Baby not gaining enough weight...advice please!

[TeaBaggy]

I have a little boy who is 10weeks old. until now i have been exclusively breastfeeding, sort of on demand but not letting him go more than 3 hours without a feed except at night. his weight gain has never been as good as hv would like and has gained an average of 3-5ounces a week. i feed him from both breasts at each feed and AM NOT dieting/restricting my calories. i didnt have him weighed last week cos he was a bit poorly (chesty cough, bit miserable but no temperature) so we stayed home in the warm apart from to go for his first lot of jabs (which made him even more unsettled).

anyway today i go to get him weighed (for the first time without dp, so feeling a bit nervous) and he weighs the same as he did a fortnight ago. hv asks me if im dieting, i say no but he has been a bit poorly. she tells me (again) to up my calories. she weighed him twice, which he didnt like, started crying while i was talking to her/getting him dressed. she said she thought he sounded like he was crying cos he was hungry (i told her id fed him only an hour before). then she asked if i would feed him so she could watch as he has now dropped from 75th c at birth to being on the 9th c so she is quite concerned. i tried to feed him but he was still crying and wouldnt latch on or settle, she tutted and said it was because he was getting fustrated by sucking and not getting any milk, and was it usually like this (its not). in the end she arranged for a hv to come see us on friday to make sure he is putting on weight cos if not "we will have to do something about it".

i had to take off my wrap id carried him there in to feed him and had to put him down to put it back on. he screamed blue murder the whole 20mins i was there and i left feeling like a total failure with what seemed like the whole room watching me unable to calm him.

i have been out and bought some formula in my despair and he has had 3 formula feeds and 2 from me since lunchtime as i really want him to put on weight. I really wanted to breastfeed until at least 6months ish and now dont no what to do as his weight gain has never been on track and i cant help wondering if he would be better off being bottle fed from now on. i have no idea how to to combi feed temporarily (if that is even possible) without making my milk supply drop.

all advice is really appreciated. sorry for the long post, didnt want to drip

I'm so sorry you feel like this, and that you aren't getting proper support on greasfeeding from your midwife IMO.

You need ticktok, she's a mumsnet regular and a BFing counsellor I think!

HVs aren't actually Bfing specialists!
Much better to speak to La Leche League I've found them to give great advice via their helpline 0845 120 2918

I'm sorry your HV has made you feel so undermined too.

Do you know if your HV is using the right charts BTW? There should be different charts for formula-fed babies and BF babies, as FF babies put on weight quicker (possibly overfed, some think!), but the charts based on FF babies were standard until fairly recently in some places I think.

news.bbc.co.uk/1/hi/health/4938234.stm

"i cant help wondering if he would be better off being bottle fed from now on" I doubt it. I think you need more support with BFing, you've done brilliantly well to get the milk established.

This might be interesting breast milk / forumla milk - differences

I suspect what the experts will say is to just strip off and lie about in bed doing skin to skin for a while and letting your DS feed on demand.

Especially if he's ill - my DS always wants to feed more when he's ill.

Did you know your body takes in a little of the infection while BFing, makes antibodies and gives those antibodies back to him? Amazing! (I thought we just gave them some at birth before, but no, we carry on making them as long as we BF). Show me a bottle of formula which does that!

Perhaps his losing weight is related to him being poorly and the dr should look at that?

Our culture is sadly pretty anti-breastfeeding, for a number of dubious reasons. HVs in the UK often seem to let their British cultural influences override their medical training and the advice of organisations like the WHO when it comes to BFing, IMO.

thanks tiny, had a pretty rubbish day an not sure if im really thinking straight to be making these decisions.

I have no idea if the charts are right or not, there is only 1 chart in his red book, not a choice of 2 depending on feeding method. my green nhs book says breastfed babies should gain 5-7ounces a week on average. he has gained 1.1kg since birth (2lb7) and for him to have stayed on the 75th c he would have needed to have gained 2.4kg (5lb4), which works out at about 7ounces per week.

im trying to hold off on making a decision about how to feed him but obviously want him to have gained some weight by friday, and dont want my supply to dry up. hopefully some more mnetters will be along with some advice in the morning.

should just add that i really want to keep breastfeeding but am just worried about his weight, this hv has told me on several occasions not to diet and to 'eat more cake'. todays disaster visit just pushed me over the edge...hormones im sure dont help.

im worried if he hasnt gained weight on friday they will interfere even more and try and make me formula feed

i did research formulas during my pregnancy just incase and am happy with my choice but really want it to be a temporary top up to get his weight up a bit

he is alert and seems content most of the time. he reaches out towards hanging toys and his grip is good. he is quite long and thin looking (for a baby) but has been since birth. plenty of wet nappies.

compressing boobs???

Sorry to hear you are having such a hard time with this and your health visitor is being so unsupportive - she should be making you feel like she is on your side, not as though you are doing something wrong.

Weight is important but the charts are not the be all and end all, whatever your health visitor says. If your baby is gaining weight, has plenty of wet and dirty nappies, is alert and feeding happily then chances are all is well and he is just not following the curve. If he was on the big side when he was born then maybe you just have a very efficient placenta and he was never meant to be on the 75th centile! Dropping down the centimes is not the same as losing weight and 3-5 oz a week sounds not too bad to me.

There is nothing wrong with giving a bit of formula if you want to, and it needn't mean the end of breastfeeding. I added formula top ups occasionally when my refluxy son was 10 weeks and managed to keep on breastfeeding about 80% of the time until he was 6 months.

Please don't doubt yourself, it sounds like you are doing all the right things and your baby is thriving, just not following the charts.

What a stressful experience. It is very difficult when your baby isn't gaining weight well and can be a very emotional experience for a breastfeeding mother. Your HV's advice about your diet and eating cake has no relevance whatsoever! Unless you are close to starvation, you will still produce sufficient milk. It is perfectly fine to diet when breastfeeding.

When you give formula it is important to try to express your milk, even if you are not getting very much, you are sending the signal to your body to continue producing milk.

It would be a really good idea to see if you can see a breastfeeding supporter to have the latch checked to rule out any problems there which may be interfering with the transfer of milk.

Plenty of skin to skin contact will help to increase your milk supply and encourage baby to feed more frequently. If you can, having a baby moon period where you spend a couple of days in bed with your baby in skin to skin contact and feeding as often as possible.

Before you see a weight gain, you should start to see an increase in wet and dirty nappies. If you are able to increase the breastfeeding and see this change by Friday, the weight gain should follow.

Did your baby lose weight after birth? The centile the baby was on at the lowest weight is the one he should be following rather than his birth weight, if he lost weight.

Does he have a dummy? This can reduce the amount of breastfeeding so is best avoided.

Poor you, step away from the HV! IME they usually have absolutely no idea what they are talking about and are often hopelessly out of date.

DS didn't gain any weight for 4 weeks at around the age your little one is - it is very common for ebf babies not to gain at some point. Try not to worry at this stage. And try to get a visit from a trained bf counsellor - in my area they were falling over themselves to come and see me - even without my asking. I guess it depends how hot your surgery is on upping bf rates.

Just one thing, I do remember saying "but he can't be hungry, I just fed him" a lot with DS and often resisted feeding because I didn't believe he was hungry when really I should have trusted him to decide. Sometimes they do snack every hour for a whole day - who knows why - but it doesn't last forever.

I really hope you get some support and, above all, that you are able to bf a bit longer as it seems you really want it to work out.

thanks everyone, might miss some stuff but will try to answer questions as you are all being so helpful in the middle of the night.

have a mam hand pump for expressing. used it sucessfully for a week or 2 before xmas but then found i wasnt getting much and what with the busy xmas period was time consuming for what felt like no reward so havent tried to express for a while.

have had the latch checked by midwives and hv on several occasions due to his slow weight gain and have always been told it is fine. he sticks his tongue out when i do so not worried about tongue-tie

he didnt lose any weight in the first weeks. at 5 days his weight had stayed the same and then at 13days he had gone from 8lb10 to 9lb4.

we do use a dummy but only as a last resort, he is quite a windy baby and it seems to help. quite often now he will pull his dummy out and try to put his whole fist in his mouth

Oh dear :( I'm afraid any health visitor who asks a mother about her own calorie intake, advises her to increase it and to eat cake is showing how very little she understands about breastfeeding and milk production.

Your own calorie intake is irrelevant - unless you are literally starving to death (and you are not - I do mean literally, by the way).

A drop in centiles needs to be investigated, for sure - the majority of babies who drop through centile spaces like this are, however, just fine, and are merely that way 'cos that's the way they are :)

If it's thought your baby needs to gain weight more quickly than he is doing then the simplest and most effective ways to do this are
i) offer at least both breasts at every feed, switch nursing so he goes back and forth
ii) breast compression
iii) more frequent feeds including at night

With a healthy baby in no urgent need of weight gain, there is rarely any need for formula, once these measures are taken. Any of the breastfeeding helplines (numbers on the mumsnet bf page), any breastfeeding supporter who knows her stuff, any health professional capable of doing her job of supporting breastfeeding, will outline the same info about how to increase a baby's weight gain.

If your HV is actually worried about his health, she should still be capable of giving you better breasteeding suport and advice.....and you may be better off with a HV who can do her job better, if you have this choice.

Hope this helps :)

(clanger - there is only one set of charts in use in the UK. Nowhere uses two charts, and the same set of charts is used for bf and ff babies).

and if i want to top up with formula rather than give him 1 or 2 full feeds then how much should i be giving him? and how often?

thanks tiktok, it is a drop in clinic so its pot luck which hv you get. she said increasing my calories would make his milk more calorific (sp?), like drinking full fat milk instead of semi was the analogy i think she used.

until today i wasnt overly worried about his feeding

Sounds like a horrible experience, you have my sympathy. Dont let an incompetent HV scare you off bf-ing though if its what you want to do. I had my DS1 in the UK (I live abroad now) and got pretty much the same treatment as you described, I was scared into giving him formula, my supply went down and he ended up on 100% ff pretty quickly, I was really depressed about it. DS2 is now 2 months old and bf is going great, and he is really fat. One thing that is making a huge difference is that in this country babies arent weighed as much (and there are no scary HV's). I am not suggesting you stop weighing him, I just want to point out that for me, it took away lots of pressure, this time I havent been fretting so much and its been much easier. Two other ways, apart from weight, that you can get some reassurance about his growth is to count the number of wet and dirty nappies per day (make sure you quote it back confidently to the HV on Friday) and gently run your hand across the baby's head to feel his fontale (soft spot) it will be more dipped when he is hungry/thirsty) so if you notice his head feeling nice and round after a feed you can feel confident he is well hydrated/fed. If you use these techniques and feel yourself that your baby basically happy and well hydrated, then dont let someone waving a chart at you persuade you that there is a problem when there isnt. If you have to smile and nod, and total ignore the advice to FF!

If you feel your supply is low, try taking fenugreek capsules, you only need to take them for a couple of days (until your skin smells funny) then you stop, they will help give you a boost. I use them for growth spurts to help milk production catch up with demand quicker.

and one more thing... I just saw this on another thread and it seems relevant "Whatever hcp's tell you is just advice it's not the law"

oh, and regarding the comments about your diet, its well documented that even malnourished women in famine situations can successfully bf their babies who are not at risk of malnutrition themselves until they are weaned. This HV clearly knows nothing about bf-ing, I would take all her "advice" with a pinch of salt.

x posts - and now tictoc is here. You are in good hands

thanks everyone, the support means a lot.

right off to try and get some sleep before he wakes up at 4ish. will check back in the morning.

TeaBaggy: if there is an HV you like and trust next time, tell her what the other one said to you.

You cannot make breastmilk more calorific by eating more yourself. Honestly, it is a disgrace that an HCP should be saying this to mothers. The calorie content of breastmilk does vary - not between individual women, though (it is pretty much the same) but according to the volume of milk in the breast (see www.kellymom.com for a more detailed explanation. No one normally needs to worry about that of course - the baby sorts it out :) It's just to show you how many million miles away the mother's intake of cake and milk is from having an effect.

(mummyabroad -counting wet and dirty nappies not relevant at this stage, sorry. The baby is 10 weeks - he could have anything from 6 poos a day to one a fortnight and still be normal! Counting wet nappies - useless as you don't know how many wees would be in one nappy :) It would be worrying in a baby of any age if nappies were often dry after a few hours, of course. Don't agree with the 'checking fontanelle' thing at all , sorry - it's very difficult to tell dehydration this way if you are not experienced and trained in it, and a dehydrated baby shows other signs....this is not the concern with this baby, who is presumably ok from that angle. It's growth that's the concern. I appreciate you wanted to help, but other people might read and be a bit misled :) )

Oh poor you I'm going through exactly the same thing so can really sympathise with how scary and stressful it can be. HVs certainly have a knack for hitting the panic button and making you doubt yourself, which in itself won't make for successful feeding .
I don't want to worry you, but my story is similar to yours (weight gain v slow an dropped through centiles) and my DS ended up having tongue-tie despite the latch being checked and pronounced to be 'fine' by numerous HVs and MWs. I had no nipple trauma and no other outward signs that anything was amiss so it might be worth checking. The only advice I can give is get help from a true professional who is qualified to advise on breastfeeding. HVs, MWs and GPs tend to have a very 'general' knowledge of the subject and sent me in the wrong direction of panic and self doubt a few times. I wish I'd done it sooner. Ask them to refer you to the infant feeding specialist at the hospital or go and see a lactation consultant or breastfeeding councillor. Hopefully they will give you the support you need and help you set up a plan of action that actually works...... Eat more cake...... Honestly!!?! Mind you, nice to have an excuse . Just remember you are the mum and no one can do your job better than you! Hang in there, and hold on to the fact that your little one IS gaining weight and is hitting development milestones so you must be doing something right.

Bloody autocorrect!

*Breastfeeding, breastfeeding!

I hope you managed to get some sleep

hi. i hope your ok today. my ds2 was exactly like this, dropped from above 50th to about 5th centile in total. i topped up with formula and very quickly ended up ff. he still didn't gain anymore weight, like your he's gained on average 5 ounce's a week. i wish I'd had more confidence to ride it out. you should of course take proper trained breastfeeding advice, but maybe like my boy yours is just meant to be that way.

Hi Teabaggy,
My DD is now 8.5 months old and I've had this battle with the HV. DD born on due date weighing 7lb2oz and last had her weighed 6 wks ago (she was 30wks old then), she was only 13lb10oz. On the centile chart, think she was born on the 25th and fell to below the 0.4th centile when she was 6 months old. I have continued to breastfeed despite hv telling me to 'top up' with formula, told hv that I wasn't going to do that because DD is happy, healthy and developing really well. So all I wanted to really say was go with your gut instincts and if you feel your DS is developing well and is happy/healthy then continue to breastfeed as you have been, no real need to FF imho. My DD did start to put more weight on once she was on regular solid meals.
My DD is manically trying to walk and wont keep still so her being small is certainly not holding her back!
Hope things improve for you