Newborn has lost more than 10% of birth weight - we have til Monday

[FingonTheValiant]

I've posted a few times about 5 day old DS who is really not feeding well. He was weighed today and he's lost 380g since Sunday. The midwife said she wasn't going to "rush me through a&e to the paediatricians just yet", but said she'll come back on Monday pm to reweigh him, and if he hasn't gained enough he'll be hospitalised, and that the paeds will then insist he has formula top ups :(

I'm desperate to avoid this, but I'm now stressed beyond rational thought.

Also, he's refusing one breast completely (screams, flails, kicks etc) and I'm in agony on the other side. I know that that means he's latching badly, but he is drinking, and with a weight gain ultimatum I don't want to interrupt the feeding he's actually doing.

They've told me to wake him and feed him every two hours. But he spends the first 30-40 mins of that fussing/screaming and not feeding, and by the time I've calmed him and got him on and fed I only have 40 mins before we're meant to start again.

They also said I have to top him up with a cup after each feed, so I've bought an electric pump to help with that. But he wont cup feed properly - he doesn't stick out his tongue, he just gulps at it and hits the cup, and half of it is wasted.

How do I fix this mess? I just want to curl up with my baby and cry forever :(

Here's a story about weigh ins. When DD was 15 days old she was due her second weigh in (they do it less frequently here). The first had shown she'd regained her birth weight and gained 5 oz by 11 days old - sorry, but here's the thing. A different HV came at 15 days and duly weighed her. I noticed that the scales said 2.something kilos instead of 3.something - they implied she'd actually lost weight to below her birth weight. The HV was duly recording it in the book and hadn't even noticed until I pointed it out. She put the scales on a different bit of carpet and there was 14 oz difference! DD had actually gained another 5 oz. A cautionary tale about weigh ins if ever there was one.

FN he was weighed at birth on stork scales, which the visiting mw did admit were often quite inaccurate, so they're no longer treating his recorded birth weight as gospel. Since then he's been weighed on the same set of digital scales, but I dont know when they were last calibrated. I assume that as long as it's the same set though it should still show gain or not?

They haven't done pre and post feed weights, and he hasn't been weighed at the same time of day.

Mama I could try suggesting we got to GOSH, I'm sure my cousin would help, but I'd feel like a bit of a prat turning up there with him after she said nothing seemed wrong with him. I suppose that should be my indicator on what to do about it in general though.

Yikes Gaelic, that's a huge difference! Maybe I should suggest she put them on a firm surface instead of the carpet next time.

Go to GOSH tell your cousin or her colleagues you are only there because you are under pressure, at least you'll be in safe hands (just in case the other strangers do start ramming formula down your throat, figuratively lol).
HCP's don't know everything, a mothers instinct is very strong and has saved many a baby's life and many a doctor has been the one to look a prat ignoring her.

Showing my ignorance here - what's GOSH?

Great Ormond Street Hospital - so I'd tend to consider her to be in the know :o

Might drop her a line and ask her whether that'd be ok if it comes to it.

It sounds a little to me that now you are on their radar that they are fretting even though, from what you've said, your DS is on the right track now, so they aren't allowing you the extra time you probably need to see if things improve. If you hadn't got onto their radar for the 10% weight loss, I'm sure the HV (who you'd have been discharged to by now) would be happy to let you go an extra week. I have recent experience of this myself...

DS (I mentioned him in my first post early in the thread) lost just shy of 10% and took 3 weeks to get back to birthweight and then was always a slow gainer (3-4oz per week rather than 6-8oz for average baby) but was always alert, healthy, meeting milestones etc. We had a rocky start to feeding so it took a bit longer to get going and he then was never brilliant at gaining but met all developmental milestones, and because he lost just under 10% nobody bothered too much at the start and then just let me get on with it when they realised it was just his way. I was threatened with concerns occasionally when he only did 1-2oz gains, but I bf him for a year and he has always been happy, healthy and more than meeting milestones (now 2.6)

DD (4 weeks tomorrow) only lost 6% so nobody was worried, but then only gained 25g between days 5 and 10 but with my experience of DS I was able to allay HCP fears by saying it was probably a family trait :), especially as she was clearly doing well on other things and she was actually feeding well - just not sure why she wasn't gaining more. She was about 2oz shy of birthweight at 17 days (so not even bsack up at 2.5 weeks), but had a great week after that putting on 160g by 3.5 weeks - low end of 'normal' range but better than my DS ever did in a single week!

Was your DS a big baby? I think that can take them longer to get back to birthweight than average because they can lose 10% fast but then have a lot more to put back on. Both of mine were 4kg. A 10% loss of that is 400g, which usually happens by day 5. And then if the average gain is only 160-220 per week then it would take minimum 2 weeks to get back up - so 2 weeks and 5 days (i.e. nearly 3 weeks) before you could expect them to be back at birthweight at best! So the whole 2 weeks thing seems totally arbitrary based on the mythical average baby.

Of course, I'm not the HCP here, but from what you say it seems to me a little like now you're stuck in the system they're going to stress about it whereas people like me get left a bit longer because we didn't hit the radar so early on.

Best of luck! Whatever they do or say, it sounds like you feel things are going in the right direction, and you're learning about your baby as an individual whereas they're just thinking of how he deviates from average. It's not to say they're wrong - it's good taht HCPs do watch for poor weight gain etc. - but it can be frustrating if they start putting deadlines in place based on what your DS 'should' be doing based on an average rather than thinking about your individual circs.

God, that's rambly and ranty I blame the biggest glass of wine I've had since before I was pregnant!

Ds1 didn't have poo/ wet nappies as my milk didn't come in until day 5. Then he went all limp and floppy and we rushed to A&E. They put him on a drip and admitted him to a childrens ward where I was allowed to breastfeed. Formula was never mentioned.

He continued to be on the 10th percentile until 4 months old when we introduced formula. Now he's on the 98th percentile aged 2 and you would never guess that's how he started.

Hospitalisation whilst very traumatic did enable us to rule out anything serious. They should check for tongue tie for the fussing. Maybe he's getting a lot of foremilk and not the fatty hind milk?

Good luck I remember it was a stressfull time

Of course! Duh!

Thanks for that Meg, I was sure that somewhere there must be babies who gain weight more slowly than the standard. DS wasn't huge, he was 3.52kg, but last Friday he was 370g down from that, so even if he was gaining at the top end, he wouldn't have reached his (dubious) birth weight again by two weeks.

I think you're right in saying that we've been flagged early and now they have to act on it all, rather than just letting it go.

I've been looking a bit online, and askdrsears.com talks about baby body shapes and weight gain. DS is long and lean, and very active, and according to them these are both things that mean babies burn calories faster and therefore gain weight more slowly. I dont know whether that holds true even at 2 weeks, but I suppose it could contribute to it.

I also think you're spot on with saying that they're not looking at him as an individual, my cousin said something very similar. And for them to calculate their averages some babies have to be at the bottom end.

I was surprised about the comments about mis-reading scales. We had a similar issue with DS (lost more than 10% at 7 days). Chief midwife was called in to see him, found he was peeing, pooing and clearly NOT dehydrated and went off to check the scales. Conclusion - the delivery room scales needed recalibrating. I had always assumed that this was a fairly isolated incident, but obviously not!

Maybe cross-check her scales with a bag or two of flour next time she comes, just to make sure?

Oh Fingon what a bloody stupid situation!

My DS was 5 weeks old before he regained his birthweight, and hospitalisation was never mentioned to me although I came under considerable pressure (which I ignored) to top-up with formula.
I was on antibiotics though for an infected c-section, which gave DS the runs and everything just shot through him, so I knew why he wasn't gaining weight, and my Mum is a GP and was 100% confident that he was absolutely fine.

I'm not going to tell you to ignore them, tempting though it is, but if you have got gallons of milk then I would be v.resistant to attempts to get you to give formula. EBM yes, although I am at the necessity when your DS is clearly getting a good feed directly from you.

I guess all you can do is carry on as you are, and hope that when you get to hospital you come across someone sensible who sends you home again once they have seen DS and seen how well he is!

FWIW - you sound a LOT more sure of yourself than you did this time last week :)

If the midwife has been weighing your baby on carpet, then all bets are off....seriously. A non-carpeted, hard, flat surface, naked baby, digital scales correctly calibrated - all necessary for accuracy.

Just wanted to say that before they weigh your DS, feed feed feed him! Get as much into him as you can to tip the scales in your favour. (The infant feeding co-ordintor always told me to do this). When DD was referred to paeds for not regaining birth weight, they wanted to keep us on childrens ward overnight to 'observe feeding'. We refused to stay because 1) I could keep a feeding record at home and that's all their 'observation' is anyway, and 2) a childrens ward is not the best place for an unimmunised baby. Good luck x

tiktok and never - now I feel a bit of a fool for not suggesting it to her before, I did wonder if it would mess up the reading. I'll definitely get her to do it on the table on Monday.

Ali - thank you, I'm still worried, but I feel more capable on in general so I suppose that's helping. Also, I'm currently on anti-bs and his dirty nappies have gone up, he has more of them and they're fuller, I did wonder whether that might have affected his weight, but again, didn't bring it up as it's on my notes that I'm taking them and I assumed she'd accounted for it.

I've told the mw that I don't want him to have formula even in hospital, there's just no need, and she agrees, so hopefully they'll just let me express.

asphyxia, that's exactly how I feel about hospital, it's an unhealthy place for a baby to be, and I had him at home to avoid it :(

I tried to feed him before she came today, but unfortunately he did several dirty nappies in the lead up to her coming, which I think counterbalanced it. I'll try again to get him filled up before she comes.

I am sorry I didn't post earlier - I did consider it, but thought it might distract from the good advice you were getting elsewhere.

To be fair, DS and I both struggled with sole breast feeding, and he stayed firmly on the 9th centile until I introduced formula when I went back to work when he was 25 weeks - at which point he shot up to the 95th centile over 3 months and then firmly rejected all further formula. I only completely stopped breast feeding when he was two.

I was in Scunthorpe when DS was born in 1999. There was a lot of emphasis on supporting breast feeding, and the midwives and health visitors were very encouraging, but not terribly knowledgeable. With more expert practical support I suspect both of us would have had a better time of it.

DS is now a hulking, healthy 11 year old.

Good luck with the next weigh-in.

Fingon what ABs are you taking? Amoxycillin in particular can give a runny tummy to the adult taking them, and also a runny tummy to a baby being BF'd by someone taking them - which is precisely what happened to us. Don't stop taking them, because you need to clear your infection, that is of primary importance and you shouldn't do anything to compromise it. But be aware that it may slow your baby's weight gain.
Definitely, definitely mention it to whoever you see - the drs will possibly be more receptive to it than the midwives, but that was just my experience!

Have a good day today :)

Fingon - midwife should know not to weigh on carpet.

Some scales are made so the surface is not so crucial.

But it's always good practice to choose a hard, flat surface to weigh on.

You could ask her to weigh on carpet and then weigh on a non-carpeted surface to check for difference.

Fingon I really really feel for you as we had an almost identical situation with DD who is now 3.

Nothing improved until I focussed soley on the advice I was getting from the BFN - was so upset on the phone to them that someone ended up coming to my house and gave me hands on, practical help. At that point I had MWs, HVs, GPs, hospital staff all giving me differing advice, my head was all over the place.

The BF people calmed me down but crucially also didn't say oh just keep feeding it'll be ok. They improved my latch, showed me how to express etc etc etc, took weight gain concerns seriously. Can't recommend it enough, sadly I don't think you'll come across many people on the NHS who can give you decent BF advice.

Good luck! fwiw DD is a big bruiser now!

Fingon more and fuller nappies sounds like he's getting lots of milk now - I've been following your thread but couldn't add any advice and it sounds like you are doing a great job. Even if you do end up in hospital for a day or two I think you've really stuck at it and your feeding sounds like it's going well now. Well done, you are being a great mum.

OP - sorry have not read whole thread (have grumpy baby fighting sleep)

Just wanted to share my experience of DD with you in the hope it will help.

DD was 7.4lb born, was being BF but being my first, i just assumed that babies cry lots and BF took a while. I never assumed she was starving. Took me til she was 6days to realise she was getting near on no milk, so i expressed. DD took only 1oz before fallng asleep for 4hrs (unheard of) The MW came the next day (DD had had about 5oz of milk in that time) and had gone down to 6.1 lbs. The MW was very supportive and said that i had done the right thing in expressing even that tiny amount. She told me to write down every feed she had (times, amount etc) and also to keep trying her at the breast and they would come back the next day to see if she was going the right way. The next day she had put on nearly 2oz, just from having about 2oz of milk every 2-3hrs. There was never any talk of formula or hospital.

I continued to express, and would spend the afternoons snuggled up on the sofa latching DD on whilst watching Midsommer Murders I found that giving her a couple of ounzes from the bottle and then latching her on would make her more relaxed and more likely to feed without fussing. I managed to express for about 4months in total but had to introduce 1 bottle of formula a day by 6weeks. I wish i had known about BF counsellors then as i am sure they would have been a huge help.

DD is now a very robust nearly 3yr old.

Sorry if i have missed something and this is no longer relevant

I'm taking metronidazole and cefadroxil, Ali.

Oh fuck, oh fuck, oh fuck. I just looked up cefadroxil in my BNF (I've thrown the pack away) and it says it's not safe to take when breastfeeding as it passes into milk. I didn't think to check when they gave it to me as I was on the labour ward and my notes have exclusive bf written all over them, so I assumed they'd check that and would warn me. Oh fuck, oh fuck.

And the metronidazole says it should be used with caution in breastfeeding.

What kind of fuckwit obstetrician prescribes for a new mother without checking the bf guidelines.

What should I do? I've finished the cefadroxil now.

OMG.

Sorry for the excessive swearing.

Sorry, got that wrong. Boot MD says it's not safe, my BNF says use with caution. And that metronidazole passes "significant quantities" into milk. So I guess that might explain his increased pooing, sadly not necessarily because he's feeding well.

I will possibly take back calling the OB a fuckwit, given that the BNF just says caution, so I assume that's what he thought. But I'm annoyed that they didn't mention anything, or tell me that there are ways to avoid high concentrations

Metronidazole is fine to take though - I took it when BFing.

Don't panic, you've not harmed your baby.

It doesn't mean that he isn't feeding well, there needs to be something there for him to poo out after all.

Is your GP involved in any of this? In your position I think I would give them a ring and see if I could talk things through.