What can a paediatrician make me do and do they understand about breastfeeding?

[AlisonJB]

My lovely 16 wk old DS has been exclusively breast fed since birth. From about six weeks, he started sleeping through the night and demanding less food less frequently. HV told me this was fine and as a first time mum I believed her.

At wk 8 I saw another HV as DS had dropped 1.5 ozs. She encouraged me to feed more often particularly at night. DS gained 4oz the following week, 1oz the week after that and then only 0.5 ozs over the next three weeks. Meantime, I'd noticed that he was feeding much less longer (only about ten mins) and only on one side. We were then referred to GP who felt DS checked out fine and was meeting all his developmental milestones except weight gain, but referred us to the paeds as a precaution.

Two days later one of the older GPs called me to say the appt with the paeds had been brought forward and that in the meantime, I should stop breastfeeding and feed formula instead. I got very upset about this, but decided to ignore him and speak to a BF counsellor instead who advised switch feeding.

In the two weeks that we've been doing this, DS has been feeding more regularly and for much longer (sometimes as much as an hour) and he's gained 10 oz in those two weeks which I thought was great. But we went to see paeds today and registrar advised topping up. I asked why I couldn't offer another breast feed instead - he then conceded that I could top up with EBM. But I'm feeding every three hours as it is, usually for 45 mins to an hour and am worried I won't be able to express that much in the meantime. We have to go back to see the paeds in three weeks. Apart from slow weight gain, DS smiles, giggles and is fiendishly active and alert. He's very tall, just not so fat.

Paed told me DS will be fundamentally weakened for life if we don't get his weight up in the next three weeks and that I should be looking for a weight gain of 7oz per week. I'm now even more worried and stressed about it and have spent most of the evening crying. Would be grateful for any advice - sorry for long post!

[DorisIsAPinkDragon]

Bless you I hate medical prffessionals sometimes..... just for making us feel so insecure....

What centile is he on, is he faling off the bottom or mid range on the charts

[daftbat]

Please please don't cry. You are evidently doing your best so stop the guilt trip right now. You talk about the weight gains but not the starting weight, which may be the issue. My DD (now 2) was 9lb 8oz born (95th %ile ish) and then dropped over a lb in the first week or so. She then started to put weight on, but only a little. Like you, I breastfed exclusively (and the charts in the red books are for bottlefed babies who are expected to be fatter) and DD slept reasonably well.... I'll post this now so you know there is someone out here for you and then I'll type more, ok?

[daftbat]

Ahh, crossed with Doris!

My HVs started to scare me witless and asked that I add a night feed, which I did (isn't it odd waking a baby for a feed in the night!! ) THat was not enough for them and they asked that I feed more often. But when I squeezed in more feeds it was counter productive as, like your DS, she fed for less time and seemed to get collicy. I was getting scared by my HVs and they sent me to Dr hinting at all possible bad scenarios.

My Dr was lovely. He told me I was a good mum and I had a healthy, if slim, baby: she was alert and he saw no reason to worry.

HVs monitored weekly and sent me to a nutritianalist who got me to complete a diary (by this point DD was on solids). All she suggested was I added high fat snacks and extra fat wherever possible. DD was then spoiled on butter, full cream custard etc. She remains scrawny, although has now crept from 8th to almost 20%ile.

Hopefiully you will be lucky like me and just have a slender but healthy child.

Having said that, I really think some HPs should be shot for the fear they strike through us.

Hope all goes well. Let us know how you get on....

[AlisonJB]

He's on 0.4th at the moment having started on the 50th (birth weight 9lbs 8oz). He gained steadily for first 5/6 weeks then plateaued around 8 weeks, dropping first to the 25th and then to the 9th. Because this all happened just before Xmas I think they left us to our own devices a bit without trying to fix the problem. I had felt so much better after seeing the BF counsellor (which a friend advised me to do), but now I just feel knocked back again. Thanks for support

[tiggerlovestobounce]

They cant force you to FF. The only thing they could do would be to refer you to social services, if they felt you were putting your DS at risk.

How much faith do you have in the registrar? If you dont feel confident then it might help if you asked to see the consultant instead.

When is your DS next due to be weighed?

[Academicmum]

Our 8 month old DS2 has also had slow weight gain (from 16 weeks onwards) and was also exclusively BF (though now he has solids as well). When we eventually got to see a paed at 28 weeks I was surprised that she deemed him a healthy boy who would just always be very slight. However this has not made the worry, stress and feeling that I have let him down any less (he really is tiny and dropped through the centiles to the very bottom of the chart where he remains). As someone who has now had months of stress and worry about this, I wouldn't wish that on anyone and if more than one doctor thinks his weight gain is a problem, I would urge you not to ignore it. That said however, I don't think that offering formula feeds is necessarily the magic solution that all the medics seem to assume. First of all, when you altered your feeding technique he had a good weight gain which is great. Secondly, if you are feeding on demand and feeding until he indicates he is full and he doesn't seem hungry or discontented between feeds there is no guarantee that he will even accept a bottle (if he's full he's full - it doesn't matter the manner in which the milk is offered..).

[daftbat]

The other thing to bear in mind is that they used to recommend real food at 16 wks (I know they don't now) but I wonder how many other babies would be losing weight if mums hadn't switched to solids.

If you are knackered and not eating properly, you need to work on that, too, just to keep your supply tip top.

Why are you so set against FF? I BF all day and gave F at the 6pm to give me a break until 11pm. Later I switched that to F too.

I breastfed the 'problem' DD for 18m, but did bring in FF too

[Academicmum]

I should also add that our DS2 is on the 0.4th centile (from the 9th at birth). The paed just said that she would not treat a dot on a chart when the baby seemed so happy and active (and someone has to be down there). Remember that whilst the charts are a useful tool for the HCPs they are just that - a tool - and should only be used in combination with them taking a real good look at the baby (and ruling out any major problems which may be causing a lack of weight gain).

[Brangelina]

Paeds know nothing about bf, in fact I sometimes wonder if they're undercover reps for formula comanies, what with the often highly un-medical tripe they spout.

DD was born on the 50th but very slow to gain weight. I did top up for a while but that made not the slightest bit of difference so I stopped. Ditto when I weaned on solids - ate loads and I added olive oil to all her food. Still a skinny minnie.

3 years on she's still tiny but very bright, vivacious and more importantly hardly ever gets sick, unlike some of her chunkier contemporaries who had one cold after another in their first 2 years.

So I'd say she wasn't damaged.

Ignore ignore ignore.

[Iamapaedsregtoo]

Just wanted to add a bit to this thread if I may; have name changed for obvious reasons.

Did the paed check for medical reasons why your ds is not gaining weight? Did they check a stool sample and send to the lab to look for elastase?

FWIW I saw a mum in clinic a while ago, dd very well buthad fallen across centiles from just below 75th at birth to 9th at 16 weeks. Well baby who had been weighed every week at the HV. I checked the baby out and sent off a stool sample. My advice was to get baby weighed monthly and come back in two months ish. Baby is now 27 weeks and has just started weaning, still well and still on the 9th centile.

IMHO if there is no clear medical reson why your lo is not gaining weight adequately then you should continue to bf. I know that the most experienced bf amongst my consultant colleagues would agree with that too.

All of this is said with the proviso that in some conditions/illnesses bf may not provide adequate calories and supplementation may be needed but this does not appear to have been identified by the paed that you saw.

In addition to the above, weight loss, unless brief and associated with an intercurrent illness or due to possible inaccuracy in scales, is concerning.

Not sure if any of that helps but I just wanted to add my POV.

Back to my real self now.

[AlisonJB]

Yes I think it's the 'give him formula' mantra that gets me. Paed didn't seem to register that we'd been doing things differently for the last two weeks and that seemed to be having a result. I don't have an objection to formula per se, I would just rather it was properly established whether there was a problem with the breastfeeding or not.

Would be interested to know what you all think about the EBM top ups - since I've been on the new regime, I'm not sure I will be able to make up enough milk as I'm getting less tan two hours between feeds. I just wish my original HV whom I now regard to be about as much use as a chocolate teapot had advised me to see a BF counsellor weeks ago, then we might not be in the position I am now. Looking back and based on DS's feeding patterns then, he probably wasn't getting what he should have been.

[Iamapaedsregtoo]

Oh, did NOT and would not advise to ff.

But then I'm a mumsnetter and have learnt much, much more re bf from this site than I learnt for any professional exam.

[OverSimplistica]

I think thats excellent advice in that last post you know

My ds4 had a weight pattern much like your child, I did ignore the order from gp to ff (ds4 would be on dairy free formula, they refused a prescription so would have been soya- no thanks).

I perseverd. After 3 'give ups' I wanted m last to be a wahey iykwim.

Well he is.

I weaned early on PAediatric advice- and we're talking 5 months here with a private Dietician to boot (for toehr reasons) not earlier

He now gains often around a kilo a week and at nine months is climbing abck up the centile. His brothers had the same pattern too, and although 2 have unrelated SN (asd) they are the healthiest kids I know; dh used (until I started feeding him ) to be known as Mr Muscle he was so slim; MIL weights 6 stone...

you get the picture.

Anyway ds4 is now taking tentaive first stteps. still BF several times daily, eats well and is a very happy 9 month old.

[Academicmum]

Don't quite see the point of EBM top-ups apart from to measure what goes into baby. This can also be done by getting a set of accurate baby scales and weighing baby before and immediately after a feed (with nappy etc to allow for weeing). 10g of weight gained roughly equates to 10ml milk in and you can get an idea how much baby takes per feed.

[OverSimplistica]

Not feeding DH bm by the way.

Just cakes and er, cakes really. OOps

[edam]

Ignore IF your baby is healthy - and you mention he's alert so sounds highly likely! Are you getting lots of wet nappies and plenty of dirty ones too?

I'd go back to the bfc and explain what the paed has said. Sounds very strange, though - if he's alert and happy in what way exactly is he being 'weakened for life'? Weight gain of 7oz a week sounds very ambitious, too. Ds was a greedy guts who got 'excellent weight gain' comments from the HV every week but IIRC there was only one week where he gained 6oz, it was usually 3 or 4.

Your 10oz weight gain in two weeks sounds excellent to me! The poster who said paeds don't necessarily know an awful lot about b/f is right. Health professionals like bottle feeding because it's easy to measure so easy for them to see what is happening. For too many of them, the answer to any possible problem is 'reach for the bottle'. You'd think none of them ever read their own flipping journals!

Someone has got to be on the 0.4th centile just like someone has got to be on the 100th.

[Brangelina]

Nooo, don't do the before and after weighing, it'll drive you loopy! I know because I was forced to do it for a while and there were feeds when DD weighed 30g. less afterwards. It's a total waste of time and will only induce anxiety.

[StripeyKnickersSpottySocks]

Ditto everything Edam and Brangelina have said.

[DorisIsAPinkDragon]

Ok I sometimes hate all HCP except IAMAPEADSREGTOO she speaks much sense.

DD2 has a chronic problems (cystic fibrosis - one of the issues being difficultly to gain weight)) and depite the HCP regular "just asking" if I was STILLLLLL bf we fed til 13 months, they would have much prefered me to change to formula to make their lives easier

[francagoestohollywood]

I really think the job of a paed is to investigate if there are underlying medical reasons for no/poor weight gain.

Having said that, I agree with brangelina. You also say that he is tall, so that matters too!

[usnkidz]

my dd2 was exclusively bf and lost weihgt and gained weight slowy and droppped several centiles, HV not to concerned although sent to gp who not to concerned as thriving. She fed until full fequently. Had good advice from bf support group.

[littlelamb]

I'm so glad I've come across this thread. My ds has been consistenty above the 91st centile but dropped to the next one before Christmas. I was told that if he dropped another centile we would be referred and guess what's happened this week? He is no on the 50th, having dropped 5oz this week (his first ever actual weight loss) He is havig lots of bf as well as solids so I don't really understand it. He is 7.5 months old. His initial centile drop corresponded exactly with when he started crawling so there is no mystery there. I am just worried now that the HVs seem to be making it out to be a big problem, and suggesting that I switch him up with formula. Obviously actually dropping weight is not good but I don't see what a referral will achieve. They have said it's initially for an appointment with the GP who may then refer us on (to who??? I don't know) Can I actually refuse the referral? Obviously if his weight continues to drop I will happily go, but I don't like the suggestion that it is because he is bf.

[Academicmum]

As an aside, at a recent baby clinic I saw my HV congratulate one mum on her nice, big healthy baby who was on the 99.6 centile. We live in a culture where big babies are perceived as healthy and small babies are not, yet what makes a baby on the 99.6 centile any more (or less) healthy than one on the 0.4th?

[mears]

I am a midwife and would agree that many paeds know absolutely nothing about breastfeeding. (some say the same about midwives )

10oz weight gain over 2 weeks is excellent. Personally I would not give EBM top ups but perhaps offer 2 hourly feeds just to boost supply a bit - baby might not want it but on the other hand might.

It was important to me as a mother not to give formula. It is not the solution to weight gain - if a baby is not getting adequate milk then the technique and/or frequency of feeds needs looked at. Best person for that is breast feeding counsellor.

Your baby is perhaps demonstrating 'catch down growth' ie born too big and now finding correct growth line.

[daftbat]

Hi, I only registered today because a link brought on how much an 11m old baby should eat me to the site and I saw a thread I could relate to. But where can I find out what all the abbreviations mean??? I can work out some, but others are a mystery - IMHO?

BTW I don't think weight loss or low weight gain should be ignored but I don't think making mothers worried and sleepless is going to help the situation at all; quite the opposite..