20 week old, still slow weight gain - any suggestions?

[rehtse]

A bit of a long story - 20 weeks of it...

We ended up in hospital at the end of the first week as DD had lost more than 10% of her birth weight. She was little (born at 5lb 13oz) and not latching well. We were sent home and told to express and try nipple shields, which we did for a number of weeks with tiny increases in weight, which weren't a worry until one week (week 8) when she lost weight and dropped below the centile curve. At that point we were told to stop any kind of breastfeeding and get some formula in to her to increase her weight. The GP who saw her thought that she is a well baby, just needed more calories than I could supply. This was an incredibly stressful time as you could imagine.

She then started gaining and she's been hovering around the 2nd centile combining breast and top up formula. Ironically, as soon as I got rid of the nipple shields and with all the expressing I'd been doing she finally started latching! DD is a bit of a red headed minx...

Things had been going ok with this mix (she doubled her birth weight and is now around 12 lbs) until 3 weeks ago when she started refusing the bottle and only taking the breast. I was quite happy with this as I would have liked to have breastfed exclusively, but I weighed her today and she's not gained any weight this week. The HV wasn't worried about it, saying if she's been under the weather or teething not to worry. She's had a viral rash for nearly two weeks and had her third jab last week - she screamed most of the next day.

My point with all this is that I know she hasn't been herself for weeks, possibly this whole 4 month development thing - her sleep has gone to pieces as well. But it upsets me that my breastmilk isn't enough for her to gain weight, and that we're having to try to get more formula down her and she just screams as soon as she sees the bottle. I'm also surrounded by other mum's who have taken to breastfeeding like ducks to water with what seem to be huge babies (I'm sure they're all around the 50th) but when someone says how small my DD is I want to slap them!

Brilliant suggestions to help with weight gain would be welcome. Have been to a breastfeeding drop-in, who said to listen to the baby, who obviously wants the breast, not the bottle, but it would appear that this isn't giving her enough...

Thanks to anyone that reads this and responds. Sorry for the long post, but I wanted to get this off my chest.

You poor thing rehtse- that's been a stressful time for you hasn't it.

It sounds like you've maybe lost your confidence in your ability to feed? The HV seemed to think that your DD was fine and weighing every week is probably going to be too much.

How frequently are you feeding?
Are you offering both sides?
Has DD been checked for tongue tie?

You mentioned at the beginning of your post that the GP told you to stop bfing ....did you completely stop for a while or start with ff top ups straight away?

I know how horrible it is when everyone comments about small babies. One woman even asked me if my DS was premature - he'd dropped off the charts too. FYI- we did blw from 26 weeks and he's piled on the weight, but will probably be short like his ma and pa!

Babies won't necessarily gain weight every week though - that's why the red book says to have them weighed no more than monthly at most. Could you give it a couple of weeks before she's weighed again?

I don't really have any great suggestions beyond breastfeeding as much as possible, and offering both sides and even going back to the first again if possible. If she seems happy and healthy then maybe hold off on the formula til she's weighed again?

Obviously you're history is making you more worried. But just one week with no gain isn't anything to worry about in it's own right, especially if she's doubled her birth weight already. My DD got to 12lbs at about the same time and she born a 1lb heavier.

Are you still weighing her every week? Maybe is now the time to switch to monthly weighings.

I know I found it hard to relax with her being at the bottom of the centiles but if you're otherwise happy with her, it's good to try and let go a bit.

Thanks for the support.

To answer crickeybadger, this is one of the changes we've made in the past weeks. We were feeding every 3 hours, then switched to 4 hourly. From birth, DD never seems to indicate that she's hungry, so have been trying to set a regular time. We've just started trying to drop at least one of the night feeds, so it's now 5-7 times a day, mainly because it was so difficult to re-settle her in the middle of the night if we were giving her bottles. Now the last feed is around 8pm. I'll breast feed her when she wakes in the night (3-4pm ish) then again in the morning (7.30-8am). It's been nice for all of us to have more settled nights recently.

I am offering both sides (which she is taking). She has been checked for tongue tie.

Yes, when the GP advised to give her formula, I started expressing and giving DD a combination of expressed milk and formula. She seemed happy with this combination and then naturally started latching again and I went to a mix of breast, expressed and formula that was working well until about 3 weeks ago.

Very much looking forward to starting on solids - six weeks and counting! No doubt it will bring a whole new series of problems...

I know it's probably too often to check weekly but because the last week had been such a change (she had barely taken any bottles the past few days) we wanted to see what impact it might have had. But indeed, we should probably relax a bit and leave it a couple of weeks - she could stay at exactly the same weight and still be within her centile.

4 hourly feeds are quite infrequent for a breastfed baby - mine is a little younger than yours but has only just started going 3 hours, though it's still often more like 2. He has more like 7-8 feeds a day. Could you add a few more feeds in during the day?

Agree with you MUA about trying to squeeze a few more feeds in.

Yes, I'd wait a few weeks and then see if the more frequent feeds have had an impact.

Good luck

I agree with other posters - go back to 2.5/3 hourly feeding in the day even if she is not demanding it.

TRy and fit in at least 6 day feeds between 7.30am and 8pm (ie every 2.5 hours). And offer "3rd" side after 2nd and then 4th etc. I also found I could get DS2 to take more by having some feeds in a quiet dark place...

What about using a supplementer like this? If you want to give your dd additional calories, it might be something to try?

I fed DD every 2 hrs night and day, basically whenever she woke, just to make sure she was getting enough.

I started trying to cut a feed but then weight slowed even more, so I relaxed into the frequent feeds. If anyone (ie MIL) said anything I just said we were concerned about weight and were under orders from HV . We also did the switch feeding. Even at 9 months we do 4 sides.

rehtse - I agree with much of what has been said, though I think a supplementer is fiddly and not necessary at this stage, because the obvious, easy route has still to be tried ie feed more often.

Four hourly is rarely enough to build up and maintain a good milk supply - some babies are laid back and don't ask for as much bf as they could do with, which is why you need to keep your baby close and respond to slight feeding cues as well as offering a lot.

Hope this helps.

Thanks everyone for your contributions.
I'm feeling a bit more positive this morning as I think we've had a good start to the day.
DD fed twice in the night at 1.30am and 4.30am and was ready to start the day at 7am. I then fed her again at 9am just before she conked out for her (v short unless on me) morning nap.
I'm going to make sure I feed her every 2-3 hours and won't weigh her for a fortnight (we're seeing the hv then).
Thanks again it's been a real help.

Great rehtse. All sounds good and the night feeds are great for milk supply too.

Let us know how you get on won't you.

Just a quick update as I'm still a bit anxious.

I've been feeding DD six times during the day (approx 3 hour intervals) for the past two or three days but she gets very sleepy during the feeds. Second night she woke twice to feed as she had done the night before. But last night she woke at 1am, 2.30 and 5, and I am feeding again at 8. I am worried that waking three times in the night means that she has not had enough during the day.

Today I am going to try to feed one side, then nappy change to keep her awake, and then swap round to the other side.

(Nappies seem to be wet and dirty so some food is definitely getting in there.)

What do people think?

rehtse - babies wake in the night for many reasons.

But lets say she is waking to get more milk - that's a good thing :)

You are concerned about her intake, which may or may not be justified.

But lets say it is justified - waking up in order to have more milk will address that, yes? It is wakeful for you, too, but can you think of ways to make this easier for you? Co-sleeping?

You can try feeding her more often in the day, if you want to, if this would work.

The night waking you describe is not all that unusual - some people would count the 1 am feed as 'last one of the day' and the 5 am feed as 'first one of the next day' - which only leaves the 2.30 feed which would mean 'waking once in the night' :) :)

Thanks tiktok your advice is very reassuring.

We are mainly co-sleeping at the moment, we have been for a few weeks as DD was unsettled in the night when having bottles. Waking up, not taking much milk and taking ages to resettle.

Now I'm breastfeeding she's not waking up fully and I'm not spending an hour trying to get her back to sleep. We're all getting more sleep and feeling better for it.

I was worried that she was waking after only an hour and a half....but as you say there could be many reasons and the more she feeds the better my supply.

The urge to reweigh next week is fading....

An update and a thank you for all your advice.

I've been feeding DD around every 2 hours.
We've just got back from a weigh in with the HV and DD has gained enough to stay on her curve (a little above the 2nd). It's been the first time since she lost weight as a newborn that she's been EBF. We'd been mixed feeding for months, so I was anxious about her gaining weight from just the breast.

(Happy) big little girl and relieved mother...

Joys of weaning to come in due course!