breastfed baby, 17 weeks, not growing fast enough (sorry a bit long)

[redtabby]

I am very upset today and wondered if anyone had advice for me. My baby is 17 weeks and is exclusively breast fed. He was born early and was IUGR, was only 1.9kg (4lb 6 oz) at birth, and in the hospital they gave him some formula (Aptamil First) as top up alongside the breast feeding, because he was so small and did not suck very well at first. I was really really keen to breast feed and I stopped the formula at about three weeks and have breast fed exclusively since then.

He was growing OK, not spectacularly but steadily along the 2nd centile, and I was feeling very pleased with myself. I love breast feeding and felt wonderful to be providing all his food. I did not have a very good supply however, and have been using Domperidone and fenugreek to boost it. He is "demand fed" and eats whenever and for as long as he wnats.

Today is my first day back at work, so rather a stressful milestone. Baby's daddy is at home looking after him, with bottles of expressed milk. He took him to the baby clinic for his weighing today and there he was told that baby is not growing fast enough and they are concerned, and must bring him back again next week. (DH said the lady was not at all friendly and seemed rather accusing. Every time I have had him weighed befrore they have said things were going fine and well done).

I am now sitting at work, having done some pumping at my desk, feeling really upset that my milk is apparantly not enough for the baby. DH suggested starting him on some baby rice to get him to gain weight, but I am aware that this is very frowned on until he is six months. I am therefore now thinking of returning to mixed feeding, topping him up with formula after each time I feed him. I feel sad at the idea of having to dp this, I was so keen to get him to 6 months just on breast milk, but if he is not growing obviously that may not be possible.

Sorry this is so long, I am feeling rather at a loose end.

What do people think?

[Mummy369]

Poor you

You need to go with your baby and red book to see a Breastfeeding Advisor. Discuss your baby's feeding routine and growth, and make a plan regarding the next couple of weeks feeds. You may need to consider increasing the number or frequency of feeds within a 24 hr period. Having said that, many babies who are not early or IUGR also sit on the 2nd centile quite happily - my own DD for example

My GP gave me the worst advice possible - to put her on solids as she hadn't gained much in 4 weeks. Also, at 16-17 weeks babies need to boost the milk supply to meet their growing needs and need to feed more frequently to do this (for a couple of weeks).

I had a wonderful BF advisor at my local surestart who looked at the whole 24 hrs and my baby wasn't waking often enough for feeds - and sleeping through the night so also missing that all-important night feed, too.

[LuluMamaaaaarrrrr]

baby rice not the way to go at this stage, certainly not without guidance of a paediatrician

weight gain does platuea in breast fed babies, i think the next step is to perhaps speak to someone via NCT or LLL about this, and get more milk into your little one, that is the most filling, nutririous and calorific thing you can give.

17 weeks, esp if baby was born early is really a bit soon for anything other tahn mikl

did you phase out the top ups or just stop?

that might be a reason weight gain has slowed, that you have stopped hte top ups, but your baby is not losing weight though? but gaining a little slower

[redtabby]

Thanks for the replies.

I phased out the top ups, but that was about 14 weeks ago, so can't be the cause of the problem now! I realise I should not start him on solids so soon, I think my DH is just trying desperately to be helpful in thinking of ways to beef up the weight, as he knows how upset I am by the poor weight gain...

No he is not losing weight, but he was on the 2nd centile and is falling off the line, onto the 1st centile.

The idea of a BF advisor is good, I did see one early on as I had latch on problems (which were sorted out), I think I may well contact her again.

Anyone tried mixed feeding in this situation, though, to try and get more milk into the baby?

[tiktok]

sorry you feel upset about this, redtabby.

One weight reading is not a diagnosis of anything, particularly in a baby who appears well and happy.

However, if there is any real cause for concern, baby rice would be the opposite of what to do - early solids replace milk instead of adding to it, and the increase in calories could actually be a net loss. Instead, more breastfeeding is the way to go - whatever way that's done eg more 'sides' per feed; more freq. feeding in the day, evening or night.

Hope this helps

[redtabby]

Thanks, I am trying to just feed him as much as possible now, giving both sides at each feed and feeding for longer (waking him up more when he falls asleep on the breast rather than just lying him down, assuming he has had enough). He did also get a top up formula bottle last night, I must admit, and I think I will give him a top up in the evenings (which is when my milk seems rather low) for the next little while. I am just really keen for this not to be the beginning of the end of breastfeeding, even if it means mixed feeding has to be the way to go.

I am a bit calmer today but still feel really bad that my attempt to exclusively breast fed him seems so far to have not been giving him the nutrition he needs, and I may have been starving him in my bid to be the "perfect earth mother" I wanted to be.

[Morloth]

I don't know anything about centiles, but DS was totally breastfed and was a skinny thing. My GP pretty much said as long as he was well and growing (even a little bit) then all was well.

How does he look? Is he alert? Lots of wet nappies? sleeping OK? etc

[tiktok]

Whoah there, redtabby! You talk about you 'starving' your perfectly healthy, happy, lovely baby on the basis of what? A single clinic visit with someone not-very-nice, when all your other visits have been totally fine?

What you are planning to do now (not the top up - unnecessary as far as I can tell) will address any intake and weight issues...if they really exist.

No need to be cross with yourself

[MoChan]

My daughter was born at 8lb, somewhere around the 75th centile, maybe? Within about four weeks she had dropped to about the 50th and the descent continued. She gained so slowly I was at my wits' end. She ended up down in the single figures somewhere by the time she was three months old. She was rather long and very thin, and everyone told me I had to feed her formula or give her food, which I ignored, on the advice of a BF counsellor. When she was about five months old she suddenly started to gain weight very quickly (still exclusively on breast milk), became positively corpulent (leapt back up to the 75th centile, and then on into the nineties), before slimming down to become a very sturdy, healthy looking toddler.

My story doesn't quite compare to yours, obviously. This experience, however, convinced me that worrying about centiles is pointless. I think as long as your baby is gaining weight, not losing it, and is happy and healthy, they don't matter that much.

I would just try to encourage him to feed as much as possible, and make sure he has a go at both sides. Like PPs have said, I would also suggest talking to a breastfeeding advisor.

Hope things are going okay.

[redtabby]

Well, maybe starving is putting it a bit strongly, but I have plotted him not only on the charts that come in the red book but also on the WHO chart for breastfed babies, and he is clearly falling off the bottom curve over the last few weeks. As he was very small (just below the 2nd centile) anyway, to begin with, this is obviously very worrying, he does not have much weight to spare!

On the other hand, he does look happy and lively, his skin is plumped out and looks normal not all wrinkly, his motor and cognitive development is normal for a three and a half month baby, despite his being premature, and he smiles and laughs all the time, so he does not look ill or unhappy. He also wets many nappies a day and has two or three poos.

I think my DH was mortified and upset and being told in front of everyone that our baby was too small! This is a much wanted baby, conceived after many years of trying and multiple miscarriages and procedures/medications, so he is loved and cherished as much as any baby could possibly be. The idea that we are not feeding him enough, or otherwise doing something wrong, is very upsetting to us (especially me, a Type A perfectionist doctor who has read every baby book and website on earth in preparation for this little bundle!). I think DH felt everyone was looking at him like we are some kind of cruel or neglectful parents who can't be bothered to feed their children properly! The fact that I went back to work fulltime yesterday (financial necessity) and was feeling very guilty about that anyway, didn't help my state of mind about it all!

As I say, I have calmed down a bit, and am just going to concentrate on getting as much milk as possible into him when I am with him. My DH and the nanny will be trying to get more bottles (ebm) into him too. I had been saying to them, just feed him as much as he will eat, when he asks for it, but now the policy will be to feed him at least every three hours and to get more into him, keeping closer track of exactly how much he is getting.

I hope all this will help, he will go for weighing again next Monday and I pray things will be better! Thanks so much for all the suppport.

[tiktok]

Great to sense you are a bit less upset, redtabby.

Totally understand your dh's reaction.

Pretty poor show of a baby clinic to leave someone feeling like this...

[Mummy369]

Just catching up with how things are going for you

I totally agree with TikTok when she says "not the top up - unnecessary as far as I can tell" because topping up in the evening when you believe your supply is low is actually going to be counter-productive to your milk supply. The more you feed = the more milk you will produce. If you give a bottle of formula in place of extra breastfeeds, you won't be giving your body the message to stimulate further milk to be produced.

I am just really keen for this not to be the beginning of the end of breastfeeding you say

I understand your concern - I felt the same way with my daughter. I was determined to do the best I could for her and was very upset when my GP told me to start baby rice - empty calories as far as I was concerned. Breastfeeding regularly and ensuring your DS has good length feeds - including the night feeds - will definitely have the desired effect. He is using up more of his energy and resources at this age - you mentioned that his cognitive and motor abilities are well developed despite his prematurity - so he is on-target to be learning to sit up; roll over; learn to crawl; reach for toys; hold his head and turn to follow your movements ...etc.

As he hasn't initiated the frequency feeding that many other BF babies do at this stage, you simply need to do that for him. This will ensure that he not only maintains a steady weight gain, but you may even find that you are able to give him an extra boost, too. I would also suggest, if you are able to, that when you are at home with him on your days off you could increase the frequency of feeds further. I found setting an alarm overnight (for a couple of weeks) for the 2am feed really helped - and by then my DD's own body clock regulated itself and she started waking herself for the night feed - that was much more gentle an awakening than the shrill of the alarm!

[redtabby]

Thanks for the interest and advice Mummy369. I have been managing the last two days with no top-up, just breastfeeding more frequently (and keeeping waking him up when he falls asleep when eating, rather than letting him doze too much on the job). Also pumping more often when not with him, overall I do seem to be making more milk now, and I have keeping my fingers crossed for the next weigh in on Monday.

I will take your advice and try feeding him ore at night too, I have already changed from only one side at a time for the night feeds, to making sure he takes both sides each time, even though it does mean less sleep! I can sleep later, right now the priority is getting the milk into the little chap!

[Mummy369]

Hell redtabby, just wondering how things are going for you. How was the weigh-in yesterday?

[Mummy369]

So Sorry - that's supposed to say Hello redtabby!

[iamapixie]

I'm a bit scared to tell you not to be concerned because obviously if there is a problem you need to deal with it BUT I was always being given what I called the "concerned head tilt" along with "perhaps you should top her up"...etc and with the benefit of hindsight, it was rubbish and dd was fine. She was born on 9th centile, went down to 2nd and then to 0.4th (where she still is as far as I know) and a big deal was made of it which I found hugely stressful. It was only when she got to over 6 months and the hv's, midwives, docs etc had shattered my confidence that they suddenly did a u-turn and started telling me that everything was fine...
The most sensible thing anyone (an hv) ever said to me through all the madness was "do YOU think she is ok - if you think she's ok, then she is". I had always known she was fine - just naturally petite (like me)...
Anyway, I know that's not an answer but however you decide to react, try to follow your instincts and trust yourself.
(+ do be a little wary of centiles - does your local authority still use the old chart? If so, ask to see a "thrive line" - you may well find that your little one is doing just fine)