Very Slow Weight Gain - Help needed!

[CJMommy]

DD is nearly 11 weeks old and ebf. She was 8lbs born and 2 weeks ago she weighed 9lbs 6oz. I think she is gaining on average 3oz per week. She is about to drop onto the second centile.

We have an appointment with the HV tomorrow for review. I don't want to top up with formula; would rather find out why her weight gain is so slow, if any reason?

I am suspicious about a posterior tongue tie so want that reviewing. Could there be any other reasons for her gain being slow?

She is not scrawny or skinny, looks in proportion and is healthy-looking. No concerns at all really.

Any advice much appreciated x

Hope your appointment helps you, CJMommy.

The most common reasons for slow weight gain are these:

• baby is physiologically a slow gainer ie this is how she is 'cos she is meant to be that way :)

• baby could benefit from more calories

By 11 weeks, the other reasons for slow weight gain (rare metabolic diseases; other congenital problems) have almost always shown up with other symptoms.

If it's thought your baby might benefit from more calories then a good HV will ask for ways in which you can get more breastfeeding done - this would be things like using several breasts at each feed ('switch nursing') and in particular, ensuring the baby has at least two breasts each time (anyone who suggests you should only feed one side to 'make sure she gets the hindmilk' can safely be ignored as not understanding how bf works); more frequent night feeds; more frequent day feeds with the breast offered more often than the baby asks.

Yes, a tongue tie might need to be ruled out.

More frequent access to the breast should be sufficient, but of course you can also express and offer the ebm as a top up if it's thought for some reason more frequent access is not possible or will not work.

Not normally any need for formula when you have the milk in your breasts already :)

Positioning can also help with them getting more calories (more fatty milk) when feeding. My DD didn't get her chin well in enough to start with and that didn't help our weight struggles. As I understand it, a TT would affect latch and positioning so a deep latch would be harder to achieve.

I'd agree that there should be no need for formula - while this obviously needs checking out, as your LO has got to 11 weeks, is gaining if not fast enough, and seems otherwise healthy, there is no emergency to get more calories in her! You have milk, she just maybe needs more of it.

Thank you both.

I do offer both breasts at each feed and she does take both but never thought of offering two breasts each time - will try this. I'll also offer more frequently - she currently demands every 90 mins - 2 hrs.

I co-sleep but maybe I should feed sitting up to ensure that she has a good intake?

WRT tongue tie, the bf consellor said she may have one, when I enquired when DD was 3 ish weeks old due to the clicking sound she made when feeding, despite apparent good latch/position.She said to monitor her weight. I'll ask to see her again to discuss.

Good to co-sleep for milk on tap- sitting up wouldn't make much difference I don't think.

Sounds like the TT could be the problem so good idea to push for getting this diagnosed and snipped if there is one.

Hope things get better for you soon.

Thanks CB. I have been suspicious about TT for a while. I asked the GP to check for it a few weeks ago at her 6-8 week check but she didn't, saying that they are usually not a problem and even if she had one, no-one would snip it as it is 'barbaric' (I know this is not true!)

I second getting the TT assessed.

FWIW my DD falls under the natural slow weight gainer, a good week in the first 6 months was 3oz, often less.

Once I'd ruled out the other issues such as TT, reflux and did switch feeding I relaxed into it. She was born on the 25th and at 9 months was just under the 0.4th. I was lucky that no HCP ever though that there was a problem as they looked at her and saw she was fine.

Not an expert so dont have any suggestions for you, but dont worry. My DS was 8lb8oz born and he had a patch where he dropped how much he was gaining. He went from 75th gradually down to just above 10th, and now he is on solids hes back up to 75th! :)

Sorry, that should say back to above 50th, he hasnt reached 75th yet!!

Been to see HV. She has gained weight, now 9lbs 13oz but has dopped another centile, so has dropped 3 centiles since birth. She's making a referral to GP but am also seeing LC on friday to check if there is a tongue tie.

She's sitting on 2nd centile but appears alert, happy, plenty of wet and dirty nappies so not worried in that respect.

OK, so thats good that she has gained weight.

Good idea to see the GP to put your mind at rest (although they are not always up to date on bfing).

Hope the LC is helpful on Friday.

how long had it been? i.e. was it still 3oz/wk?

Good luck on friday and if your not happy with what the GP says then get referred to a pead. they're normally more relaxed and knowledgeable about these things by all accounts

Penguin DD was last weighed at GP 13 days ago so 7.5oz gain since then.

I'm not holding out any hopes with the GP as she was the one who told me silent reflux didn't exist and TT's aren't treated anymore. If her answer is to formula feed then I will ask for a referral to paed - I would much rather find out if there is a problem rather than just treat the symptoms.

Am looking forward to seeing the LC on friday though

Tiktok (or anyone else who might know) - do you mind if I ask a question? How do you tell whether your baby is just physiologically a slow gainer or actually needs more calories? I'm constantly worried about the latter but hoping it's the former, iyswim. Unfortunately I don't have good HVs in this regard. Their advice with slow weight gain issues is always to feed formula.

Sorry to hijack your thread CJMommy!

Physiologically slow gainers meet their expected developmental milestones; they gain weight, rather than lose it (just slowly); they are healthy - eg no infections, no fevers; they are slim but sturdy - no sign of 'wasting'; they show by their behaviour they are basically happy and content; they are usually eager to feed but refuse or mess about when offered more opportunities to feed; they are alert.

Disclaimer: I am not a health visitor. Can you share that list with your HVs and ask if they disagree with any of it or have anything to add?

Thanks, Tiktok. That is really, really helpful. Lots of things there that make me feel SO much better. DS (9wks) ticks all those boxes. The only thing I'm not 100% sure about is the refusing when offered more to feed. He has never refused the boob and I feel sure he would stay there all day if I let him. Some of this desire is comfort sucking but I never feel confident that he's not still hungry and that I just have a really slow let-down or something which is making it hard work for him.

Re the health visitor thing. I'm glad you're not one. As for showing them your list - I doubt mine are interested in looking at anything except the Red Book. But if I ever find one who seems even moderately interested in helping a mum who is trying to persevere with EBF then I will. Mostly they seem to take great pleasure in allowing you to believe that you are the only mum ever whose child is slow to gain weight. Thank God for MN and those of my lovely friends who went through the same grief. Thanks again.

SweetApril, what happens if you do let him stay on for as long as he wants to? Presumably he must get to a messing about stage/not really all that active sucking stage, which is when you take him off...and he accepts you taking him off, I suppose, yes? That all sounds fine and normal.

If he stays as long as he wants he almost always falls asleep doing feeble comfort sucks!

As a general rule he sucks really hard for about five minutes and then moves on to less active sucking and starts to snooze. If I take him off then he yells so I put him back on and he'll want to stay there doing smaller sucks for probably half an hour in total. I always offer him the second breast and he'll take a fair bit from there too.

However, at the moment we're also trying switch feeding and different positions (both recommended on another thread I have going) to deal with the falling asleep issue. But it still takes the best part of an hour per feed.

If he hasn't fallen asleep on the job then he will usually come off by himself grinning all over his cheeky face - which makes it all worth it

CJ - if you come back to this thread I am really sorry again for this major hijack.

SweetApril, falling asleep doing feeble comfort sucks is fine....not sure what the prob is, honest :) The pattern you describe - five minutes very active and then less active followed by snoozing - is normal too. You take him off and he protests - normal, so you let him hang about a bit and then offer the second side, which he takes.

The whole thing can take most of an hour - truly, this is well within normal. Some babies take less time by this age, but plenty don't.

He's healthy, you say, and happy.

Sounds like a confidence thing to me, rather than a feeding problem. Switch nurse if you like - but I don't see the benefit of doing so, and it is prob working against just letting feeding 'happen' :)

Thank you, thank you, thank you!

There is a big confidence issue, you are right. The HVs are twitchy because he is only pootling along on the 9th centile (having been born on the 75th and losing 15% of his birth weight because my milk took 5 days to come in ) and I feel under tremendous pressure to try to get as much milk into him as I can so that the scales say what they want them to say and they get off my back.

But it is a massive confidence boost to have you saying such positive things to me.

I'm guessing you're a bf counsellor or something, right? I've seen your name mentioned on here lots - in a good way!

yes, I'm an NCT breastfeeding counsellor.

Maybe talking to a bfc on a helpline will give you confidence.

I suspect it's not just the HVs that make you feel pressured. You had a Big Fright in the first week of your baby's life. It appeared your baby had lost 15 per cent off his birthweight (before you met a healh visitor, I expect) and that would have come as a bit of a shock (milk taking 5 days to come in is not so terrible - it's within normal).

The memory of those feelings are prob still with you, and while other mothers gain confidence in their own judgement and understand the major limitations of some HVs, you are not able to trust yourself to do so. You thought everything was just great - and then kapow!, your baby's weight was way down. Difficult for you to trust yourself after that - but there's no real reason why you need to have these feelings hanging over you now.

Your baby may not have been 'intended' for the 75th centile - birthweight is a snapshot, anyway. It can take a while for babies to find their 'own' spot on the chart and while 75th to 9th is worth a raised eyebrow simply to check all is well, when all is well, people can stop worrying.

Don't get me started on how weighing is so often inaccurate, either. There is plenty of research on this.

In your case, it will help I am sure to look at your baby and not the scale. No reason for healthy babies to be weighed more often than monthly in the first six months - in fact it's poor practice for weights to be more frequent than this, unless there is a clinical reason for it.

Afaik, what they lose in the first week almost doesn't matter if they then stablise and follow a centile. DD lost 15% too, but then stablised on the 2nd centile and no-one was fussed at that as she followed it and was obviously healthy & happy (I think I have a very good HV!).

Even the red book has notes about weight loss in the first 2 weeks being normal so I'm not sure where your HV has got the idea that they need to get back to their birth centile (or anywhere near).

Sweet April No problem re: Hijack . My DD has gone from 75th to 2nd centile. She is, as Tiktok descibes, gaining weight slowly and meeting milestones, looks in proportion and is active/alert. If she's not TT'd then I'm pretty sure she will even out along the 2nd centile but will see waht happens on friday. I am still waiting for a call back from the HV about referral to the GP due to dropping 3 centiles but I am not in an hurry!!