Poor weight gain in a 6.5 month old: Please Help!

[toobreathless]

Hi,

I could really do with some advice. DD is 6.5 months (28 weeks.) She was 8 lb 8 (3.88kg) at birth (42 weeks.)

Since then she has steadily gained an average of 2-3 oz a week, never more than four oz. This has seen her slide down the centiles from almost 91st (birth), to 50th (2/52) & now between 2nd & 9th centile. She was 13 lb 10 (6.22 kg) today. She has been consistently 25th centile for length & 75th for head circumference.

We were referred to Paeds at eight weeks. They suspected CMP Allergy & this was confirmed on skin prick tests. I have been on a dairy free diet since.

DD was EBF until 5 months when under Paeds guidance we began to wean her. I was keen to do BLW but they wanted her to have purees & we have been happy to do this.

She is having three meals a day:
Breakfast: baby porridge/weetabix plus fruit
Lunch: protein (salmon/chicken etc) plus some carbs plus veg
Dinner: fruit/veg

She is having an average of 4-5 BFs a day, always before meals & one at bedtime.

She is happy, alert, not quite sitting alone yet. Sleeps well 6pm till 8am. Paeds are still not happy, they feel she is underweight. For the record I am 5 ft 6, average build. DH 6ft 4 (!) & a total bean pole.

Paeds have recommended a FF a day (neocate), fine happy to do this. I have really had my confidence in breastfeeding knocked. I am worrying she is not getting enough. I rarely leak/feel engorged but I thought this was normal by this stage. She does tend to latch off during feeds but I thought that this was just her getting distracted by her surroundings.

Would it be worth going to the GP for some domperidone to try & increase my supply? I was thinking of joining LLL but the nearest group is 40 minutes away.

Any other suggestions?

Many thanks.

If I were you I'd give her the ff. Formula isn't evil and you are being advised by a pead, not an untrained HV. It might not be your milk that's the problem but they concerned about your DD health. Formula means they will be able to eliminate one thing from the concerns.

FWIW I do found the paediatric staff very pro ff. So i understand where you come from. DD admitted to hospital yesterday. Multiple doctors asked how much she drinks in bottles. They made a funny face when they were trying to put DD to sleep and she wouldn't take a dummy, and that she's bf. Basically lots of offhand comments like this. And DD only 7mo. You'd think it's a common thing to bf a 7mo! Oh and one doc even made the comment how strange she takes a full feed in 5min! He said he thought it's supposed to be much longer.

So yes they aren't really informed about bf. But I don't know if a bf counsellor or lactation consultant are medically trained enough to give advice either.

By 6.5 months, if you had chronically low supply you'd really know about it from her behaviour, though. Is she listless? Does she go through enough nappies? 4-5 feeds, no engorgment, she's not constantly whining for more food/more feeds, all of that sounds like a baby who feels she is getting enough. Domperidone isn't going to help unless you really feel like she's unsatisfied and constantly asking for milk that isn't present, and it doesn't sound like it.

I don't want to discount the weight loss thing, but really by this stage, I would be incredibly surprised if your supply was at issue. You're right that not feeling engorged is usual, as is the distractability. I'm very impressed that she's sleeping through, but of course that makes it harder to get more calories into her.

Try higher calorie purees? Avocado, banana, humous, I assume she is dairy free? Also try breastfeeding after solids, she might eat a bit more but will still fill up with you - which is how it should be, of course, your milk is the most calorific thing she'll get.

Lilham, my DD was admitted to hospital at 4.5 months, and every. single. nurse that we saw - and we were there a week, so that was a lot - tried to give her a dummy despite me saying, she's unlikely to take a dummy. They didn't like the fact that she wasn't on bottles because they couldn't measure if she was getting anything, and we had some real problems with the fact that she was hard to settle in a cot, being used to co-sleeping. I guess all of those attachment parenting things are fine until you can't be attached for some reason or other!

too breathless Im in a v similar situation to you right now and totally sympathise. My DS is 24 weeks, was born at 8lbs6 and is now just 14lb12 having pretty much stayed weight static since August - he's on the 9th centile now...He's now been diagnosed as CMPI too, and like you am dairy free (DS won't touch the Neocate!), and I think they do gain weight at a slower rate.

I too had terrible concerns that I didn't have enough milk as I had a tough time BF to start with, and suffer a lot of blocked ducts, but LC assured me this is not the case. Agree with tortoise your DS would be listless and crying for food if hungry, but she sounds like she's doing fine!

I know it's terribly disheartening when everyone else's babies seem to look twice the size of yours (god yes I do!) but sounds like your doing well with the feeding, hopefully your DD will take the Neocate, and will gradually put on weight - may also be she is just a slight framed thing too and just not built to be a heifer!

toobreathless - it's difficult and confusing facing a situation like this :(

If the paeds think she is short of calories then formula is only one option among many - it's a medicalised option to select a specialist formula, and it's not surprising this is the one they have proposed. There's nothing terrible about the suggestion and of course you feel fine about it, but you could ask about other options and get them to explain why and if they are not suitable.

Other options:

• increase calorie intake by increasing breastfeeds either in frequency, or by 'switch nursing' and swapping breasts a few times each session (this in itself would increase your supply - no need for meds to do this)

• increase calorie intake by making the solids she has smaller in quantity but more calorie dense - fruit and veg are fine but depending on the ones you use, large amounts are not calorific but could replace breastmilk. Decrease low calorie fruit and veg and instead offer banana, avocado , potato. Salmon and chicken you are already offering - fine

• consider adding cheese to your dd's food

Most babies who have gone down the centiles like your dd are actually fine. They do merit checking out, and it makes sense for the docs to discuss her intake. It does not sound as if they are terribly worried about her - and your description shows a healthy, active, happy baby who is the size she is because she is 'meant' to be that way :)

lilham HVs are VERY highly trained - just not (as standard) in breastfeeding. Paeds are the same - very highly trained but not in breastfeeding. HVs can say bloody stupid things - as can doctors - but it's important for people to understand that they're both very highly trained. Just not in breastfeeding.

Lactation consultants (ie IBCLCs) are very often (and soon to be always) medically trained. Breastfeeding counsellors (NCT/LLL or ABM certified) are not necessarily so. Both, however, are clearly given boundaries and they absolutely should and do work with and alongside the medics, basically filling in gaps that the medics have because breastfeeding is the speciality of the LCs and BFCs.

In this case there's a combination of possible pathology (CM allergy) and concern from the OP about her breastfeeding. Seems to me that a combination of support from people in both areas of expertise would be the ideal way of finding the best solution.

If the baby is alert and happy and making good progress in other areas, why this much focus on her weight? I do sometimes think that the professionals just like to see everyone progressing within the guidelines they have set down, but they fail to remember that every baby is an individual and just as some babies will be off the scales when it comes to weight gain, some babies will be under it.

If your baby was not feeding and lacked energy then you might have a cause for concern. However your baby is gaining weight, albeit slowly.

You are the mother and you know your baby best. If you want to continue breastfeeding then do so. Just because they have lots of qualifications it does make them gods in this area. There is a stupid presumption in the medical profession that breastmilk is somehow lacking and whenever there is concern about a baby's health, whether that is sleeping, feeding, weight gain or pooing their first suggestion is usually to swap breast for formula. I even had one qualified GP who specialised in infant health telling me that because I had to stop breastfeeding because I was taking anti-biotics for mastitis. I walked into the chemists to buy some in tears, but thank God I came onto Mumsnet and asked first.

Your breast milk is specifically tailored for your baby and your baby's needs, so carry on with that. Make sure that your baby completely empties one breast before going onto another because your first milk is the thirst quenching stuff and then the second milk is the calorie concentrated stuff, so don't just swap halfway through. Make sure she empties that breast.

Plenty of rice, bread, pasta and other starchy foods. It might be an idea to cut out glucose too and see how that goes. Drink only soya milk for now and buy some 'Free From' foods from Sainsburys.

Don't let these professionals push you around. You sound like a great mum and you alone can see how your baby is day-to-day and if your baby is energetic, curious, sleeping well, feeding well and soiling her nappy regularly then I don't really think there is anything to worry about. She may always be on the small side, but is that so bad?

"Plenty of rice, bread, pasta and other starchy foods. It might be an idea to cut out glucose too and see how that goes. Drink only soya milk for now and buy some 'Free From' foods from Sainsburys."

Why?

Free from - yeah - dairy free stuff for sure. Soya not so much - some babies who are allergic to dairy can also have a problem with soya. Oat milk might be a better option, or you can have rice milk (she can't until she's over 4).

But why starchy foods? Why cut out glucose?

Because glucose is another common allergy so it might be an idea to cut it out and see how she gets on with that. I know loads of kids with glucose allergies now.

dd's friend is allergic to dairy but can happily drink goats and soya milk.
And starchy foods because they tend to be calorific. Normally dairy would boost your calories but since she can't have dairy then starchy food might help. She could make rice pudding with soya or goats milk with a fruit puree.

Just a suggestion.

Thank you so much for the replies.

Tortoise: she is a very alert & lively little thing. The kind that deliberately smiles & plays up to strangers. Definately not listless. She doesn't whine particularly & sleeps very well. Yesterday we went swimming & she kicked her legs & splashed for a good 20 mins. she is considered by others to be an 'easy baby.'

Taranta: so sorry you are going through this too.

Tiktok: I will definately give switch nursing a try. WRT purees I try not to give endless low calorie purees. She is dairy free so adding cheese isn't an option. The dietician did suggest adding a teaspoon of olive oil to her purees once a day.

In the cold light of day I think the problem is threefold. I think she had an artificially high birth centile due to her being 15 days late. I was told to prepare for a small baby (she measured a bit small) had she been born on the 9th centile everyone would be happy. Two: she sleeps so well that she really only has ten hours to try & get an adequate intake into her. Three: lack of dairy makes her food not as calorie dense as it could be. I don't think BF is the problem but am finding it hard not to lose confidence.

Paeds are quite concerned, we are seen every two weeks for weigh in plus dietician/consultant review.

I think a simple solution to keep everyone happy might be waking her for a FF at roughly midnight. I also plan to give switch nursing a try.

Sorry, daft of me to suggest cheese with the dairy thing!

Not sure why you would wake her at midnight to give a ff - if you are happy to wake her, in order to boost her intake, why not a bf (easier, for a start :) ). Please don't fall for any notion that your breastmilk is not calorific enough.....

Topping up with ff sounds like a good idea.
Could you not try a mild goats cheese? Olive oil sounds like a gross idea that may just put her off her purees for life! Try tinned sardines instead with plenty of tomatoes. You can puree it into a paste and put it on toast.

Oh and eggs - eggs are good.
And wot tiktok said.

It's totally normal for babies to fall down the charts after birth, thier birth weight is not an indication of thier natural genetic weight/size, it just shows how well the placenta fed them before they were born.

My ds (9) and dd3 are on the 9th percentile, ds was prem but dd3 was born on the 50th percentile then dropped to the 2nd (due to severe reflux) but since that has resolved she is still settled on the 9th. My two other daughters take after thier dad and are 99 percentile and have been since birth. Ds went up to the 75th percentile when he was a baby as I was advised to wean him early, and top up with formula, but as soon as the formula stopped and he was regulating his own food intake he dropped straight to the 9th again which is his natural size, he's small for his age (my 6 year old dd is bigger than him) but he's as healthy as a horse, full of energy and eats like a horse.

Try not to worry, I think looking at the baby and not the scales is always the way to go, as long as they are healthy, happy, alert, weeing/pooing regularly then everything is fine. Health proffesionals get too caught up in looking at the weight and asking someone to overfeed thier child when there is no diagnosed health issue causing weight loss to make them put on weight is silly. Your baby eats enough and is getting lots of milk, why do you need to top up? Your breasts are settled now, they are producing exactly what she needs rather than making too much which they do early on, they are not underproducing, it's normal for your breasts to be soft and not leaking at 6 months.

I got so much hassle with dd3, in the end I just stopped getting her weighed and dealt with her milk protein intollerance which was causing the reflux and she is thriving, just a tiddler.

Tiktok: Paeds are very keen for me to give a FF & I don't like to be seen to be not following their advice. That is the only reason.

Rhubarb: DD has a positive (immune mediated) skin prick test to cows milk protein. We have been told (by dietician) that given the potential severity of the allergy not to give goat/sheep foodstuffs. I like the idea of the tinned sardines.

Have to add that the dairy allergy won't cause weight loss unless your baby is throwing up alot (dd3 was like the exorcist until I went dairy free).

The domperidone is an option but it doesn't sound like you are underproducing, your baby would be very angry, frustrated and upset at the breast if you were. I'm not breastfeeding anymore but I am on domperidone as a treatment for gastric problems atm and I'm leaking like crazy so it's worth an ask if it would put your mind at ease but honestly it doesn't sound like you need it from what you have posted.

To bump up dd3's fat/protein content in her dairy free diet (she can tollerate cooked milk now at 18 months so not as important now) I used to give her peanut butter sandwiches. She was more or less on a vegetarian diet at the time as she had no teeth until after she was one so couldn't chew meat very well, lol.

I can understand that, breathless - you don't want to appear perverse in the face of people who are clearly caring and doing their best :)

It's just there is an illogicality in offering formula of any sort and wondering about using meds yourself to increase supply....if you think your daughter needs you to make more breastmilk/take in more breastmilk, then bf more often ticks both boxes, and formula neither.....yes? :)

breathless your DD sounds like my DS - a really chipper little soul once the CMPI diagnosis was realised and my diet changed. For what it's worth my DS simply won't take the hypoallergenic formula, so I am breastfeeding him on a dairy free diet - he is now starting finally to gain weight, albeit slowly, without weaning (it would be early in his case, I tried a little and it made things worse) so it goes to show it is perfectly possible to make a difference on BF alone.
I have of some of the posters here to thank for their advice and persevering even though my HV and paed looked aghast in the first instance, and would still probably rather I got him to take the Neocate for a quicker weight gain organic carrot cake and tiktok - thanks!

I'd agree with tiktok. I think the peads just wanting her to get in more caleries and if that is the case then waking her for a BF is probably better then offering FF. You may espicly find it difficult to get her to take the formula as they do tend to be strong tasting, a baby who's not had this type of formula before by this age may just refusse it due to the tast. I guess I'm trying to say it would be way easier for you just to feed her more then trying to mix things up.

Would not suggesting to the pead you try adding in an additional Bf in the night and try that for a few week's then if it's not working try the FF. They may be a bit more leant if you don't just say no you woun't try the formula.

Might also be worth politely asking why they are suggesting FF rather than additional BF. Just knowing that answer could give you some guidance. If they say it's because there's no enough calories in BM you know it's them talking crap. If it's because (say) they want to remove all traces of CMP from her diet, then there's logic there - while you do so so that no traces will come through your milk (takes about 2 weeks).

Sardines are a great suggestion.

rhubab I thought you were suggesting that breathless ate the starchy foods, not the baby... which confused me because I thought that you were implying that this would improve her milk quality, which is not true :) . You mean the baby though? Well, high fat foods are better really, for little ones. Glucose I'd not heard of - very interesting, I'll look into that. Soya can be a problem for those with CMP problems but not for all (same as goat and sheep milk can be ok but not for all).

Noooo, I meant for the baby! Sainsbos does free from foods which includes free from dairy products and their pasta, rice and bread ranges would also be ok for weaned babies I should have thought. I used to give mine chopped up pasta with boiled tomatoes all mixed into a paste and they loved it.

Do you mean gluten btw? Not glucose?

Dunno - do you? You wrote glucose originally .

Gluten - makes more sense than glucose . Yes, I have heard of babies being intolerant of both dairy and gluten, but on the other hand this is dairy allergy which is different. I don't know if they're linked (medical stuff really).

Free from range is very helpful, I agree. I used it a lot when DF for DS2 as it's just easy to know there's nothing hidden in it.

Oh shit did I? I meant gluten obviously I blame my sneezing fits, I've been sneezing all day today with a streaming nose and watery eyes. It can't be hayfever at this time of year but it is really getting on my tits now and making me type the stupidest of things!

Aww you poor thing :( OK, well I understand now .

To clarify: DD was diagnosed with CMP allergy at 8 weeks & I have been dairy free since. Me going dairy free made no difference to her weight gain but she is generally happier & is less sick. She has also had skin prick tests which showed a strong positive reaction to milk.

Tiktok: you raise some good points & I appreciate that going to the GP for domperidone on one hand & giving a FF at the same time is silly.

Deep down I suspect my supply is fine. I wanted to breastfeed & want to continue doing so, so much that I worry that my desire to BF blinds me as to what is best for my baby. I have these flashes when I think 'what if I am starving her?' clearly I need to pull myself together!

I have fiddled around today & worked things out so that we now do 5 breastfeeds & one FF a day. (was doing 4 BFs) in addition to three meals a day. The baby never stops eating :)

Ps: meant to add that my aim if she gains well over the next few weeks is to the slowly phase the FF out, leaving us with five BFs a day.