby to go hungry just because you are eager to exclusively breast feed.

Exclusively breast fed babies who aren't getting enough nourishment and are dropping centiles need extra nourishment. Formula isn't harmful, it's nutritious. Babies thrive on formula.

If you try using formula and you find the baby is still screaming, despite the extra nourishment, then you will know that the problem isn't that the baby is hungry (or that that's only part of the problem) - and you can explore other possibilities.

The important thing is that you change something now - your current feeding pattern isn't working if your baby is unsettled and not growing as he should.

[SWLondonmum111]

Hi

It is horrible feeling that your baby might be hungry. I have been there twice and sadly ended up supplementing a little bit both times although ds2 feels like a success story comparatively even though I was desperate to make ebf work this time.

On your first question there will be many more qualified responses but the obvious things you haven't mentioned before supplementing are breast compressions and switch nursing. I suspect that your real life advisors will have mentioned these.

On your second question, I have posted recently on another thread. I had similar issues with weight gain with ds2 and ended up giving one bottle of Ebm/formula per day at 11 pm while I expressed. We are now at 8 months and the formula stopped soon after ds2 started solids. If supplementing I think that 1 bottle a day is better than regular top ups as baby doesn't get so accustomed to a bottle. (I did regular post feed top ups with ds1 and Although we kept going till 7 1/2 months I didn't feel like the breastfeeding was as important iyswim).

Personally, having had lots of qualifed RL support and tried many things to increase milk transfer by ebf, I felt that I needed to give the top up to get reasonable weight gains so I didn't feel like I was underfeeding and it has worked out well insofar as we are going strong now and (unless i am tempting fate by saying so) see no reason why we won't make it to at least a year. So if you do decide you need to supplement a bit it is possible to keep bf. Good luck.

[TitaniaP]

I think he may have silent reflux and we've been trying him on the Gaviscon for a couple of weeks ( GPs advice) and it seems to have helped with the pain but not with the weight. Also gives him poo like play doh!

When pulls of breast crying sometimes he'll go back on sometimes he wont. He also really struggles to nap during the day and I wonder if this could be related?

If I have to give him formula in order for him to thrive I will. However I'd rather explore every other avenue first.

It sounds daft but I feel I've failed my son by not being able to fully nourish him myself.

[HarperSeven]

It's a bit concerning that the HV isn't concerned. Why isn't he/she worried? The baby is at the bottom of the charts and unsettled. The OP's instinct carries more weight for my money.

OP, you're talking about 'my bf relationship' - which makes it sound like you're eager to continue bf to fulfil your own need for closeness with your baby. That makes me a bit . What matters most here is that your baby is well fed. If that means FF, then so be it.

[TitaniaP]

Just to add I do both breast compressions and switch nursing (offer both sides at each feed and then back to first if needed and so on).

Thanks SWmummy for your story. Good to know that top ups don't have to spell the end for bf.

[JetLi]

Hi Titania - do you do breast compressions from the start or later on in the feed when the gulping has died down?

[HarperSeven]

"It sounds daft but I feel I've failed my son by not being able to fully nourish him myself."

I understand that completely. Been there - got past it.

By 'exploring every other avenue first' you mean that you are content to leave your baby going hungry, for weeks on end, with negligible weight gain - just because you're stuck on the 'Breast is Best' message?

You will only have failed your son if you don't get past your own needs and just look at his needs.

I would ask the GP to refer to a private paed who knows reflux inside out. This isn't an area for GPs who dabble occasionally.

[reastie]

just to say my dd went from 95th centile to 25th. she has now been on 25th centile for months - she just lost alot at the beginning to find her natural place. obv this may not be the case for you (and I only skim read your post ), but wanted you to know we were fine and dropped ALOT of centiles!

[peanutdream]

'He is now hovering between .4 and 2nd centile,' if he stays here, he may have found his line. or he may gain momentum and put on weight if you stick with the good information you have been given - breast compressions, offering 3 or 4 sides, feeding frequently.

4-5oz a week is not 'negligible weight gain', particularly if your baby has been pooing a good amount - how much exactly? how many poos a day at least the the size of an 'ok' sign you make with your thumb and forefinger?

the weight loss at the start was a significant amount and it took a while to regain it, but it may have just been a 'slow' start.

perhaps you could give it another week or two, see what happens?

'You will only have failed your son if you don't get past your own needs and just look at his needs.' bit harsh?

[peanutdream]

being at the bottom of the charts is not an issue in itself - some babies are just smaller.

[cluelessnchaos]

You could be me 7 months ago, my ds was born at 8lb15 didn't regain his birth weight til 4 weeks gained four ounces a week for the next few weeks then took off. He is my 4th dc and I have had every problem going whilst feeding my dc, the turning point this time seemed to be a deeper latch. An almost exaggerated latch and having the confidence to feed more frequently. I see you are feeding ten times a day already I was feeding at least hourly during the day and going maybe three hours at night by this stage.

It was important to me to not introduce formula and I can't really explain why given my previous three had it at somepoint in the first 2 years of life, but that was my choice and of course had he been losing weight or not gaining at all I would have given it. Ds2 is now a healthy 24lbs at nine months.

[peanutdream]

some people find other things work - fennel tea, nettle tea, you can get 'mother's milk' tea or something i think too. oats i've heard?

[TitaniaP]

Harper of course I won't allow my son to starve just through being stubborn about breatsfeeding. The unsettled behaviour is a very recent thing and as I've said none of the HCP seem worried.

If I wasn't concerned I wouldn't be asking for advice. I do believe that for me breastfeeding is a massive part of bonding and developing a close relationship with my son. This is not more important than his health however and please rest assured that were he losing weight ( and he's not - he's just gaining slowly) I would have topped him up long before now.

I will ask for more specialist advice on the reflux though - it sounds like that might be a contributing factor.

[bramblina]

Tatiana, I can sympathise with a lot of what you are saying though my dd is now 3 I remember it like it was last month.

She also had poor weight gain, never seemed very settled and so after I persisted, finally gave in to introducing solids (very reluctantly, I really wanted to get to 6m exclusive) at 5 months. This didn't make a blind bit of difference so that lasted a week! She did get to 4 hourly feeds through the night at probably 4-6 m but then I re-introduced solids at 6m as I didn't want to leave it too long. This was the worst period of my life! She screamed after about 2 spoonfuls of every meal, it was horrendous. The HV took a food diary to a dietitian who said her vit (etc) intake was fine so then the HV said all she could suggest for weight gain was to add double cream to her meals!! Formula was suggested to me by various people, probably most weeks. I am like you and was completely against giving her it. I had broken sleep for those 10 months because of it but would not have changed that for anything. We saw 2 paediatricians, they all just checked her stats and development etc and asked us back in 2 months. At ten and a half months, she snapped out of it within a week. We saw the 3rd and final paed that week who then diagnosed that it was probably reflux. Great! So it all fell in to place.

I was never concerned by her poor weight gain, she was healthy and growing well, she has always been little, but was and is absolutely fine. What I mean by all of this is, for me, hell though it was I am so glad I never gave in to something just for her to gain weight. I may be corrected on the importance of weight gain, but for me it wasn't the most important thing when everything else was fine. With all due respect, I disagree with HarperSeven, it isn't always the solution to hungry/unsettled babies. I do agree that babies thrive on formula yes of course, and no it isn't harmful, but it isn't as beneficial as excl. bf. For now your son will have a sterile gut, and this for me was very important. This would no longer be the case if you intorduced a bottle then found that wasn't the solution. Formula is made from cow's milk if I'm not mistaken; it is also nutritious but synthetically so, as opposed to breast milk. I don't mean to offend, HS, but I can completely see where Tatiana is coming from and I would much rather my baby had human milk!!

It sounds like you're doing as much as you can to improve your ds's intake of brest milk but you don't say how each feed goes, does he feed for long? If he pulls off how much do you try to get him to try again? To get 10 feeds in in a day I would wonder how many of these feeds maybe only consist of fore milk? (I know some people believe this doesn't exist) Does he get to the let down reflex stage?

HTH and does not offend anyone

[HarperSeven]

I'm not saying you're deliberately allowing your son to starve. And it's not stubborn. It's a very emotional personal thing - but at the end of the day, for the baby it's mostly a means to an end. Getting fed.

I'm aware of the huge amount of pressure we can put ourselves under to EBF - and when it doesn't all go according to plan, it's really upsetting and worrying.

All the best of luck.

[HarperSeven]

bramblina - but what if Titania simply isn't producing enough milk (not saying that's the case OP, but for argument's sake). Do you suggest she just gives the baby whatever she does produce and just ignore her DS's demands for more?

If Titania's DS has reflux (again, for argument's sake) then he will need either meds or specialist formula or a combination of the two to get on track.

Babies with reflux often don't get the quantity of milk they need because they find feeding uncomfortable. If the OP's DS has reflux, then any supply issue is going to mask or exacerbate the problem.

Bramblina, a 'sterile gut? What are you talking about? A gut isn't sterile. It's full of bacteria. And it needs to be. If you're putting a 'sterile gut' before weight gain, that's seriously misguided.

I mean no offence either.

[crepesagogo]

If your gain is 4-5oz a week you are hitting the average gain of 4-7oz a week which is reassuing. Are you switch nursing as well as using compressions? It is really effective if you aim for 4 or more sides per feed couple it with a few days of as much feeding as possible with lots of skin to skin and if your supply needs a boost this would help.

[LesbianMummy1]

TitaniaP have messaged you

[bramblina]

Sterile from any chance of introduced infection.
I wouldn't suggest putting a "sterile gut" before weight gain but for me that was a very important factor to consider because of the problems my dh has suffered. As peanutdream says, some babies are just smaller. Goddamn centile charts, we are not machines! Our mothers managed without them!

[youjusthaventearnedityetbaby]

4-5 oz weight gain is normal I think?? Sounds fine to me... I'd be happy with that. My HV's only like to weigh once a month, I've got an 18 week old boy, my second baby, and I'm definitely fussing about weight gain less doing it monthly! I had ds1, now aged 5, weighed weekly.

My first ds was ebf til 16 weeks when I topped up with formula, no real need, I think I just wanted to try it! My 2nd is still ebf. I'm a single mum and have to be separated from my son when he's with his father so I express... Have been expressing since 12 weeks, didn't really have much joy til 14 weeks though and now I express every morning whilst ds2 is feeding off the other boob. I can express at night too but not so successfully but if I do night and morning I can get 8oz. I've got an electric Avent pump. I don't think I would have been able to express at 9 weeks, I simply didn't have the milk. I think I was able to express more when he slept for longer...

Ds1 was 9lb1oz born, not sure of the centile... but he's now the skinniest thing and between 2nd and 9th centiles!! He was a great feeder, even with a tongue tie, still eats loads, he's just meant to be skinny... Ds2 was 8lb3oz born and I haven't had him weighed yet this month but last time he was on the 50th centile. He's definitely putting on weight though as he's growing out of his clothes! He is a good feeder and will happily finish an 8oz bottle. He is not massive, just normal. He does take forever to feed though and I certainly had the clicky problem at first, definitely still at 9 weeks. The doctor diagnosed thrush but I don't think it was that, I think he just liked clicking!! He is a very sucky baby and has dummies but he prefers his fingers, looks very cute... Have you tried dummies, could your baby be using you as a dummy for comfort?

So anyway... haha, sorry... question 1, I think his weight gain is fine... question 2, no, if you top him up with formula it will not necessarily mean the end of your bf relationship... I fed ds1 til 18 months and I plan to do the same this time! I want to get to 6 months ebf then I'm not averse to giving formula, but if I can carry on expressing then I will... There are all sorts of things you could try to increase supply... have you got any raspberry leaf tea left?? I read somewhere that was good... I'm still taking my pg vitamins... Fenugreek as well I think?

Have you tried //www.kellymom.com amazing website, I've learned loads...

Good luck! You're doing a great job!

[crepesagogo]

Harper a bf baby has a gut full of gram positive bifid bacteria. This is of benefit to the developing immune system and one of the ways that ebf makes babies much less susceptible to illnesses.

If a baby has reflux meds may be needed, specialist formulas are not required indeed breast milk is the preferred food of choice. A baby gaining within the average range on a weekly basis isnt showing signs of any sort that would imply the need of a specialist formula.

If the baby needs more milk then there is no reason to think the op can't provide it supply is adjustable. The baby has only been recently unsettled and this could be all sorts including a growth spurt.

[TribbleWithoutACause]

I'm sorry you're going through this OP, Fwiw if you do decide to introduce formula it won't be the end of your bf relationship. A lot of people do mix feed very sucessfully.

[bramblina]

I didn't know that, crepesagogo, but I knew it was something like that! Thanks, it's all very interesting