Baby dropping through centiles, advised to top up, please help (long)

[HarderToKidnap]

I'll try and keep this as brief as possible but I want to include as much info as possible.

I am very very committed to EBFing. I absolutely do not want to give my baby any formula unless not doing so would be very harmful.

I have 12wo DS. Born on 50th centile, only lost 20g on day 5 weigh in. Above birthweight at 12 days. Weight gains are as follows:

Birth: 7lb9
6 days: 7lb8
2 weeks: 8lb2
3.5 weeks: 9lb8
7 weeks: 10lb4 (now on 25th centile)
9 weeks: 11lb 2
Today, 12 weeks: 11lb12.

He's now on the 9th centile. Advice today was simply to top up, no breastfeeding advice whatsoever. I said no and was advised to take him back in 2 weeks with a view to topping him up then.

He is a very happy, settled baby. Rarely cries, occasional colicky evening. 7 sodden nappies a day and up to three big yellow stool, very occasioanally we have a day without a poo. He's developing normally, smiley and chilled. Has a bit of chub.

Feeds 2.5-3hrly in day and overnight, was what I thought was an efficient feeder only being at the breast a few mins. Now wondering if this is a problem. Rarely wants a second boob, so I have got out of the habit of offering. Settled after a feed, latch is good and audible swallowing with every suck. Co sleeps for part of the night and feeds 2-3 hrly then too. I seem to have lots of milk, can always squirt across the room, can hand express 6oz or so in 20 mins.

Specific questions and my plan:

Am going to offer boob 2 hrly at least in day and always both sides. Breast compressions when I'm at home.

Not going back for weigh in for at least a month.

He comes off the breast very quickly so I pop him back on the same one up to 4 times before swapping as I don't feel he has had a good feed off the first breast. Should I be switching breast every time he comes off?

Sometimes towards the end of a feed he will come off, be a little unsettled, go back on for a few sucks, come off and be unsettled etc etc basically pop on and off and be a bit annoyed. I still have plenty of milk coming out so I interpreted this as wanting to suck without wanting to get milk and give him a dummy at this stage of the feed, and he then immediately settles and falls asleep. Have I got this wrong, should I be doing something else at this time?

Any advice/comments welcome, please! Sorry for length

Has your ds been checked for tongue tie? Any winding issues? If he's bobbing on and off and fussing during feeds then something's not quite right with the logistics I suspect- which is no one's fault but if your ds is dropping through centiles the HV is right to want to keep an eye.... Do you have any breast feeding supporters in your area, either from the nhs or the NCT or la leche league? if not I know both NCT and la leche have advice lines, check their websites? Good luck

How tall/long is he in terms of centiles? If he has a bit of chub then is he just in proportion?

When you say quickly do you mean a few minutes, a few sucks, 10 minutes? If it's a few sucks then putting back on the same breast might be the best bet. If it's 10 minutes then swapping would probably be a good idea. What do you think?

If he is still wanting to suck could you offer the other side? There is a kind of suckling that gets minimal milk out on purpose called non-nutritive suckling and babies can do that without any direction from mum if they want more comfort than food so if you have the time you can do that instead of using a dummy (it's just a fake nipple after all!)

It's fair enough to raise a question with a baby who seems to be gaining slowly like this, but to be advised to top up with no further options is not good :(

There are many things you can do to address his weight gain without formula. Here are the first ones to try:

• increase the no of feeding sessions (which you are already planning on doing)
• breast compressions (ditto)
• at least 2 sides every time, and three or four if he will take them

Dummy use seems to be minimal the way you describe it - good idea to take it out of his mouth when he settles so it does not keep him from 'asking' for a bf.

The majority of babies whose growth slows like your baby's is doing are fine and this is just how they are....but it makes sense not to assume this, and to maximise opportunity for breastfeeding.

You need to explain to the HV how underming it is to be told to use formula, when you know there are other options.

Thanks so much for advice everyone.

blondie he was checked at birth by community midwife (should say now, I am a community midwife in my day job) and didn't seem to have anything, I do think the latch is OK. His tongue comes out a lot too! He does bob on and off at the beginning of a feed and fusses at the end - feeds last 7-10 mins when he is properly on, although sometimes he comes off after 2/3 mins - this is when I put him back on same side. Fussing tends to happen in evening and this is when I pop the dummy in which I think is what he want really.

Truth he has never ever comfort sucked, something I have found upsetting at times. He sucks and swallows and then doesn't want to know. He doesn't want to come to breast for anything but food, when he is tired, after jabs etc he wasn't interested in boob unless it was to eat.

Thanks tiktok, I so appreciate your advice. I am just filled with desperation and sadness in case in doesn't work. I do have the number of a BFC who I am calling tomorrow.

Hmm if you have lots of milk ie enough to make big squirts, it is possible that you have a fast let down reflex and he's swallowing air at the beginning if each feed, hence the bobbing on and off and fussing. Have you tried winding him after a minute or two when you first feed him then letting him relatch? All of my babies have had to cope with my fast let down but ds3 (lazy feeder as a newborn) definitely struggled the most and regular winding seemed to sort him out. If your baby's tummy is full of air it might also be making him feel full when he's not and so he's not actually taking the amount of milk he needs. Just a thought.

The centiles are just averages. Someone has to be on the bottom. Don't be sad if he has a low weight compared to the average, just stop getting him weighed and enjoy how happy, settled, chubby and chilled he is.
Get help from a BF counsellor if you're worried though.

I was going to say exactly what Baldrick says. I seem to have fast letdown on my right boob, not left, so when feeding DS from that side he wriggles and comes off gasping. Seems to be better when feeding lying down, also regular winding helps. I have seen suggestions of expressing a bit off first, or of letting first few gushes go onto a muslin cloth but I have not had to try these myself.

Good thinking from pp about fast letdown and the dislike of comfort nursing would fit in with this. See www.kellymom.com/bf/supply/fast-letdown.html kellymom]] for more info.

oops try again www.kellymom.com/bf/supply/fast-letdown.html

RE knowing when to end a feed ... Sometimes my DS conks out so I know he has had enough.

Most of the time though he just starts going on and off and thrashing about and shouting. I wondered what this meant but I now know it means that actually he has had enough (even though if you offer more he cant stop himself latching on again!) If its the first breast and he does this, I offer the other, he then usually is happy to have another couple of mins. If he has already had both breasts then I assume he is full.

I stand him up and talk to him and see how he reacts. If he can quickly be jollied into smiling etc then I know he is satisfied. If not I wind him and we have another go!

If he is still very grouchy but not feeding it is probably that he is tired and wants me to give him his dummy and settle him down.

(Would be much easier if they could say "full now, thanks mum!")

Try keeping him on the same boob longer. When BFing, the milk that comes out furst is watery, later comes the fstty, rich and creamy milk that contains the calories and should aid weight gain. Breastfed babies may drop centiles, but nit that many. - i would be concerned. Is there a local NCT breastfeeding support where you live?

citytovilage, that's not quite true about the milk changing, and babies who need more milk/greater weight gain should not be deliberately kept on the first breast longer.....see kellymom for good explanation and a de-bunking of this myth :)

I am having an almost identical 'problem'. My baby was born on the 50th percentile and is now between the 9th and 2nd. Yet, he is jolly, sleeps pretty well, is not chubby but has some coverage. I just can't get him to eat more. In fact he rarely seems hungry and his longest feeds happen when is asleep, literally. I've given up taking him to be weighed as it just upsets me and the hv has very little advice anyway. I think he's fine, just littler than average. And as it's been said a thousand times, someone has to be at the bottom of the chart, and someone has to be at the top.
I think if your baby seems happy and content, and gains weight, if not as rapidly than others, then he's fine.
My daughter was average at birth and by 1 year old, she was off the chart, sometimes off the page. She is now 5 and is very skinny still, but she is absolutely fine. Full of energy, bright at school. Just a bugger to feed!
Don't over stress, they all turn out fine in the end.

I was told by my HV that the growth charts they use are based on weight gain in bottle fed babies, who gain weight more rapidly than bf babies so not to take the centiles etc as gospel.

baldricks I don't think that is the case anymore, the red book charts are from breastfed babies only.

BT, when did an HV say this to you? It has not been true for several years, and in fact never was true - the charts that were in use were from data based on babies whose feeding was not differentiated (though many of them would have been ff, of course). Formula fed babies don't grow more quickly than breastfed babies, anyway - not at first. The more rapid growth is not seen until after about 5 mths.

Hi everyone, thanks for answering.

Thought I'd give you an update on the first day of the new regime. I boobed him every time he squeaked and the compressions definitely made him more interested in staying on the boob longer. I fed every 90mins or so and we just spent a few hours in bed this afternoon feeding on and off. He seemed more interested in feeding than he ever has before and I wonder if I was just literally missing his cues and because he's a chilled chap he was content with what he got, although he wanted more? I don't know. Anyway, will carry on feeding him up. I am alone in a room with a pair of scales Monday so might give him a sneaky weigh then to see how things are going without the HV there to pass comment on it.

Veggy thanks for sharing your experience, it helps. I'm just not quite confident enough to totally stop taking him to be weighed yet, I don't feel happy at the moment that I am doing everything exactly right.

Hi,

Cannot help with breastfeeding advice as I stopped at 10 weeks, but wanted to share my story as its remarkably similar to you.

DS2 born on 50th centile, fed without a problem (but very quickly) and gained weight very well until week 6, then started dropping centiles ending up just below the 9th. I was advised to top up (again with no other support offered/suggested), didn't regain and continued at 9th, dropping slightly. I decided that I was not able to feed him so switched to bottle feeding, and you know what he stayed at 9th. Bottle feeding was just as difficult with him (actually more as i could see how much he wasn't drinking). Only this week has he started to feed better at nearly 6 mths, which coincides with weaning (not suggesting for a minute you should wean early by the way)

Absolutely you should get some help/support but I wish I had held my nerve as I have a feeling we would have ended up at the same point anyway.

Good luck

You sound like you know what you are doing. Good luck with the extra feeding.

I think if he doesn't drop further but stays at 9th centile then that is where he is meant to be. Obviously if he keeps dropping it might be a worry.

My HV said about the growth charts a few years ago when ds1 was a baby, although they're fairly useless at the clinic I go to, so it wouldn't surprise me if the information they gave me was inaccurate! Glad the bf is going better OP :)

I'm no BF expert but just thought I'd share that my DD sometimes will fuss halfway through a feed, come off and keep trying to relatch but can't stay on. At that point i usually just sit her up for a little break. I never pat or rub her back but she usually will then burp of her own accord and then i pop her back on again and she'll continue to feed. If she doesn't burp i still put her back on as for some season sitting up just seems to help her anyway.

Sounds like you are on the right track. :)

I just wanted to say that I had similar advice when DD a similar age and did provide top ups (mostly EBM, but also some formula as I struggled to express). This went on for a few weeks, then she started to reject the bottle due to being full and we went back to exclusive BF until weaning.

So, great if you don't need to mix, but it doesn't have to be the thin end of the wedge and spell the end of BF.

Glad things are going better for you with the extra feeds, OP.

Before I saw your update I was going to ask whether you were feeding on demand, and if seems you're really getting to know your baby's hunger cues and going for it now so that's great. :) Personally I wouldn't be bothering with the dummy as he will be able to comfort suckle without getting a lot of milk, and it could encourage weight gain through more frequent suckling, but it sounds to me as though you're doing really well and he is just getting on with gaining weight at his own pace! The charts aren't law, some babies don't 'fit' them well and are perfectly fine. As long as he is gaining weight, is well in himself with plenty of wet and dirty nappies, I wouldn't worry too much.

Good job! :)