AIBU to not be THAT worried about 4 month old son?

[Lentilleaves]

So around 4 weeks ago I went to my nearly EBF 4 month old sons health check. He is doing absolutely great, already rolling over, laughing, smiling, mimicking, cooing - so basically meeting/exceeding milestones. Only thing that came as a bit of a shock was that he had dropped from the 50th to 5th percentile. I noticed around 2 weeks previous that the wasn’t taking as long at the breast but just put it down to him having learnt to feed more effectively / quicker. At that time we were feeding between 8-10 times per 24 hours. He has around 4-6 wet nappies a day.. although there never really bursting at the seams.. but he is otherwise generally content, active, engaging and happy! Does get fussy when he’s tired but I think all of this is just totally normal.

anyways I went to get him weighed two week after the health check and he only gained 110g in two weeks. I figured there must be something going on with my milk supply and it was suggested to me to get my thyroid checked. Turns out it is under-active (was previously over-active) and was very likely effecting my milk supply. Started taking thyroxine and adopted quite a stringent feeding schedule - feeding every 1.5-2 hours from 7am-8pm and then pumping while he sleeps (3/4 times a day for too ups) all seemed to be going well and milk supply back to normal (+ extra for top ups).. in the last week he’s gained 160g! I was overjoyed as doc told me he needs to gain 20g per day. But doc still not happy and says the weight gain isn’t normal?! I feel super deflated at this point. I’m doing all I can and my baby is gaining weight, albeit not as much as he previously was… should I really be that worried? I’ve BF 3 babies now for over a year at a time and both my other children also fell a percentile in the 3rd month, albeit from higher percentiles, but no one really batted an eyelid back then?!

at this point I am trying to accept that baby is just smaller than my last two, and that’s okay! But I’m worried I am being somehow neglectful. My midwife told me today that just because baby sleeps through the night, it doesn’t mean he’s not suffering .. and that babies ‘get used’ to being hungry and suffering in the end ???

Am being given conflicting advice from different professionals regarding formula top ups and I’m just feeling quite confused about it all. My gut is telling me to relax but it’s hard when the professionals I ask advice from give contradictory answers !! I really would prefer not to start ff as it will be a doenward spiral with my milk supply and I’m only a few weeks off weaning so seems silly to start now .. any advice or experience would be truly appreciated. 💕

That should say EBF nearly 4 month old

We had a similar experience and the end result was a combined anterior and posterior tongue tie. Diagnosed at 4 months and missed by several HCPs. It took a specialist nurse to diagnose in the end and it was divided there and then. We were warned to manage our expectations in terms of impact but it was like flicking a switch. Weight gain improved and I could tell the milk transfer has improved significantly (more forceful feeding). He'd been working so hard to get milk beforehand he'd been tiring himself out and so not getting enough.

We had lots of advice, instructions, and investigations before we reached this stage so just wanted to suggest it may be worth definitively ruling TT out in the absence of other explanations. In our case it wasn't immediately obvious but had caused huge amounts of stress for us all.

Can you speak with an infant feeding specialist and/or La Leche League if you haven't already? We found the latter to be more knowledgeable than many NHS staff for whom breastfeeding, especially when not quite going to plan, just wasn't part of their expertise.

I'd find somebody who is really knowledgeable about breastfeeding, unfortunately the training of NHS staff about breastfeeding varies so hugely and some of them have none at all.

When you say he has dropped from the 50th, are you starting from birth centile or the first measurement after 2 weeks old? Birth centile should be disregarded because this is not relevant to longer term patterns and can cause alarm. The fact that your other children had a similar pattern with a drop could be a sign that you grow them bigger and then they "catch down" to where they are meant to be, this is not uncommon.

Babies do not grow in a steady pattern like 20g per day, where these rules are given it's more of a rough metric to judge whether weight gain is happening over longer periods of time. You can't really judge a baby's weight gain over the course of a week. We tend to have this idea that as we are feeding them it's like we're laying down tiny building blocks with every feed and so the amount consumed has a direct effect on their growth, but it doesn't really work like that in reality, it's more that they take in fuel in the form of milk, that's converted to energy and then some of the energy some of the time is used for growing, but growing is not something which is happening at a constant steady rate, children grow in spurts. It only looks like a smooth line if you measure them infrequently.

That said, I'm not sure why the doctor is complaining at a weight gain of 160g in a week which would seem to fit into their (flawed) theory perfectly!

It is possible to introduce formula in a way that doesn't compromise milk supply, but I would definitely seek advice from somebody with more training and experience in breastfeeding, to find out first of all whether you actually need to, since adding formula as a first resort isn't usually very helpful, often there are many alternatives such as feeding more frequently, giving top ups with expressed milk, techniques to increase supply, addressing medical cause of lowered don't - some of these you've already done - and from 4 months you also have the option to supplement with food instead or even use formula like a weaning type food, eg baby rice or porridge made with formula.

I think your instincts are telling you to stay calm for a reason. I would seek out somebody more specialised if you can.

One option would be to try early weaning.

We did this as DS was lactose sensitive so we had this truly horrible tasting lactose free milk. He’d basically drink a tiny amount to slake his immediate thirst and then refuse any more. He was not putting on weight and he’s small anyway. Two doctors advised we start weaning from 4.5 months, to supplement his diet with other sources of calories. It took a little while for him to take to it but once we established a little bit of solids several times a day as part of his routine he started putting on weight really well.

Just one idea - and I think the advice is to check with your doctor if you consider early weaning. But worked for us.

We started with puréed fruit and vegetables and weetabix with formula / breast milk by the way.

Hi OP, it’s not the daily weight gain that will be concerning them I don’t think. A drop from the 50th to 5th centile is quite substantial and it’s not unusual for that to be something that flags attention. When you say sleeping through the night how long do you mean? I wouldn’t personally be happy with my 4mo EBF baby sleeping more than a few hours at once, the words ‘suffering’ were extreme but it is possible for a baby to sleep despite hunger. With a drop in centile as huge as that I would be waking my baby 3hrly or topping up before bed. You don’t need to give formula, you’re expressing so there’s no reason not to feed that in a bottle. Also please don’t consider early weaning without medical supervision, it’s not necessary and really harmful to a developing gut

@senior30 agree it needs medical supervision, disagree on harmful to developing gut. I have not harmed my child. Just needs to be done carefully and with a doctor’s say so.

My 1st DD was born on 53rd centile and dropped to 5th centile during first 6months. I think they are worried because it happened much faster with your DS. I think now the thyroid issue is fixed and given your DS is meeting milestones and is gaining weight steadily, he will gradually catch up 110g gain in 2 weeks and then a 160g gain in 1 week…you are on the right path…he’s gaining weight faster and faster. Don’t panic.

My DD grew up fine & healthy, she just turned out to be tiny like her mum so for is it was mostly genetics causing the drop in centiles.

Also please don’t consider early weaning without medical supervision, it’s not necessary and really harmful to a developing gut.

How harmful @senior30?
I'm interested because early weaning is now recommended for babies at high risk of food allergies (eg babies with an allergy already or those with eczema, especially bad eczema).

Contact a lactation consultant, la leche League and breastfeeding network.

I wouldn't wean personally. I would review what foods support your thyroid.

Thyroid medication can be weaned and replaced by plant based/natural alternatives. Discuss this option with your GP.

@senior30 over here in Australia we were all happily weaning at 4 months at least 10 years ago and I don’t think we have a generation of babies with damaged guts!

I’m not saying you should wean by the way, personally I don’t think it makes much difference to weight gain as all they’re having at first is veg anyway for a couple of months. Up to you and whatever is the advice these days.

I think if the doctor and midwife are concerned then I'd be wary of disregarding their advice. What is it that they saying you should do? Are they suggesting formula top ups? And waking her during the night to feed?

I had problems with supply and weight gain. What they advised me to do was feed from both breast and then offer a formula top up. If she took it I knew she was still hungry. And wake her up every 3 hours to feed.

Then I was supposed to express to try to build my supply and use anything I got as part of the next top up. It doesn't have to mean that you will stop breast feeding or lose your supply.

With introducing solids, it's difficult to know as the advice seems to keep changing, but at least when I had DD2 3 years ago, they were saying wait until 6 months and introduce allergens quickly and repeatedly after that, before 1 year.

I thought they’d linked early weaning to higher chance of allergies?

my mum had 4 children, 3 of us weaned at 6 months then there was a big gap to her 4th when the advice changed to 4 months. That child has tummy problems and the 3 older don’t. Could be a coincidence, might not be.

Current medical advice in France is to start weaning at 4months. It used to be 6 and they pushed it back to 4 because apparently it helps prevent allergies. They do have a sort of schedule of what order you should try different foods though, so not quite 4 months = start feeding everything.
Anyway, OP you should ask your dr about early weaning rather than just going for it, but I wouldn’t panic about it being dangerous or detrimental when other countries will excellent medical care are currently advocating 4 months as standard.

So I’m in Germany so all health checks / weight checks have been carried out by an experienced paediatrician. He’s checked for a tongue tie and apparently there are no issues there except he can become lazy after the first let down - so I now use breast compressions to keep him actively feeding. I’ve also seen a board registered lactation consultant who’s happy with latch etc and how we feed now I’ve started doing the breast compressions. Both of these professionals have told me not to introduce formula or anything else.

Midwife has suggested giving formula after BF + expressed milk if he’s still hungry. So for an example, in the evening I will breastfeed for 20 ish mins. Give around 60ml expressed BM and she is supposing I then also offer 60ml formula. I don’t know, it just seems like a bit much. I tend to only give the expressed milk in the evenings when he is more fussy and it does seem to settle him and often he will fall asleep mid bottle.

Lately, he’s been sleeping 8pm-11pm feed then been going through to 5/6am. So not 100% sleeping through, but still a decent few hours , which has helped me tremendously energy wise. But should I be waking him? Say at 2/3am!?

If milk isn’t the issue, should I be pushing for tests? Maybe endocrine tests or the like? I am concerned by the huge drop in centiles. He was 50th at birth and remained there until 2.5 months.. it was only just before the 4 month check we noticed the drop.

thanks all for the advice so far, really appreciate it!

Anyway, OP you should ask your dr about early weaning rather than just going for it, but I wouldn’t panic about it being dangerous or detrimental when other countries will excellent medical care are currently advocating 4 months as standard.

I think this is good advice OP. I just wanted to add that in my experience with 4 DC the 4/6 months “weaning” term midwives use is a bit of a misnomer, as it’s really introduction of solids. They don’t drink any less formula or breastmilk until around 12mos, but they are eating some solids on top. So that initial 8-6mos is adding in solids, rather than weaning away from formula/breastmilk. They start needing less formula/breastmilk around the 12mos timeframe. I heartily agree with don’t panic!

It’s a tough one OP. I think I would let him sleep through the night, babies usually are trending that way anyway. The midwife’s idea of offering a bit more during each feed is a good one, but it doesn’t have to be formula, could be100ml ebf instead if you have the supply. It’s not really a lot imho. They normally need more and more and 4mos is growth spurt, there will be another at 6mos where they are voracious.

He lost the weight rather quickly after doing fine, and the weight loss happened when you had the thyroid issue. I’d perhaps give it a chance for him to catch up now you have the thyroid medication and the extra feeding of top ups. He’s gaining 160g per week. Perhaps if he’s not made enough progress by the 6 mo check up ask about tests?

Of course, if he starts losing weight/not feeding enough or not seeming healthy/right in himself/loss of energy then take him straight in to the Paediatrician.

I have mixed thoughts about this. We are going through something a little bit similar but DC is gaining 200g a week now so my plan is to push through to 6 months assuming our doctor agrees (because it’s my decision but it’s important to have the backing of a medical professional as I don’t want to do anything to his detriment). It sounds like things are going in the correct direction though so well done/I would be minded to continue feeding:

BUT I am very biased about this as I saw my nephew on the 0% and starving as their mother and my brother happily went about their business ignoring healthcare professionals/not seeking help and doing frankly stupidly shit like trying to settle them without milk/always shoving a dummy in when they needed milk. The mother clearly had PND and they wouldn’t accept help or advice so I’m always scared of ignoring others/Being that person

I have also fed 2 other children successfully and I share your frustration/worry/stress. You are not alone!

You won’t know if your child has been harmed by early weaning until they’re an adult.

The problems caused by early weaning are things like IBS and Crohn’s, so you won’t know for a very long time yet the impact early weaning has had.

Upon reflection, you say he nurses around 20mins and then gets a bit lazy. The longer you can keep him nursing at the same breast the better. Part of the problem might be him missing out on the hind milk. When we breastfeed the fore milk is high water, vitamin and immunity content, but later on the milk goes to hind milk which has a high protein and fat content. Alternate breasts in terms of 1 for each feed. If he’s not getting enough hind milk, he’s losing a lot of fat/protein. So a formula top up isn’t a bad idea as that usually has a decent amount of fat/protein in it. But you have a lactation consultant, I’d ask them about ways you can keep him nursing on the same breast for longer so he can get to the richer hind milk.

Yes, previously they recommended introducing allergens late if baby was thought to be at risk.

This advice was found to be wrong.

For things like peanut allergy it is much better to introduce these foods early. I think the current advice is wean from 4 months for these at risk babies (with eg diluted peanut butter being given early) but from 6 months for babies not at risk. I didn't know it was different in France, that's interesting. 4 months always seems to be the very earliest time recommended though.

I don't think I'd rush to endocrine tests just yet OP, as it seems the weight loss may have been linked to your thyroid issues and you have sorted this out.

Agree re the fore and hind milk too. That's a good point from @Discovereads.

If you weaned early on medical advice then of course you haven’t harmed your child, sorry I should’ve chosen my words more carefully. They’ve weighed up the needs for your baby to wean against possible issues later in life and early weaning is vital for some babies, I just hear a lot of people causally suggesting when a baby is slow to feed etc with no consideration of the possible issues this causes in later life

the problem is how many adults who develop IBS, crohns, allergies, diabetes etc would relate it to having been weaned early? I certainly wouldn’t have thought to ask my mother if she weaned me at 4 months and made the link. Whether you’re doing it happily or not the fact is that no baby should be weaned early unless a medical professional says so. We were doing many things 10 years ago but I live by the rule of when you know better, do better.