Slow weight gain, worried now.

[TeaandCake]

My DD is 8 weeks old tomorrow and is still 170g below her birthweight. She has only gained 60g in the last fortnight.

We had a v rocky start, lots of problems with her latch resulting in a 15% weight loss at 6 days old followed by 24 hours in hospital on IV fluids to sort out dehydration. Awful and v stressful, I think my supply was damaged most at this point.

Tongue tie was diagnosed and divided at 10 days, feeding improved but weight gain still slow and a bit up and down.

MW not at all happy with this and advised formula top-ups so I have been giving her 50ml 3 times a day and BF as much as I can at all other times and only BF through the night which until recently I had to wake her for, she now wakes herself. I would really like to wean her off formula if possible when things stabilise so don't want to give too much volume and expand her stomach.

I have hired a hospital grade breast pump which I use as often as I can but it's a real struggle with feeding DD as much as possible and caring for two older children.

I take fenugreek - 4 capsules 3 times a day and milk thistle 1 capsule 3 times a day. This does seem to have an effect but I have no idea if this dosage is correct. Can anyone advise? I also drink fennel tea, don't know how effective it is, but willing to give it a shot.

My GP is watching the situation quite closely and will refer us to the peads team if DD slips any further from the 9th centime. We have to go back in 12 days' time. She prescribed Domperidone for 10 days but only 10mg 3 times a day. I think 20mg is recommended for lactation but she refuses to prescribe any now.

DD usually produces 1 dirty nappy a day but occasionally she misses a day and does 2 the next day. I thought this was ok but am worried now that this may not be enough. Again, any advice?
She seems to produce good wet nappies but they have not been quite as heavy for the last couple of days. Also worried about this.

I put DD to the breast 8-9 times a day and she feeds at least twice in the night.
She has preference of the LHS over the RHS and is sometimes difficult to get her to latch on the RHS how big a problem is this?

Her gains are as follows to give a better picture:
Birth 4020g 8lb 14oz
Day 6 3470g 7lb 9oz
Day 10 3570g 7lb 13oz
Day 13 3530g 7lb 11oz
Day 17 3450g 7lb 9oz
Day 20 3570g 7lb 13oz
Day 26 3600g 7lb 15oz
Day 31 3640g 8lb 0oz
6 weeks 3790g 8lb 5oz
8 weeks 3850g 8lb 7oz

Lastly, I have been quite ill for the last 5 days with tonsillitis accompanied by a high temp and fever, DD has fed ok but will it be a factor? I have been prescribed penicillin. Could this affect milk supply?

Really sorry that this is so long but wanted to give the full picture and would really appreciate any advice on improving this situation.

TIA

no advice but bumping for someone knowledgeable ie tiktok :)

my only thought was that 8-9 feeds in the day doesnt seem that much? i am sure mine fed more than that, but then 8 feeds in the day and 2 at night is 10 over 24hrs which sounds reasonable ish,? maybe it just felt like mine fed more than than? hard to remember those sleep deprived nights.

i guess i would just feed her as often as you possibly can, particularly at night as that is best for stimulating supply?

but i really think you need to speak to tiktok and have you seen a bfeeding counsellor in rl as that would be top of my list of things to do in your situation :)

how does she seem, happy, content, smiling ie normal milestones being met?

also where you on a drip during labour? sometimes that can affect birthweight? ie extra fluid weight? but thats only something i have read about on ment and some fb bfeeding sites, if you are on fb then the armalytical armadillo and also the leaky boob may be good sites for a bit of advice and support :)

Tea, I'm sorry to hear of your troubles but on first glance I woukd suggest that the number of feeds is on the low side. Are you able to increase the number offered?

Also, do you feed from each side each feed?

My 10 week old feeds 14 times in a 24 hour period so I would also say more feeds is worth trying.

Tea, hope ths can be resolved. I can understand why there is concern about this - on the plus side she is gaining and appears well. But I do agree it needs tackling.

You don't say what RL help you have had so far - would be good to get someone knowledgable on the case. Are you able to do this?

Formula may well be needed in larger amounts temporarily to ensure your baby has the energy to bf well.

The feeds are not that frequent - not frequent enough for catch up growth, for sure. Can you work out ways of feeding often as possible and through the night, too? Switch nursing (search archives) and breast compression (ditto) would be worth doing. It is essential you feed from both breasts at least once and possibly twice or even more at each session.....sometimes mothers in your situation have been advised to feed one side only and this is quite wrong where there is concern about weight gain.

A call to any of the bf helplines would be good, but I think you may need help and support that goes beyond what can be offered on the phone - someone needs to see you feed, for a start, to see if anything can be changed WRT position and attachment (and to see if you need to be referred for a tongue tie check, too).

HTH

Can I just add to tiktok's brilliant post (as usual) that one dirty nappy a day is absolutely fine and doesn't mean that she's not feeding well. Wet nappies are a better indication of it.
The fact that sometimes she latches on one breast does not help at all. It would not be a problem if the left breast was over producing but if it is not then you can see why she's not getting enough milk and it would be very difficult to increase it by switch nursing.
If you're lucky enough that she takes a bottle why can you not increase the amount of top ups you give her at least for the time being?
So: put her to the breast more often, offer larger top-ups after each feed and get RL help to check latch and milk transfer.
HTH :)

sorry that should have read "the fact that sometimes she does NOT latch on one breast"

Thank you all so much for your swift responses.

My HV is pretty pro BF and been so far v supportive. I am due to see her next Mon (15th). I did see a brilliant infant feeding co-ordinator who diagnosed TT and gave me an action plan until the appt came from the frenulotomy clinic arrived.

I am also well supported by a v good friend who is a neonatal nurse and LLL peer supporter who has been at the end of the phone 24 hrs a day, she has been wonderful and got me this far.

I feed DD a often as she will allow. If I offer when she is not hungry she just screams and squirms away. If I try to wake her too often in the night she simply falls back to sleep (and it takes some effort to wake her in the first place). I always try to feed on both sides and switch feed regularly, especially with the problems feeding on the RHS.

The last few days have been particularly difficult WRT milk transfer, I am listening throughout every feed for swallowing but sometimes she is sucking hard but not gulping any milk for some of the time. I have used breast compressions with mixed success, sometimes she starts to swallow again but sometimes it has no effect. Perhaps I need to look at my technique?

Something I forgot to put in the OP was that when the TT was divided the HCP commented that DD has very high palette and short tongue 'which may grow' and posterior band (I don't know what the last one means though).