Feeding issues

[BakingBunty]

Our son is coming up for 10 weeks and has been breast fed from the start which went pretty well to begin with. He has now developed apparent feeding related problems and is not gaining weight half as well as he did in the first few weeks. And our community midwife said today that his vinegar smelling nappy (like he's downed a bottle of Sarson's) is because he's not getting enough milk and is producing ketones as a result (like a dieting adult).
Anyway, midwife suggested upping his feeds to every two hours (it's around every 3 hours at the moment, but often less). Here's some of the stuff that happens with our son: When he first feeds he seems to be quite happy but this usually only lasts a short time (3-10 mins) before he pulls away, cries, wriggles, kicks and also draws up his feet. We try to wind him often during a feed. He burps sometimes, other times nothing. At this point we'll often also change him, give him a break and then try again. The unhappy phase may pass and he'll go back to feeding, though usually not for long at all. This pattern will repeat itself throughout the duration of most feeds. Eventually he just loses interest altogether and snoozes or just suckles without feeding.
As a result even though he might be feeding for quite a while, he hasn't taken a great deal of milk. His weight gain has slipped from the 75th centile down to between the 50th and 25th over this time. He totally refuses to take a bottle (from anyone) so can't top him up that way.
In himself he seems otherwise ok. Alert, interested, happy, temperamental, grouchy and very loveable.
Taking him to the GP tomorrow but wondered if anyone had any similar kinds of experience and/or advice?

Does sound like something that need further investigation so good your taking him to see the GP.

I'g agree with midwife and up feeds to at lest every two hours during the day and no longer then 4hours at night to. Offer both sides at a feed and then switch back to first side again, keep switch untill he woun't take anymore. duration of feed it's outside of normal for a baby this age, if at this point you just offered the other side would he happly take it? crying and pulling up feet sounds a little colicly but could just be normal fussy baby behavior to.

Mmmm, I could be completely wrong here but I seem to remember reading somewhere that vinegar smelling poo could indicate cow's milk protein intolerance.

Hopefully, someone else will be along who will know, but this could explain the fussiness and slow in weight gain.

susana-s.hubpages.com/hub/Dairy-Intolerance-in-Babies--Children

The vinegar smell could be a red herring, or it could be an indication of something else. Lactose intolerance is really, really rare and is unlikely. Cow's milk protein intolerance is much more likely and it may be worth trying cutting out ALL dairy from your diet for a minimum of 2 weeks and see what happens.

In the meantime, though, the key thing is to get more milk into him. The slipping through the centiles is fine at the moment but needs an eye keeping on it. Certainly feeding every 3 hours or longer is very long gaps between feeds (timed from the start of a feed to the start of the next).

The behaviour could be totally normal, or could be discomfort, say, from CMP intolerance. It's not really possible to tell from this and I would suggest that you see if there is an NCT or LLL breastfeeding counsellor in your region who could come to see you in person - would that be possible?

In the meantime, keep up the good work and feed, feed, feed. Try to be relaxed about it and not push him, just snuggle up, skin to skin if possible and let him have free access to the breast as much as possible. Can you take a few days just to be with him?

bunty hope the GP helps.
I am not a medic or a midwife, but a breastfeeding counsellor. So I don't know about medical issues. But my understanding is i) that ketosis is indicated by 'pear drops' smell, not vinegar ii) ketosis is very rare in older babies iii) it is a serious condition indicating serious undernourishment - which is not consistent with a baby who is gaining weight.

A move from 75th centile to 25th is within normal and not a cause for concern, normally.
(not sure why you are still seeing a community midwife, BTW - 10 weeks is way beyond the usual area for midwifery support, which ends at 6 weeks at the very outside).

His other behaviours sound normal - in that it's something all babies do at some time. 3-10 mins before fussing is within normal, too. Winding throughout a feed may not be necessary and may be winding him up! Babies usually don;t need help to bring up wind, esp not at 10 weeks.

Honestly, I don;t see the 'feeding problems' you mention - maybe the GP will be able to explain why the midwife is worried.

If there is a cause for concern about his weight, then increasing his feeds will increase his intake. I don't really agree with organic that 3 hours from the start of one feed to the next is a 'very long gap' - not at 10 weeks - but it's true that many babies would have more frequent feeds if they were on offer :)

Hope all goes well.

Thanks everyone for the advice and importantly the reassurance :) GP this afternoon and will go from there.

Hope you'll report back - I am esp. interested in the query-ketosis as it's something I have not heard of in a baby fitting your ds's description.

duration of feed it's outside, sorry that should have read 'isn't outside of normal'

I should read back more sorry.

(it was the "or longer" that I was looking at, TT - meaning I read it as minimum of 3 hours but usually longer - and given the OP's concerns it seemed that more frequent feeds may be worth a go - but can see I worded it too strongly :) )

But it was '3 hours or less' in the OP , organic - 3 hours was the longest gap between (start of) feeds.

Oh cripes - I misread .

Very sorry, OP.

Yes, looking back I interpreted it as every "3 hours... or often less" meaning often fewer feeds than that, rather than less time between feeds.

Either way, also thanks for pulling me up that three hours may well be ok anyway with a 10 week old.

:) no worries