Two week old losing weight

[porpentine]

My son is 15 days old today. 4 days after the birth he had lost 275g of his birth weight. 3 days after that he had gained 60g, but he only gained another 20g over the next 8 days and today (1 day later) he's actually lost 40g.

He falls asleep a lot at the breast, so even though feeds were taking 40mins-1hour (1 breast) he wasn't actively sucking for all of that time. The HV said to feed him every 2 hours for 10-15 mins a side, then express from both breasts and try and top him up with that. I've been doing that today and the main result has just been that he now cries inconsolably after each feed because he seems unsatisfied. I'm expressing hardly anything - less than 25ml so far today - and have only persuaded him to take the bottle once.

He also hasn't pooed in almost 20 hours now, although he is still peeing frequently, so obviously there's something wrong. He slept 9 hours on Sunday night, which might be the cause of the loss, but I was waking him up every 3-4 hours last night to feed.

Feeling a bit tearful and desperate - any advice?

You could try switch nursing - everytime he falls asleep at the breast switch to the other side to keep him interested. You can switch multiple times in each feed til he seems satisfied. Basically just feed him as often as possible, and offer as many sides as he'll take at each feed.

My ds was a sleepy baby at first and I fed him at least every 2 hours in the day and 3 hours at night for the first couple of weeks until was sure he was gaining weight.

I don't have any experience of expressing but it sounds like a lot of work when you could just put him back on the breast.

Is he feeding ok, is it comfortable for you? Has he been checked for tongue tie?

Ok. You're having a rough start here. It's understandable that you feel tearful and desperate!

First of all, all these weighings, are they naked, on the same digital scale? Because otherwise, these sorts of changes may well be down to differences between the scales. So I wouldn't get too worried about that.

How much did your son weigh at birth? He's still a under his birth weight now? That, combined with the lack of poo, suggest that he could be not getting quite enough milk.

You're doing right to wake him up to feed, given the situation.

The expressing doesn't sound like it's suiting you both, though. It's not really an idea I'd recommend. Is lots of skin to skin an option? That might encourage him to feed more.

Have you heard of breast compression? That might help him get a bit of more milk when he feeds. (google it - there are good videos)

It might also be worth swapping breasts when he falls asleep ...

You might do well to call one of the BF helplines if you are in the UK. Any idea which BF group provides the support in your neighbourhood?

Do the feeds that he does, hurt at all?

My LO kept falling asleep as well during the first week or so. I found that every time the sucking kept tailing off, I stimulated her by making a round and round motion on her back just to remind her to keep on going helped.

Gosh, thanks - so nice to get advice. The expressing IS a lot of work - obviously I'll do it if it works and gets some weight on, but he overall seems less happy than when I wasn't doing it, so...

Some of the weighing has been on different scales but yesterday and today was naked, digital, same scales, so I think it must be accurate. He weighed about 3.3kg at birth and is about 3 now - he's hovering at around an 8-10% loss which isn't picking up.

The feeds themselves are fine - don't hurt on the whole, sometimes when he's cross in the evenings and pulls himself off they get a bit sore. Part of the reason I'm surprised is because he actually attaches and sucks very well and it's always been really comfortable and easy, plus he used to eat all the time - I was on demand feeding him basically every 2-3 hours anyway - so it never occurred to me that he wouldn't be putting on weight.

The switching sides thing I'll definitely do, moving breasts always perks him up anyway. The HV said the point of expressing was to stimulate supply, but presumably switching him over will do that equally well. She was also concerned that if he's at the breast a long time and not getting much milk, he might be expending loads of calories sucking and so expressing was supposed to get around that.
I do feel like I have less milk than I used to - they used to drip in between feeds and they don't anymore - but there's always some there when I put him on.

I realise I've been doing a bit of compression on the advice of another midwife, but not very scientifically - I'll do this more thoroughly. Skin to skin also a good idea, I've been feeding him in his vest today but we'll both take more clothes off next time.

portentine - it's good you are tackling this as it is a real concern - your HV is right that long unproductive feeds and long sleeps are absolutely not good.

2-3 hourly feeding is often not sufficient, and a baby who sleeps long hours may be doing so not out of contentment but to preserve energy, so it's good the cycle is being broken.

The HV's suggestion (feed often and then express) is ok, but it may not be enough. Switch nursing, frequent feeding skin to skin, feeding through the night - all these are important, emergency measures to preserve your bf and to ensure your baby gets calories.

I would still be concerned, though, if you are not expressing enough to top him up sufficiently. When is your HV visiting/weighing again?

Switching (and compressing) will do more to stimulate supply, than expressing will, I think. It doesn't sound like he's expending much energy sucking - it sounds like he's sleepy, instead.

Skin to skin should wake him up a bit, and get him feeding more.

The amount of poo he makes is a better indicator of how things are going, than the weighings.

To increase your supply, regular feedings, particularly at night, are the best thing. Where is your DS sleeping?

NQC - expressing and switching and compression is the way to go....the expressing (done often enough and effectively) does stim. supply - no idea if this would be more (or less) than switching and/or compressing (how do you know?).

Gotta disagree with you about weighing being less indicative than poo - not at this age (14 days). Poo is very useful in the first week to 10 days, when weight is a bit all over the place but even then, you'd not want to see a baby losing weight. At this age (14 days) you want to see weight loss stopped, weight gain started, and poo would be part of the 'jigsaw'.....but even if the baby starts producing lots of yellow poo, it would still be a good idea to weigh to get the whole picture.

She's visiting again tomorrow morning. DS usually sleeps with me for a bit of the night and then in a crib by the side of my bed.

So every 2 hours I should be skin-to-skin switch feeding while compressing until he seems satisfied, THEN expressing, then trying to top him up with that? Does that sound right?

He was pooing frequently, but as I said he hasn't had a dirty nappy since approx 10 last night.

Thanks everyone, I really, really appreciate your help.

Also: if I do the switch feeding I imagine feeds are going to take the best part of an hour. Will I have enough milk to restart feeding an hour later?

porpentine - you don't need to worry about 'leaving time' for the milk to be made. The more often you feed, the more quickly the milk is replaced - that's how it works :)

That's why when people leave long gaps between feeds, production slows down and less milk is made.

Yes, feeds will take a long and fiddly time :(

But what you are doing at the moment is 'rescuing' the situation. You will not need to do this forever.

Ah, I remember those early days of feeding for an hour then starting again an hour later! Some days it wasn't worth getting out of bed

Feed times did get shorter though, dropping to about 30-40 minutes after the first few weeks. My ds was always a slow and frequent feeder - every 2-3 hours, and even at 12 months took about 20 minutes to feed.

As tiktok says, milk is replaced as it's taken, so no need to worry about filling up.

Sure, expressing on top of feeding makes sense - but limiting feed times, and then expressing, doesn't sound like a good idea.

And YY to not worrying about leaving time - milk is always being made. And the more time your baby spends feeding on a (relatively) soft breast, the fattier milk he will get, and the more your production will be boosted.

ok, so i've now been switch-feeding for a good hour and a half. he still seems pretty keen and cries if i take him off the breast. should i just carry on? when should i start the next feed?

and do i still need to express? I've taken him off now because he was losing interest a bit, although not at all sleepy and now crying heartily. i'm supposed to be doing the next feed in half an hour, should i?

If he's happy on the breast then I'd let him stay there - could be a comfort thing as well as feeding, can you hear him swallowing? Then I'd probably just not let him go more than a couple of hours between finishing this feed and you offering again.

Yes, keep feeding him . He sounds hungry. It's normal for babies to want lots of little feeds at small intervals, and actually if he is more fretful this may be a sign that he's getting more now and becoming less sleepy and more demanding. This is a good thing as it will help you to catch up psmile], but it is hard work and tiring, so well done.

Does it help to think rather than that he has "a feed" every x interval, that he "is feeding" on and off frequently?

Could you think about expressing when you feel he's no longer feeding effectively? There are some useful videos on this site that might help you guage good drinking -looking for signs of swallowing. It might also help you to work out whether there are any tiny improvements you can make to his latch. It's not just about how comfortable you are, although that is important, a baby who is well attached will get more milk more quickly than one with a slightly less good latch.

Keep going, you're doing the right things.

Nursing teas won't harm but I have never seen any good evidence they really help....apart from possible placebo effect, of course :)

NQC - I understand about the apparent futility of limiting the time at the breast each session. Sometimes, this is necessary, so the baby does not expend energy, and becomes unable to take the supplement - no idea what is happening vis a vis this with the OP, of course....and we have to remember the HV has seen the baby and observed feeding (and HV also sounds as if she has a clue, too, which is a good thing :) ). If the baby is actively transferring milk effectively, no need to limit time. It all depends on what the baby is doing, really.

Ok, he's gained 40g this morning so clearly something's working. Those videos are very helpful, thanks - I think he's pretty good but always room for improvement. The HV enthusiastically seconded the switching breast thing, which has been working really well, so hopefully things will continue to improve.

Thanks everyone, really helpful!

Sounds good, porpentine :)

Great, keep going! It's a lot of work. but it won't be like this forever. Hopefully a snuggly breastfeeding-intensive Christmas week will help sort it all out . Some babies take a little while to get going. What sort of birth did you have?

Your HV sounds like a keeper .

c-section, with quite a painful recovery which hasn't been helping.

About having enough milk: the GP claimed that every 2 hours was too often and it should be more like 3-4hrly. In fact I've been doing every 2 hours or more often if he seems hungry, feeds of about 30 mins switching back and forth between breasts. Will the milk be too thin do you think?

I don't know any bf babies who managed to last 3-4 hours between feeds - think your GP is thinking of formula. Formula is hard to digest so will sit in a baby's stomach for hours whereas breastmilk digests much more quickly (I've heard about 90 minutes).

The longer you leave between feeds, the thinner the milk will be. Feeding frequently means the baby gets fattier milk.

Shame your GP is not more clued-up, porpentine - 3-4 hrly is rarely enough for any baby (and most adults eat or drink something rather more often than that, anyway).

The fat content of the breastmilk increases the emptier the breast is; frequent feeding keeps the breast relatively empty and the milk has more calories. Infrequent feeding leads (in the short term) to full breasts and the milk is proportionately waterier - you can see a better, fuller explanation at www.kellymom.com. In the medium/longer term, infrequent feeding leads to less milk.

Hope things continue to go better for you :)

Ok, good, because it just seems crazy to not feed him when he's obviously hungry.

Just one more quick question, if you don't mind... I've started getting shooting pains in my breasts. They're not particularly hard, what do you think it could be?