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. 💕

I'm in Germany too. German midwives tend to have more breastfeeding training than UK midwives but might not be as experienced as an IBCLC unless she happens to have that qualification too - you should be able to check, and there might be a "Stillgruppe" locally run by a BF expert.

Paediatricians do not generally have much more than very basic BF training and their weight chart interpretation seems all over the shop.

4 months isn't considered "early" weaning in Germany, you might have seen this graphic? It's considered parental choice to start at between 4-6 months but then the timescale for introducing different foods and each meal is much slower than the UK. I think in the UK earlier weaning is discouraged partly because culturally there's this push to wean in order to get babies to sleep, which isn't evidence based, and partly because there's a culture of very fast weaning so once you start it's a kind of race to get them to 3 meals a day ASAP - both of these outdated but culturally prevalent ideas, which aren't as widespread in Germany.

Of course you can also discuss solid foods introduction with your Hebamme or Kinderarzt. Another option is looking for a local Elterncafé, these are often run by organisations with childcare training to advise families (similar to the old UK Sure Start) and can give good advice on this kind of thing as well.

Foremilk and hindmilk is an outdated concept, you shouldn't be trying to affect a baby's feed pattern as feeding for too long on one side is called block feeding, it's a technique to reduce supply in the case of oversupply. Not appropriate for general suggestion. There are no more vitamins in the later part of the milk, the baby will get everything from the start.

Have you been referred to a consultant regarding the drop? I’m in the UK so don’t know how the system works for you. He’s gaining a good amount of weight now which is reassuring, if he had dropped from 50th to 5th and not picked up his weight gain I would absolutely push for testing.

60ml formula after 60ml BM and a 20 minute feed sounds ridiculous, I really doubt he would even take that volume of milk. Your baby doesn’t need formula, you may need to be quite firm with your midwife now and ask that she doesn’t push this any more. If you’re still under a paediatrician and lactation consultant do you need to be seeing a midwife? In the UK you’d have been discharged long before now.

If you’re bottle feeding bm right before bed and he’s taking 60ml then I wouldn’t wake him. It sounds like you’re everything you possibly can and he’s gaining weight, you can’t undo the big drop he’s had so just focus on how he’s doing now.

I have similar medical reasons for low supply and just accepted that I'd need to use some formula. Why do you think formula will stop you BFing?

I eventually settled at 50/50 BF/FF for first year (got up to 3-4 7oz bottles between 5 and 7 months) and BF to 3.5 years.

Don’t have the in depth knowledge of other posters but just wanted to give a perspective from the other end. Our youngest was always 95-98 in height but around 30 in weight. Just wasn’t interested in eating and it used to worry me endlessly.
19 years on, he’s 6ft 4 and 15 stones.

You could up your supply fairly quickly by taking fenugreek, maybe you could try this before formula?

kellymom.com/bf/can-i-breastfeed/herbs/fenugreek/

Are you pumping before feeds OP? Is baby definitely getting the hindmilk at every feed, the thicker milky fat milk that comes in after the lighter milk at the start of feeding?

I think given the level and speed of the fall off, I'd definitely be taking the midwife's suggestion about offering him a bit more at the end of feeds
It's a significant enough fall offf.

Thanks @senior30 😊

As a breastfeeding supporter I would suggest getting some specialist breastfeeding help.

Often we see mums with babies at the 3-4 month mark when there haven't been any outward signs of a tricky latch (so baby is gaining weight and mum is comfortable), but when they get to 12 weeks-ish they don't feed as efficiently as they could do. I think you would definitely benefit from checking he is feeding as well as he can.

What centile is he on now? A drop that crosses more than two lines is a red flag, that's why they are concerned, but has he now fine back up?
I think the "lazy" comment is concerning. Babies aren't lazy about eating, it indicates a problem. Are you sure there's no tongue tie?
I've supported lots of women with feeding, and fed mine through tongue ties, and I think you need to keep looking at why he is struggling to feed effectively, and also see where he is on the chart now.
Re the hind/fire milk comments, it's not really two types of milk, more a steady increase in fat content like when you turn the tap on and run it to get hot.
But switching sides a lot helps stimulate milk production so don't block feed too much because as has been said it will reduce supply.
Ideally, I'd see a lactation consultant as there's definitely still something going on, but sounds like you are doing a great job and really responsive to your baby which is fab.