How long is slow weight gain in a newborn tolerable

[BookSnark]

Could someone sit with me to pick over if it is time for top ups with DD.

She is 15days old and still 8% below birth weight (birth weight over 9lb) - only slightly above her day 5 weight.

Day 10 weight was 60g down on day 5 weight. Day 12 weight made the 60g back - and day 15 has made 20g. So she's now gaining but it's very slow.

She's exclusively breast fed. Latch checked by experienced counsellor & basically OK. Feeding frequently day & night. Started fenugreek a few days ago and breast compressions. Alert, generally happy,wees and poos. I'm expressing several times a day (after feeds) - and feeding the measly output back to DD.

MW has been very supportive - but question is how much further we can continue down this road.

[CunfuddledAlways]

I did this for four months with my 2nd child, I eventually put her on formula.after she caught a bug became ill wouldn't feed and her weight dropped and I couldn't get her to gain. My third child I breastfed for only two weeks as she also didn't gain weight. My first gained beautifully and was fed until 1 1/2 no idea why the next two didn't gain. Don't beat yourself up if you choose to either top up with formula or completely formula feed. It's best that both you and baby are happy.

[CunfuddledAlways]

I would also advise only to weigh once a week always on the same scales that aren't moved if possible. Xl

[CunfuddledAlways]

As different scales.can show different results especially if on different surfaces

[FATEdestiny]

2 weeks to not reach birth weight is not that unusual in itself. The midwives won't discharge you until baby is back to birth weight and I think they start getting more worried closer to 3 or 4 weeks.

Slow weight gain is not the same as losing weight, which some babies can do for several weeks (and is very concerning). Your baby is gaining, which is a positive.

However I echo what the first poster said, formula is not the end of the world and is not evil. Don't beat yourself up about using it. If baby is not thriving, you do what's best for baby and if that means formula then that is what formula is there for.

[BookSnark]

Same scales in the same place - I think it's genuinely slow gain. 20g over 3 days is quite weak - though 80g over 5 days is maybe more flattering...

[CunfuddledAlways]

If you look at it weekly instead of every few days it may give a better picture as obviously if baby poos extra one day or has one less feed or has just had a feed or is just coming up for a feed-it can all make a difference. Realistically even weekly is a bit often for weighing as all these fluctuations make a big difference in a new born. Are you managing to express much?? Have you tried expressing before.baby feeds?

It really is up to you how long you keep breastfeeding with no supplements as.long as baby is alert and well, it's just knackering!! I also found it upsetting when I had been feeding/expressing ALL the time only for her to loose weight or gain very little, in hindsight I should have put baby #2 on formula much sooner as.my mental health suffered.

Do you want to continue breastfeeding? Do you want to use top up formula? Do you want to change to formula feed completely? Whatever you choose it may not be easy

[BookSnark]

I've walked this road before. So I know that formula is not the devil - but I also know that mix feeding is also tricky to pull off. For me, my mental health dips plummets when I reduce breastfeeds - and the babies tend to show signs of CMPI - so generally I'd rather stick with it as long as it is safe for the baby.

[CunfuddledAlways]

You could always get soy milk/similar if cmpi is a problem. As long as baby is healthy I would stick at it if it is beneficial for you both.

[tiktok]

booksnark this is concerning and it's not surprising the hcps are monitoring weight. However, your dd started off bigger than average and there may be an element of catch down. Can I check you are using both breasts at least once per feed, and switch nursing when you can ( deliberately switching sides as soon as your baby starts to slow down )?

Top ups don't have to mean the end of bf and they can be dropped also when weight picks up. Not possible to say here if they are necessary or not yet, and if health and hydration is fine, there's no immediate emergency for them.

Stick with weighing - a week is too long to wait IMO, in this situation though normally it would be too often.

[CunfuddledAlways]

I saw a top consultant with dd 2 as they where going to diagnose failure to thrive, he was horrified that she had been weighed 2/3 times a week as it didn't give any time for her to gain. I would ask to see I consultant/specialist doctor.if your baby continues to gain slowly. Fwiw my not even on a centile baby at 16 weeks is now 4 and although she is petite she is not much smaller than some of her class friends and is somewhere between 25th and 50th centile.

[Racheyg]

Hi op,
I can't really offer much advise but I am going through a similar situation. My ds2 was 9lb 14 at birth and lost 1lb 2oz on day 5. He was then weighed 2 days later and no change then 4 days later he lost a further 3oz. He last got weighed 2 weeks ago and only put on 4oz. Ds2 is getting weighed again tomorrow.

Keep doing what you are doing it will take time as I have been told larger babies can take more time to reach back up to their birth weight.

Don't beat urself up if you need to top up. As you can drop the top up once weight back up. I bf my son all day and night then give 1x top up at 11.30.pm.

I hope all works out for you x

[Mamab33]

Congratulations on your DD just keep her close to you and keep offering. Eat and drink as much as you can and rest at every opportunity. Check for tongue tie. Not all hcp know how to diagnose and some will say there is not one if they don't know. Call the Breastfeeding Network helpline for advice if you need it. Come on here. We are here if you need us. I couldn't have continued BF without the support that I had from you lovely ladies.

[BookSnark]

Good luck with that weigh-in - Rachey !

[Racheyg]

Thanks snark. I've only gone a messed the days up, it's tomorrow. Opps.

I hope you are getting on ok x

[BookSnark]

Good luck for today!

I had an 'unofficial' weigh in which seems to suggest weight is flat

Official weigh in on Friday - but if there's no convincing gain then - then we'll be referred to the hospital.

I'm thinking that we have to start defensive top ups - because intrusive hospital based investigations are likely to destroy what breastfeeding we have.

[trilbydoll]

Will the hospital not start with top ups? If she's alert and nappies are ok, I don't think they'll necessarily go straight for worst case scenario investigations?

I found the midwives were obsessed with weight gain but doctors were interested in the baby overall and what you've described wouldn't necessarily worry them.

Could you ask to go to GP rather than hospital, our GP suggested a urine infection is v common and can stop them eating properly. Hospital never even considered testing for that, just stuffed her full of formula!

[BookSnark]

I'm under the impression that the hospital would want to identify whether it is a feeding problem or a health problem by basically feeding her a measured quantity of formula for a day & seeing if she gains.

Don't know what the next step would be - and how traumatic the experience wouldbe.

[Racheyg]

Hi snark,
Sorry to hear about the weight. Fingers crossed Friday has a better outcome.

My little man has put on and is now 4.44kg. He was 4.49 at birth so nearly there. I still had to speak to hv as he isn't quite at his birth weight but she was unconcerned as he is gaining.

I'm no hcp so can't advise but the 1x bottle of formula seems to have helped, and I am planning on dropping it as soon as he has back up there with his weight.

Explain to the hospital that you want to breastfeed as much as possible and they should help and support u.

Let us know how you get on on Friday xx

[Mrscog]

If you do introduce a few top ups, the advice is that it's better to offer a large number of small top ups over 24 hours than to do one big one if you want to continue breastfeeding. I supported someone who's midwife suggested they gave 4oz in one go as a top up! Where as spread out over a day the baby would still be hungry enough to bf to keep up supply and still get the same amount topped up.

As for slow gain my DS was a slow gainer, it's just how he was, typically 2-3oz per week until 20 weeks, and then he just suddenly gained nearly 1lb per week for a month. Very strange, and completely different to my 2nd DC who has done a steady 1/2 lb per week.

[trilbydoll]

Actually yes, the hospital did blood tests and put in a cannula in case dd needed antibiotics. Which all turned out to be unnecessary - I didn't really care, the fact it made dd cry was a good thing as she slept thro her heel prick test! But not very nice to watch esp if you don't think it is necessary.

Definitely try for gp before hospital if you can.

[BookSnark]

We get weighed today.

She's had a few oz top ups (from Wednesday ) - but not very hopeful that the weigh in will be reassuring - since the mw is going to want a big gain from Monday - and I know we were flat on Wednesday.

Had the chat with DH about the possibility that this appt might trigger an escalation in HCP response .

[BookSnark]

trilby I don't have any issue with bloods/screening.

What I'm really concerned about is that they'll push to admit her and feed her industrial quantities of formula under controlled conditions to rule out metabolic disorders.

She's not my first slow gainer - and she's self-evidently perky and bright - so I really don't think that would turn anything up - but I think it would put her at risk for reacting to the formula (her siblings showed lots of CMPI symptoms) and wrecking the bf entirely (not to mention traumatising all of us through not being home!).

Do you think that would be on the table at this stage?

[trilbydoll]

We went in with a baby that would not wake up, they forced 100ml down her then put us on a 3 hourly schedule of boob, top up, express. The top up amount depended on how long she fed for - our problem was she was only having a few mouthfuls at a time so nowhere near enough.

With a baby that appears otherwise well, and is gaining albeit slowly, forcing huge quantities down her sounds like a massive overreaction! Maybe start offering 50ml top ups and see if she wants them? That's not a huge amount but might be enough to generate the numbers the midwife wants?

[CunfuddledAlways]

Could you explain your worries about cmpi so if formula is given it has no cows milk protein in?? What did you do fir your other slow gainer? How was it resolved? And could you do similar for this baby?

[Racheyg]

Hi snark, thinking of you today. Hope all goes well with the weigh in. I know how stressful and upsetting it is waiting to see results on the scales.