BFing issues with 15 wk old underweight DS

[Notthebestfeeding]

DS is 15wks and very small, born on 9th centile but dropped to below 2nd, currently around 0.4th, he has always been a bit of a fussy feeder but the last few weeks it has got really difficult. He latches on and then tugs as far backwards as he can and tries to feed with a really poor latch and milk dribbling out the side of his mouth, if I try to draw him closer he arches his back and pulls backwards even further, he also squirms around, bites with his gums and often comes off screaming or pulls so far backwards he tugs off and starts screaming. He used to feed for an hour every 2 hours in the daytime but now often just feeds for five or ten mins before seeming to give up but doesn't seem very content. I know his feeding pattern is changing as he gets older but it seems a very drastic change and I worry he is not getting enough, every time he gets weighed by HVs I come away very demoralised feeling like I must be doing something wrong but can't work out what it is.
He has been very windy and I thought a lot of the fussy feeding was due to that as he squirms and farts through the more difficult feeds but have started to wonder if it is me doing something wrong, as he gets bigger I don't seem to be able to get such a good latch, I feed him on a pillow but would really like to be able to feed without one but trying to make changes to his feeding position just really stress him out.
I'm trying not to stress about his weight as he is getting bigger just very slowly, switched to just feeding on demand a couple of weeks ago (used to wake him in the night for feeds and feed every 2 hours dring day as advised by HV) and so he is now feeding a lot less than before, he goes to bed at 8pm and mostly sleeps through till 5/6am and thenseems hungry roughly every 2-2.5 hrs in the day so some days only has 4 feeds in 24 hours and these can be really short feeds. Can this be enough? Sorry this is a bit long & waffly!

Sorry to be brief, but didn't want to leave you reply-less!

Do you have a strong letdown? This can make some babies try to back away while feeding, and dribble the excess. I didn't have this (the opposit in fact!), but have read that expressing a little before you feed can help stem the flow a bit.

Have you considered reflux, or silent reflux? The back arching is what makes me wonder. Please read up a little about it, esp Silent Reflux, and see if your DS fits any other symptoms.

My DS was an awful feeder, born early so small and always between 2nd and 9th centiles, and hasn't risen much since. He's 15mo now and I've accepted he's just a small and slender boy, he's never going to pack weight on like some of his contemporaries.
It took us til 4mo to sort out his feeding, then til 8mo before we sorted his reflux, he's thrived since, but is still wee compared to his mates! Try not to worry about how much he gains, as long as he's still gaining. Everything changes once they wean too!

firstly, dont stress! There will be someone along soon with more experience but in the meantime.... what has the HV said about this? If you dont feel confident speaking to them can you get to a LLL meeting nearby? or perhaps call the NCT BF helpline to see of there is a BF support group or counsellor in your area? Both LLL & NCT have well trained people who will have come across this before or be able to consult with someone who has. They really supported me when my LO was not gaining weight. I have had to accept he has fallen to the 9th centile and staying there!
Good luck

How are you dong now Notthebest? Have things improved at all?

You mention latch, have you had your latch checked recently? Have you seen from Dr Jack Newman?

I'm not trained but I don't think 4 feeds is nearly enough at this age, whatever their weight is. Know I wouldn't be able to cope with just 4 glasses of milk in a day anyway! I think your HV has given you some good advice. I had a patch when I was concerned about DD's weight and I did exactly as your HV recommended.

Blame mentions letdown, does what you are experiencing sound like this? And have you read How might I increase my baby's weight gain?

SirCharles mentions seeing a BFC, have you managed to get along to a Bfing Support Group yet or have you telephoned one of the Bfing Helplines?

Sorry it's been difficult, I know how stressful it can be. Definitely research silent reflux. You have just described DS when his reflux isn't under control. The pulling, squirming, arching, he can also be v windy from all the pulling off/on.

The biting down with the gums i think a lot of them start doing around 15 weeks. Kellymom has some good info on breastfeeding manners here

DS has dropped down to the 9th as feeding can be difficult. If its not controlled then he goes off it completely & often won't feed at all which stresses me out! I would say four feeds a day is not enough though. Could you try giving him more in the day? V he sleeps so well!

I would stick with the pillow. I didn't use once until recently & my back is suffering because of it.

V he sleeps so well! know what you mean Suck, but sleeping through isn't always a good thing, especially if there are weight concerns.

Notthebest, most of the things you mention make me wonder about tongue tie.

have a read of this

He might have been checked for tongue tie already, but many HCPs miss tongue ties, especially posterior ones.

this is useful too

DS has a TT too which probably doesn't help. My understanding is this can be related to the reflux as it effects peristalsis in the body, so worth getting checked out.

The first thing I though after reading your post was has baby been checked for tounge tie?

Four feeds a day is certainly not enough for an baby of this age. I think you still need to be waking him to be hoist. And you need some real life support as soon as possible. If you don't have a local breastfeeding cafe then ring one of the helpline. I think you may need to see some one more experienced then this but ruling out any simple problems first is a good step.

Thanks all, I've asked HVs about reflux a few times but been told that as he is happiest lying on his back, is pretty settled between feeds and sleeps well he doesn't have it. I didn't know about tongue tie, can't see anything wrong myself but will check with HV. Also not sure about fast letdown as he often feeds well for the first few mins and during the letdown but then gets stressed after a few mins.

I started just feeding on demand after calling the national bf helpline a few weeks ago he was going through a phase of getting very upset when I offered him a feed and kept refusing feeds altogether, was told that it could be his feeding pattern changing as he gets older and to try and just feed on his cues - we used to wake him at 11.30pm for a feed but this was never very successful as he would either feed half heartedly for a few mins and go back to sleep or just refuse to feed altogether and go back to sleep, then he'd wake anytime between 3 and 5 crying, but when we stopped waking him at 11.30 he immediately started sleeping till 6ish and woke up really happy and smiley and had a really good feed, he still does this now although on hotter nights recently has been waking earlier anytime from 3 onwards. I see various different HV and the last 2 said it was ok for him to sleep through at this age but wold be preferable to get more feeds into him as he is so small.

I have called various helplines over the last few months and tried to get to the local support group as much as possible but also have 2 yr old DD and she gets really bored so end up spending more time trying to entertain her than chat to other mums for advice, the BF counsellor is great but very busy and I haven't managed to speak to her for ages. Have been trying to find a lactation consultant locally and finally managed to get hold of one today, she's coming to see us on Sat so hopefully will be able to help with latch and positioning as I am pretty sure I am getting worse at this! She thinks the recent problems could well be caused by a drop in supply after a few weeks of feeding less than before so I need to work on boosting my supply, any advice on this? I struggle with expressing and don't have any spare time in the day to devote to it, maybe should try expressing for 5 mins mins after each feed?
Would love to be able to stop worrying and just enjoy DS as he is adorable, I never expected him to be a huge baby as DD was very tiny and DH & I were small babies but not sure whether he is just naturally tiny or if it is something I am doing wrong.

I had problems with supply (possibly caused by untreated tongue tie). I addressed it by hiring a hospital grade double pump and aiming to pump 8 times every day. (I never managed it!). If I managed 6 times I was really chugged. More often than not I got to 4 or 5 times. How did I do it..... Hard bloody work!!!

1. First thing in the morning as soon as I woke up/before DS woke. For 15/20 mins

2.. 30 mins after the next feed for about 10mins

1. Ditto
2. Before I went to bed / about 50 mins after the mid evening feed express for 20 mins
3. Straight After the midnight feed I would express for 15 mins.

6, 7 & 8 - fitted those in randomly as best I could even if they were only for 5/10 Mins after a feed.

I had a chart above the kettle in the kitchen to keep tabs on a daily basis. I was also recommended to have a small
Bowl somewhere with 8 sweets in and to take 1 out at each pumping. It worked!

I was told by a LC that your body needs to be stimulated well at least 8 times a day to build your supply and at least once between 11pm & 2am. So I figured that once the TT was cut and as DS got bigger some Of his feeds counted towards that target too. The expressing really worked and we are now Ebf after a v shakey start.

Good luck. In the grand scheme of things it does not take long - ie only takes a few weeks to address supply issues in the way I described above. Now we are reaping the benefits of not having to sort out formula, which at one point was looking increasing like the way we were headed.

Good luck with the lC and keep us posted.

Btw my 13 week old is being treated for reflux and he is settled between feeds, sleeps well etc but he does squirm on the
boob, bobs around, gets bad wind and he also has a cough. Will see how the treatment goes but your comment re your HV made me want to share .
In your case I would check with a baby friendly GP and not just rely on the HV opinion.