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.

That sounds like a plan. Really pleased you're getting the right help & wish you all the best of luck.

TitaniaP well done you for remaining level headed. Your plan sounds great. Please let us know how it goes

Harper - I don;t come out the woodwork to tell mothers to bf. That's a preposterous distortion of what I did here. I was responding to the OP's clear preference to bf, without persuing any agenda (unlike yourself). There is hardly ever any justification for anyone to recommend a big step like using formula on a talkboard - who knows if we have the full story anyway? The best thing is to share general information and a few pointers where a poster can get decent, real life info.

Failure to thrive/faltering growth is not just semantics. You betray your own lack of sensitivity and awareness in saying it is. 'Failure to thrive' is a loaded term and it is a diagnosis - ie the baby is not developing healthily. Current terminology uses 'faltering growth' because we cannot tell from weight alone if a baby is 'thriving' or not...so it is descriptive only, and is preferred for this reason. Of course there are babies who 'fail to thrive' but this diagnosis needs more than slow weight.

Tiktok - please declare your interests here. You don't by any chance run a private BF consulting business?

"There is hardly ever any justification for anyone to recommend a big step like using formula on a talkboard" What paternalistic, controlling BS.
The OP was talking about considering formula herself in her original post. But to your mind we should just ignore that or tell her it's the wrong thing to do? You are downright dangerous.

You're accusing me of being insensitive? You are being insensitive by insisting that someone struggling to see growth in their child should continue breastfeeding exclusively, with FF only seen as a last resort - as though it's conceding defeat. You're out of touch with reality. What is paramount after all is the child's health. The baby is "hovering between .4 and 2nd centile" as a result of BF and you insist that the mother continues with it, until when exactly - just how far down the chart should the baby fall.

Did you even read the OP's last post? It seems she appreciated receiving a more balanced view, and I'm relieved to see she's come to terms with the fact that FF doesn't indicate failure.

Harper do you have more issues over feeding than you admit to? I feel very passionately about bf but have used formula and don't feel the need to pushy views as aggressively as you.

OP great that you have a plan that you are happy with:)

Harper your posts are making me wince. Tiktok should declare her interest...what that she gives up a huge amount her her time and training to support mothers on their terms sharing information and generally empowering their feeding decisions? That she works for a charity as a bfc? That she has a pro mother agenda, that even though more than able to assert this herself many others will want to do so first in outrage at your comments.

Yes tiktok, how DARE you push the interests of women and babies!

Flipping heck Harper, tiktok answers women who desperately want help to breast feed. Women like me. She doesn't barge into threads by people asking how to make up bottles, she adds extremely helpful, up to date, carefully researched advice to women who are often desperate to breast feed their babies in very difficult circumstances. In a world that does NOT like breast feeding.

She's not pushing her business, (if she even has one!) although anyone lucky enough to see her in real life would be onto a good thing.

She is a trained NCT bf'ing counsellor and has given countless hours of her life on here improving the lives of hundreds of mothers and babies. She is also completely non-judgemental. If you hear criticism in her posts you are projecting!

I for one think she deserves a bloody medal.

Oh yes and I consider her to be a true feminist.

Harper I have said that I will not allow my son to fall any further down the charts. I've laid out a plan to try everything possible to get my son to increase weight by breastfeeding. If and only if that doesn't work will I consider using formula.

I came on here to ask for people experience on introducing formula and continuing to bf. People have been kind enough to share their experiences. They've also made some useful suggestions like trying switch nursing and cutting out dairy. I discussed both of these with the IFS yesterday and she said they were excellent ideas. Can I reiterate that my son is gaining weight albeit slowly and the HV, IFS and indeed the GP at his 6 week check aren't worried as he is now holding his own on that curve. It's me that's concerned which is why I asked for advice.

I do appreciate all the different opinions but it seems that you do have an agenda. If Tiktok is promoting her own business then I can only assume you work for a formula company!

Can I just add that I gave my DS an admittedly small bottle of ebm last night (well DH did) in the middle of his 6-9pm cluster feed and he slept for 3 chunks of 3 hours last night waking to guzzle milk from me and fall straight back to sleep. He's just had another feed and is laying happily in his bouncer grinning at me. And to add to that I've already managed to express 30ml today ( a bit of a personal record) and it's only 9.30.

Titiania well answered, It sounds like your milk supply is increasing to his needs well done you for not giving up at the first hurdle.

Titania you are doing fabulously :)

Have you cracked feeding while lying down yet? I found it to be a lifesaver. Doing it right now actually.

Oh, and the best thing I ever bought was an iPad. Fantastic for preserving sanity during feedathons!

OP have you tried expressing during the night? I can only get about 40ml during the morning, nothing at all in the afternoon but 80-100ml at 2am!

Titania,

As the father of a very skinny first baby with reflux (he dropped to the 0.4th centile for quite a while). Reflux is generally caused by a weak sphincter which causes the acid from the stomach to come up, rather than down, causing pain and, usually, vomiting. The point is that coming off the breast crying is a symptom of reflux and, if left untreated, will cause "food aversion". This is what happened to our son and it took a long time for it to settle down.

It does not seem to be widely appreciated that Infant Gaviscon is merely a "food stabiliser" binding the food together to make it more likely to go down than up. It does nothing to treat the pain caused by the acid. There are various drugs which can be used to do this. Ranitidine worked very well for us but there is also Domperidone (I am suspicious of this one as it has been associated with heart arrhythmias) and, I think, more modern antacids which have come out in the last year or two. The point is that you want to treat it sooner rather than later because, once a baby associates feeding with pain, it is hard to reverse this. I would speak to a paediatrician about starting some antacid as soon as possible.

It is hugely stressful having a very skinny and reluctant feeder and a formula top up can work well. My wife heroically persisted with EBF until 4 months and then we supplemented with a bottle of "high energy" formula once a day. She nonetheless persisted with 70% BF until 9-10 months. I think the benefits of breast milk will be 99% there as long as you mostly BF. I do not think there is something magical about EBF.

To sum up, I would make an appointment with a paediatrician (not a GP, as they generally cannot prescribe the appropriate medicines) and start your baby on an antacid, both to discourage food aversion and to make him more comfortable. It cannot be nice to continually be bringing up hydrochloric acid! You also want to get his height and head circumference measured to see how "thin" he really is. A 2nd centile height baby who is also 2nd centile weight is not thin at all. Weight by itself is a very crude guideline. Give the meds a chance. If after a month or so, he is not at least holding a centile (ideally 2nd or above) I would definitely consider a high energy formula top up.

Yes, it would be worth googling for evidence of the clinical effectiveness of infant gaviscon. As far as I could work out there isn't any

OP it may be that like Larry there is something medical going on with your son. If so, it would fantastic to address that. However I just wanted to emphasise that some babies are just like this at first. I was convinced my ds had something wrong with him for ages, but it was just him being him.

Honestly, we have trouble doing the legs of his clothes up now, he's so fat :o

Oh, and ds' head was on the 91st centile. He was a lollipop!

I haven't quite cracked feeding lying down. He had a tendency to bury his nose and tuck his chin under so his nose engages with my breast and not his chin. He then obviously cant breathe easily. I try tilting his head back a little but he resists. We keep persevering though. I also haven't tried pumping during the night. I might give that a go tonight - if it means only pumping once or twice instead of 4+ times then it's worth it.

Larry thanks for that - If the reflux doesn't get any better very soon then i'll definitely ask for a referral.

Having checked his red book again it seems that he may just be little. He's .4% centile for height and 9th for head circumference.

Titania,

He does just sound like a little, cute baby. Ours was around 35th centile for height and 95th centile (!) for head circumference whilst (at worst) 0.4th centile for weight. Given his weight and inability to hold his head up until very late, we had all sorts of fears. However what he had was reflux and a HUGE head.

If he is still coming off the breast in discomfort whilst feeding, I would see someone sooner rather than later. The paediatrician told us that once "food aversion" develops, it takes a long time to go away. Although our son is now a very healthy (12th centile approx) 2 year old, he is still a fussy eater. Better to knock the problem on the head early IMO.

re feeding lying down, lie parallel to him and use your upper arm to pull his body especially chest right up against you. I find this helped to get my ds head to tip back rather than the nose feeding! Wish I'd got it together earlier as feeding lying down gives eveyone a rest.

Good luck.

Titania I also have ds who was and is just little. He is short in stature, 0.4 centile and 2nd in weight. He is 21months now and has been consistent since about 4weeks. He is perfect, and little. He was also a very hungry breastfeeder, I found my notebook from the early days a few weeks ago, and for the first few months he fed 8 to 12times in 24hrs. Just active, hungry and perfectly healthy. And small.

Read with disgust Harper's comments from yesterday. Anybody with a basic grasp of statistics would know that it is just a distribution, and somebody has to be in the lower centiles. It does not mean there is a problem, bigger is not better. Even if the entire population was in fact overweight, there would still be somebody "languishing" at the bottom, that doesn't make their weight healthy. How dare anybody attribute the word "failure" here? Disgraceful. How dare you suggest that constitutionally small children are a result of a "failure"? Or that any mother's choice in feeding is failure?

If your baby is healthy, happy and producing enough nappies, and their weight gain has stablilised, then your feeding sounds ok. If the baby is dehydrated and weight is still dropping, there is an issue. If the baby is unsettled and unhappy there may be other stuff going on, and you are acting on all that.

Hope all works out Titania, sounds like you are doing a great job :)

C'mon ticktock - do you run a BF counselling business? I'm genuinely curious.

No OP, I don't work for a formula company. Again, I wish you luck.

Spag, that's small minded nonsense. Never heard of 'failure to thrive'? You're the one misunderstanding the charts. Go find a medical professional who would recommend that a 9w.o. on the charts at this level should continue being EBF.

Quite honestly, I think MN is a hotbed of quackery. I think it's embarrassing for the board that anyone in favour of FF gets shouted down and asked to leave.

Haven't you read the OP's posts Harper? All the medical professionals involved in her ds's care are happy for her to continue.

You didn't get shouted down for being in favour of formula, you got shouted down for your unpleasant and insulting posts. Even if Tiktok does run a business as well as volunteering, what difference does that make to her advice?

Yes I have heard of failure to thrive, and yes I know that weight is just one criterion used to define it. Specifically the failure to gain, or the loss of, weight, not the absolute position on the chart. As a scientist I believe I have a reasonable grasp of populations, it is a distribution not a quest to achieve the mean.

My DS was on a low centile, and all health professionals were happy with that position as he was clearly healthy and his weight was in keeping with his stature.

I chose to EBF, which is what the OP wishes to do. I do not judge or shout down anybody who chooses something else. But I will judge someone who aggressively, and in a misinformed way, attacks another person for their choice which is what you have done. I disagree with your POV, but even more so I disagree with the way you have delivered it.

This is degenerating into a very silly supplementation vs EBF debate. It is very much a personal choice. Given the stats Titania supplied about her baby, I think that there are a few things that she could try before she supplements, should she choose to do so. Equally, a small amount of supplementation will not destroy the benefits of breast feeding if she feels better doing that.

As Spagbolian says, FTT is defined using various criteria, not just weight. Titania's baby is nowhere near FTT as she is tracking a centile, albeit a very low one. On the other hand, it is ridiculous to attach some negative connotation to a diagnosis designed to get a baby extra help. It is no more a moral judgment than diagnosing someone as failing to stabilise their blood gases before ventilating them.

Nothing wrong with FTT being used as a diagnosis, and clearly this needs to be addressed if the case, and supplementation is a possible and perfectly acceptable solution.

Linking FTT with "failure to see sense" as Harper did is highly offensive and unhelpful, and probably irrelevant in this case from what the OP has shared.