Baby dropping weight centiles and unhappy on breast

[WillowsTree]

Hi, I am new to mumsnet and this is my first post, so here goes!

I am a first time mum so still pretty clueless! My DD is 13 weeks tomorrow. She is EBF and feeds on demand every 2-3 hours. She started between 91st and 75th centiles, and has now dropped below the 50th. GP is not overly concerned - yet (she is really lovely and helpful and has 2 young children so has also been there, and it was her who suggest I post here) but wants to keep an eye on things.

The problem we're having is when feeding: DD fusses, latches on, pulls off, screams and cries and repeats this for up to 5 mins before settling for a proper feed of 30mins, sometimes more. She has been checked for thrush and her latch, but I am concerned as she is obviously very unhappy, even in pain, and I am not sure what is wrong or how to help her. The only feed she does without this is when I do a dream feed because she is relaxed. If she is pulling off because of pain, would she not be in pain with the dream feed too?

DD has happy moments, but can be very unsetled during the day. We have been using gaviscon for 2 weeks but things are the same. I have started a dairy free diet today to rule out any lactose intolerances too.

Sorry for such a long post, was hoping to find some pro's out there to offer ANY advice.

Sounds like you're doing really well with keeping going to 3 months, and with the weight. Honestly, honestly 75th to 50th over 3months is no big deal.

The pulling off - worth getting someone expereinced to observe in real life - but it sounds to me that your milk starts flowing with such a 'woosh' that it overwhelms the baby at first. It's a compliment really!

Hi welcome to MN, well done for EBF and congrats on the 'new' baby. These days can be worrying, I am sorry, no advice but hopefully someone will be able to that has more experience than me!

Ask for your post to be moved to the feeding section, you might get lots of answers then

As you're new you might not know how to do that though, I'll report it and ask

@WillowsTree

Hi, I am new to mumsnet and this is my first post, so here goes!

GP is not overly concerned - yet (she is really lovely and helpful and has 2 young children so has also been there, and it was her who suggest I post here).

your GP is obviously VERY wise.

@gigglewizz

Hi welcome to MN, well done for EBF and congrats on the 'new' baby.

Indeed a warm welcome and congrats on your DD

Willows, yes, it is puzzling.

Clearly your baby is healthy and thriving so no urgency here, but of course she and you deserve comfort and happiness when feeding :)

I don't get the reason for the gaviscon....usually it's prescribed for reflux, but is this what you and your doc think is happening?

You could call a bf helpline, and really discuss things, 'cos there's a range of possible starting points:

• your baby might prefer to feed more often, with a quicker response to feeding cues
• do you offer/has she taken both breasts each time?
• has there been a history of slow weight gain, and/or supply issues, even at the very beginning?
• have you tried biological nurturing positions ('laid back' breastfeeding)?
• could it be super-speedy let down - poss resolved by feeding more often so there's no quick-trigger-release .

There are other avenues worth exploring but that's enough for now :)

Welcome!

I'm sure more will be along with advice about the specific problems you're having with the first 5 minutes of feeding, there's a lot of things it could be.

I just wanted to say re: dropping centiles, don't worry! My DS went from 75th at birth to 25th at 2 weeks, then down to about the 7th at 13 weeks and stayed there till he was 6 months (possibly older, I quit weighing him so much after that). There was some talk of him having mild tongue tie, but nothing ever done about it. I did EBF until 6 months and then started solids. When he was weighed at a year he was back up around the 25th centile, and at 2.6yo he was dead on the 50th for both weight and height.

Have heard similar stories from others about babies that were always skinny or always huge and became the opposite after a year or so. If she's healthy otherwise and doesn't seem to be losing weight or ill, I'd advise not getting her weighed too often, just to protect yourself from all the anxiety.

have you considered expressing and feeding that way she's still getting the goodness and also you can monitor how much she's having?

kialiana, expressing is in no way indicative of how much a baby is able to extract directly from the source. Anyway, input can be measured by output eg, dirty / wet nappies.

Just to add: while it's true that dropping centiles is not a worrying sign in itself, and that normal, thriving babies do this without it indicating anything significant - and the doctor has confirmed the baby is fine - it's not right to say it means nothing....in this situation.

The baby's behaviour, described by the OP, is indicative of a baby who is not happy feeding, at least some of the time. Maybe there is a supply issue, or an issue with getting that supply 'in' - both those can be fixed, and they should figure in the question 'what's going on here?'

kialiana - expressing and giving breastmilk in bottles is a pain, and knowing how much the baby is having is not much help in most situations. You might see the baby is getting x mls, but what if the baby actually needs x minus y mls or x plus y mls? :)

i know expressing is more of a pain. i did it my ds was really struggeling so i expressed for 2 feeds and this made a big difference and i looked onling at how much he needed as it goes by weight. i desided to switch to formular after a while but atleast he got that little bit longer with the breast milk. also expressing between feeds can help increase the flow which might also help.

Oh my goodness, thank you all for the posts! Have just had a chance to read them through and I am so grateful for the replies. Flisspaps thank you for ensuring my post was in the right section!

Thank you ALL for putting my mind at ease about the fact DD is dropping centiles. I was advised to get her weighed at least at 2 week intervals, but will see how it goes as dont want to obsess. Main priority is sorting the feeding situation!

tiktok gaviscon was prescribed in case of silent reflux. I stopped using it yesterday to see if anything would change. DD has been feeding better today, but has been bringing up a lot of horrible smelling sick, so think maybe will re-start the gaviscon (unless I am REALLY unlucky and its a reaction to the soya milk!?!) She has been a lot happier today despite the sickness issue! Have never offered both sides as she never seems to empty the first.

FiveRingsForDinner I also think that I used to have a really fast letdown (spraying all over DD if she pulled off) but now that doesnt happen. Could possibly be going the other way now and have too slow a letdown, maybe that is whats stressing her?

I spoke to my breast feeding peer supporter who has said there is a midwife/breastfeeding "expert" who I can be referred to see so will definitely be exploring that avenue aswell.

I struggle with expressing and for long enough had the worst cracked nipples, so am kind of scared of doing it because of the pain factor! Also dont want to start confusing her with the introduction of a bottle at this stage.

YankNCock DD was tongue tied at birth and it was quite bad so we decided to have it snipped. After she fed for about 8 hours straight! Was a long night in hospital!

Someone mentioned teething today, not sure if this is a possibility, or just similar symptoms.

So many ifs!!

Sorry, another mammoth post!! Im away to clean the sick off me now but hope to hear more pearls of wisdom :) xx

Willows, you need to offer both sides. There is no need to worry about not emptying the first side - it is quite wrong for mothers to be told this nonsense that the first side needs to be emptied :( :(

You can't empty either breast, anyway. There will always be milk there.

Mothers should not be told 'one side only' - it's utterly wrong. Some babies are totally fine on one side only. But as a routine instruction, it reduces milk supply and reduces the amount of milk going into the baby :(

The easiest change for you to make is to offer both sides. When your baby indicates she has had what she wants on side one, offer the second side. She may or may not take it - but she does need the offer.

If the fighting and struggling is to do with supply, then this is a step towards fixing it .

tiktok Wow did not know this about the not actually being able to empty a breast! Health visitor has told me several times not to offer the other breast until the first is empty!! Should really have come on here sooner! That is the first and probably easiest thing I can do in trying to solve this situation.

I know its perhaps a 'how long is a piece of string' argument, but is there any sort of time gauge I can use as when to change sides?

There are a few useful guides for mothers wanting to know if their HCP really understands about breastfeeding.

They are poorly trained and don't know enough if they

• ask about diet/fluids and say anything about making sure the mother eats properly or enough
• talk about offering only one side so the baby 'gets the hindmilk'
• talk about making sure she 'empties' the breast
• indicate the clock has anything to do with staying on for long enough :)

You use your baby, not the clock, to decide when to change breasts. Your baby will guide you by changing her behaviour - she will come off spontaneously, or she will cease sucking and dose, or she will fuss a bit. You will learn what the right time is. She may want a little gap/rest/burp, and then you offer side 2.
Sometimes, the word 'empty' is used even by people who do know what they are talking about, but they do not mean literally empty - it's just not possible for the breasts to drain completely, because milk is being replaced all the time.

No time frame - just watch baby and read her cues:

• if she comes off and looks 'milk drunk' and completely out of it asleep then you don't need to offer the next side to her but when she wakes up you can,

• if she comes off and is fussing then you can offer the next side,

• if she is feeding but just sucking with no pauses (each pause is a mouthful of milk - e.g. suck, suck, suck, suck, suck....... not suck, suck, suck, small pause, suck, suck, suck, small pause) then switching sides can help stimulate another let down and help baby to access more milk,

• if she comes off and is quietly alert then you can offer the next side but she may be full but not sleepy (this is fine btw!) so may not want it,

• basically if in doubt offer the next side and don't worry if she doesn't want it

btw it's incredibly rare for babies to be have lactose intolerance (that's not triggered by a stomach bug or presenting at birth with a very, very ill baby) as breastmilk has lactose in it (and in larger quantities than in cow's milk). Cow's milk protein intolerance (CMPI) isn't as rare as lactose intolerance and CMP can come through breast milk. CMPI and soya allergies seem to go hand in hand ( I can't remember the %ages that have both though but it's moderately high) so it may be the soya milk (I guess you are drinking this instead of cow's milk? You could try almond milk, oat milk or rice milk for your own use as an alternative) though it may be either there's not been enough time to clear the CMP from your body or you are inadvertently eating milk in some form (check for all types of dairy in the foods you eat - the labels should say if it contains milk in any form but it can be quite sneaky in it's guises!) or there isn't an issue with either CMP or soya and there is something else going on.

TruthSweet and tiktok thank you for this. Didnt realise how uneducated I was on breastfeeding, even 13 weeks in! Tiktok, I have been asked about all 4 points you indicated so have been carrying on with the wrong pattern unbeknown to me :(

Offered both breasts at last 2 feeds and she did take them both. :) She is also a lot more settled and seems to be latching on better. She is still coming off and on for a bit at the start, but not screaming or crying. Almost as if she is distracted and being nosey?

I will carry on with soya tonight and monitor the sickness. If it continues it will be other alternatives. Am I wrong to assume that a small amount of feed coming back up is normal? Or should there be nothing coming up at all for there not to be a problem?

So far only one person I have told has asked if i will just start Formula feeding DD, but I would only do that if she was not thriving, which I am happy that she is.

Possetting is normal (possetting means milk regurgitation) if baby is gaining well, isn't bothered by the milk coming back up and is happy and content (mostly - these are babies we're talking about!).

Large enough volumes in a high enough frequency to cause weight gain problems, pain/screaming/crying when vomiting, or pain on laying down or possetting while the baby 'postures' (tries to elongate their body and basically throws their torso back - it's baby's futile attempt to escape the pain of the acid refluxing up their oesophagus) are signs that something isn't right with baby and help is needed.

It's a rare baby that never ever possets and most babies do bring up small amounts of milk either, most feeds, daily or from time to time without there being any problems. This is because the oesophageal sphincter (the ring of muscle that acts as a drawstring at the top ot the stomach) is fairly lax in small babies so it doesn't take much for some milk to escape.