3 oz average weekly gain in ebf baby - is it ok?

[guendalina]

HV suggests I should offer ebm or - if not possible to express - ff to DS because he's only gaining 3oz per week (weighed at 8, 12 and 16 weeks) and he's sliding down the charts. Is it really necessary? I don't really want to give him formula and I hate expressing. Can there be any long term consequences if I don't?
TIA

Anyone please?

I'm not an expert, just another BFing mum but didn't want to leave you unanswered. Hopefully someone will be along in a bit who is more of an expert with these sorts of things.
Is he doing plenty of wet/dirty nappies? How does he seem in himself? Are you BFing on cue or trying to stick to a routine? You could try doing breast compressions whilst feeding and offering both sides if you aren't doing so already. Have you checkout the kellymom website here kellymom.com/. Has he lost any weight at any point?

All my EBfed daughters gained 2oz per week from birth to age 2+. Nothing wrong with them, perfectly healthy, just ended up tiny, compared to the charts, by age 4 months. Luckily I had wonderful HV who focused on the important things- Alertness, dirty/wet nappies, and meeting milestones and did not fuss about the slow weight gain. DD1 is now 17, measures 5ft5, is a beautiful size 8 and still growing; DD2 is now 14, measures 5ft 2, is a beautiful healthy size 8 and still growing. DD3 is now 2.7, weighs 11kg, is a size of a small poodle but perfectly healthy and also still growing.

sorry kellymom.com/

Forgot to say, all three born on 50th centile on the nose (all 7.5lbs) and were 0.2-2nd centile by 4 months. As long as they're not actually losing weight, I wouldn't worry too much. Also bear in mind the signs/symptoms of inadequate nutrition (lack of energy, drawn look etc,). Some HV focus way too much on the charts and not enough on the actual child.

3oz per week suggest 3lb on since birth, is that right? It does sound a bit slow but I don't have a red book to check against. But remember some of them weeks will have been more, some less.
If he is consistently putting on weight then that is good, he is just putting it on slower.
You shouldn't feel pressured to resort to ff top-ups. Offer him both sides each feed and if he wants offer the first again. If he doesn't want extra then he probably wouldn't take ebm or ff.
Are you worried about supply? The more you feed the better your supply. Feeding on demand or when you feel your breasts are full will keep your supply at best.

His weight gain could just be slow, if he is happy and alert between feeds, settles well and looks well then he will be fine

Yes he takes both breasts and seems perfectly satisfied (kind of milk drunk look ). No problems with his health or development either. No he's never actually lost weight.
Every time he gets weighed it's a bit of a shock really and I'm starting to dread seeing the HV. Really it shouldn't be like that!

Please please please keep bf your baby. My dd did exactly the same. Wad gaining the 'recommended' weekly gain till she was 10 weeks but then slowed till just 2 or 3oz per week. The hv made me feel so inadequate and I used to cry at the very mention of her size. She had never been ill, was hitting all developments, alert, and a very happy baby. I did introduce a bottle of formula for her last feed before bed but stuck with bf. I'm so glad I did. The best thing I did was stop getting her weighed each week and also 'forgetting' her book. I knew she was gaining weight and all else was well so stuff em politely decline the hv crap advice.

You will know if your baby needs help. Some babies are just more dainty, like my little Pixie :)

dd doesn't seem to be following the charts, either.

you don't have to have him weighed, you know (it might be better for your sanity not to for a while)

dd poos like it's going out of fashion and wees like a drunk
she's getting bigger and healthier every day.

guendalina - if you think your baby needs more milk, then he can be offered more....as he is bf, he is capable of adjusting his intake nicely to his needs, and you don't need to worry about over-feeding. Offering more means offering more 'sides' per session, making feeding more frequent day and night, and responding more quickly to feeding cues.

However, weight gain is only one aspect of well-being and it is perfectly possible for a baby to be in the pink of health and to gain slowly - and it's a shame your HV only offers the ideas of ebm or formula, because this rather shows her lack of skills in this area (I'm assuming she hasn't also suggested the offering more breastfeeding thing).

oh, yes, i forgot her book twice when she was weighed.
HV didn't blink.
(not literally, obv! )
what they don't know won't hurt tham

I still get pissed off slightly annoyed when I think about how I felt. Everyone's answer was give her formula, Mmmmm yes that'll do it. Grrr. Sorry.

Actually I think some hv don't blink, some are robots afterall!

Sorry in advance if this is a silly question, but does your red book contain FF or BF charts?

My (2008-born) DS' growth curve never followed the FF charts properly, used to look like he was all over the place. HV never used to worry me because she knew the curves wouldn't really work for us, but couldn't find a BF chart for me at the time (think they are more common now). Just a thought?

springforward the book has the WHO charts and I've personally double checked the dots were in the right place as she didn't seem too clued up on charts or anything else as a matter of fact .
tiktok no she didn't mention feeding more or more often but to be fair this may be because she observed a feed and DS fiercely refused the "third" breast when he had had enough like he normally does.
Sorry if this sounds like a silly question but what can she do if I refuse to follow her advice to top him up?

I don't think she can do anything! I had a HV like this one with both of my children in different parts of the country. With DD ( now 16 years ago) the HV was obsessed with weight gain and DD was like yours only 2-3 oz a week but she was feeding all the time. I was first time mum and allowed myself to be bamboozled out of Breastfeeding her in the end and I regretted it for months afterwards.

If your baby is alert, happy and contented and otherwise meeting milestones I say go with your instinct. I don't think you have any obligation either to let the HV visit you to weigh baby or to go to clinic- Isn't it voluntary? ( mine kept coming round- DH sarcastically said it was because we lived in the nice part of town and had choc biscuits on offer- he finally snapped and suggested to her we didn't need her anymore!) I became surprisingly busy on Thursday afternoons after a few weeks.......having coffee with the other mums I had met through clinic and who couldn't face her anymore!! Keep going OP and good luck!!

TBH if she is very concerned about your DS's health then she should be referring DS to a paediatrician or asking you to take your DS to the GP at the very least. Advising you to feed ebm or formula isn't going to help if your DS is not gaining enough weight to be healthy and may mask a problem (if there is one as opposed to a baby that is finding his own growth pattern rather than the HV's preferred one).

Not that I have seen your DS but you don't describe an ill baby [I have had one of those] no shrill cry, lethargy, agitation, floppiness/lack of muscle tone, refusal to feed at all (saying no thanks mum I have had enough by turning away from 3rd side isn't refusing to feed btw) or constantly feeding all day everyday for weeks on end (so not a growth spurt which might last a week) or a significant lack of wee/poo or unusual wee or poo (dark wee or constipated hard stools for example).

If she insists you ff or ebm feed then ask for an urgent referral to paeds. Bfing directly is the biological norm so if you have to move from that you could say that you want to dot your 'i's and cross your 't's to make sure there is nothing else to be done/wrong with baby. Or you could also ask for a referral to the Infant feeding co-ordinator or the Infant Feeding Lead in the HV team.

3oz is around 90g, right? I'm facing similar but much earlier - DD has gained 80g in her third week and HV is telling me to express and top-up (massively painful due to fissures and stopped working last week - will be giving it another try this weekend). Out of curiosity, how was your early weight gain? I'm currently quite freaked as we have until Wed to make up the 160g to her birth weight, and doubt we'll make it. I find it worrying it can go on so long...

(I have a thread here: Nervous about weigh tomorrow in case anything said there is of help)

Thanks ardenbird. He's been gaining more or less a pound a month since birth, i.e.100 gr a week. She says he should be doing 4 to 6 oz a week. We haven't been given an ultimatum like you but I fear we may be heading that way!
truthsweet thanks for your advice. It's given me a boost of confidence which is what inexperienced bf mums like me often lack!

hi. i have no pearls of wisdom to offer but just want to add i have a gorgeous 21 week old who started on 75th centile and has found her line is actually the 2nd. the most she has ever put on in a week is 140g so less than 3oz. (it took her 9 weeks to regain birth wt) Thankfully i have a fab HV who visits me at home to safe me getting funny looks from any other health professional if i go to clinic for a weigh in. she monitors dd's weight more frequently than the recommended 4 weeks so that we don't miss anything. I don't have a story yet of a striking but petite 21 year old but I'm pretty sure that I will have.
If your lo is well,not losing wt, pooing the right sort of poo,weeing and doing all the right things then you prob just have a baby who is finding his line. Get a paed referrel if you are in any doubt. i for info do top up with ebm and it has been a right old pain but hv was sure we'd have been TOLD to do ff top up because our case is so extreme. My mw was ranting about nasal gastric tubes in the early days when I was crying about having to force feed a syringe worth of milk into her.

By the way my 8 yr old was similiar but not so dramatic hence hv's confidence that we're doing the right thing in managing dd's wt.

guendalina - if you are worried about baby in any way, see the GP and ask for a referral yourself to Paeds. If the GP thinks there is something that needs to be checked they will refer, if they think everything is fine just slower than average weight gain in an otherwise healthy infant they aren't going to waste their budget on referring you to get exactly the same opinion from a Paed (an vastly more expensive opinion though!).

If you do see the GP ask them to write what their opinion is in your DS's red book and show it to the HV at your next visit (try not to crow too much).

It you have concerns about bfing and want someone qualified to check (most HV have very little training in bfing unless it is an area of special interest to them) try one of the bfing helplines or look up on the Assoc. of Breastfeeing Mothers's, NCT's, La Leche League GB's or Breastfeeding Network's websites to see if there is a local group/bfc who can help.

Thanks Truthsweet. I do go to my local monthly LLL meetings but it never occurred to me to ask what they thought of DS' weight.
Thank you all for your helpful replies!

I totally agree with what TruthSweet said - Tell your HV in no uncertain terms that if she is worried about the weight gain, to the extent that she's recommending that BF isn't good enough then she must be worried enough to refer you to a paediatrician
and that if she isn't worried to that extent, then telling you to change the food you give him rather than increase its volume or frequency is obviously very wrong. (and yes, in this case, I would still class ebm as changing the food - why would he take it from a bottle that he's never seen rather than straight from the breast in the method that's intended. - I tried to give DD some ebm once and she looked at the bottle, gummed the teat for a second, and kind of went "bored now" with her face, and pushed it away.)

Yes i tried to give him ebm too once and he looked disgusted and gave me a look. So funny how their facial expressions can say so much even at this young age!

I've challenged HV based on advice I was given here. She's now come up with another theory which again makes me feel inadequate. She says that if baby isn't gaining weight faster with all the feeds he gets it must either be my supply or the "quality of my milk". Because clearly I don't have a supply issue fountain comes to mind then she thinks it's my milk not being fatty enough. She says this typically happens when you "do too much".
Is she tasking a load of tosh?

Yes, she is. But you need Tiktok to come here. She is the hexpert on such things.