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Failure to thrive (another one) advice needed please.

(43 Posts)
suwoo Sun 09-Aug-09 15:52:37

DS is 10 days old, weighed 8.9 at birth and was readmitted to hospital 6 days later at 7.4 shock which is a loss of 15%.

I protested about not giving formula and was allowed to carry on bf overnight (2 hrly) and see what happened. He gained 2 oz and we were allowed home. He hasn't been weighed again since but is due to be weighed tomorrow on the same scales.

He is doing 5 or 6 poos and plenty of wees per day.

At the maternity hospital I was advised to offer one breast per feed. I have since been informed by the lactation consultant that this is wrong and I need to switch feed.

My question is this: he is feeding for about 20-30 minutes on each breast, this is not active feeding I realise but a lot of suckling. Even when I latch him off after an hour he is still rooting. He's not still hungry is he? Is he just comfort sucking? I don't want to be counter productive and tire him out by allowing him this long on each breast.

Should I switch him between breasts after 10 minutes or so and end up with him having 3 or 4 breasts IYKWIM?

I also think I may have a slightly shallow latch, can this be a problem?

This is my third DC but the first one I have bf and it is really important to me to carry on.

FluffyBunnyGoneBad Sun 09-Aug-09 15:56:40

I'm not an expert at this but could you try expressing into a bottle to see how much he's taking? The lactation consultant is correct about switching sides, giving him a little wind in between will help with air he may have swallowed and will wake him up.

An expert may be along soon. smile

suwoo Sun 09-Aug-09 16:00:20

I pumped in the hospital and got 70ml which they said was good.

FluffyBunnyGoneBad Sun 09-Aug-09 16:06:51

If he's finding it hard to latch on then he won't be taking 70ml IYSWIM. If he's still rooting then he's probably still hungry. Is he managing to attach himself to the end of your nipple or all around? Placing him on a pillow to change his position can help. Have you tried this?

suwoo Sun 09-Aug-09 16:10:19

I have had 4 midwives, 2 lactation consultants, 1 peer supporter and 1 friend grin look at my latch and have all declared it perfect. I'm not 100% convinced.

FluffyBunnyGoneBad Sun 09-Aug-09 16:14:51

grin

I found it easier to prop ds up on a pillow. He was level with the nipple that way, this helped.
They do normally loose a little weight after birth aswell. I think 30 mins on each breast is too long. How long are the gaps in between feeds? Is he falling asleep whilst feeding?

Babieseverywhere Sun 09-Aug-09 16:19:08

In a healthy baby who is not losing weight, there is no problem in continuing to nurse as long as he/she likes and from as many sides as they want.

However in a baby who is having problems retaining/gaining weight too much comfort nursing may tire them out.

You really need proper information on your situation, either Tiktok on Mumsnet or have another talk with the lactation consultant in real life.

Good luck

NB. Expressing is not a clear indictation of how much milk you have or how much the baby will get.

suwoo Sun 09-Aug-09 16:19:08

3 hours in between as advised. Yes he is dozy whilst feeding. I have him on two cushions and a hand underneath to reach my pert 32G breasts

<<preen>> [grin}

AcademicMum Sun 09-Aug-09 16:19:08

It could be just that he is still at an age when he is feeding really frequently. When ds2 was this age, I felt I would never be able to leave the sofa again, he was feeding so often. However, when I actually considered it more, then although he had times when it felt he was latched on for ages, small break and then latched on again, it was easy to forget that he had had e.g. 3 hours where he was asleep and hadn't fed at all. Could this also be the case with yours?

suwoo Sun 09-Aug-09 16:21:38

I was very loathe to express as I know it is not indicative of supply, luckily it got them off my back. Can meet up with LC anytime. Will do next week I think.

TheProvincialLady Sun 09-Aug-09 16:22:16

3 or 4 or more breasts is absolutely fine Suwoo - as many as it takes to fill him upsmile However if you don't have a good latch and your baby lost all that weight, it is possible that he is not feeding efficiently and TBH I would be looking for expert support (BF counsellors, etc) and I would be wary of the hospital advice simply because they have already sold you a duffer - one breast at a time is rubbish advice.

It if good that he put on weight overnight - are you still feeding him frequently through the night? Does he ask to be fed frequently or is he a bit sleepy?

Comfort suckling is fine and normal, good for your milk supply in fact, but he may also be feeding for the whole period with little rests. Do you hear him swallowing? The fact that he is pooing and weeing well is a good sign.

Expressing will not tell you how much your DS is getting, only how much the machine (not your baby) was able to get out on that one occasion.

FluffyBunnyGoneBad Sun 09-Aug-09 16:23:55

See, I knew there were experts on here. smile

JollyPirate Sun 09-Aug-09 16:26:48

Suwoo - I would be really happy to hear that a breastfed baby is doing 5-6 poos a day, equally I also hear the advice to give one breast at a time but have heard via a lactaton consultant that the current advice is to offer both breasts - start with one and then switch if baby is still rooting after the breast is emptied.

pseudoname Sun 09-Aug-09 17:53:38

SuWoo, when he is suckling, he should start off with quick 'fluttery' sucks which may continue for a minute maybe 2. When a letdown occurs, the rhythm of the suckling changes from 'suck, suck, suck' to 'suck pause suck' at the pause you should see a swallow in the throat, and a pause in the jaw. Sometimes their ears wiggle a bit and the temple has a movement too.

Once the milk flow starts to slow down, you can try breast compressions which will get the active drinking happening again.

Once you don't get anymore active feeding with breast compressions or the baby seems to be dozing, you can now switch breasts.

Don't think timing think of what the baby is doing at the breast.

videos of feeding.

tiktok Sun 09-Aug-09 17:57:12

suwoo - you;ve had a difficult start and no wonder you are feeling a bit wobbly about the whole thing

A baby who has lost 15 per cent off birthweight at 6 days has not been feeding effectively, and the midwives caring for you should have spotted this much earlier - and whoever told you to offer one breast per feed is in urgent need of retraining

In the early days, it makes sense to offer the baby both sides - he may not take it every time, but he should at least have the chance to say 'no thank you'

Switch nursing can be helpful if there is a supply problem, but it's not clear this is the case with you. You can't tell when to swap by the breast being 'emptied' - the breast will always have some milk in. Instead, judge from your baby's behaviour - when he has stopped actively feeding, take a pause and then swap.

Don't express to 'see how much he's taking'....this shows you nothing that's helpful at all. The baby may take more than the pump, or less than the pump. So it's not useful information. In any case, we don't know how much an individual baby 'should' take at any one feed.

I think it will help you to have someone sit with you and observe you feed and spend a lot of time supporting you and answering all your questions. Your health service owes you this - they messed up the first 10 days of your bf so they should fix it

Perhaps the breastfeeding supporter you have found best so far could see you again.

Maybe your attachment is good now - it may have been a question of infrequent feeds plus the 'only one side' advice.

3 hourly gaps between feeds are too long for most babies of this age, by the way - it's fine if the baby seems to want this infrequency and is gaining loads of weight, but most babies will feed more often than this, if given the chance. 3 hours is prob the longest gap - is that what they meant, do you think?

pseudoname Sun 09-Aug-09 17:59:08

PS Breast compressions are in the the video helpfully labelled "
4 Day Old After Tongue-tie Release With Compressions" smile

hope all works out. 5-6 poos is excellent. in your position I could see me torturing myself with the thought of the scales tomorrow.

suwoo Sun 09-Aug-09 19:14:20

Thanks for all that. Just some comments and answers to points raised.

It was the maternity hospital where I had my section that advised me to feed from one breast at a time to get to the hind milk hmm. This is a large womens hospital that doesn't have breastfeeding friendly status.

It was more than one midwife that said this, this was the only advice I was given during my 4 day stay. DS didn't feed hardly at all for a good 48 hours, we only established feeding when we were home. He wasn't weighed on discharge, just on day 5.

We were admitted to another hospital to the childrens ward. The nurses there still said to feed from one breast each time. On my feeding sheet I had to write which breast I had fed from and alternate.

The lactation consultant was the first to say to offer both breats and to basically say everything that tiktok and all of you other experts have said.

This afternoon after my mammoth 1 hour feeding that just didn't feel 'right', I have switch fed for the last two feeds. The 1st time we still did an hour, but he had 6 breasts in that time shock. Just now, he has had 3 breasts. He has seemed a bit more alert too.

I have been feeding 3 hours after starting the last feed and possibly 4 hours in the night (ish). Early evening it has been more often so roughly 10 feeds per 24 hours.

I don't think supply is an issue, I have been taking fenugreek and my boobs leak and spray if you just look at them.

Curious to see what tomorrows weigh in will bring. What is a rough guideline as to what he 'should' have gained in 4 days?

suwoo Sun 09-Aug-09 21:09:10

Bump

suwoo Mon 10-Aug-09 08:17:48

Morning bump before the mw comes. What could we expect him to have gained in 4 days?

pseudoname Mon 10-Aug-09 08:51:53

It isn't fair to say what you should expect. I think you should expect an upward trend. As long as your baby is gaining that is a good thing.

good luck.

as a first time breastfeeder who also had a lot of problems in the first few weeks and a lot of bad advice, one thing that would have been helpful for me was to see what early hunger cues were. I eventually found this on the net and maybe you'll find it useful too.

Babieseverywhere Mon 10-Aug-09 08:59:42

Weight gain is hard to predict. According to Kellymom at your son's age you can expect an 4 to 7 ozs gain weekly.

That said growth in a baby is not a smooth curve but rather a set of steps. So your baby might put on less or more than this range.

I think I have read Tiktok suggesting two (well taken) weight readings a week apart as a clear indication to if the baby is putting on weight. But as your baby has already lost 15% I doubt they could/would wait that long, hence the weigh in today.

Hope everything goes well for you today.

suwoo Mon 10-Aug-09 15:55:18

Yay!!!!!!!!!!

He gained 4 oz (in 5 days) so she was really pleased. She said to keep on doing what I was doing.

She was suprised that I had been told to offer both breasts at each feed, said the advice keeps changing hmm.

She is an old school midwife grin but my mum couldn't believe I had been told to offer one breast, she thought it was preposterous.

tiktok Mon 10-Aug-09 16:11:25



about 'the advice keeps changing' - it really, really does not, at least, not advice based on a good understanding of how breastfeeding works. Midwives should not be trained to tell mothers to use one side only - this is a misunderstanding of the 'ensure the baby has what he wants off the first side before switching sides', and if you have any bf support groups or local bf strategy group then it would be good if you could let them know what's being taught locally...and how this landed your baby in a pickle

traceybath Mon 10-Aug-09 16:17:57

Glad to hear you had a good weight gain! I had similar with ds2 and used to find weigh ins immensely stressful - just like weight watchers in reverse.

Tiktok - am interested in the offer both breasts advice. When i had ds1 5 years ago i was obsessed with him getting the hind milk. However with my newest arrival whose just over 2 weeks i've instinctively given her both breasts at most feeds but had worried i was doing something wrong so glad to know its ok. She's gained weight well so guess i just have to trust my body.

AnarchyAunt Mon 10-Aug-09 16:23:49

Really glad to hear this suwoo smile

I remember your threads during pg about how worried you were - sounds like you have got lots of determination, and some good advice on here, and that its starting to work out. Congratulations on your new DS!

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