Poor weight gain at six weeks

[maisie215]

I had an absolute disaster feeding Ds1 who is now 2. Was desperate to breastfeed and thought all was well until he had lost 12% of his birthweight at 2 weeks and was readmitted. I was given no choice other than supplementing with formula. Cue three weeks of feeding, supplementing, expressing on a 3hrly cycle day and night with fenugreek and domperidone. I reached the point where I just couldn't sustain it and gave up. He immediately started to gain a pound a week. No one could tell me what went wrong- it just didn't work. I regretted giving up and even though it was the right thing I'm still not really over it and feel very raw that I was denied a full breastfeeding experience. That's the background to where i am emotionally at thus stage.

Dd born 6 weeks ago. I was determined this time i would succeed and saw LC antenatally. I even expressed colostrum antenatally (and had a shed load to express). We had a bit of a rough start with jaundice on first 24hrs and a skin infection requiring iv antibiotics- in hospital for 6 days. Again all seemed well but she has had really poor weight gain. She is on the second centile gaining just under 4oz per week. She was 6.13 at birth, now only 7.8. At the moment she feeds virtually all day. Plenty wet and dirty nappies. She never really comes off the breast on her own but is relatively contented and sleeps a 4 or 5hr stretch at night.

I guess I just need to decide what is best for her. Do I reconcile myself to a skinny EBF baby (she looks unhealthy) or supplement and have her gain properly? I am so committed to bf and don't know if this is clouding my judgement. At the moment she has a 2oz top up of ebm (expressed after night feeds- I can't get much when i express and although I know it is no indication of how much milk she gets it is pretty confidence sapping) at bedtime given by SNS. I just feel it is a bit unsustainable and I need a slap one way or the other but don't know the right thing to do. My confidence is rock bottom and to be honest I feel I have failed again this time already. On the plus side DH is an angel and really seems to get it and is there for me. He thinks she is doing ok but I'm not so sure.

Any thoughts or experiences appreciated. Sorry for the essay but thought it would help to write it all down. Oh and she also had a posterior Tongue tie snipped at three weeks but I wasn't sore and don't know if it has made much difference- they said it was a really minor one.

maisie I haven't got any experience or advice but just wanted to bump this for you. Hopefully someone will be along soon.....

Can you speak to your LC again? Don't want to post and run. But no real advice to give.

I think a 4-5 hour stretch at night, plenty of wet and pooey nappies and general contentment are all excellent signs that things are going well. My understanding is that those things are a better indicator than centiles, although I think if they drop more than two centiles (not 2%) that can indicate a problem?

I am not an expert, though, so I agree to speak to an LC if you trusted yours. Good luck.

Has anyone checked her for tongue tie maisie?

I agree with tortoise- the signs that you have mentioned indicate that she is fine. She is just gaining weight a bit slower than you would like - is that right?

I don't agree - well, not fully. A 4-5 hour stretch at night for a six week baby who is gaining only very slowly is not a good sign - and the facts that the baby 'looks unhealthy' by which I guess the OP means looks skinny, and 'never' comes off the breast spontaneously add to that picture.

Nappies are really irrelevant at 6 weeks - unless the baby goes a long stretch with no wee and looks dehydrated. So 'plenty' of nappies tells us nothing, really.

The main reasons why babies don't gain weight as they would be expected to - and this is a baby who has gained about 2 oz a week and while this is a gain and it is consistent - are i) the baby is a physiologically slow gainer and is fine and ii) the baby is not getting in sufficient calories

I don't think there is enough evidence to be sure of i) - yet. Maybe in time the picture would be clearer, but with a 6 week old baby and a worried mother, we can't really hang about with fingers crossed, so we have to work on ii).

OP - can you get someone who really knows what they are looking for to observe a whole feed/feeding period of an hour or two and guage if your baby is transferring milk effectively? A baby who 'never' comes off the breast spontaneously would concern me, and I'd be looking for sufficient active feeding and swallowing, not just tickling about, and that's what I'd suspect - too much tickling about, getting a trickle, which keeps your baby ticking along without serious health issues but without the good growth you'd expect with non-stop feeding.

You could also get an opinion on whether your baby really does look unhealthy - and this might also help you decide if your baby is likely to be i) or not :)

Hope things work out.

I feel for you. We struggled like this for the first 6 weeks or so. I'm lucky that I had a wonderful local support service. These are the things they told me: breast compressions, when baby sucks squeeze breast when she stops you stop... There are ways to get back from supplementing too so its not the end of the world. First 6 weeks went boob-bottle (ebm/formula depending on stores)- pump. I did and still am taking domperidone. She's still a diddy thing but I'm very grateful for the professional support I got then and am still getting at nearly 5 months.

shuck - good suggestion about the breast compression. You watch for when the baby has stopped sucking/transferring milk, and you compress the breast to enable more milk to get into the mouth, which stimulates more sucking.

OP - I really think you'd be helped by someone observing you feed and helping you see if and when your baby stops transferring milk.

Just to say I'm right there with you. It sucks

Sorry OP, I thought you meant that DD was gaining 4oz a week, I didn't do the maths right!

In addition to the suggestions from others, you may also find this article helpful.

But ultimately, as tiktok says, it would be really beneficial to see someone face to face. Is your LC an IBCLC? If so, then there's a good place to start.

Thank you everyone! Tiktok you clearly see my dilemma, so many of the signs could be good or bad. I have seen LC today who hasn't seen us feed but suggested two 2nd top ups per day. I don't think that's enough so will give her three oz.
I know about watching for swallowing and have been doing breast compression. Sometimes she drinks well and sometimes not- I think I have a slow letdown. I'm feeling really low. Went to gp for6wk check who wants to see her again in two weeks then refer to community paeds

It's so hard because in really committed to bf but at the moment am struggling with 2yr old ds and bf all the time. She is almost always at the breast so I barely have any time to interact with her otherwise. Feel like a failure whatever i do anyone successfully mix fed to any decent age- would love six
Months but a year or two would be better?

Should say 2 x 2 oz top ups!

Crikeybadger- great article, thank you! She has been gaining about 4 oz per week...
I just think she is so tiny and my instincts are telling me she is always hungry and i don't think she is getting enough. LC is IBCLC and very good. I just think this approach won't fix anything fast. Btw my DH and I are not small (6'1" and 5'8") so don't think she is just petite.

Oh try not to get down about it maisie- if it is just a case of not enough calories going in, then it is easily solveable.

Has the LC checked for tongue tie?

I had similar issues (including a mixed fed DS1 and determination to get it right second time around). I saw BFCs and then well regarded LC and concluded that my supply just wasn't that great (and baby had high palate and receding chin - no ventouse by the way) and it was right to top up with a mixture of EBM and formula as DS2's weight gain was too slow without it. So he had a bottle at eleven ( while I expressed) and put on weight. I couldn't have dealt with the lower than expected gain on a long term basis. (I took domperidone religiously for six months and had a load of blood tests to see if there was some "reason" for my supply issues - I was low on iron and d3 but no idea if relevant - worth thinking about?

He is nearly 8 months now and eating well and has turned into a big boy. Still bf, no formula and I have what I yearned for with dS1 of the baby turning to me for feeding rather than getting excited about a bottle. I am worrying now that he won't feed enough during the day which is like a joke given all day feeding marathons I recall from when we were at your stage. There were lots of bad times when I thought I couldn't stick it as he was getting frustrated at the breast but for me getting to where we at now has been worth it. So a very longwinded way to say that a bottle a day can work to let you keep bf for a long time (and that you should of course keep doing all the things you are doing to maximise milk transfer). Hope that helps.

Thank you again for all support. She had a minor posterior tongue tie which was snipped at 3 weeks. I don't think it made much difference though although she still clicks a bit when feeding and tends to slip off the nipple. I am not, and never have been, sore.

I have just given her her first 3oz bottle (and used up the last of my EBM store so it will be a mix of EBM and formula tomorrow as I can only express between 2 and 3oz total per day ) and she has settled and is sleeping 40mins earlier than usual. I have used the calma medela teat so she doesn't get it too easy and will hopefully still suck well at the breast. I feel like this is the right thing. Like SWmum I just can't face the thought of lower than expected gains week on week. It feels like delaying the issue and ending up with a skinnier and skinnier baby who is even further from her true centile. LC reckons this may be enough to get her to turn the corner and start gaining well. Fingers crossed!

buttonmoon78 how are you getting on now? Was just reading you r previous thread. Any more luck on the gains? Have you managed to maintain EBF?

have posted this info before and may be out of date but i was worried sick with first childs weight gain.....then had uni researcher told me the charts at back of NHS red books and the ones the HVs use were based on charts compiled in 1960's and based on formula and breast fed kids which "distort" overall averages.

would love to see charts for just bf only infants

They have updated in the last year or two and the new charts are for breastfed babies. They also don't have any centile lines for the first 2 weeks to account for normal weight loss.

Maisie still ebf but in the face of increasing lack of support from dh. Having trouble with jaundice too - bili levels were too high on Weds so bloods being redone today. If they've risen then we can expect phototherapy to follow. Been doing breast compressions to help transfer of milk.

Think I'm going to have to think seriously about supplementing. I'm obviously not much cop at bf. This is dc4 and my 3rd failed attempt.

indababa - you were told wrong. The researcher you spoke to was talking about the US charts, as far as I can tell. Brit charts were always different and nothing like what you say....but it's good the charts these days are based on good data from bf babies.

But bf babies tend to gain weight more quickly anyway in the first weeks, so using a different chart does not make any difference, really, in the cases you describe.

buttonmoon- sorry you are going through this too. I gave my first formula top up today with the SNS and it actually felt ok. It was the right thing to do for my baby and I know that. It is horrible having that experience of failing before and going through all that hope and disappointment all over again.

I've been reading some stuff about 'defining your own success'. I think mine is that she will still go to the breast at 6 months. Even if she gets barely any of her sustenance from me I think I owe it to her and myself to do the best that I can with my crap breasts and give her what the will produce even if it is not a lot along with the boost of extra calories that she needs to grow properly. I need to forget about the calories because she is clearly not getting enough from me and instead focus on the antibodies and other goodness that she can get from small amounts of BM. I think that is a pretty good aim. Good luck!

Maisie and Button - I only once persuade my DD to take a tiny BF!!! The rest was anything I could express plus FF. I was a wreck. I think you have both done amazingly well, even if you do need to introduce formula eventually. Good luck to you and your little ones.

As well as breast compression are you switch-feeding? Swapping sides every time she seems to lose interest.
This was a big big help for us.

Maisie - if you have got to this stage with steady weight gain (even if not quite enough) it sounds like there is every prospect that one top up a day will do the trick (as I said we did one bottle a day at 11 pm while I expressed) and keep going as the major part of baby's sustenance until solids start. Doing one bottle rather than top up was suggested to me as a better way to keep bf going - your LC will no doubt advise.

Defining your own success is a good idea - I kept setting myself targets (four months as the end of peak SIDs risk then 6 months) and taking it day by day after that. Bad patches mostly passed by. So if it helps to be positive, I think you should. But if it helps to do one day at a time and not stress about where you get then do that!

DS had a bottle last night at 9pm - 1ozbm, 3ozfm. Took it all and was utterly content for the first time all day.