Positive stories from 0.4 centile needed

[TeaAndSlanket]

I have a BF nearly 4 month old who is considered to be a slow weight gainer, who is gaining weight at roughly 200g per week, until last week, where it was 100g. He is on the bottom line on chart.

I'm taking domperidone, but have had recurrent breast health issues, mastitis, thrush etc. I am not able to express effectively (very limited and frustratingly unpredictable output, and pumping makes my nipples swell or become sore with friction, having tried different shell sizes). i have been advised to attend the GP weekly for weighing, as I was very unhappy with HVs attitude and needing to repeat my entire recent health history at each visit, to explain the situation.

However, following this week's GP weigh in, I have been asked to introduce a 2nd bottle of formula, I already give 200ml each evening. I really don't want to do this too, as it will be curtains for my supply and probably BF altogether. Is there a particular problem with being on the bottom line? DH and I are both tall and slim and DS looks to be similar. What else can I be doing to turn this around? Baby is otherwise healthy and alert, but I think affected by the repeated doses of AB's and anti-fungals. He feeds every 2-3 hours in daytime and 4 hourly overnight from 11pm.

Feeding currently quite painful with mastitis, but I'm willing to plug on, but could do without the confidence sapping remarks and it would be helpful to have a good response for GP to get them to back off, if possible. Or a strategy to boost him up below the bottom line before weaning, which I'm in no hurry to do.

As long as he is healthy and gaining weight steadily I wouldn't worry

Ds was small and lost more than the allowed amount if weight after birth due to latching probs (he then refused and I expressed for a month with one formula top up). We then moved onto ebf until he was 18 months. He was weaned at just under 6 months

He never actually made it into a centile line. He was about 1cm underneath the bottom one but after his initial probs his his growth line was in proportion. We were referred just to make sure he had no underlying health probs such as not being able to digest/ absorb but all is fine

I was lucky to have understanding health visitors. We joked about him making his own centile line up. The local area infant feeding co-ordinatir was a friend of mine and an nct bfc( I was branch chair at the time)

Apart from The first couple of weeks when he was jaundiced and failing to thrive we only had him weighed monthly. The HV said weekly was unnecessary and counter productive.

He is now 8 years old and the size/ weight of a 5 year old. School have asked if I want him to be referred to school nurse as they don't think he has grown at the same weight as his sister but they don't buy his trousers. My only concern now is he won't eat meat do I have to try and sneak protein into his diet in other ways.

I'd say if you are happy that your baby is content between feeds, lots of dirty and wet nappies etc then try not to worry.

My DD was a slow weight gainer too. She started on the 75th centile and by 3 months had dropped down to the 2nd. She has reflux and was sicking up most of her feeds. With her, we were advised to introduce formula top ups and at the same time, we got her on the correct dosage for reflux. Finally, she started to put on weight, although I was advised that the amounts of formula I was giving her couldn't possibly explain the weight gain. We continue to give her small top ups which we mix the Infant Gaviscon with. Once she's on solids I hope her reflux will calm down and I can cut out the top ups.

But, my point is that DD is now 4.5 months old and is going between breast and bottle quite happily, is now on the 25th, and I've not really noticed any issues with supply. So, top ups don't necessarily spell the end of breastfeeding!

Just do whatever feels right for you. I have no regrets about introducing top ups - just wanted to give you a positive story if this is the route you go down.

Both my ds's are on the 0.4th centile.

We had referrals to the speech and language therapist to check ds1 was able to eat ok, he was referred to the paediatrician and dietician too. After all the interference and appointments it was decided he was just made that way. He was mix fed from 5 weeks simply because I had problems bfing, pain mainly. I was told by hv's to add more formula to his diet and it was a bit of a slippery slope from there. He started to prefer the ease of the bottle and ended up formula fed completely from 5 months. The dietician prescribed him high cal formula and powders to add to his food, these would cause a short term growth spurt then he would go back to gaining slowly, most likely because they totally killed his appetite for food and made him constipated. We finally had enough of all the interference and slowly weaned him off the high cal supplements. His appetite increased and he eats better all the time (now 4yo). He still eats small quantities, that's just him. He just follows the 0.4th centile nicely and I'd happy and very healthy and full of energy. There is nothing wrong with being on the bottom centile, someone has to be there, just as someone has to be at the top of the chart, that's how they work out the averages!

Ds2 came along, gained weight in exactly the same way as ds1. Quite well in the beginning then slowly slowed down and he also ended up on the 0.4th centile. This time I managed to exclusively bf him and he weaned well. This proved to me that I just make em genetically small. He was referred to the paed just to monitor him for a while but after 3 appointments they signed him off as they could see he was following the centile rather than dropping down for instance.

When born ds1 was 9th centile and ds2 was 25th centile so they both gradually dropped down the chart over the first year but they settled where they were meant to be.

Like ds1, ds2 is happy and healthy and full of energy. I haven't had him weighed for a while but we occasionally check him on the bathroom scales and he's still on the 0.4th.

I would say that if your lo is consistently gaining weight and is bright and full of energy and having wet and dirty nappies then there's probably no need to worry. Of course I say 'probably' because i'm not a dr.

I would say weekly weigh-ins are far too frequent and will probably cause you more stress. I was told to weigh my ds 1 every week till he was 6 months old and it turned me in to a nervous wreck. Each week the hv would question me about his feeding and make me feel it was my fault. You don't have to do what your hv says, you don't even have to see her.

I got ds2 weighed a few times in the early days then had a bit of a gap and got him weighed around 19 weeks, after that it was quite a while, I remember I got him weighed at his 1 year check and thats when he has settled on the 0.4th centile and we saw the paed a few times. Since the paed signed him off we've weighed him infrequently, ourselves at home. Him being our second we listen to our instincts a lot more.

Am due ds3 any day and am expecting him to follow the same pattern

At the end of the day, if you want lo to have more milk, it doesn't have to be formula, you can offer the breast more often. It might be worth seeing if there is a lactation consultant in your area who can advise you on this a bit more. Do you attend any kind of bfing group?