12wo EBF - Less than 2lb weight gain

[chocolateOrCake]

First time poster but I've been avidly reading this section during night feeds and found it hugely useful, but now I could do with some specific advice please. This may be a bit long as I am trying not to miss anything out.

DS1 is 12 weeks old and EBF. I thought it was going really well although the HVs have been checking his weight every two weeks as he was dropping percentiles. He seems to be developing really well in terms of neck strength, alertness, kicking/batting at toys etc and is happy when he doesn't have tummy-ache.

Two weeks ago I expected the bad news at the weigh-in as he had had a cold but yesterday I was sure it would have increased a lot as he seemed to be feeding constantly. Anyway weight increase was 40g in a fortnight making a grand total of 840g (1 lb 13oz) in 12 weeks. He was 3.64 (8lb) at birth (12 days overdue) and is 4.48 (9lb 13oz) now, most of the increase was in the first six weeks, he was 4.22 at his 6 week check. He feeds pretty constantly during the day, it seems like he is never off me during the afternoon/evening but generally sleeps through from 9:30pm to 6:30am, only waking for a feed in between about every other night.

On the HV advice I have made a doctors appointment for tomorrow to check there is nothing physically wrong with him but she said that if they didn't find anything we would have to talk about formula (she is very pro BF usually). I feel really strongly about EBF so formula is the last option for me.

I told the HV I was confident in my milk supply as my breasts often feel full if he doesn't feed of a couple of hours (pretty rare during the day) but I've noticed that he often pulls away and starts crying halfway through a feed, then will go back, suck a few times then cry again - this goes on for a few minutes - could this be because he is struggling to get enough milk out? I have tried expressing a couple of times, the first time got a couple of oz in about 20 minutes (morning), this time I seemed to get a good flow for about a minute and then virtually nothing (evening after lots of feeding). I know the volume you express is not related to the amount the baby is getting but I wondered it the tailing off could be. I haven't managed to give the baby any of the expressed milk yet, DH tried for about 5 minutes the first time and then brought DS to me as he was distressed. I may have to get him to harden his heart a bit if expressing seems to be the way to go.

I have just started giving him infacol for most feeds (it is difficult to define when one feed ends and another begins sometimes) in case wind is the problem, we sometimes get a burp out of him and then he carries on feeding but this doesn't always seem to be the problem.

We have plenty of wet nappies, sometimes he goes a few days without a dirty one and is obviously uncomfortable after a couple of days without one.

Does anyone have any suggestions as to what the problem could be/how I can get more milk into DS or what to say to the doctor tomorrow if they try to push formula as the first solution?

Sorry it's so long ? I have gone from being not at all concerned to worried sick. People keep coming up to us saying ?he's gorgeous and SO LITTLE? - I know they are just being nice but it is twisting the knife each time.

Mmmm, well unless there is a physical problem that your GP can tell you about tomorrow, then it's just a case of he needs more calories in him.

That doesn't need to be formula of course (it has fewer calories than bm I think).

You say he feeds often through the day and evenings,- are you offering both breasts at each session? You can also switch back to the first side again.

Have you had a bfing expert check your latch? If it's not quite right, then he might not be transferring the milk so efficiently.

Expressing does usually work best in the morning and like you say, it doesn't work well for everyone.

How many centiles has he dropped? It's normal practice to only be concerned when they drop 2 or more centiles I think.

You could also give one of the bfing helplines as they will be able to support you through this and help you deal with your GP. Often, GPs are a bit lacking in their bfing knowledge and suggest formula straight off.

Oh and finally (sorry for rather random thoughts)- has he been checked for tongue tie?

HTH

I'm in a similar situation - DD is 12 weeks tomorrow, she was on the 25th centile at birth, dropped to 9th by week 5 and to 2nd last week. She has reflux, though, so I know why she's been dropping.

Anyway, I've been using breast compression since then and it's made a noticeable difference already. If your LO is pulling off because the milk flow slows down, breast compression might help.

WRT expressing, I have no trouble getting 4 to 6 oz in the morning from one side while DD feeds on the other, but in the evening I'm lucky if I manage 2. So I wouldn't worry about the flow tailing off in the evening.

HTH and fingers crossed GP won't default to formula tomorrow.

Have you rang any of the BF helplines?

How does your baby seem in himself i.e. if you didn't know about the weight? I'd have thought with being 12 days overdue a catch down the centiles could be expected.

However, I'm not a expert so think you should get some RL help, either helplines, LLL or other BF cafes or lactation consultant/councilor (whatever they're called in the UK).

I can say that DD has been a slow gainer, but no HCP has ever raised any concerns. 3oz a week would be good for her.

For the crying during the feed have a look here it should hopefully help rule out or rule in some possibilities.

Finally remember, after speaking to RL experts you don't have to do what your HV tells you to.

Thanks everyone

He has dropped from 50th at 2 weeks to 0.4 now ? that's 4 centiles I think. I wasn't worrying as I knew so many people whose babies were dropping down them a fair bit but this last measurement is almost taking him off the scale.

I offer both breasts but he won't always take them (sometimes screams, thrashes head but will happily take the first one again).

I haven't had my latch checked in a few weeks. I often find I have to squeeze my breast a bit for him these days so his nose isn't blocked ? I will look at getting it checked again.

I was told he had very minor tongue tie at birth but not enough to worry. HV/midwife agreed when I mentioned it later. He can stick his tongue out a fair way but I will bring it up again.

He seems a pretty content baby except when he has a problem feeding - then he arches back/headbutts me/screams etc, this used to just be on and off for an hour in the evening and sounded normal but I think it is getting more frequent now. I really didn't think there was a problem at all until yesterday.

Thanks

Nooo, any tongue tie, no matter how mild can cause problems. Go back and demand to have it sorted

poor you Definitely worth getting him checked out if he has dropped 4 centiles.

Try not to worry though - as hard as it may be not to. Things can be turned around over time.

Well worth speaking to one of the helplines before you go to the docs tomorrow if you can.

Hope you get some help.

I have just spoken to someone at NCT, she agrees it would be worth getting someone to check my latch. I'm trying to sort that out now.

I thought I had read the whole of kellymom but PenguinArmy's link has taken me to whole new sections - I will have a delve there and on jacknewman when I get a second.

Thanks again

OP, what you have written suggests that you need some additional, skilled, support IRL and not just from online sources, however good.

I think it is significant that your lo has a tongue tie and that he has been dropping so many centiles since birth - they can be tricky things to properly assess and I would suggest you ask to have it assessed again by a skilled MW or infant feeding co-ordinator or breastfeeding counsellor and referred for division (if necessary) as an urgent case. Note that I am not telling you to have it divided - because I can't see you or your lo and discuss all the factors that are at play.

It is worth bearing in mind that some tongue ties take a little while to show themselves - partly because in the early weeks your supply is moving from being hormonally driven to responding to your baby's needs.

You are right, however, to query your HV's view that formula supplementation is the only option - more effective breastfeeding should achieve the same result. There are some good suggestions above - looking at latch and positioning, using compressions.

Regarding expressing - yes, it is not a reliable guide to supply and yes it is quite normal to see big variations in how much you can express at different times of the day.

HTH and keep posting....

Op I would second getting the TT reassessed. I've just started a support thread for parents with TT babies because it seems to be such an issue and often not well managed at all. Feel free to join that thread too :) Hope things improve for you soon.

As well as latch, positioning is very important - it really affected my DD getting enough fattier milk early on. IME many BFCs and peer supporters have very little expert understanding of positioning issues - you need an infant feeding specialist or lactation consultant

Well we've had a traumatic day - turns out his latch is fine but he has a heart problem which means all his calories are going into breathing etc rather than growing.

Hospital have referred us to a speciallist unit for a detailed assessment tomorrow. It does show how important exploring both avenues is, I was convinced the trip to the GP would be a waste of time and it was the breastfeeding help I needed.

Thanks again for the support

Hi chocolate, sorry to hear you've had such a bad day.
Is it a heart murmur they've found? I went through a v similar thing with dd2, who went from 75th to 9th percentile and had a heart murmur. Turned out she had a tiny hole in her heart but it was not the cause of the weight issues. I won't blather on about that in case that is not what they have found for your DS.

Now on dd2 who has now gone from 91st to 9th, with no heart murmur. I think it's just the way my babies develop!

Wow, how scary. Glad you got it recognised though - and stuck with bfing (it can be best for sick babies).

Obviously it's best for healthy babies too

You poor things - what a terrible thing to have happened.

Hope things can be resolved.

you poor thing

You're completely right about the advice to get the GP to rule out medical matters.

I really hope things go OK for you and I hope that the fact you have BF up to now (and hopefully beyond) will give you some comfort.

Make sure he gets lots of extra hugs from all of us.

thinking of you PA