EBF 9 week old dropping centiles..

[TitaniaP]

Hi - sorry in advance for the mammoth post.

My DS will be 9 weeks on weds and has up until now been exclusively bf. He was 7lb 4oz born, and lost 9.5% by day 4. He didn't feed much at all for the first 48 hours (couldn't wake him up/latch him on). He took nearly 4 weeks to gain his birth weight and since then has gained between 4-5 oz a week. He is now hovering between .4 and 2nd centile and was 8lb 10 last Wednesday (at 8 weeks) (was born at 25th and was at 9th at 2 weeks)

I've been seeing the infant feeding specialist (who is excellent) at our local hospital since he was 2 weeks old and she helped me sort out his latch. I feed on demand upwards of 10 times a day and he doesn't ever go more than 4 hours at night.

He does make a clicking sound when feeding but the world and his wife have checked him for TT and posterior TT). I've seen 3-4 different peer supporters at different support groups plus weekly visits to the support group at the hospital. Everyone says his latch and attachment look OK. Also I'm not sore.

His nappies seem OK (plenty of wet and a couple of dirty per day). I've been talking domperidone for two weeks which doesn't seem to have made much difference. I struggle to express (I realise this is no indication) and never get more than about 20ml and sometimes much less ( I have a medela swing and continue pumping after flow stops to no avail). I never really feel full and my breasts don't leak (and never really have done).

I co-sleep, use a sling, feed in the bath, and do plenty of skin to skin, and breast compressions (as I believe they are all supposed to help increase milk production or transfer). My baby is very unsettled - will spend hours at the breast and cries a lot throughout the day. He often pulls off the breast crying too. I think I'm coming to the conclusion that the unsettled behaviour is due to hunger and that I'm going to need to top him up with formula.

I really don't want to do this. I want to ebf my baby boy and it's really upsetting me the thought of giving him formula. So I guess my questions are:

1. Does anyone have any suggestions on how I can increase his weight gain without giving formula, given that everyone thinks his latch is fine and it's not TT - is there anything else it could be?
   

1. Also if I do give him a top up, will this be the beginning of the end of my bf relationship (had planned to continue to a year at least)?
   

The HVs don't seem worried - but surely this slow gain together with the bouts of screaming aren't right?

Sorry for the mammoth post - and thanks in advance if anyone reads for long enough to reply.

[crepesagogo]

You had the essence!

[HarperSeven]

crespagogo - "If a baby has reflux meds may be needed, specialist formulas are not required indeed breast milk is the preferred food of choice. A baby gaining within the average range on a weekly basis isnt showing signs of any sort that would imply the need of a specialist formula."

You clearly don't know what you're talking about. Specialist formula is often prescribed and recommended by specialists for previously EBF babies. Particularly ones who aren't thriving. Specialist formula alone may well be the key, and if it were introduced, it could mean avoiding medication.

[AllyBallyBe]

Try to relax. You are doing well. Having some rest and relaxation and eating well will help your milk be plentiful. If you do a top up feed it's not the end of breastfeeding at all. I did this with my DC1. With DC2 ended up filling him with gaviscon from the doctor until I realised he had issues with dairy. I kept breastfeeding, ate no dairy and DC2 became an excellent feeder! Same happened with DC3 - again I breastfed with no dairy and all went well. Had to use soya formula for DC2&3 when I eventually weaned. Doctors wouldn't believe any of it and I got no support from medical profession at all - but I followed my instincts. Now DC2&3 are older I can see I was right as they get excema with dairy (but ok with goat milk & soya) - so they did have an issue with cow dairy afterall. Hope this helps.

[Tortoiseonthehalfshell]

This baby is not failing to thrive, Harper, and you are scaring the OP unnecessarily.

OP, it sounds like your son started as a smaller baby, which is of course normal; the centile chart represents a normal statistical deviation, wherein some babies will be at the bottom and some at the top without either being 'too thin' or 'too fat'. (And I do know mothers who've beaten themselves up about having 95%ile babies, too, by the way). There is cause for concern IF:

Your baby isn't having wet/dirty nappies. The amount you describe sounds normal and fine.
Your baby drops more than two centile lines - so in your case he has, because 25 - 10 - 5 is the two lines. But that's just one factor, remember.

It also sounds like you had more than a usual weight loss in the early weeks and a slow regain, which is now back on track. Weight gain should be figured from the lowest point, not the birth weight.
4-7 oz a week is fine for weight gain.

To be honest, because you've gone down more than two centiles I would usually say, see someone. But you have. You're seeing HV and infant feeding specialists. So if they're not worried, I'm pretty confident that things are fine, and I think the issue is that you had a slow start which has put your son 'behind' his growth curve.

[HarperSeven]

So the baby is 'hovering between .4 and 2nd centile'...

One of the defining characteristics of an infant with FTT is: "A child younger than 2 years old whose weight is below the 3rd or 5th percentile for age on more than one occasion".

Don't think I'm scaring anyone. Just the facts.

[MoChan]

My daughter dropped loads of centiles in the first couple of months, and didn't gain weight quickly despite feeding constantly and producing lots of nappy... she even got a bit scrawny between 1 and 4 months, but she was bright and alert. She very suddenly started to throw weight on at around 4/ 5 months - everyone kept asking if I'd weaned her, and I hadn't, she just suddenly gained. She didn't need formula, IMO, she just needed to grow at her own pace, though I came under lots of pressure to stop BF. I think you should try and relax about it all.

[TitaniaP]

Thanks everyone for all your help and support. It's much appreciated. I'm seeing the infant feeding specialist again this afternoon at the hospital. I will talk about the reflux to her and see what she suggests.

I'm also going to cut out dairy (which will be really really hard ) as he often sounds congested ( like he has a cold) too so it might be cows milk intolerance that's the problem.

To answer a few questions. I've been trying fennel tea too, but have now run out. It didn't seem to help so will finish off the raspberry leaf I've got in my cupboard.

Before I started him on Gaviscon we would have 3-4 dirty nappies a day the size of an Ok sign. Now we're down to 1-2 but they're much fuller IYSWIM but still the right colour etc.

I'll ask the infant feeding specialist to show me breast compressions. I have large breasts so find it a bit awkward and it often affects his latch so prob not doing it right. That might help with the milk transfer.

Thanks once again. I don't post much on here - but when I do the support is always fantastic.

[JetLi]

Hi Titania - don't have time to read all the way back just now. DD2 is often unsettled at the breast - what I have observed is that sometimes she just wants to suckle and doesn't actually want the milk - the milk comes anyway and she gets very frustrated by that. Not much I can do about it and she hasn't been particularly keen on a dummy.
Raspberry leaf - I think La Leche recommend not more than a 2 week stretch at a time, but I will check tomorrow. I take nettle leaf daily - just a holland and barrett one. Its a good post pregnancy/childbirth general tonic.
From Mums I have known who have cut out dairy, relating to reflux, the difference has been dramatic within just a few days. I think "officially" 2 weeks is the period to aim for, but anecdotally for the Mums & babies we have seen where it makes a difference, it shows up within a few days - if that makes sense.
Take your red book to the infant feeding specialist and talk to her about all your concerns - get it all off your chest.
Kellymom on the clicking http://www.kellymom.com/bf/concerns/baby/clicking-when-nursing.html.

[crepesagogo]

I would love it if you could qualify what your understanding of specialist formulas is harper. This baby has neither galactosemia or pku both of which would impact of breastfeeding and which would require specialist formulas.

Outside of these situations specialist formulas would very rarely be used for an ebf baby and more rarely still used correctly.

Titaniap ask your lc about the switch nursing too, ime very often more effective than breast compressions.

[cluelessnchaos]

Harper, I introduced formula with my ds1 and within a couple of months breastfeeding had disappeared. I believe now I was given bad advice and the scenario was similar to the one op describes and not as dramatic as when I had ds2.

Given encouragement and the right advice I was able to get past the problems in the early days this time and the baby who was dropping centiles is now on the 94th. Now if I had wanted to ff then it wouldn't have been a problem, breast milk is superior and if at all possible it is what I would choose for my children. I would not force that choice on anyone else and wonder why you are determined to force your choices on the op.

[buttonmoon78]

Harper you are right. That quote is one of the defining characteristics of ftt. Only one. Titania's baby could hardly be classed as ftt with a gain of 4oz per week regardless of the centile it is following.

DD1 had severe reflux and ftt. She was never prescribed specialist formula despite stays in hospital etc.

Please don't state that people don't know what they are talking about. IME we rarely have a real handle on what experiences people have on here and by being so prescriptive and opinionated about 'the facts' the only person who looks silly is the one being those two things.

[maisie215]

Just wanted to add my support. I'm sure you've seen my thread which recounts a situation virtually identical. I am now giving 2x3oz top up via Sns or bottle depending on how I feel. I feel so much better about the whole situation now and for me this is a good solution. We may get back to EBF or we may not. Tbh I'm not that bothered at least now I know she's getting a bit more. Hope you are keeping well. Someone very lovely told me to be sure i let others be kind to me!

[crikeybadger]

Titania- sorry that you're having such a crap time of it.

You can see a video of breast compressions if you google dr jack newman plus breast compressions.

I know you said that many people have checked for TT, but it can be difficult to spot and doesn't always lead to sore nipples. These people come very highly recommended and have a good tt diagnosis service. It might be worth giving them a call and having a chat.

[tiktok]

Harper, it certainly sounds as if you have the OP's interests at heart but you don't sound well-enough informed to be pronouncing on this with such confidence. I don't think anyone here is, to be honest, as we cannot - any of us - be sure of anything from the limited info one gets on a talkboard.

FTT is no longer used as a diagnosis (though of course it will take some time to die away totally) and the better term is 'faltering growth' which is descriptive rather than diagnostic.

The OP's baby has to do a lot of catch up from a difficult start and this has to be taken into account. Weight gain seems within normal limits now, and if all else is well, then it may well be a case of just waiting, feeding often, and ensuring that no opportunity to get milk into the baby is missed....I think 10 times a day is actually not very often for a baby in this situation, and it doesnt sound as if switch nursing has been tried, either. So there may well be further options to try, and maybe you can discuss these, Titania, with the real life support you have?

A baby who's unsettled may well be going short of calories, and more breastfeeding is usually the answer to that, but if not then judicious use of formula top ups is sometimes an option - but it should be last on the list, with a baby whose health and growth is not really an urgent issue.

I don't always find it reassuring when HVs say nothing is amiss, by the way. I come across plenty of situations when they simply don't really know what to do, and they overlook sometimes quite serious difficulties in the hope they will resolve themselves. I don't know if this is the case here, obv.

OP, maybe now is the time to consult again with whoever you trust most?

[bramblina]

Harper I do think what you have said is a little scary, I'm pretty sure you do not have the same passion for breastfeeding as Tatiana or I have, and therefore you find it easier to try formula as a solution at perhaps the first hurdle. Where I wouldn't suggest you try to agree with anyone else's feelings or views, I do believe that in order to help you would need to understand Tatiana's eagerness not to feed her baby formula; I get the feeling you are not interested in adressing this issue, which to me seems a massive factor in the problem Tatiana has. I don't think she is against solutions, just like me she seems dead against feeding a human baby milk that comes from a cow!! The human race survived millions of years on breast feeding alone, before formula and bottles were invented!!
Tatiana, I would suggest you trust your insticts as a lot of the stories on here now seems to suggest that with hindsight lots of women did or wished they had!

[HarperSeven]

tiktok - I know you come out of the woodwork on MN whenever someone suggests FF, just to ensure they stay the course with BF... that's your agenda, fine. 'Faltering growth' not 'failure to thrive' is it? OK, well that's just semantics. A hungry baby languishing at the bottom of the charts, in the absence of a medical problem, is a failure of some kind. A failure to see sense perhaps. I'm pleased you are being sensible enough to concede that FF may have a place at all. But 'sometimes' and for 'top ups' only hey? What nonsense. Who are you to give or withhold permission to FF?

bramblina - i'm pleased for your kid's sterile gut - really. But I think you're the scaremongerer, not me. "Passion for breastfeeding"?! That is losing sight of the woods for the trees. The point is to see your child grow up healthy, be it on BM or F, not to satisfy some passion. You drank the BF kool-aid.

[buttonmoon78]

That is, in my experience, bollocks. With the greatest of respect obviously.

But being as you've obviously got an agenda, why don't you bow out of this discussion? You're actually not helping the OP in what she has already stated is her aim and now you're calling her child who is putting on the lower end of average weight gain on the lower end of average growth charts a failure. Very helpful

There may well be a problem but you, frankly, are not helping.

[Gincognito]

Bloody hell, and who are you to scare a vulnerable mother just to score points? And arf at your interpretation of tiktok's agenda.

OP your story sounds very familiar to mine. Ds was born on the 25th centile and dropped down to the 4th. My HV was very supportive, he was checked for issues but apart from being incredibly unsettled he was fine. I offered him the breast at every opportunity, co-slept, bathed with him, used a sling etc etc.

Eventually something clicked and he started chubbing up. I took him to be weighed at 7 months and he had moved up to the 75th centile! And that was with being ebf to six months and then baby led weaning (in other words he still gets most of his calories from milk).

Obviously you need rl support but I just wanted to share my positive outcome.

[HarperSeven]

what's bollocks? what's your experience exactly and who are you to be telling me to get off the thread.

OP, I hope you realise that when you consult people on MN about a BF issue you invariably only get one side of the argument - which is the doggedly pro-EBF message at all costs. That's just the way it is.

[RitaMorgan]

Harper, you're talking to a mother who is breastfeeding her baby, and wants to continue breastfeeding. Trying to bully her into using formula and insulting those who are offering advice isn't helpful.

[tasmaniandevilchaser]

hi Titiana, your story also sounds very familiar to mine. DD was born on the 75th centile and had dropped to the 2nd by 5mths. She was colicy and very hard to settle day and night. Obviously that was very stressful so I did introduce a bottle of formula in the evening around 5mths (with the occasional bottle of formula before that as well). When she went onto solids her weight started to climb back up the centiles by around 1yr she was on the 25th centile. Even now at 2;6yrs, with an ENORMOUS appetite, she's only around the 50th. She's still very hard to settle, we have to run her down to the very end of her energy before she'll sleep and daytime naps are a very distant memory.

If I had to do it again, I wouldn't weigh her so often, maybe every month at most, as she always looked healthy and was meeting all other milestones. Those centiles are there for guidelines, each baby is different and they certainly haven't read about those centiles (or those books that tell you when they should be sleeping!)

I would also have got her checked properly for TT (I see from your post that you have already done this though), as when she started sticking her tongue out at around 7-8 mths, there was a very clear heart shape on the end (and you can still see it to a lesser extent). This is despite going to see various bf counsellors, specialist GPs, health visitors etc. and me not being particularly sore.

Anyway, I hope your DS puts on weight soon and settles down. I know it's a very stressful time, but it sounds like you are getting the right support in RL, so his health is being monitored.

[tasmaniandevilchaser]

Oh and HarperSeven, you are being thoroughly obnoxious in talking about "failure". It's totally unnecessary to be so aggressive, especially using words like that with a new mum. Think about how that is going to make the OP feel.

If anyone is guilty of pushing their own agenda, it's you. And you're being amazingly rude in the process.

[buttonmoon78]

My experience of tiktok's help and witnessing her help with others. I've never interpreted her advice as anti-ff. Pro-bf yes, but that is what bfc people do, surely?

And the OP was wanting bf advice, so yes, people will post advice about bf.

I suggested you bowed out as your help in this situation is negligible. And that is being kind.

However, that is the limit of my interaction with you. This is derailing the OP's thread and not providing her with any help at all, which is not fair.

[TitaniaP]

Just wanted to thank everyone for their advice again. I went to see the IFS (infant feeding specialist) again today and feel much better. The IFS is a specialist in Infant Feeding (breast or bottle) and while she will always support mums to BF if that's what they want she's given me some suggestions on ways to introduce formula if that's what I chose to do. I wanted to make it clear that I'm seeking the advice that's best for my baby - not just to fulfill my ideal of what my relationship with my newborn should be

My current plan of action is over the next few days to feed at every opportunity, use switch nursing/breast compression where necessary to keep my son's interest. Plenty of skin to skin etc.

I will also express at every opportunity and use this to top him up.

I will also cut out dairy from my diet and see if that helps settle the reflux. The IFS has given me some other drugs to suggest to the GP if the Gaviscon still doesn't seem to help. She observed him feeding today and thinks silent reflux seems very likely.

I will also discuss TT with an expert. to rule that out (or not) once and for all.

I will try this for a week and if its still not helping his weight gain/ and hes still really unsettled I will try introducing formula. Does this sound sensible?

I appreciate all the different views that have been expressed on his thread - its made me look at why breastfeeding is so important to me and come to terms with the fact that I need to do the best for my son. If that means FF I wont have failed I'll have done what I need to do for my son.

Thanks so much for your support - it means a lot (Especially as my local bf support group isn't running for the next two weeks!).

[crikeybadger]

I think Titania, that that is a most splendid plan.

Good luck with everything over the next week.