Poor weight gain & low milk supply

[RachMB]

My ds is 8 weeks old and isn't putting on enough weight. He was born on the 75th centile and has now dropped to the 9th. I am breast feeding him on demand which is 2-3 hourly in the day with cluster feeding in the late afternoon/early evening. I feed him at around 10-11 at night then when he wakes again which is anytime between 2-4. I try to express if I get time but he doesn't sleep very well in the day unless I take him out in the sling or pram and when I do express I get hardly anything, 5-10 ml normally. He's otherwise well with lots of wet/dirty nappies and is very alert/smily etc. I've been told that my supply is low and to top him up with formula (or EBM but seeing as I get so little it's going to be formula) after every feed but I'm worried that this will reduce my supply even more. He also vomits much more after having formula and it seems to hurt his tummy - tonight he was really distressed at bedtime, drawing up his legs and only settled after I'd cycled his legs for a while. I'm wondering whether I should ask for Domperidone to increase supply. Going to BF clinic tomorrow to check the latch etc but just wondered if anyone had any advice. Sorry for the long and rambly post!

Is he gaining weight each week? If he is gaining weight and he has lots of wet and dirty nappies it seems normal.

Just because he started on the 75th centile doesn't mean he necessarily has to stay there.

If he is gaining weight and you feel happy that he is thriving then don't top up if you don't think it is the right thing to do.

Can you get another opinion on whether he needs ff top-ups? From a BFing counsellor? It is difficult to give advice on MN because no one here has seen your baby.

FWIW my DD started on 25th centile and dropped off the bottom of the charts. I was told to top up but didn;t because she was gaining weight every week even if it was just a little. And she seemed happy to me so I just kept feeding her whenever she demanded. If you start supplementing with ff it can have a devastating effect on your milk supply so proceed with caution!

If he's happy/ alert and producing nappies I'd stick with bf rather than going on the slipery slope of formula/ bottles/ expressing. I ending up just on formula after trying it as my supply dried up. My rule with the weight charts is 'would I know there's a problem if he wasn't weighed?' if the answers 'no' then I don't worry too much. My ds hasn't gained in 4/5 weeks at all! He's ok though and it will pass I'm sure now we're starting to find solutions, give it time I say. IF he starts getting sleepy/ distressed/ not producing nappies or dropping way off the chart re-evaluate the situation. Hope the latch is the solution.

I know I bang on about it-but for wind there's an Eastern European tea we make that really does make a difference. Boil half teaspoon of carraway seeds on the hob until you have a tea, cool and feed to baby (tiny amounts are fine). It really soothes their bellies.

"He's otherwise well with lots of wet/dirty nappies and is very alert/smily etc. "

So when you don't look at the growth chart, you feel he is well and happy right? That's good then.

Alot of babies start on a high centile then find their own line to follow.

Who has told you your supply is low? How much you express is not an indication of your supply.

Are you offering both breasts at a feed (and even back to the first side again)?

Could you squeeze another feed in somewhere?

Rach - it's horrible to be anxious like this

I hope the bf clinic helps.

I think there is an issue to be checked here - the slow weight gain definitely needs assessing.

The best way to tackle weight gain is the easiest - feed more

2-3 hourly may not be enough - he needs at least both breasts every time, and you will be helped to feed more often by keeping him close and feeding every time he stirs.

See what they say at the clinic, and do report back

What makes you think you have a low supply? Does he seem hungry when he has finished a feed? If he seems satisfied and is going a reasonable time between feeds (which it sounds like he is to my non-expert ear) then surely your supply is fine?

I really think you should get a second opinion. Formula doesn't agree with all babies and while I am sure there are some who need extra food maybe you are making enough milk and your baby is fine. The wet nappies/happy/alert baby stuff makes me think maybe everything is ok. FWIW, my DD1 slid down the centiles too, from 50th to below 9th, and I've never had my DD2 weighed but from standing her on the crappy scales at home it looks like she might have run a similar course (from 75th to 9th). They're both perfect, if rather energetic, so I think maybe some kids are just made that way!

Ah there you go, sensible advice from someone who knows more than me!

I hope they are helpful at the clinic tomorrow.

Rach - I had the same problem, for me a bf clinic was my saviour. Someone can have a look at how you feed your baby.

In the end I had to feed and feed and feed my baby. Every 2 hours during the day.

I should add that in the end my baby ended up on the 81st percentile, after being born on the 75th and dropping to the 9th.

I found it really worrying, I would not use formula just yet as that will not help your supply.

I just buckled down and fed fed fed and did pretty much nothing else and it picked up eventually.

I was also told to express after a full breastfeed to increase my supply, but to be honest I was so tired I never did.

Good luck tomorrow.

Thankyou so much everyone for your replies, will let you know how I get on tomorrow...

The clinic was very good - I was given help with attachment and told to try the 'laid back' approach where the baby sort of sits in a more upright position facing you and finds their own way on to the nipple. And also reassured just to feed whenever he asks to be fed, both sides for 20 minutes.

I'm also going to try and express as often as possible so I've always got EBM to top up with. But mainly it was good to see someone to give you support and see that there are other people out there having difficulties too! My ds is going to get weighed again on wednesday to see if it's working...

Thankyou again for the advice!

glad you're feeling more positive now Rach and that you've got some support.

Rach, that sounds positive. Did the BFing counsellors think he needs to be topped up with FF?

You shouldn't need to express, just keep feeding him when he demands it. But if you are going to express you will get more if you do it in the mornings before you feed him. If you wait till after a feed the expressing machine might not get anything out because it is not as good as your baby at getting the milk. Express 1oz from the breast before you feed for the first two feeds of the day and that should be enough to top him up later if you think he needs it.

FWIW I expressed quite a lot when I was BFing my twins - I'm not sure whether it helped but it was hard work and I wonder if it was worth it really. Your baby and your body will work together to make sure you have enough milk - just keep feeding him the way you are doing and don't worry if he doesn't keep to the line on the growth chart.

Obviously if the HVs are still concerned about his weight gain then ask if you can see a paediatricion to have him assessed. But if they are only worried because he is not following 'the line' then I would not use FF because as you say that will reduce your supply further.