Question for tiktok; can you expand upon this please? Also piffle!

[MerryLittleCarrotmas]

tiktok

you wrote the following in SGK's thread:

When a baby who is being responsively breastfed, with no restrictions on timing or frequency, and being given 'extra' ebm, does not gain weight as expected, there are four possibilities:

1. the baby is growing physiologically, ie the growth is normal for that baby

1. there is something organically 'amiss' in the baby such as underlying infection, a heart defect, a rare and non-obvious metabolic disorder

1. the breastmilk supply is maxed out, because of a difficult start (there is some evidence that capacity is calibrated in the first weeks, and for some women and babies, that might mean supply is capped at a level lower than the baby needs)

1. the baby is not transferring milk as effectively as he should be because of less than optimal positioning and attachment

Reason 2 would almost certainly show up with other symptoms by now, including weight loss.

As you know, babycarrot long since dropped off the bottom of the charts. I sincerely hope that the reason for her poor gain is number 1, but...

...can you provide a bit more info on what symptoms I might observe if there was a heart problem, or other disorder? I realise I sound like a complete hypochondriac (on dd's behalf IYKWIM), but I find it hard to hold my nerve when she seems to be a more extreme case than anyone else as far as I can tell at the mo.

Anyway, it's my job to make sure I don't miss anything, no matter how repetitive or paranoid I sound!

I am of course somewhat reassured that several GPs and paeds have listened to her heart with stethoscopes, so presumably they would have picked up any concern. I hope!

Just that, well, things aren't improving. She's averaging 2 ounces a week, and is only 9lb 4 oz at 20 weeks old. At this rate, she just diverges further and further away from the bottom centile line, and will never catch up back onto the charts.

piffle mentioned her dd was similarly skinny, but that she has a heart problem

Could I be missing some underlying problem? God, I hope not, but I'll never be able to live with myself if I'm complacent and miss something.

No stone unturned.

[tiktok]

Carrot, I am really sorry, but I can't expand....it's getting into medical territory which I am not qualified to do. You have done the right things, and so have your doctors, by having her checked out, and maybe you could share your concerns and ask them to check again, asking what they are checking for precisely and whether everything would show up with these checks.

My understanding is that underlying disorders would show up with other symptoms by now but you absolutely can't rely on me for that, as I could be wrong. Speaking to you mother to mother, and not as a breastfeeding counsellor, a further full discussion with the paeds is perfectly justified....they will know that unexplained very slow growth can, in rare instances, mean more than just a calorie deficit, and they should not think you are being paranoid.

Stay in touch.

[MerryLittleCarrotmas]

Thanks for responding tiktok; I understand.

I don't know what to do. Taking her back to the paeds just opens up another opportunity for them to suggest formula, which I don't want for her, and is always hugely stressful. And she doesn't seem ill at all, just skinny.

Not taking her makes me worry that I am being selfish and not putting her best interests at heart. Maybe she would be better off without my insisting on bf excl. Clearly something is not "normal" with my bf for her to gain so slowly. All the other slow gainers who are kindly lending their support and encouragement to me still seem to have their own little successes of 5oz here and there. I'd give anything for those sorts of gains.

I feel like a failure. I feel like I'm failing my dd. I've exclusively breastfed her, but at what cost to her? And I'm scared that my inadequacy is preventing her normal growth. And yet I'm stubbornly continuing, which may not be best for her.

I desperately hope that when she hits 6 months I can start to get some high cal foods into her, which will be better for her than my milk. I know that wouldn't be the case for a normal breastfeeding situation, but in our case, surely it must redress the calorie deficit.

Sorry. I'm a bit low today. Doesn't help that my dh works away, so I'm on my own Monday to Friday every week. It makes it so hard to express to increase my supply, or top her up, especially as most days she will never let me put her down for longer than a few minutes. I'm still not dressed today!

Let me just thank you for the amount of time you've taken to help support me (and also many many others on mn). This website has been the most incredible source of support to me. I really don't know where I'd be without your help. Thank you so much.

[Rosyrednosily]

I think it is such a deep routed urge for us to feed our babies. We want them to be a bit fat. But your baby is still gaining. You probably just need some reassurance. I've bf 4 babies and 3 of them have been big and chubby but ds2 has always been dinky. He is 3 now and he eats LOADS but he is still little and skinny.

[tiktok]

Carrot, the fact the paeds have nothing to suggest but formula is, paradoxically, a good thing for you, as it shows the only thing they think is 'wrong' is a lack of calories. And as your baby has as many calories as she wants, because she is excl bf in response to her needs, you can conclude she is growing the way she is growing because that's the way she just is

One other option is option 4 on my list, but IIRC, you have already been there!

You are not 'inadequate' and nor is your milk. She is gaining on it, and remains healthy and happy, and close to you.

When it comes to weaning, yes, you can start off with calorie dense foods, and see if she takes them. They will not be 'better' for her than your milk, though, because food is more than calories

[MrsGrinch]

MLC - my dd has a significant heart defect and I hesitate to post but I've read a couple of your posts and from what I remember your dd seems happy and smiley - I think that's a good indication that she is probably fine.

dd was off the top of the charts when born and off the bottom by 14 weeks - having gained a measily 1lb. Other than the weight loss and in the 6 weeks before she got her diagnosis there was true weight loss, her symptoms were breathlessness, profuse sweating initially whilst feeding but later pretty much all the time, very pale and also vomiting (similar to reflux). She was not a happy smiley baby - she often looked 'panicked', she didn't wake for feeds, she had lots of infections.

IF you are worried than of course speak again with your paed and if you are specifically worried about dd's heart then ask him to do an ecg and a SATs test - both are cheap and none invasive and will put your mind at rest.

I never, well rarely, post on feeding threads because my experience with dd was extreme and I would never want to worry anyone uneccesarily.

[Beachcomber]

Do not have any medical qualifications and you may have looked at this area already, but have you considered an allergy?

My breastfed DD1 was very slow to gain and diagnosed failure to thrive at 4 months. She turned out to be allergic to dairy (and some other foods). Once I stopped eating the foods that bothered her things improved. My DD had other symptoms that lead us to this conclusion (and we did a test) but I have a friend whose DS was dairy intolerant, failed to gain but didn't have any clear symptoms.

Allergens can irritate the gut lining and cause malabsorption, this is what was happening to my DD.

I hope things work out well for you and your little one, good luck.

[MerryXMoss]

Carrot, what are you doing Friday? The morning I have bf support at Whiston which you could always attend, although I know it's a bit of a drive, or in the afternoon I have nothing so we could meet up if you like, in Liverpool if you want, as you sound like you are a bit down about everything.

I know babycarrot is more of a pixie than ds - he's more of an elf! - and I understand that you're scared because she's so little and you look at her and compare her to other babies the same age and you worry in case there is something wrong.

Cold comfort I know but she is at least gaining and not losing weight, so she is not going to waste away in the time it takes you to find a paed who is willing to give you a second opinion.

I am off out now, but I will send my number to you via facebook if you want to meet up.

[MerryXMoss]

(Not saying that you need a second opinion, iyswim, just that it can't hurt if that's what you want)

[Piffle]

hey hey
I know lots of babies who gained like my dd who had nothing amiss
And it was proved that is was not my dd's heart defect causing the weight gain after all BUT her genetic condition.

DD did have other symptoms - which under a paediatrician were obvious...

DD was always happy, alert, she only ever fed for 5 mins every 3 hrs - if we tried to up her feeds she puked (mild reflux)

DD's mumur was picked up by the GP at 6 wk check very obvious.

If your dd is alert, developing normally in every other way, sleeping, content and looks a good colour then you're 99% not to worry

Ask for referral to a dietitian to get calorie supplements, or just for advice
Breastmilk is the best honest And it is enough
DD now aged 5 has eaten high calorie foods and eats like a horse now and it has made NO diff to her weight gain at all.
Some people have to be petite.

[Piffle]

I meant not that you should ask for the supps btw
Just that they are available to mix with EBM to increase cals to reassure you/and doctors that it's not the brastfeeding that's the issue.

My eminent paed said I wish people would look at the babies and not the weights, mothers know best
He is a star indeed

[suzi2]

I agree that another chat with your paed or GP to try and reassure you would be good. But can I ask if you had never seen the numbers on the scales, would you be worried about her? If not, then it's likely that everything's just fine. My friends DS was gaining in a very similar way but was obviously getting longer. He moved onto formula and the weight stayed the same. then at about 5 months he started gaining loads and is a really chubby 10 month old now!

[MerryLittleCarrotmas]

Thanks everyone, I logged off for a while and continued feeling nauseatingly sorry for myself for some time. I'm currently giving myself a good talking to...

So, some answers:

• DD is pale, it's true, however she is mixed race, so her complexion was never going to be like her redhead mum! She very rarely has colour in her cheeks, but this may well be just her genes.
• She often falls asleep when she feeds, but this could be because she refuses to sleep anywhere other than glued to me, so sometimes she's just knackered and this is one of her favourite ways to fall asleep.
• Some feeds last 5 minutes and she's asleep, some last 45 minutes and she's still going.
• She is a little sweaty. Her hair is very often damp when she sleeps, and she seems to need less clothing than me to keep warm.
• Hardly ever pukes - the tiniest little possett perhaps once a week!
• No infections (that I know of)
• Doesn't need waking to feed (because she won't sleep on her own) Wakes to feed in the night (co-sleeps with me)
• Doesn't seem breathless
• She is happy and smiley, unless I'm not picking her up / feeding / burping her fast enough, then she's a banshee!
• She seems quite strong, she can bear her own weight and has been able to for a couple of months, and can hold her head up quite well.

MrsGrinch - I'm actually really glad you posted, so thank you. I already knew paleness and sweating could be symptoms along with the poor weight gain so that was behind my concern. I'm actually reassured by what you've shared, because she is lacking other symptoms.

Mossy - I acually will be in St.H this weekend for my Dad's b'day, but not sure whether I can get over for Friday am, although I'd love to. I'll send you a text. thanks!

I need to think about what to do next. I think I'll sleep on it.

thanks everyone.

[Rosyrednosily]

The mixed race thing may be significant. My children are also mixed race and that is not taken into consideration because it is a bit of a minefield I suppose and difficult to generalise. But my ds2 is finely built just like his Dad. The others are bigger boned after me.

[MerryLittleCarrotmas]

So

I go to baby cafe today and speak to the infant feeding co-ordinator (the very supportive one that helped when we saw the paed last time).

We agree that next week she'll take another look at our latch in case there could be any improvement made - prob not but worth ruling out.

And then we may (my choice) set up another paed appt, poss after Christmas, with a paed who she promises is very bf friendly and will NOT recommend formula, but would take a look at the other remote concerns such as heart and metabolism.

And she thinks that BLW is a fab idea, (knew all about it) wishes she'd done it with her kids, and is very supportive of my intention to do this with babycarrot in January.

So Yay!

Feel much, much better. I'm still gonna fret over the measly weight gains, and if she starts to gain less than usual I'll speed up the paed appt. Thanks to all of you for listening to me worry out loud, and for your wonderful words of support. You ladies rock, you really do.

[tiktok]

Sounds like a great plan, carrot

[5goldrings4MONKEYBIRDs]