Slow Weight Gain - HELP

[TicTacsMum]

My dd is nearly 10 weeks old and breastfed. She was just above the 25th centile at birth (7lbs 1 3/4oz) and dropped to the 9th centile, where I thought she'd stay. We were at the HV for a weighing today and she has only put on 7 oz in 2 weeks, so she is now 9lbs 6 oz and on the 2nd centile. The HV said she wasn't worried yet but the way she said it made me think that she was on the verge of being worried about the slow weight gain. I know they say to look at the baby and not the graphs but when you see the line dipping into the red you can't help but worry.

dd is having plenty of wet nappies and is very active and alert when awake. She's mostly happy enough during the day but has some days when she's a bit whingy. She sleeps anywhere from 7 - 10 hours at a stretch during the night and seems to feed almost constantly during the evening from about 6/7 till about 10.30. The HV has suggested that I give her a bottle of EBM (5oz) in the evening and see if that sees her through to her last feed of the night. She seems to think that this might help with the weight gain too.

I really don't know what to do as the HV mentioned supplementary feeds of formula which I really don't want to do as I'd hoped to breastfeed for at least 6 months. She also said something about weaning in about 6 weeks which seems awful early.

Sorry this is a bit of a ramble but i'd appreciate any advice.

Thanks

my dd also had low weight gain
How is her height in comparison to he weight on the cetile? Is it corresponding?
Ask for a GP/paed referral before topping up if you think your dd is happy, sleeping, alert and developing well
You could try cluster feeding in the early evening or waking her for a dream feed at 10 pm.
We tried this.
If you feel under pressure form your hv but are confident of your own dds health you can always white lie to your hv
Mine stil think dd had aptimil supplements from 6 week and was weaned at 16 weeks

Like the idea of white lies but I blush really easily and don't think I could pull it off!!

Her length when last done at 6 weeks was nearly on the 50th and head circ right on the 50th centile.

I'm no expert but a couple of things you might want to think about:

• the charts in those red books are based on a population of bottle fed and breast fed babies - the weight gain of the former is going to be more rapid. For a fairer assessment of how your little one compares with other breast fed babies, have a look at the Kellymom.com website which has charts for breast fed babies only.
• you say your baby wets loads and is active and alert - this sounds really promising, and other mumsnetters have often written that this is at least as important as the actual weigh-ins.
• your baby sleeps well at night. In my experience, our DS wakes early when he has missed a feed the day before, and is probably a wee bit hungrier. Therefore, your DD sounds like she must be fairly happy to sleep through for such a long time.

When my mum was a midwife in the 60s, they used to weigh the babies before they were breastfed, and then immediately afterward, in order to gauge how much the baby was taking at each breastfeed. Is this an option for you? - if only to set your mind at rest?

HTH.

Get her length done again, if there is a large discrepancy its worth getting a GP's advice.
My GP slated my HV for telling me to wean/top up as it turned out my dd had some other problems which would have been made worse by doing the things she advised.
I'm only advising this to get your hv off your tail and to ease your worries too

tictac your dd has followed almost exact same pattern as my ds. from 25th to 9th and then to 2nd centile. i was getting him weighed every couple of weeks for ages. From when he was about 6 weeks old he was really only putting on 2-3 oz a week. It sounds as though your HV is being a bit alarmist. mine always said that 2-3 ok a week was OK. He just stayed there, scraping along the bottom of the chart for ages. As he was quite small he was happy with milk for ages and was a LATE weaner (not interested in solids till nearly 9 months). i do think your HV is wrong to suggest weaning as a solution to this - there are more calories in milk than in anything that you will wean her onto. solids will just fill her up and she'll take less milk. My situation got resolved cos i just kinda got bored going to get weighed all the time. He stayed on the 2nd centile and seemed fit and healthy. It was always stressed to me that even if he fell off the chart it was no reason to panic - as smellen says the charts are totally inaccurate for breast fed babies. you could also get her head circumferance measured as this is a more accurate way of establishing growth than either weight or length. I really don;t think there is anything to worry about at the moment - just monitor it as you wuld with ever new baby. she will be small and cute like my ds

I've got a copy of the 'breastfed from birth' centiles (snuck into my red book instead of the original - they never notice). I'll have a shuftie later and see where your daughter is on it (it's rather close to a sleeping baby at the moment, so I don't want to chance my luck by getting it).

Personally, I rarely bother getting my daughter weighed by the HVs. And yours doesn't sound much cop, if she's giving you such unhelpful advice as suggesting topping up and weaning at 16 / 17 weeks. Both of which are contrary to current Department of Health guidelines.

My ds was over 9 lbs at birth, dropped over 10% in the first few days and didn't get back to his birth weight until he was 7 weeks old. He then had very slow weight gain until he was weaned. He was always perfectly healthy and most importantly I stuck to what was important to me and fed him myself. So long as she's having the wet nappies etc I'm sure she'll be fine.

RedZuleika - where did you get the bf centile chart from? I would love to see a copy. Did you find it online - if so pleaes could you post hyperlink?

TIA (if possible!)

Tictacsmum
I had the same with my ds dipping in his chart and it was around 11 weeks, same as your dd. Ds also at about 10 weeks fed constantly early evening and had trouble settling him each night but would sleep for nearly 10 hours when he did settle. This problem passed though he is now 21 weeks and stayed on the same line on the centile the last two times I have had him weighed (I stopped getting him weighed so much too as I was becoming obsessed!). He now settles at 7.30 each evening and still sleeps for 10 hours then another 2 after a short feed.

So really what I am saying is that I have been there and it does get easier and am so pleased now that I did not supplement with formula. Also think yourself lucky that your dd sleeps for up to 10 hours at a go!

My HV did actually get me a 'Breast from Birth' chart but as far as I can see it looks exactly the same, except it starts from the EDD and doesn't have space for Pre Term measurements. I'm confused!!

It's reassuring to see that others are having similar experiences. I'll stick in and see what happens!!

tictacsmum - I had similar problems with ds1, born at 7lb 10oz/ 25th centile but dropped quickly to 2nd centile by 2 weeks (6lb 14oz) and didn't get back to 25th centile until around 11 weeks.

My mw and hv recommended that I breast pump after as many bf as I could manage, and then give to ds1 after subsequent feed - way to increase my flow and his food - risk at such an early stage that extra bottle at night would affect my supply. I found with ds1 and ds2 that once I recognised that they were going to feed nearly all evening, I could just go with the flow (dh could cater to my every whim!)

I must confess I found breast pumping after (most) feeds a blo*ody pain, continual round of feeding, pumping and sterilising, but if you have the time and the patience it might work for you too. Alternatively, those breast fed baby charts might show you that there isn't really a problem at all. Second the idea to compare what's happening with weight with what's happening with length and head circ - only if 2/3 or more are going down is there real cause for concern I think.

Good luck.

Where can you get the breast fed centile charts from? Does anyone know?

Hi tictacs Mum - sorry if I'm repeating other posters I've not read all the resposnses

My ds dropped from 50th to 0.4 over a matter of weeks despite good feeding and what I thought was miraculous sleeping.... I jumped on a thread where TicTok advised me to wake him in the night for a feed as no feed during his long nights was inhibiting milk production.

I did a week or two of feeding every two hours during the day and an over-night feed just before I went to bed to increase my milk and now he's following the 0.4th percentile quite happily.

Hope this helps as it sounds like you're going through a very similar pattern x

I posted about something similar a few weeks ago, although in my case dd2 had dropped from the 90th to the 50th percentile.
The conclusion I came to was "look at the baby, not the chart". DD2 is a happy little thing, alert, lots of wet/dirty nappies etc. I've since stopped taking her to be weighed since it was only making me feel stressed. I had no idea or suspicion that her weight gain was slow until she was weighed (if that makes sense). If you are satisfied in your own mind that dd is fine..... maybe you could just not take her to be weighed? For example, is she starting to grow out of her clothes, nappies etc?
Another thing to consider is your own size. I am a little rounded, and dd1 seems to tend this way. On the other hand, dh is quite skinny and I came to the conclusion that dd2's slow weight gain might reflect the possibility that she has inherited his build....
Finally, I think it is very common for babies to feed a lot in the early evening (cluster feeding). I don't think it is any indication of insufficient milk or poor quality milk; I think it is more baby's way of tanking up for the night ahead.

Morning. I have the chart. As far as I can see, your daughter was on the 25th centile line at birth and is now between the line for the 2nd and 9th centiles. This is pretty much exactly what my daughter has done (she was 7lb 1oz at birth). As I said, she had a huuuuge growth spurt in January (at about three and a half months) and is back up between the 9th and 25th centile lines.

The 'Breast Fed from Birth' charts do differ from the ones in the red book (and how many HVs actually realise those charts are based on bottle feeding...??) - the curve is more gentle.

From Kellymom.com: "...pediatricians should be aware that breastfed babies tend to gain 600-650 g less in their first year than formula-fed babies, with the most marked differences seen between ages 3 and 9 months, Kathryn C. Dewey, Ph.D., said at the annual meeting of the American Academy of Pediatrics..."

You can see the charts online at Promom and Kellymom . You can buy them somewhere (would have to search for that link) but you have to buy in bulk as they're intended for health care professionals, I imagine. I had an independent midwife who gave me mine.

If your HV is going to be generally unhelpful, you could just buy one of these scales and weigh her yourself. They've discontinued the 'babytrousers', but I just hang a cellular blanket from it and put DD in that.

Thanks for posting hyperlink RZ - very interesting site....I've printed off a copy to put in my red book. Will be interesting to see what my HV's thoughts are.

Thanks for these links RZ. No need for the scales - dp is a weights & measures inspector so i'll get him to take some home- they should be super accurate!! Actually, he has been telling me not to worry anyway as he has doubts about the accuracy of hvs scales as they do not get calibrated and there are no checks done on them.

Interesting article about weight gain of breastfed babies vs bottlefed + hv's duff advice guardian article

Interesting indeed. Still even when the new WHO growth charts are published (seem to have been in the pipeline for ages from what I've read), I'm sure health visitors and PCTs will still be peddling literature at variance with official advice. I found this in my post-natal session on weaning: the bumpf was all about starting at 17 weeks and the only reference made to exclusive breastfeeding until six months was for babies with allergies.

Re: scales. I've also thought the calibration is questionable. My daughter was weighed on the hospital scale at birth, then on the midwife's scale. These two tallied. She continued to be weighed on the midwife's scale before and after the HV's visit and weigh-in. The HV's scale weighed nearly a 100g lighter than the midwife's reading, just 24 hours later. It didn't seem to occur to her that it might be down to her equipment.

chocolateshoes: Will be very interested to hear your HV's comments!

You mean it didn't just happen to me - MW and HV made me feel like I was not normal.
DD lost more than 10% in the first few days but no-one considered the fact that she hadn't fed for the first 48 hours, she was then expected to play catch up as by 6 weeks she hadn't reached her birth weight despite gaining slowly each week. Ended up giving her two formula feeds a day along with bf despite my reluctance. Still regret giving in but was made to feel I was just being too emotional. After reading this thread am determined to only bf my next.
Thanks!

Very interesting article ruthy. Will print it out as ammunition!!