Poor quality breast milk?

[littlemissnormal]

I have a 14 week old DS who was 9,10 born and on the 90th centile. He is EBF but has not put on a single oz in the past 4 weeks and after previously dropping to the 75th, he is now on the 9th. This caused concern with the HV and we saw a Dr today who is also concerned and is looking into primarily whether he has a urine infection causing the lack of weight gain.

She mentioned that we may have to look at a feeding plan for him to help him gain weight. Selfishly I don't want to give up BF as we are doing so well (I thought) but I will obviously do whatever is needed for DS.

So this evening as well as a normal BF I also gave him 3oz of formula which he guzzled down without a problem. I'm now concerned that it may be my milk that is not giving him enough calories to enable him to put on weight, and was wondering if this is actually a possibility?

And if I'm to supplement breast feeding with formula, can anyone advise on how much formula and which feed is best to give it to him at so my supply doesn't dry up and I can continue to BF him? Or should I just try and give him more BFs in one day and not offer any formula at all?

Oops, DP has just spotted a typo in my post! I wrote 30 oz which is clearly wrong: TruthSweet, it looks like you have assumed I meant 3 oz but in fact I meant 30 gms, ie about 1 oz.

Figures are from here and are based off studies looking into milk intake in ebf babies. Formula milk consumption does have to increase as the 'formula' stays the same whereas BM changes over time to adjust to the needs of the baby/toddler/child (e.g. fat content increasing from ~4% at 6m to ~11% at 12m+).

EBM figures should be very similar to ebf figures though there is some question over whether EBM is different to BM drunk at the breast (storage, limitations of pumps, etc) but it's not going to be as different as BM to FM - a Schrodinger's Cat paradox if you will

I did think a 30oz top up was a tiny bit excessive so assumed it was a typo for 3oz (having heard of that sort of top up 'recommended' many times before ). 1oz/30mls isn't a 'bad' sized top up but that may well be doubling the volume of milk already taken as a 10 day old has a stomach capacity of 60-80mls but may not fully fill their stomach every time they feed. Switch nursing or offering another side (even if it is the 4th or 5th....) may help increase volumes taken as may doing breast compressions if the feed isn't as effective as normal (e.g. suckling is slow or more sucks to swallows than normal)

cominx, always bearing in mind that the MCA has seen you and the baby and knows the history, speaking generally, the plan she has suggested for you is not compatible with establishing bf. This does not mean that every mother who supps at the suggested level will end up ff, or that no baby should ever be supplemented.

But if the plan suggested has not even included a discussion of other ways of tackling or even viewing concerns about intake and growth and supply and tiredness, then I stick to my guns: outside an urgent health situation, any HCP who makes supplementing the only strategy in the discussion is showing how little they really understand about infant feeding.

Hope things get sorted for you.

Hi guys, well DS has been weighed again today and the gain in the last 5 days is approx 50 gms, or 60 gms from lowest weight 9 days ago. Having said that the two weighings today and 5 days ago were done on different scales which I know can make a difference, even a sizeable difference. If taking the figures at face value though it's definitely an ok gain in the 2-4 oz range that one of the posters above mentions.

I've been assiduously feeding frequently and from both sides and finally have read the kellymom page linked to above about fore and hindmilk - great clear explanation there. Off to the baby cafe drop in now... I really don't feel like the latch is an issue but I think talking over the whole thing with a bf counsellor face to face will be good.

Thats good news comix. I hope that the weight gain along with the support from the BF cafe means that you're feeling a bit happier about things.

How are you getting on littlemissnormal? Have you found any of the advice useful?

Hey, DSs urine test has come back clear so with the advice from here I have not given him any formula but started waking him at night for extra feeds and using both breasts as suggested.

Dr said this is a good place to start. Weighing him with her next Friday and hopefully he'll have gained something!

By breast compressions do you mean pressing down on the breast he's feeding from?

I m really glad the urine was clear :)
Also that you re doing extra feeds. dd very rarely has ever had longer than 2 hours between feeds, greedy thing!

over her 1st 3 months my DD slowly went from 75th centile down to nearly the 9th

My Mummy instinct told me she was fine... she fed a LOT in the day (every hour and 45 mins for a good hour) and had 2 feeds at night.

by 9m she had shot up to the 91st centile! (started weaning at 5m, but only tiny amounts of fruit / veg, until she was 6m)

she is never consumed formula, cause i felt that "if i was a caveman i wouldnt be worrying, so i didnt" and she IS / WAS fine.

obviously you need to and intend to do whats best for your baby, but i know so many EBF babies who seem to drop a lot in the beginning, then make it up when a little older.

So DS got weighed by the HV again today and to my upset he'd actually lost weight .

Brilliant HV and Dr sent us straight to the paed unit at our nearest hospital where they gave him a thorough check over. They said while babies can drop centiles to find their own place, it's not usual for them to drop as much as he has as he is now on the 2nd.

Nothing obvious is showing up so they took bloods to test his thyroid among other things and I have to keep a feeding diary, keep upping the feeds and reweigh at a paed clinic next Friday.

He is not dehydrated, spent the whole time we were there smiling and flirting with the nurses and is so happy that my gut feeling tells me he's just going to be little. I hope this is the case!

Sorry to hear that OP.

I'm very glad to hear he's still happy, alert and well hydrated. A mother's gut feeling is usually right.

I went through a similar thing with DD2 when she dropped across the centiles and everyone started getting twitchy and even mentioning failure to thrive.

She was thriving! She was alert, happy, healthy in every way, sleeping well and making lots of progress in all areas of development. What she wasn't doing was following the lines on their charts.

I went along with all the tests, etc because you have to do that just to be sure but I was right, she was just naturally small.

I hope it all turns out the same for you.

I'm glad your HV and Dr were quick in sending you to the paeds.
It shows that they're not just going to do "oh just give him formula!" like some do, as if that's a quick fix that'll solve everything.

if there's a problem, then it needs to be found, not just ignored by changing the food.

littlemiss very sorry to hear of your disappointment/upset. At least they are investigating thoroughly. Good luck with it! As you say if he's otherwise doing very well hopefully it is just that he is small and that's all there is to it.

I too had a weighing today - DS hasn't lost weight but he's not put on anything like the amount hoped. This was the HV doing the weighing so a different set of scales, different person; she didn't seem very worried and we've left it that the maternity care assistant will come back on Friday to re-weigh (on one of the sets of scales that have been used already) and the HV will ring me again next Tuesday so we'll see how things go during that time. In the meantime I went to another local breastfeeding drop-in cafe this afternoon and had a very good session - they helped tweak a few things to do with length of time I left DS on each breast, some small adjustments on how I held him, etc. It felt like a confirmation that basically the latch is pretty reasonable, while at the same time giving me some stuff to work with and hopefully improve DS's weight gain. Well, let's see what Friday brings...

OP, the time between your change of plan (so you are ensuring you get more milk into him) and the weight yesterday is not really long enough to have an impact on the scales.

The usual reason for a baby dropping through centiles yet remaining healthy is i) the baby needs more milk or ii) the baby is naturally small

It is certainly worth investigating why your baby has dropped on the charts, but either of those reasons is more likely than any underlying problem so you do need to give the extra feeding a chance to work :)

Tiktok, how long would you say should be given to see the effect of OP's changed feeding plan? I make it around six days / one week between saying she'll change feeding to the next weighing.

Likewise, if you are seeing green poos and as a result you change feeding (keeping DS on each breast for longer in our case) how long before you reasonably could/should see poos change colour, if the changes are effective?

comix, maybe I have misreda, but I counted from her post of Sunday as being the start of the new regime, and the OP's baby was weighed Tuesday, so not long enough, really.

Can't really answer your question with any super-accuracy, but most people would give it a week for the weight to reveal any impact. If the green poo has been down to over-supply, you'd expect a change within a couple of days, though.

Thanks for the info, tiktok. Of course the OP is the one who knows when she actually started the new feeding plan but I took it as her starting from 30th aug, when she said she would try the suggestions: that's why I wanted to get some sort of feel for the length of time, just to be sure we were all on the same page...

I started the extra feeds in the night from the 29th which was the Wednesday which is why I was hoping by the Monday he would've gained a little.

How long would it take to see a difference do you think?

Sorry, just saw that you said a week.

Friday D-day then comix

Had DS weighed at docs and he's gained 6oz and a centile! Phew!

Many congrats, littlemiss!

Our progress has been mixed - the poos are now more brown than green, as of this morning (so it took a good couple of days), and today another weight check showed no gain - static weight (though he did do a couple of poos in quick succession so I suspect that if he'd been weighed a couple of hours earlier we'd have seen a minimal weight "gain" of 30 gms or so). Next weighing is Monday, which is nearly a week since the second visit to a breastfeeding cafe; a week since the changes in feeding have really started to be consolidated. But I would have thought I'd have seen an improvement in this weight check, if only a little...