Baby slow to gain weight, not enough hindmilk - confused about what to do!

[noodleysoup]

My LO is 4 weeks old now and after initially losing a lot of weight, 14%, he is now only gaining slowly and is still a long way off his birth weight. He is a sleepy baby so feeds take a long time as he keeps dozing off and i have been told he is probably not getting enough hindmilk due to this.

I am using breast compression which i think is helping but i have had so much differing advice from midwives, BF councillors and HVs I don't feel like I know what I am doing! One MW told me to do 3 feeds from one breast before switching, but another told me this could damage my supply, another told me to do switch nursing changing sides every 10 mins but then i was told my LO wouldnt get the hindmilk doing that, and another told me to do one breast per feed - so what am I meant to do??

Also, the last HV told me my LO's weight was okay at 8lb 8 as he is bang in the middle of the growth charts, but isnt it more important to look at his current weight compared to his birth weight of 9lb 7? in which case he is surely still very underweight?

He is doing lots of wet nappies and poo, most of which are yellow although there is the odd green one.

Any advice would be great, I am getting so panicky and obsessive about how long he's feeding for, sleeping for and how many dirty nappies he is producing I am turning into a complete mess!

It's so hard when you get all this conflicting advice so I'm reluctant to add my twopenneth but... I'm thinking that if he doesn't seem hungry and dissatisfied all the time, is producing enough nappies and his weight isn't causing concern for the HCPs, he is doing fine and gaining weight at the right rate for him.

Breastfeeding is such a leap of faith, it's hard to believe it works especially first time around.

I would just be v careful who you listen to (so feel free to ignore me!). There are so many badly/ under trained HCPs out there, that I would try just to speak to specialist BF counsellors who are more likely to have the most up to date information. I have always found Kellymom to be a brilliant resource- there's info here on increasing weight gain. If you want to see someone in person (maybe just to check latch again and encourage efficient feeding) get back on to the BF counsellor attached to your maternity unit or try the LLL helpline on 0845 120 2918.

14 % is a lot of birthweight to lose, it's no wonder he has struggled to regain it.

The good signs are:

he's producing plenty of pooey and wet nappies
he is gaining weight, albeit slowly.

It could be that nothing is wrong at all, and he is just a small baby despite being a good birthweight. Were you or the baby's father small babies?

I don't know about the switch /compression bfing - that really is for an expert - I hope you get the advice you need.

p.s. with the switching sides/ not switching until you've done 3 feeds from one side...really not sure about that. Again, do check this with an expert but I always fed from one side until DS had drained it (usually signalled by coming off a bit and losing interest) and then would offer the full side. He'd either have a go at that or not really bother. So he'd be getting a good drink of foremilk followed by the hindmilk. And the next feed would commence with the one he'd last fed from (if I could remember which that was!).
Hope this doesn't add further confusion, that was just my experience of it.

I don't want to confuse you bit will tell you about my DD1. She was born 7lb 10oz she never dropped but stayed the same weight for the first 3 weeks resulting in her dropping from the 50th centile to the 9th by 4 weeks now she is 2 and is still sitting firmly on the 9th centile for weight and height. I was told she was just rounding down to her ideal weight as she was overdue. Sleeping is different for every baby and you need to just follow his lead on this. As for feeding I feed off one side then when she unlatches I burp her and offer the other side.hen I offer the second side first at the next feed.

I had little faith in my MW when it came to feeding so found a local BF group and spoke to other mums and peers supporters.

The feeding for 3 feeds on 1 side and then the next 3 on the other is usually used in cases where there is an oversupply as it can reduce supply.

For me wet and dirty nappies, babies general colour, tone, respiatory rate and general hydration are much more important than weight.

I agree that you probably need to pick one breastfeeding support group (NCT, LLL, ABM) and speak to a councellor, then if you are happy with the advice they give stick with them.

Just one point, switch feeding will not mean your baby will not get enough "hindmilk", the milk changes throughout the feed and has a higher fat content towards the end of the feed, so when you switch back to the initial breat your DD with just continue with the milk that has a slightly higher fat content.

My DD was born on the 75th centile and dropped to the 5th, major panic from all helth care providers, she is now a dinky dot at the age of 5 and was obviouly always meant to be that size. She was physically well, passing urine and normal stools, however I had the fear of god put into me by my HV etc, to the point where I have not had my other children weighed to avoid this.

Feeding three feeds from one breast is called 'block feeding' (easy to google) and women use it to reduce the amount of milk they have when they have too much.

keep going. feed him often. try and go with him - look carefully at how he is feeding. babies will often suck suck suck to encourage the let down reflex, then they start gulping as the milk is let down and then they slow down a little as the feed progresses. breast compression is a good idea. once you have used the breast compression a few times - you can do it all round your breast - and he starts to fall asleep maybe, you can try a few things to wake him up - stroking, breath deeply etc and then switch sides. then he can get all the milk from the other boob. do the same again. if he falls asleep after this boob, you can just hold him r put him down for a little sleep. when he wakes up, put him on again and repeat the whole process , even if this is half an hour later. your boobs will soon get the message to produce more milk.

the fact that he is producing lots of wet and pooey nappies suggests he is eating and digesting plenty of milk and simply needs time to catch up the weight. he won't put on 3lb in a day anyway, so it will take a bit of time. your body and your little one need to work together to produce more milk, so focus on getting him to 'empty' your boobs as often as possible. (they are never actually empty and if he is doing little fluttery sucks at the 'end' of a boob is fine too.)

as for whether he needs the other side - that is up to him - if he gulps for 20 minutes from one boob then that might be enough for him - if he just nibbles at one boob for 20 minutes it might not - this is why a good latch is important so he can get the milk from the boob.

excellent website too

well done, keep going, feed often from both boobs, and enjoy your baby.

do keep an eye on the weight at this stage but try not to panic and obsess .

oh and don't watch the clock, watch your baby .

during growth spurts when my DS was trying to make more milk, i would go back and forth between breasts - he would drink from one, and when he stopped drinking even with breast compressions, i would swap him over, then again and again, and again. an 'empty breast' will manufacture milk sharpish so while he was emptying one, the other one was working hard to produce more, so when he went back on the first breast there would be another let down, and so on. within a few days i had lots more milk.

(this advice is from jack newman's book - his website is pretty good too.)

Just to add, the hormones that help produce the hindmilk are produced while you sleep. If you can, try to get a little sleep between feeds if possible. It explains why you have gallons of the stuff at 2am.

I didn't do this, and produced loads of sugary foremilk so perhaps it was a cause of dd's colic. It was only much later that I read a really useful article in M+B that explained this. It was something that we were not told at the ante natal classes.

Firstly congratulations and well done!

I think going to a bf cafe or support group is the way to go. My baby lost weight and did not regain birth weight until around 6-7 weeks! For me the help of a support group was invaluable. I had to sit down and just feed, feed, feed.

My baby seemed ok too - but now I look back at early photos and am shocked at how skinny he got!

Thanks everyone, hearing other mum's experiences does help! One of the big things that was confusing me was being advised to block feed and switch feed which seem to be used to produce completely different results!

I think my supply is okay as I do get full leaky breasts, which I'm taking to be a good sign and I have had our latch checked several times and am always told its good.

I have also tried expressing for top-up feeds (another suggestion I was given) but I couldn't manage it even though I had one of the hospital grade double pumps, I think I was jsut to tense/stressed for it to work.

On a postive note, one of the more consistent things I have been told is that my LO looks well as he is alert, has good colour etc, its just his weight gain that is causing concern. I think my main worry is that if he is growing (he does seem to be getting longer!) but not really gaining weight then will his growth/development be stunted as he will just be using up his reserves IYSWIM.

Its so difficult not to worry about the weight checks, before the midwives signed us over to the HV's they were weighing either everyday or every other day so his weight was constantly going up and down. One midwife even got all worked up when he lost 1 gram!

belgo I was a big baby (i'm from a tall family) I was 10lb and my DH was about 8lb and it looks like my LO will be tall too as he is a very long baby with big feet .

My LO was also 2 weeks overdue, not sure if that influences anything.

tb I haven't heard that about sleep + hindmilk before, will definately try and fit in some naps!

It is so difficult not to worry about the weight checks.

What helped me was pretty much doing nothing but bf for a while - so stop all chores, cooking, washing. Let someone else do that and just batten down the hatches and snuggle up to your gorgeous baby and feed and feed and feed. And don't forget to ensure you have food.

1 gram could be lost in a poo! It can't be fun having to deal with worked up MW's.

I do not think you should be getting the baby weighed every day - I would say no more than once a week, unless they have some specific concerns. Especially if you are having to get ready, go out of the house and all that malarchy in order to get the baby weighed.

I was advised that the milk in the very early morning was the fattiest.

Expressing is hard work too and I think your baby is more efficient at feeding than a pump. Although I understand that they may suggest that to increase your supply, in my experience I found I was too tired to express to increase my supply.