Low-centile 12 week baby: top up with EBM?

[Quodlibet]

Hi

I'm hoping someone informed can give me some advice, as I am not confident in the advice from my HV.

My baby is on the small side - she was born at term at 6.2lb. Her dad was also a very small baby.
I have been EBF, and other than some latch/soreness issues in early weeks which have now resolved, BF is going well. She regained her birthweight inside the first week. Since the early weeks where I was diligent about not letting her go more than 3-4 hrs, I've been feeding on demand, at her hunger cues.

She started off just under the 9th centile and has hovered around there ever since. Today at 12 wk weigh-in, she was marginally nearer the 2nd centile but still closer to 9th.

I am otherwise not alarmed by her weight - she is alert, happy, lots of wet/dirty nappies, sleeps well and is developing fast.

HV has advised that I should address the weight issue by expressing milk and then topping her up with a bottle after feeds and wants to see me in 2 weeks to review. I can't understand the logic of this. If I am feeding her, I feed her til she is not hungry any more, when either she comes off the nipple herself or falls asleep. She does get a bottle of EBM most days as DP does the last feed and puts her to bed, but often she won't finish the bottle. She will eat plenty from a bottle if she is hungry (I leave her with DP occasionally while I work and she happily guzzles EBM then)

I feel like if I pump after every feed and then try to bottle feed her, I will be spending my entire life feeding. I'd like some reassurance that there is actually cause for concern, and a logic to this plan, before I start!

[Mildpanic]

Tbh this is why it is better to avoid weighing.
If she is happy, alert, feeding regularly and settled between feeds then she is fine.
There is so much concern about centiles and weight, better to avoid going there if you can.
She hasn't even dropped 2 centiles which would be more of a concern. She is only 12 weeks so only recently finding her centile to follow.
If not drowsy, no health concerns, born at term an nothing else to indicate an issue then please don't worry. Follow your instincts.

[girliefriend]

What you are doing sounds fine, if baby is happy and healthy and there are no other concerns then I don't think you need to top up any more and don't start giving formula as that will just mess with your supply

I suppose you could do an experiment so that after she has a good feed you could try her with ebm/ff and see if she will take any more... my guess is she won't as she will be full!!

My hv was always very anxious about my small baby dd (6lb 14oz at birth and then rapidly lost 10oz in her first week - she was poorly in scbu and tube fed ) put the weight back on but only at 1 or 2 oz a week at most. I bf on demand and gave the occasional ff as well if I thought she still seemed hungry.

However it was around the 12 week mark that I found my supply really picked up and I just bf with no need to top up. However the hv used to stress me out with constant weighing and peering over charts! I trusted my instincts that she was fine and she is now a great big 8yo in age 9-10yo clothes!!

[KBwan]

Hi. I think you're right, if you're feeding her till she's refusing, then offering a bottle isn't going to add much (other than a lot of stress for you!).
My dd2 was born on the 25th centile, and dropped to below the 2nd by 12 weeks. She was also refusing to feed some days, so ended up getting her checked out by a paediatrician. He advised that the birth weight is heavily dictated by the efficiency of the placenta, and over the first 12 weeks the baby finds their natural weight curve. He said if they're pooing, weeing, generally happy and gaining some weight, then all is usually fine. And by 'some weight', he clarified he meant as little as 1oz every 2-3 weeks... Which is frighteningly little when you look at the red book.

He said definitely not to weigh more than once a fortnight, and to try not to obsess! (Easier said than done, I realise).

Some babies are light, some are heavy. Sounds like yours will be easier on your arms for longer - congratulations!

[Quodlibet]

Thanks for the reassurance people.

The only thing I can think might be getting in the way of her gaining faster is that she often nods off after one breast, so I don't always get to offer the other. I have started recently being more diligent about offering both even when I think she is full or sleepy and she sometimes surprises me, so maybe I should just see if this has any effect?

[MissRatty]

Just posting as I've been there! Our LO was on the 25th centile and is now about the first...rapid regain of birth weight but then very slow gain thereafter...falling asleep at the boob and seems to have a poor appetite...however has lots of wet and dirty nappies and is very alert and contented.

We did introduce ebm top ups, and his weight gain did improve. It went from 2-4oz a week to high of 7oz He was falling asleep at the boob and his latch wasn't great, so the top ups really helped get a bit more in him. As he has gotten a bit older, now 14+6, his latch is improving so we're tending not to top up as much (we mix feed now as well, but it was just ebm in the beginning), and we've gone from him being weighed twice a week to now twice a month (much less stressful as our lives were being dominated by that bloody chart!).

As far as we are concerned now, he's happy and seems healthy, and hopefully he'll get a spurt later on (hubby and I are both six foot, he's on the second centile for height too), so we're trying to relax a bit.

As previous posters have said, they tend not to get too bothered unless babies cross two centile lines, and see any gain as a good thing, even if its low. I would say perhaps you could see how things are in a week or so, try to rub hands, change nappy when LO dozes off etc., to see if more boob or other boob will be taken, and see if that helps first. Expressing for top ups is quite difficult time wise, so maybe see if your LO will take a bit more at the boob if you prefer to try that way? Also try boob compressions...I am sure that they help, as well as getting a good latch. My LO's was so shallow the LC likened it to drinking through a pinched straw...hence he was falling asleep as he was getting bored!

Its worrying to us though, but try not to worry! I know its easier said than done (my hub even has a spreadsheet with the WHO raw data in to track LO's weight...but we're trying to be less neurotic now!).

Good luck!

[TinyTear]

For the centiles to work there need to be big babies and small babies.

My daughter has been on the 9th centile religiously since 10 weeks and she is 2 yo and just had her 2yo review and still on the 9th

If your baby is hitting milestones, alert, happy and with plenty or wet and dirty nappies ignore the advice...

What I made sure i did was offer both boobs at each feed and only refused feeds when she turned 2 yo (now she only feeds morning and bedtime)

[TheScience]

Someone has to be on the 9th centile, just like someone has to be on the 91st. If she regained her birth weight quickly and has pretty much stuck to her line then I don't see the problem really.

I would offer feeds more often/offer more sides before getting into expressing and bottle feeding.

[Quodlibet]

Thanks people. Interesting to hear that this tactic worked for you Ratty. I don't think she has a bad latch any more as I can quite often see she is getting mouthfuls of milk but I will keep an eye on it. Thinking about it, I think her falling asleep is more because she winds down with a feed before a sleep - she has a cycle of play-feed-sleep-feed rather than the classic feed-play-sleep.

Anyway, seeing as she hasn't crossed a single centile line yet, I will do more boob/compressions etc before starting on a pump plan.

Can anyone explain why the lines are 0.4, 2nd, 9th, 25th centile and not, say, 10th, 20th, etc?

[TheScience]

I'm not sure any babies naturally do feed-play-sleep - they're designed to feed to sleep really.

[crikeybadger]

How about going back to your HV and asking her why she thinks there is a weight issue. Nothing in your post indicates there is anything wrong with your baby.

[43percentburnt]

My 6 month old was born 25th and is now about 9. We get him weighed every couple of months. He is breastfed or given expressed milk as I work ft. My daughter was 2nd centile, she is now a normal height weight for a teenager.

Try not to stress, feed on demand. If you stress to the hv they will offer solutions. Ours don't because we remain upbeat and tell them he's healthy and happy.

Dirty nappies, wet nappies, alert, interested, no dip on the soft part of the head. Then just keep going.

I read babies can go down two centile lines with no worries. The hv reiterated its normal.

Out of every hundred babies someone is the 2nd smallest.

[ALittleFaith]

I agree with crikey. Your baby hasn't lost weight, has she? Perhaps not gaining quite as much as expected but she sounds like she's doing exactly what she should be doing!

My experience - DD was really tiny - 5lb 4oz, born at 38+5 so 0.4th centile. When we were in the hospital she was ravenous so they advised us to give FF top ups until my milk came in then EBM top ups. By day 5 she was feeding effectively so we were able to stop the top ups. She fed just like your DD and just grew! She's now around 50th centile and had tripled her birth weight but 6 months.

I would carry on doing what you're doing. Baby sounds happy and healthy.

[geekaMaxima]

Quodlibet - the centile lines are at odd numbers like 9th, 0.4th, etc for pedantic but (probably? ) well-founded statistical reasons. Each centile gap is two-thirds of a standard deviation, so the 25th centile line is 2/3 SD below the 50th, the 9th centile line is another 2/3 SD below, and so on.

Quite why the UK wants to use 2/3 standard deviations is something to take up with the Royal College of Paediatrics and Child Health Other countries do perfectly well using round numbers like the 25th, 10th, 5th centile lines, etc.