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6wo ebf baby failing to gain weight

(74 Posts)
blonderthanred Wed 12-Dec-12 16:42:18

I'm so upset and don't know what to do for the best.

My DS was born by CS after a failed IOL at 38wks due to GD. He was 8lbs0 at birth or 3635g and had lost more than 10% of his birthweight at day 5. On day 7 he had lost a tiny bit more and I was put under pressure by the mws to top up with formula but I asked for a few more days. At day 9 he had put on 20g, since then he has gained weight slowly (80-100g/wk) but has not yet returned to birthweight.

Last week the mw referred us to the paeds and said we should hear from them in the next few weeks. I've not heard anything yet. We also saw the GP for the 6 week check who was also concerned in case he wasn't strong enough to withstand catching a cold but said she thought I was 'doing the right thing' by continuing to ebf. She ordered a urine test which came back clear. Everyone we have seen says he looks healthy, alert and is meeting his milestones (lovely smiles this week). He has big feet, hands and head circ like his dad who is 6'3.

This week I was so hopeful as he seemed chubbier but he had only gained 10g. He is now 3.57kg. The HVs were very concerned and keen for me to start topping up. I asked them to check on how soon the paed appt is likely to come through so they are doing that.

I am bf on demand, average every 3 hrs although it's not as regular as that. He seems to have a good latch and I can hear him sucking and swallowing, although he is fussier during night feeds and sometimes in the latter stages of a cluster feed so I sometimes have to help him more with compressions etc. I try to offer both breasts although he prefers the left. If he is sleepy I remove a layer of clothing or change him, unless I think he really needs a nap.

He was checked for tongue tie at birth and we were told he was fine. He sticks his tongue out with no probs, maybe a very slight heart shape at the end.

I've worried about supply (as anyone would) as I have never felt really engorged but he comes away with milky chops and doesn't seem hungry or dehydrated. The HV today said maybe the milk wasn't good enough quality and asked a lot of questions about my diet (which I didn't think affected milk). He has plenty of wet nappies and generally at least one full dirty one (apart from 5 days when he didn't go but he made up for that after) although they are sometimes on the greener side of yellow. I don't get much from expressing (only a few ml from 15 mins each side) and find it quite stressful although I'm willing to stick at it if needs be.

I just don't know what I am doing wrong. In every other way motherhood is fantastic, exceeding all expectations. I am just so scared I am doing my son a disservice by declining to top up. But my instinct (and understanding) has always been that ebf is the best start for him.

Sorry this has been so epic but I've tried to include everything. Thanks to anyone who has read this far and for any thoughts and advice.

hillyhilly Wed 12-Dec-12 16:56:40

My dd was very similar, though perhaps for a slightly shorter time than your son, once she regained her birth weight she gained weight really quickly and I have spent most of the 7 years since worrying about her being overweight!!!
It sounds like you're doing everything right, is there a drop in breast feeding clinic you could go to? They helped me a little, more on my confidence than technique & I have to say I was so glad that I stuck it out, we fed for 22 months after such a shaky start.
Somehow, something clicked with her (it felt like she got hungry!) around 4 weeks old

blonderthanred Wed 12-Dec-12 17:25:29

Thank you hilly, yes I have been going to bf sessions weekly and the latch seemed fine, they could see & hear the milk going through. I keep hoping this is the week we've turned a corner as others have said once they've regained bw the gain is much faster.

I've had a lot of mixed messages about fore/hindmilk as mw & hv both said I should stay on the same breast to get the hind but the bf counsellor said it was not relevant and to switch feed. I did wonder with the greenish poo if he was getting too much foremilk though.

SamSmalaidh Wed 12-Dec-12 17:41:15

Switch feeding is better if you are trying to increase supply and the amount of milk he is getting - keeping to one side will reduce your supply. BF counsellor is trained in breastfeeding, HV/MW aren't (or may have done a 3 day course).

I would increase feeds - 3 hourly is pretty infrequent for a 6 week old so there is definitely scope to get more feeds into him. Switch feed at every opportunity, keep offering the other side every time he comes off until he refuses any more.

Can you get someone else to check for tongue tie as well? Again, MWs aren't trained to spot them.

blonderthanred Wed 12-Dec-12 18:02:14

Thanks Sam. I was told 8x in 24 hrs so I thought 3hrly was ok but am going to aim for every 2 hrs.

Who would be the best person to ask about tt? I asked the hv today but she said she wasn't an expert.

I just had the hv on the phone, she said the paed won't do anything unless we've tried formula first. I said I wanted to speak to the paed myself so please could they chase up the appt. She said yes but they will just say top up (so why refer?) We went round in circles for a bit but she is going to speak to the GP tomorrow and ask her to speak to the paed.

SamSmalaidh Wed 12-Dec-12 18:06:12

The BF counsellor would probably be able to either check herself or refer to someone who can.

8 in 24 hours is a minimum, I'd aim for more often if there are weight gain issues. Can you spend a few days just in bed, skin to skin, concentrating on feeding as often as possible?

blonderthanred Wed 12-Dec-12 18:28:27

I will try the staying in bed thing, sounds fun! I do really enjoy bf which is also why this is so frustrating. We spend most of our time in contact & I rarely go out so most of the last 6 weeks have been focused on feeding although I've had to fight helpful relatives from 'soothing' him because they want me to nap. He sleeps in a bednest or on my chest. I have a sling but it just makes him sleep so I don't think that would be helpful.

I'm going to try and keep a closer track of his feeding in case I am not giving him as much as I think but I am trying not to give myself additional stress (hence not pushing the expressing so far, but maybe I should have).

blushingmare Wed 12-Dec-12 19:05:00

I'm no expert, but just wanted to say I think you're doing a great thing for your baby by keeping breastfeeding. My dd lost 13% of her birthweight and took 4 weeks to put it back on and I know it makes you start to doubt yourself. I would echo what a pp said about increasing the frequency of feeds. I literally fed her whenever she was awake! Sat on the sofa all day and fed fed fed! Could you cosleep and feed lying down so you can feed as often as possible at night without completely exhausting yourself? Disclaimer: you may create a milk monster as dd (now 6mo) still feeds every 2.5 hours and every 1.5 hours at night

Good luck!

blonderthanred Wed 12-Dec-12 20:06:58

Thank you, that means a lot. I have read up on co-sleeping but really can't get the logistics of it so thought bednest was next best thing. I will work out feeding lying down though and definitely up the feeds. Thank you again.

ChunkyTurkeywiththetrimmings Wed 12-Dec-12 21:55:51

I'll add about the switch/block feeding - although I don't claim to be an expert...

As I understand it, the breast has to be completely emptied to get both supply up and hind milk into baby. Switch feeding is slightly different to the normal offering both sides... you offer one for a few minutes, then the other, then switch back & repeat. This will up milk supply/volume. Block feeding allows the breast to be emptied fully, which allows baby to get the hind milk. You offer the same breast repeatedly within a certain time frame.

The green poos do suggest a slight foremilk/hindmilk imbalance.

DS has had really good weight gain although I can't claim to know why - as DD didn't pile on the pounds easily. However, I don't automatically offer the 2nd breast (I put him back on the same one for a few more minutes) & offer the 2nd if he comes off the first naturally, & if he feeds again within 1.5-2hrs, I put him back on the same breast (within reason - some days this could go on ALL day!!).

More details about increasing weight here

SamSmalaidh Wed 12-Dec-12 22:02:10

That's not entirely true Chunky, as the breast can't be completely emptied, and it isn't necessary to keep the baby on one side, or return to the same side, to get hind milk.

Hindmilk just means the fattier milk that comes from a emptier breast - so if a baby is feeding frequently from both breasts they will get fatty milk.

When a breast is left to get full, the milk is less fatty/more watery - so if one breast is not used for a length of time (as in block feeding) then the milk will be foremilk.

Switch feeding also doesn't mean only feeding for a few minutes off each breast - it means feeding til the baby stops/comes off, then offering the other, then back to the first, and continue doing that until the baby is finished.

StuntNun Wed 12-Dec-12 22:36:27

It's very early days yet Blonder and there is absolutely no need to top up with formula unless you want to. You can tell a healthy baby by looking at them: are they alert, do they look healthy, are they having plenty of wet/dirty nappies. My red book recommends weighing a baby every month, there is nothing to be gained from weighing frequently and looking at 10g weight increases. A belly full of milk and a full bladder could increase your baby's weight by 120g. So don't be unduly influenced by these weights. To put it in perspective my 6yo was put on nutritional supplements due to poor weight gain but only gained 100g in three months. Then in the next three months he gained 2kg! Weight gain is in spurts and leaps, not a steady process.

There are a number of things you can do about your supply. You could ask your HV to weigh baby before and after a feed so you can see how much milk he is getting. Make sure you eat regularly and get rest so your body can make milk. Let feeds go on as long as baby wants to stimulate your supply. Try fenugreek or get medicine from your GP to increase your supply. Use breast massage/compression.

From your description it doesn't sound like your baby's health is currently at risk. You certainly have time to try a few things to improve the situation. You need time to see whether your baby's weight is following the percentile line and remember they don't necessarily stay on the percentile they were born on (my DS1 was born on the 50th but dropped to the 2nd over the first few months and then stayed on the 2nd.) Also it is normal to move two percentiles before they even refer your baby for investigation.

Unfortunately formula is seen as a quick fix but unless there is something wrong with your milk which is exceedingly rare, breastfeeding is still the best for your baby. In my opinion you are doing the right thing by resisting formula. If you try to improve things and it doesn't work then you can introduce formula in a few weeks knowing you have tried everything else.

ChunkyTurkeywiththetrimmings Wed 12-Dec-12 22:47:39

Sam5 I don't claim to be an expert - as I said - and happy to be corrected, but I have read frequently (on LLL, Kellymom etc) and from conversations with other bfing mums and peer supporters that block feeding is one way to increase hind milk...

Hopefully the info here blonder will help you be confident you are doing best by your baby. Best wishes

midori1999 Wed 12-Dec-12 22:48:07

It sounds like you've had a very hard time OP.

I think it is probably worth getting some more support with breast feeding, from a breast feeding counsellor or lactation consultant and also getting your DS checked for tongue tie by someone who really knows what they are talking about. Not sure what area you rare in, but Milk Matters may be able to help with this?

8 feeds in 24 hours is the minimum really, so you are right to try and increase feeds. Switch feeding will help and have you tried breast compressions also? You are right that what you eat won't affect the quality of your milk, so don't worry about that. Just eat to hunger and drink to thirst. Keeping our baby close so you can feed at every little sign he is hungry or at every stirring is good too and skin to skin helps with milk supply/let down. Feeding as frequently as possible and with as many sides as your baby will take will also help with milk supply.

However, you really need some good real life advice from someone who really knows their stuff about breast feeding.

tiktok Wed 12-Dec-12 22:58:08

Blonder this is a concerning situation and its good its being taken seriously. Problem with a talk board is you get info that may not be right and you can easily become deomoralised and confused. This has happened on this thread ie not everything people have said is correct.

Best step next is to get real life help. Try the helplines. If your hv says she is no expert (and her questions about diet indicate she is not) can she refer you to someone who is?

blonderthanred Wed 12-Dec-12 23:16:49

Thank you Chunky, I've spent ages looking through Kellymom and LLL websites and trawling the Internet but I really wanted a sense of whether I was doing the right thing to persist and have faith in bf or whether it was time to give in - and you and the others have reiterated what I felt, so thank you very much.

Stunt it is really good to hear your perspective and read a success story. And also to feel like it's not this urgent situation which is what it feels like but possibly part of a bigger pattern. Just wish I could see a few weeks ahead!

Thank you for the votes of confidence. Have been switch feeding since 5pm with a few breaks for gurgling and smiling (him not me) so hopefully due a couple of hours guilt-free sleep soon.

blonderthanred Wed 12-Dec-12 23:22:54

Thanks to midori and tiktok too, it is so hard to know who to speak to IRL. I exchanged emails with someone from LLL a few weeks ago but there are no meetings in my area. I could go back to the GP maybe? She said she'd see me anytime even without an appt.

I will keep pursuing it anyway but thanks for the input and support.

Ameybee Wed 12-Dec-12 23:34:30

Hi blonder recognise you from the staying awake thread. Sorry you're having a tough time! Just wanted to say that we just found out DS isn't quite gaining as he should, I've started expressing to increase supply and We are trying (only x2 successfully) to top him up with expressed milk, will see what his weight gain is next week but may consider 1 formula feed if the HV suggests it. Has anyone suggested expressing? You could maybe see how much LO is taking then? X

ChunkyTurkeywiththetrimmings Wed 12-Dec-12 23:36:01

What about the NCT or Sure Start centres? I think the NCT also have a helpline & my local childrens centres run breastfeeding support groups... They might be able to refer you to the appropriate person.

maillotjaune Wed 12-Dec-12 23:42:32

Blonder when I was in a very similar situation with DS3 almost exactly 3 years ago I had excellent advice from tiktok and after a few weeks he just started putting on weight. I didn't even change anything!

I was feeding him more like every 1 1/2 hours and every 2 to 3 hours at night with a cluster in the evening.

Hope you find something that works for you.

blonderthanred Thu 13-Dec-12 09:03:09

maillot I hope that happens for us! But have been hoping that every week.

Chunky I'm going to an nct group tomorrow so will see if anyone I can speak to.

Had huge row with DH at 1am as he wants me to sleep. Unfortunately DS is having a fussy night so I am convinced I'm starving him despite mammoth feeding sesh. This way madness lies.

KatAndKit Thu 13-Dec-12 10:36:10

Hi blonder sorry you are having a tough time with the BF. Your HV is totally wrong about the milk quality thing by the way. The problem is likely to be that your DS is not transferring milk effectively from your breast. I would be inclined to strongly suspect a tongue tie. Posterior tongue ties are particularly hard to spot. My DS had a tongue tie although fortunately it did not affect his weigh gain. Breastfeeding was way easier once it was snipped.

If you are finding it hard to access good BF support via the usual channels perhaps phone up La Leche League - the LLL round here have good bf supporters who are very knowledgeable. They also have a BF helpline and hopefully will be able to put you in touch with someone in real life who can give you support in person. Round my way the sure start centre has an excellent bf drop in staffed by a proper lactation consultant but this is not true of all bf drop in groups.

I agree with the advice to feed more often. Try to offer a feed every two hours and see if that helps. I am 8 months in now and only now am I down to 3 hours between feeds in the daytime.

shouldIbecrossaboutthis Thu 13-Dec-12 13:08:25

blonderthanred, I'm not as much use as others on this thread (especially tiktok) but I just wanted to reassure you that even if your baby was gaining weight well (mine was born on 75th and has gone up to 91st and stayed there and is a baby tank!) breastfeeding will still mess with your mind.

I found you just need to have faith in your body. The thing that keeps me going when my baby is being fussy / my boobs seem less full / we haven't had a poo etc is that my baby has plenty of wet nappies and is alert and generally happy. You just have to keep thinking this and reassuring yourself that your body knows what it is doing.

If your baby isn't gain weight as quickly as they would like then it sounds to me like the best solution is to keep feeding and then feed some more. Try not to get bogged down with all the other things like expressing, worrying about which boob to use, just feed feed feed switching boobs when the baby comes off naturally.

Good luck with everything!

Elizadoesdolittle Thu 13-Dec-12 13:24:45

Waves hi blonder.I popped over to this thread after you posted in our post natal group. My DD is 5 weeks tomorrow and still not back to birth weight. I got her weighed 9 days ago and she was 3.4g, today exactly the same, in fact a little bit less. She too had the urine test and came back clear. The hv made a dr appt for her this afternoon. She does have a hacking cough so has been sick more than usual. But like your lo she has wet nappies and although she doesn't pooh everyday when she does it is of good colour and consistency. I am yet to give into formula top ups as I didn't think she needed it but am close to relenting. So although I don't have any advice I just wanted to know you have my sympathies. It's tough but at the end of the day our lo's are happy and appear healthy so we must be doing something right!

tiktok Thu 13-Dec-12 14:20:15

blonder - try the helplines and ask your HV who is the infant feeding specialist in your area (might be at the maternity unit).

Any baby at this age not yet up to birthweight is doing something very unusual....a few babies are just physiologically slow to gain, ie that is just the way they are, but the majority of them are likely to benefit from more feeding, or more effective feeding.

They all need to be checked out - tongue tie, other oral anomaly eg cleft palate, underlying infection, and usually more than once, and by someone who knows what to look for.

First and easiest step is to feed more often, from at least each side each time.

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