Low weight baby - bf to schedule

[TeacupTempest]

DD has dropped below bottom centile. She is 7 weeks. We had been bf on demand.

After being checked out at hospital they could find nothing wrong with her or my milk supply.

We have been sent home with instructions to stop feeding on demand and to start feeding every 3 hours for a max of 20 mins...

They say on one hand she isn't getting enough calories as they say she falls asleep on the breast ( she does as she also comfort suckers but this is at the end of a feed or an additional visit to the breast) on the other hand they say she is expending too much energy sucking for so long.

Seems very contradictory as an explanation.

The advice seems counter to how I want to parent. I feel sick having to take my tiny baby away from the boob and for so long.

I have been to a local group and they said my latch and her feeding were good.

Lost.

Teacup now you're back.
one thing i thought about last night as i tried ti ignore dd screaming because i needed a wee is, Do you feed her when she cries or do you stick to this schedule regardless?
the mn guide to babies says that the "feed me" cry is like a u-lah u-lah noise, and i looked out for this in DD- it's true, she does that noise when she wants food, and we've not noticed the earlier clues.
other crying noises can be stopped by changing or entertaining, but the u-lah is constant.

I was responding to the feeding cries before hospital visit. The doctor however said to adhere to the routine.

After trying to follow his routine over the weekend, altering it somewhat so I didn't starve my tiny baby, I am pleased to say I am now ignoring him and his stupid schedule.

:)

Honestly I don't know why we listened to him at all. Some of the things he was saying about breastfeeding were quite simply ignorant!

I think we were/are worried they will take DD off us if we don't do as they say!

I am trained as a doctor (not practicing) and I can confirm that we only get taught the very rudiments of breastfeeding and are as affected by the culture of bottle feeding as everyone else

Don't worry about that
just feed your DD as you see fit, and as stops her from sounding like she's suffering.
It's the only way - my DD seriously seems to want to be fed constantly, and I couldn't cope with her crying if I tried to put her on a schedule.
Sometimes she'll feed every hour, sometimes after 3 or 4 hours (usually if she's been asleep - she'll need more food if she's been entertained for an amount of time)
At this stage, we're blind leading the blind, I've never done this before, DD has never done this before - each day is a new experience, and as her mum, all I can do each day is get her through, happy, not crying and alive. :)

I fed my son on demand and i would never bf any other way. Sometimes he would go 1 hour sometimes 3 or 4 but he fed when he was hungry. I don't think they had all this unhelpful advice years ago yet people managed to bf on demand and very successfully too

Hi teacuptempest.

I just wanted to post to say that I have had two dcs (DC3 and DC4) who dropped below the bottom centile. They were both born quite big (around the 75 centile mark), gained weight well for the first month or so, and then started putting weight on so slowly they fell off the curve altogther. All the while they were happy babies, who fed well on demand, slept well, and who got longer, more alert and more beautiful... but not fatter! I suspect it may have been to do with them not feeding all that often (maybe 5 feeds per 24 hours), but they were fed on demand, and when, at the doctors insistence, I woke DC3 2 hourly to feed, he just wasn't interested.

At 5 months for DC3 and 4 months for DC4 I introduced solids, and although they ate happily and hungrily they didn't really start to gain weight until 6 months. Now both are growing happily, are average sized children and all is well.

I am glad I carried on doing what I felt was best, despite huge pressure to switch to formula. I just felt that my children were fine and that no one would be worrying if they hadn't weighed them and measured them up against the chart.

When DC4 was slow to gain weight, my GP was not worried at all, she just said that she seemed to be following in her brother's footstpes and would turn out alright.

Thank you peasandbeans it's very reassuring to hear of similar experiences that turn out well :)

I hope we have the same outcome

Hi teacup, does sound like you were right to follow your instincts.

tiktok thanks for your response to my post, I am disappointed to learn that I was given at best incomplete advice by the MWs, though reading this thread it does sound quite common.

What annoyed me was that I didn't want to keep weighing my DD so much, but was visited every 3/4 days for the first month, so didn't really have much choice.

Also is it true the centile charts are based on ff babies? That seems ridiculous to me.

Bumble they used to be but aren't any linger

is the WHO chart - it's supposed to be for breastfed babies

Its for breastfed babies, but the bottom of the chart is still fatter than what it used to be when it was for ff babies, strangely.

LOs night feeds used to go on for hours 'cos she was so sleepy so I used to try and hurry her up a bit by jiggling boob/nipple in her mouth which made her start sucking a bit more vigourously but other than that, it's true that frequency is key. It's also true baby may not actually be feeding as much as they seem to be, but could be doing a lot of comfort sucking. This is normal though and i wouldnt stop your baby from comfort sucking as it still helps your milk supply. I think from what I have read that they are telling you to do a minimum of one feed every three hours (even if that means waking baby up to do this) but it sounds like you already breastfeed more often than that anyway?

Does baby produce lots of wet and dirty nappies? Otherwise healthy? BTW if you/partner are small it is not unnatural that your child should also be small. On the other hand, babies do vary a lot in weight gain and growth in the early weeks and months and wirght/size now is not relly very indicative of adult size either. Is your baby actually "underweight" for length/height, or about the right weight for length and just a small/short baby?

i didn't put a space

peaseoudding, bf babies tend to gain very slightly faster than ff babies at first (though there's not much in it). Then the weights tend to diverge after about 5-6 mths and by the of 12 mths, the average ff baby is significntly heavier than the average bf baby.

The idea that bf babies are naturally smaller than ff babies (in the first months) is incorrect.

RealMBJ - you ask what to do when everything has been tried. The baby should be checked for any hidden condition, and if everything checks out then the chances are the baby is just small because that's the way that baby is :) The only real worry is the baby who loses weight or whose weight is genuinely static over weeks - most babies who are slow gainers are not like that and are fine.

Well I am hoping she is just small! We have been checked for underlying conditions and all seems well. She has never been static lost.

Just had HV weigh in and DD is up 80g/2.8oz...That's since last Thursday night.

DH here again. Another question...

This WHO weight gain graph. Do you know exactly, mathematically, how it's arrived at? Sample sizes used? etc.

Seems from reading this thread and others that rather a lot of people have babies which are at one time or another underneath the 0.4 centile - which is counter to my expectation based on the most obvious interpretation of the graph.

Ah but MrTeacup, the sample here is biased. Only people with problems/worries post

I'm sure if you do a bit of extensive googling you can come up with the answer This should be a good start though

Yes I agree! I seem to know a lot of people with bf babies who are under the bottom of the chart, at least until they switch to formula. The formula often seems to make them put on weight more quickly than they had been. Perhaps changing something with the bf might have been effective in increasing the weight gain, but where I am ( in France) generally people just switch to formula as soon as the baby is flagged up by the doctor as not gaining fast enough.

reading through the methodology of the WHO study, it would appear that any babies who started the study fully breastfed but who then switched to ff within the first few months (perhaps because their GP had considered them to be failing to thrive??) would be excluded from the final count. So could it be that a large proportion of (perhaps) naturally slow growers were excluded because the norms had in fact already been set before the study took place?

Quite possibly pease.

Mothers of slow growing babies are put under enormous pressure to swap to formula IME. One mum I know was told, (loudly) in a public GP waiting room full of other patients, by a HV, while waiting for a totally unrelated appointment that she was risking her baby's neurological development, despite the paediatrician having no concerns.

The child is small, but totally normal in terms of milestone at 12 months

TeacupDH, I have been following this thread, but not posted, because others here know far more about bf than I. But, at last, a question I can answer! (I'm a statistician).

The WHO methodology is described here but the number you're asking for is 454. Just 454 girls were studied longitudinally to create the early months growth chart. (Additional cross sectional samples were included, but not before 18 months of age). Then a smoothed box-cox power exponential distribution was fitted, apparently chosen because it provided a better fit to the tails. So the tails of the distribution are poorly estimated, with only 2 of the observed 454 girls expected to lie below 0.4% line, and will depend heavily on the distributional assumptions.

I don't generally have great faith in the tails of any distribution. But, also, MBJ makes the point that you can't compare to the self selected group of parents posting on this forum, as we probably found out way here after one feeding difficulty or another, including low weight.

PS, our twins were born at identical weights, but by 1 week I was being told to eat ice cream by the midwife because one was growing smaller than the other and it had to be down to my milk. The fact that they were both drinking the same milk apparently didn't matter! (The smaller one had tt, but the local hospital didn't cut posterior tongue ties). Anyway, they are now 16 months old, and small girl has stayed small, but is full of energy, climbing, running non-stop. While boy baby has stayed chunkier and is now two inches taller. Turns out she was just always going to be small.

I certainly would have switched to ff if dc3 had been dc1. My gp told me that I needed to take him to A and E immediately for further tests or simply switch to ff. I managed to bargain to get him reweighed a few days later. Multiple reweighing didn't make him grow faster, though it did make my life hell for a month or two...

He turned out fine, luckily.