I'm worried about my skinny baby

[SpanielFace]

DS is 19 weeks. He is EBF after a rocky start - he had a tongue tie which caused poor milk transfer & static weight, and it took him until 4 weeks old to return to birth weight (6 lb 10). The tongue tie was snipped at 5 weeks old.

Since then his weight gain has been slow but steady, and he's hovered around the 2nd centile. My DH is very slim so I wasn't too worried, and he's been progressing normally.

In the last week, his feeding/sleeping patterns have gone crazy. I assumed it was a growth spurt / 4 month sleep regression, and have been trying to just "ride it out" - the 2 hour afternoon feeding sessions, hourly night wakings etc. But as well as this, he's starting slurping/clicking on the nipple like he did when he had the tongue tie, and I'm worried it could have reformed (posted on this elsewhere). He's also not pooed for 10 days, alarmingly - I know breastfed babies can do this but he's normally at least every other day. And when I looked at him the other night, really looked when he was naked, I was shocked by how thin he looked - I can count every vertebra, and clearly see his bottom 2 ribs & pelvic bones from the back.

My mum is a HV in a different area of the UK, so I asked her to weigh him this afternoon when she was over, and his weight is now below the 0.4% centile. Length is on the 9th centile. DM said to try not to worry but to see the feeding consultant who had diagnosed tongue tie, I have an appointment tomorrow.

I'm so worried about my little boy. Sometimes I think I've done him no favours being dogmatic about the breastfeeding (and believe me, it was bloody hard work, especially before the tongue tie was treated). I love him so much, I wanted to give him the best possible start but he looks like he's starving at the moment. I feel like my body has failed me, like it was all one big lie that my milk supply would be enough for him & that treating the tongue tie was the answer.

I don't know what the feeding consultant will say. If the TT has recurred, I don't know whether I can face having it re-snipped at his age, or if it's even worth it. I don't know whether I should think about supplementary formula (I'm not anti FF by any means), or early weaning (I had wanted to do baby led weaning, but again, am not anti-purees), or what would be best. I just want to do whatever is best for him.

I'm getting upset sitting here feeding him in the dark and feeling how light he is compared to my friends' babies of the same age, and how I can feel all the bumps in his spine .

Does anyone have any wise words? Should I be worried about the lack of poo? Is his little body just using every ounce if my milk at the moment or something? How is best to try to increase his weight gain? Has anyone here dealt with similar?

[SpanielFace]

Thanks for the reply. We have no family history of allergies on either side. I'm taller than average, and (when not carrying an extra 2 stone of baby weight!) a fairly average size 12 build. DH is average height, but very slim with a tendency to eat like a horse but not be able to sit still, and just burn it off. We were both chubby babies, both breast fed.

The reason I never though of allergies is that he's never had signs of reflux, he's literally only posseted twice in his life, and apart from a brief period on infacol at about 7 weeks with trapped wind, has never had any signs of pain. Surely you'd expect one of those things? I eat pretty healthily (although too many biscuits!) - I'm certainly not eating too little. I do have milk on my cereal / in my tea, but reluctant to cut it out without a definite diagnosis, surely we both need the calcium right now?

I also don't think I have a forceful let down - to be honest I used to doubt if I let down at all, I don't feel it, if he comes off I don't see milk dripping, I have never leaked. My HV taught me to look for the change in his sucking that indicates I had let down, but that is the only way I can tell.

I sound like I'm being argumentative, I'm really not meaning to be! But I just don't feel that allergies are likely to be the problem. I will speak to the feeding coordinator about it though & see what she thinks.

[tiktok]

SpanielFace, sorry about your worries :( It's good you are getting some support an evaluatiuon. Babies of this age should not normally look skinny, and if the weight is accurate, this is cause for concern. Some skinny babies of low weight are fine but some definitely need more calories, so you are right to think along these lines.

Your diet is not an issue. Increasing the fat in your diet and increasing the protein will make no difference - individual people may feel this made a diff. to them, but there is no biological reason why it would, and the research 'in the field' is very clear that it does not.

Instead, you need to ensure he removes milk frequently and effectively, and the bf specialist will be checking for this, as well as looking at the TT.

He needs to feed from both breasts frequently (google 'switch nursing' and 'breast compression') and this should be day and night.

Hope you get good help tomorrow.

[blonderthanred]

Hello, I don't really have any words of advice, just wanted to give you support. Reading your words made me quite tearful as I have been going through a similar thing with my DS 11 wks (although he has had weight gain probs since birth). I know exactly what you mean about wanting to give him the best start and feeling like it's all a lie. But we are trying to do our best for the babies we love.

I have started formula & ebm top ups this week (most feeds apart from late-night and one during day). I hired a hospital pump to maximise what I could express and also to stimulate my supply in case the formula meant he fed less often (which is true). It is a relief this week to see him slightly fatter.

For me like you the tipping point was to see how skinny he was and to find that he had dropped way below the 0.4 line. I want to solve our problems and keep bf but I also needed to get some calories in him, fast, and have tried my best to do that. In a couple of weeks if he is doing well I will try and reduce the top ups and allow him to find his centile.

We just had a TT clipped last week and hopefully his new, post-TT latch will mean he is taking on more milk from bf. I know how difficult it is to put your child through the TT procedure. I hope it's not that but you get some answers that allow you to carry on.

[SpanielFace]

Well, the tongue tie has partly reformed, but also he has a high arched palate which she thinks is part of the problem. I was offered re-referral to the surgeon, I said I'd think about it. It was also suggested that I feed every 2-3 hours and pump 45 minutes after each feed. Which, considering he takes 45-60 minutes to feed, is impractical to say the least. Also breast compressions. He's not officially failing to thrive, but I'm to have him re-weighed in 2 weeks.

I don't think I'm going to go along the lines of surgery again. The tongue tie reformed once, why would it not happen again? And there is nothing a surgeon can do about his palate. I think I just need to accept that he is an inefficient breast feeder.

Ideally, I think the solution would be to pump, and feed expressed milk. But I am crap at pumping, whatever I do I don't seem to let down - I pump for 30 minutes and get about 1.5 oz. It's just not realistic.

So, after much soul searching, I've decided to introduce some formula feeds. I don't want to stop breastfeeding altogether, and I will continue to do the breast compressions, and pump a couple of times a day. But he is so much more efficient on the bottle - I gave him formula tonight for the first time since before his tongue tie surgery, and he took 7 oz in about 15 mins (this is compared to 45-60 minutes to breast feed). He obviously finds it so much easier.

I am just so tired of worrying about his weight. I just want to get some extra calories into him & to see him grow & thrive. And if I combination feed, surely he'll still be getting the antibodies etc from my milk?

Please don't come on this thread & tell me about the evils of formula. I was the most pro-BF person before he was born, and I have worked so hard to make it work for us. I think I just need to accept that it's time to compromise.

[Whatevertheweather]

Spanielface you've done a wonderful job to get him to nearly 5 months ebf. He will have gained so many benefits from this. Fwiw after reading your first and subsequent post before getting to your last post I was going to say perhaps give him some formula top ups. It sounds like the best compromise in your situation it really does.

My dd is 21 weeks and because I'm having to go back to work in 6 weeks I'm starting to think about introducing daytime formula in the next week or so. I'm just so proud of myself for getting this far with ebf - further than I ever thought I would. I hope you are proud of yourself too.

I really hope this is the solution for your little boy and that you see a leap in his weight gain xx

[bamboozled]

Well done for being brave enough to go with the formula - all that matters is that your baby eats - and anyone who has a pop at you about giving him some formula has never had a baby shrinking in front of their eyes. It's such a hard decision when you never planned to do it - I remember doing exactly this, tears streaming down my face silently begging 'spit it out, spit it out' as Dd1 had her first bottle but she drank the whole thing as if she had never been fed before. Life got so so much better after that - so fingers crossed it will for you too. X

[realhousewifeoffitzrovia]

I think you are absolutely doing the right thing, and you are a hero for working through this. Please post your DS's weight gains; would love to hear it :)

[forgottenpassword]

I had an Ebf baby who just stopped growing at 4 months. He turned out to be mildly anaemic and slightly short of vitamin D. Eventually I had to switch him to formula at 10 months which made me sad but was necessary. He is still skinny at 3 so I think it is mostly genetic but I would ask for a referral to a paed just to be sure. Best of luck! I know how stressful this is.

[BouncyPenguin]

Glad to hear your DS is liking the formula. For me formula is wonderful stuff. I know how it feels to watch a baby getting thinner and feeling inadequate. And the utter relief after giving them formula and watching them recover and thrive. Love love love formula.

[SpanielFace]

Thanks for all the lovely supportive messages.

It's such a hard decision, isn't it? Even last night, giving him the bottle, I was thinking, "Am I doing the right thing?" He took it with no difficulty and settled to sleep easily afterwards, although he did look a bit confused! I have to keep reminding myself that there is nothing wrong with formula, that he's had 19 weeks of exclusive breastfeeding (except for a few formula top ups at 4 weeks old when we were waiting for the tongue tie surgery), and that it's the sensible option. But I thought I was going to get negative comments on here, so thank you! I have some very pro-BF friends in real life, so am a bit nervous about telling them - but at the end of the day, it's none of their business, is it?

So, those of you that combination feed - how do you do it? My mum (who is a HV, and also very pro BF, but has been 100% supportive of my decision) said that replacing a couple of breast feeds with formula would be less likely to adversely affect my supply than topping up at every feed. So that's where I'm going to start. Probably 2 feeds a day, I think, spread out so I don't get engorged.

What do other people do?

[Loislane78]

If any of your pro-BF 'friends' have got anything to say about it I'd question whether they are really your friend.

I EBF because that's my choice and we haven't had any real issues; I would never pass comment or question someone else's decision on how they feed their baby, either through choice or necessity, cos its none of my business.

Hope you'll be pinching a pair of chubby thighs soon :)

[blonderthanred]

Spaniel it sounds like you are doing exactly the right thing. In fact I might take your mother's advice myself as I am sure my HV & GP's advice to top up after every feed was fairly arbitrary and possibly harmful to my supply. If you do express I really recommend getting a hospital grade double pump. Done in 10 mins instead of an hr!

bamboozled I also half-hoped DS would spit out the formula with a cry of Mummy, this is not my usual fine quality tipple... But he took it without a murmur and of course it is well worth it to see him start to fatten up.

[BouncyPenguin]

I mix fed for a while with both DS. But unlike you I found BFing impossible/difficult and expressing quite easy and could get a decent amount. For a while with both I would express twice a day and get about 4 ounces each time and all the rest were FF. I think it makes sense to keep putting him to the breast whenever you can or whenever is convenient but offer him some formula if he hungry and either you feel the milk isn't there or he can't get enough of it. Let him take the lead and he will naturally fall into a routine. I don't think they get confused by it. With my DS1 I BFed a little with a nipple guard for a few weeks, expressed and gave formula and he just took whatever I gave him. With DS2 I have found I am much more confident in making decisions about how to care for him and care very little about what others might think. I try things out and if it doesn't work for me then I just change it and do what works. For me that's what parenting is all about. So for example when I just came to wean DS2 I waited to 6 months as he seemed fine with it, then tried baby led weaning. When he gagged and choked on banana during xmas dinner and I had to hold him upside down and bang him on the back to get it out I didn't agonise over it all I just thought, right, that's it, baby led weaning is not right for us. My DS2 had whooping cough at 3 weeks old and I have had enough of seeing him choking so I am giving him purees as with DS1 and that is totally fine. Others can do what works for them. When you first become a mother you put yourself under so much pressure to do it all 'right' and give them the 'best'. But having been through it all once I now feel that as long as they are given some sort of milk, some kind of food etc they will be fine and all the rest doesn't matter. I now make decisions about how to care for them based on what is right for the whole family (including me!)

[peanutdream]

OP what a nightmare for you - such difficult decisions. You have ebf for 19weeks despite having major difficulties and stress and this just means you are amazing!

Even though the formula is helping at the moment, it can be a short term solution until your LO is well established on solids. After that, some people prefer to phase out the formula so you are doing just food and breastmilk, effectively replacing the formula with food, so that is always an option. (I thought I'd mention it as you have said how pro breastfeeding u r).

Also, it might be an idea to keep the night breastfeeds - these can help maintain your supply, and continuing to feed your baby on demand whenever either of you want to - it doesn't have to be set times, can also help keep your supply chugging along happily. Any breastmilk your baby is receiving is full of antibodies tailored to your environment so definitely worth carrying on :) . And even if your boobs feel empty and your thinking hmm is he actually getting anything, they're not, and not only is he telling them to make more, he's also getting lots of lovely fatty milk to help him put on that weight.

Hth x

[SpanielFace]

Well, things seem to be going ok so far.

I'm giving him a bottle of formula for his late evening feed, and another late morning (I'm still demand feeding, but he has fallen into a pattern of sorts). I picked those times because late evening is practical as DH can do it occasionally in the future, and i wanted to spread the times out as much so i didn't get engorged, hence 12 hours later. I still plan on doing night feeds myself, to hopefully help maintain my milk supply. He's taking about 8-9 oz at each feed, and is clearly getting more milk as his number of wet nappies has gone up and I'm now having to change him overnight.

Otherwise, I'm breastfeeding on demand, and he's still feeding loads! So yesterday went:

8am breastfeed
10am breastfeed
11.30am formula feed
3pm breastfeed
5pm breastfeed
7.30pm breastfeed
10.30pm formula feed
4am breastfeed

So he's still having 6 x breastfeeds in a 24 period. I think the 10am feed was mostly comfort sucking before his nap. But it will all help keep up my supply, right?

Interestingly, both my DH and I both looked at him independently and thought he was a bit chunkier around the thighs. I'm not sure that's possible after just 4 days of top ups, or if its wishful thinking!

I'll get him weighed in another week - I want to give him 2 weeks on the combination feeding before seeing if it's made a difference. I'll keep you posted!

[emmyloo2]

Honestly I wouldn't give it a second thought about introducing formula. You are feeding your baby. He needs the nutrition.

And if anyone says otherwise they are ridiculous.

I exclusively breastfeed until 4-5 months then introduced formula and never looked back. I will do the same with DD who is due in May.

[peanutdream]

SpanielFace well done :) you sound encouraged that you have fallen into a workable pattern and you are right, any extra feeding, comfort sucking or otherwise, is keeping your supply going and giving him more of your milk which you've said is what you would like to happen so that pre nap feed is fine! I bet he has a lovely nap too :) full of your milk.

Some people find breastfeeding them before their bottle means they take a bit less formula, say 5 or 6oz instead of 8 or 9oz - a smaller amount of formula means he gets more of your milk, and in this way, it can be possible to phase out the formula should you want to.

Some people also find that 10:30pm feed, as lovely as it is for you to have a break and get some sleep, can short circuit the supply/demand process, but others go on and on with that feed with no problems. Basically, the more stimulation your boobs get, the more milk they will make, so the longer they sleep after that 1030pm feed, the less use your boobs get - breastfeeding can be very much a case of use it or lose it lol! You could always feed him before that feed sometimes, everytime, if your DH isn't there, whenever you feel like it basically, and that'll be a signal for your boobs to make a nice amount of milk for that middle of the night feed!

Good luck and keep us posted x

[SpanielFace]

Just to update all you nice people who replied...

DS is now having 2 bottles a day, occasionally 3, as well as 3-4 breastfeeds. We go:

8am breastfeed
11am bottle
3pm sometimes breast, sometimes bottle (unfortunately he sometimes refuses the boob for this one now, especially if he's really hungry when he wakes from his nap).
7pm Breastfeed
11pm bottle
4am breastfeed

This is all on demand - it's just the pattern he seems to have fallen into. He also sometimes has little "comfort" breastfeeds throughout the day, especially before naps, but doesn't take much milk at these.

He takes 7-8oz when he takes a bottle.

And......(drumroll)....... I had him weighed this morning and he's gained 2lb 3oz in 2 weeks! He's jumped from below the 0.4% centile to the 9% centile, and looks so much better & more in proportion. I can no longer see his pelvis, he has chubby thighs, and more importantly he's so much happier & more settled. It was such a hard decision to make, having planned on EBF, but I have absolutely no doubts now that it was the right thing for us. My only concern is the occasional boob refusal but its not regular and never at night, so hopefully we can carry on partially breastfeeding for as long as possible.

[blonderthanred]

Oh that's great news Spaniel. I am really pleased for you. It is an amazing feeling to see them chubbing up isn't it.

We have seen a similar improvement from supplementing with formula after feeds but I am really interested in the advantages of doing it your way. I haven't had any breast refusal but weirdly he has started refusing ebm in bottles. Anyway if you are looking to phase out the formula after a while (once he has settled on a centile?), I would be interested to know how it is going as that's what I am hoping to do.

[Curtsey]

Delighted to hear that his thighs are chunking up! It's a lovely sight.

For what it's worth, my DD had a mid-morning formula feed from about 19 weeks to about 9 months. (I went back to work, pumped for a while, but just hated the pumping- formula was easier.) She's now 12mo and I'm still breastfeeding her.

Just enjoy him :)

[SpanielFace]

Blonder, if I'm honest I'm going to stick with what we're doing. I feel it's working for us, so I don't feel inclined to change. He should still be getting most of the benefits if breastmilk (I hope!) - and I was so anxious and stressed about his weight, I feel that trying to go back to EBF would take me back to being stressed again, and I really don't want that. He's 5 months now so we'll be starting weaning soon anyway.

I can really see the advantages if doing it your way though, if you're planning on returning to EBF - at least he's still used to having to initially work for his milk, rather than the instant gratification of a bottle, so maybe less likely to get breast refusal? I don't know, just a thought.

Good luck with it, it's so hard to know what to do - everyone tells you that exclusive breast milk is the best thing which makes it hard to accept that it's just not working for you!

[blonderthanred]

Thanks Spaniel, I know what you mean about stressful it is. We just want to see them thrive. I think your way sounds eminently more sensible but at the moment I would be scared to deviate from our HV's plan even though she is crap as it's doing the trick and that's all that matters. I wish you and your LO all the best and chubby thighs!

Great to hear that Curtsey is still bf later on.

[Whatevertheweather]

Wow! That is great news Spaniel well done you for making the right decision for all of you.