Help! Weight loss!

[TandB]

We are having huge problems with feeding at the moment and everyone seems at a bit of a loss about it.

DS2 fed very well to start with - only lost a tiny bit of weight, regained birth weight by day 4 and piled it on over the first week or so. We then had a lot of discomfort and were referred to a tongue-tie specialist who was unconvinced that he had a tie and suggested cranial osteopathy due to his very tight jaw and lopsided head. We saw the osteopath 3 times and his jaw loosened up a lot, his head changed shape quite substantially and the pain eased and stopped.

Feeding was then fine for a while - we could even feed completely hands-free in the sling on occasion! I got him weighed at 8 weeks, by which time he had started fussing quite a lot over his late afternoon and evening feeds - coming on and off and crying - he had slipped from just below the 50th centile down to the 9th. I got him weighed again this week (11 weeks) and he is still heading downwards - now just above the 2nd centile.

Feeding is now a constant struggle. He unlatches constantly, rarely staying on for more than 5 seconds. Sometimes he does this right from the start of the feed and sometimes just towards the end. Sometimes this degenerates to him refusing to latch at all and just lying there lunging at me repeatedly and screaming. He will never, ever stop feeding of his own volition - he either falls asleep or has to be taken away by his dad or put in the sling. Quite often at that point he will stop crying and go 2 hours perfectly happily. He feeds better at night and until a few hours ago he fed better with me lying down, or in the sling.

Today every feed has been a fight - he is on and off constantly, pulling his head away to the side and wailing, then re-latching and doing it again immediately. He is trying to feed at least every hour and won't settle in between, presumably because he is hungry. He wouldn't latch properly in the sling. He will settle and sleep in the sling but that means I can't pump to increase supply in case that is the problem. I also now have to keep hold of my breast at every feed or he lets go immediately.

Bizarrely, he is still sleeping 7 hours at night though, which is odd if he is hungry.

Any ideas would be appreciated as I am not sure what we are going to do if we can't get him feeding effectively.

kungfu, what a difficult situation.

I think this is worth taking very seriously - you don't say who you have seen or what they have said, but to my mind a referral to a paed would not be out of order, and also to someone who is clinically experienced with bf babies ie not a peer supporter HV or even breastfeeding counsellor unless they are really very experienced with babies in this situation.

There are two possibilities - i) he has some underlying condition that means he is finding it hard to gain weight, despite frequent offers of a bf ii) there is a supply problem that goes back to the early days despite the apparent weight gain - it might even be connnected with oversupply which overwhelmed him enough to make him feed poorly, and your supply lessened....his behaviour (long sleeps at night; fighting in the day) is consistent with a supply issue, in fact

Whatever - it needs careful checking out.

Hi Tiktok
We have seen 2 BF counsellors - one vastly more experienced than the other. She has seen him at least once a week since day 5.

Various suggestions have been:

Go back to get tongue re-checked - next Thursday
Pump to increase supply - doing that when I can
Revisit latching/positioning very carefully
Swap sides every time he comes off even if it means swapping every few seconds - this did seem to work for a couple of feeds
Top up with expressed milk - having one bottle of 4 to 6 oz each evening.

I can pump between 4 and 6 oz on one side in the mrning and between 1 and 2 at any other time of the day so the supply issue can't be chronic.

Incidentally, we had similar problems with DS1 from day 1 but he was mix fed very early due to not feeding properly from the start - in retrospect he was barely BFing at all even though we kept goin till 4 months on two BFs per day.

OK, if it is a supply/transfer issue then you're doing the right things, but I'd add

• continue with the switch nursing long term for the moment
• breast compressions when he stops sucking

Consider a nursing supplementer/lactation aid with ebm in it.

I'd still want him to see a paed, personally, too. And I am surprised neither of the bfcs has asked you to do this, to be honest.

Has he actually lost weight?

Thanks for your replies.

No - the thread title was misleading, sorry. He hasn't actualy lost weight - he is just sliding down the chart. He was 3.45 kilos at birth (nearly 50th centile), 4.6 at 8 weeks (9th) and 4.9 at 11 weeks on Thursday (between 2nd and 9th).

No-one has suggested a paed. The first BF counsellor has seen us through all sorts of niggles so may not realise that this is more than a niggle - I haven't seen her since we had him weighed this week. The second counsellor (who I actually think might have been a peer supporter) was the one who suggested the switch nursing but didn't seem unduly troubled about the weight loss.

Kungfu, I wrote a very similar post last week www.mumsnet.com/Talk/breast_and_bottle_feeding/1427740-Baby-dropping-through-centiles-advised-to-top-up-please-help-long

Basically, baby went from 50th to 9th centile despite early good gains and no apparent supply issues. After the latest weigh in, I offered a feed very frequently (every 90 min/2 hours) with breast compressions for the next five days and he gained 7oz, putting him back towards the 25th centile.

Then it all went horribly wrong. He began to refuse the breast every time it was offered, really screaming and hysterical. He would feed every 3 hours in the day for about 2-3 minutes, just, I felt, to take the edge off of his hunger. He was so distressed by the boob, and I felt panicky and near suicidal at times.

That lasted five days, slowly got better and we are back to normal today. Loads and loads of time in bed with him skin to skin, letting him have a bit when he felt like it, taking the breast away from his view as soon as he got distressed, my husband making him laugh and giggle whilst I slipped the boob in and frequent baths together. I also co sleep with him and got a lot of feeds in during the night whilst he was half asleep.

Can you just babymoon with him? And cosleep and make the effort to get a feed in him every 2/3 hours in the night just whilst you overcome this problem (dreadful I know, especially if you have other children). Don't worry about the weight just for a few days - get him back to the boob, feeding, and then you can concentrate on upping his milk intake?

Good luck x

Sorry www.mumsnet.com/Talk/breast_and_bottle_feeding/1427740-Baby-dropping-through-centiles-advised-to-top-up-please-help-long

Hi
That is quite a similar weight pattern - we even started on 7lb9 too!

Going to try putting in a night feed - he usually stirs around 3am so I can try to feed him then. I'm also going to pump whenever I can.

Babymooning isn't really an option - I have a 2 1/2 year-old and I am on my own for a fair chunk of the week as DP works in London. I can try to get some serious feeding time in on Wednesday and Friday when DS1 is in nursery.

We already co-sleep and he spends a lot of time in the sling so he has access whenever he wants it.

Do you ever hand express a bit before he feeds, to really get it flowing, so he gets immediate satisfaction? It sounds like he isn't getting that big mouthful of milk straight away, which is pissing him off.

I haven't tried hand expressing before a feed because I have always assumed the milk got going quickly. When I use the hand pump the milk starts on the second or third squeeze, and when DS2 unlatches after just a few seconds there is milk on his mouth. I don't think it is flowing too quickly though - there is no spluttering or anything like that and I very rarely leak.

Bizarre night last night. Having decided to feed if he stirred at night, not only did he sleep like a log, he didn't even want to wake for his last feed, so he went 8 till 8 with a feed at 5.30.

kungfu, I am sticking to my guns here :)

You need another opinion about all this - if you don't want to see a paediatrician then get someone with clinical experience in breastfeeding as well as infant health (a GP who you trust?). The bfc you have been seeing may be too close to the issue and in any case getting a fresh view on it - which is what you have tried to do by posting here - makes sense.

I think Kidnap's idea of babymooning is a good one, and well worth adjusting things in your routine to make it happen for a couple of days if you can - obv you'll need help with your toddler etc.

But I don't see that this is a baby frustrated with the slow flow at first.

The falling down the weight charts, the fussy behaviour, the fights at the breast, the very long sleeps at night, the screaming.....all individually are not major issues but taken together, they indicate that something needs checking out.

We will make a GP appt next week - the local GPs are pretty good here. There is no scope for extra help unfortunately. DP doesn't have the kind of job where he can drop everything and take short notice time off and my very helpful MIL is working part-time and my SIL doesn't cope well without lots of help so MIL tends to finish up with her children on the days she isn't working.

He woke up perfectly happy this morning. Started feeding well but deteriorated into usual fussing, although without the screaming and crying.

Right. Being proactive.

He has taken a 5oz "top up" which is going to deplete my entire stash in a day so something needs to happen fast.

We can see a private paed in London tomorrow (we are up there 2 days a week) for £200 which is a lot of money but I am willing to spend it if there is a chance of getting this sorted out.

Also toying with the idea of taking him into the NHS drop-in clinic today, just in case everyone has missed something obvious.

That's sounds like a good move kungfupannda. Hope they can provide some answers.

You mentioned tongue tie at the beginning but it seems this was ruled out. May be worth getting another opinion on this?

Can you get a bit of time in bed with him today, even for just a few hours to have some skin to skin and switch nursing?

Bollocks. Typed a massive reply and it disappeared. Fortunately I am angry enough to re-type it. While bashing the keyboard really hard and muttering "arse" a lot.

So I really enjoyed paying £200 to be dismissed, patronised and belitted by an arrogant, chauvinistic, ill-informed arse of a man who might as well have opened the door and announced "I am a MAN and a CONSULTANT. You are a silly girl. Have some formula. That will be £200 please."

His opening gambit was to try to sell me an enhanced immunisation program because the NHS one is apparently "woefully inadequate". When I didn't jump for joy he said "What, don't you want to?" I said no, I was quite happy with the existing schedule and he raised his eyebrows at me.

He then plotted DS's weight and announced that he needed to be on a 3 hoursly feeding regime. I said he was demand fed and he said that was the problem. At this point I hadn't actually told him why I was there - the only infomration he had was the booking-in form which said "feeding problems and poor weight gain". I tried to talk about the problem and we got into a circular conversation where he kept saying that DS was out of his routine and needed to be got back into it and I kept trying to point out that he wasn't out of routine, he was just not feeding. He didn't listen.

He then examined DS for about 2 minutes maximum - he looked at hips, stomach, eyes and throat and had a bit of a sneer about his cloth nappy.

He then told me he needed formula top-ups on a 3 hourly schedule. I made repeated attempts to take him through the history and he dismissed everything I said and eventually announced that I didn't have enough milk. When I tried to discuss this he just kept saying that DS needed formula if I didn't have enough for him. I told him that I was there to establish if there was an underlying problem - he said "no, there's nothing wrong with him - you just don't have enough milk"

I made a few more attempts but was knocked back every time and told "it's not about what you want, it's about what he needs" and eventually gave up. He then had the utter gall to say "and I will see him in a week's time". I had just enough gumption to say "er, no you won't actually".

I am generally more than capable of sticking up for myself (notorious for it in fact!) but DS1 was tantrumming (he did not like Mr Consultant Man), DS2 was screaming for food and I just wanted to get out of there. The whole tone of the appointment was "Everyone is wrong except meeeeee! I rule! I am important with letters after my name!" I wish I had let DS1 wee on his shiny consultant shoes.

Some of his finer moments:

Re: lactation consultant - "oh everyone's a breastfeeding consultant these days"
Re: cranial osteopath - [sneer]
Re: DS's weight - "Oh yes, I can see he has lost weight" - he hasn't.
Re: virgin gut theory - "rubbish. His gut is populated by now. It makes no difference"
Re: me wanting to EBF - "Why?"
Re: formula reducing supply - "It won't because you will still be BFing - he will just take more formula as he needs it"
Re: demand feeding - "he is all over the place and so are you"
Re: pumping 4 to 6 oz in the morning - "well that's not enough. you clearly don't have enough"
Re: tongue-tie - firstly "he doesn't have one" - he hadn't checked. Secondly - "tongue tie doesn't affect feeding, only speech" Thirdly - "tongue tie midwives are a waste of time"

The list of things I should have said is a mile long. I am not used to kicking myself for not finding something to say - I generally say it! Top of my list is "You are an utter arse of a man. Get your hands off my child and stick your immunisation schedule where the sun doesn't shine"

Ironically, feeding today has been miles better. I am not sure whether the EBM top-ups have given DS a bit more energy to feed, or whether the extra pumping has given me a boost, but the first two feeds today were pretty much normal (no top-ups) and the next one was only a problem because it was in Arse-Face's office. The fourth one was normal till right at the end when he got fussy and took 2 oz of EBM and the evening one was similar. Yesterday he took 20oz of EBM and today it has been 8. We haven't given formula yet although it has been very close as I am out of EBM.

I wonder if DS2 has decided to sort himself out in order to avoid another encounter with Arsey McArseFeatures!

The other thing I really wish I had said, when he said "oh everyone's a consultant these days", is "including you allegedly".

Oh my G_D I am speechless! Hopefully this is just a blip then and things are improving and he will back on boob fuss-free soon. How about proactively waking him for a couple of night feeds to get some more milk in him?

Oh dear, panda, that is just awful.

Would you PM me and tell me his name?

I don't think you are any further forward unless the improvement in feeding continues, as the physical exam he gave cannot have been v. thorough.

He clearly knows very little about how bf works, too.

I am astonished at the 'enhanced immunisation schedule' he tried to sell you.

How did you find this man?

pmd you his name.

He is part of a group of paediatricians. I found them on the internet but they appear to be reputable.

Still going better. Sleep more normal - he went 6 hours and woke to feed. Top ups have been smaller and he is currently feeding in the sling without delatching. Have 4oz to do a couple of top ups today and can probably pump another 4 or 5 over the day.

Kungfu - does your guy have the initials JS by any chance?? If so, he's great at enhanced immunisations but I have found him useless at everything else.

PMd you!

What a small world!