15 week old extremely slow/nonexistant weight gain, topping up?

[thunksheadontable]

Ds2 was 9lbs 3 at birth and is a mere 11lbs 3 now. He is beginning to look pretty skinny and is dropping through the centiles just like his older brother did. His older brother was supplemented with formula for failure to thrive at about six weeks (I think?) and I always thought his continuing low/slow gain was to do with that supplementation. Ds2 seems to be following the same pattern though.... grrr.

He is fed on demand, I switch feed and on the days ds1 isn't here (3) I do biological nurturing and keep him close to the breast all day, this isn't really possible when ds1 (2) is here. I do wear him in a soft sling on those days and keep him close, I also cosleep and he feeds a lot during the night. Ds2 is a contented enough feeder but there are signs of tongue tie - clicking when feeding, my nipples look like they've been clamped, he's losing milk from the sides, coughing and choking during feeds. I discussed this with the health visitor but she basically said, well, it's too late to do anything about it now anyway.... I know this probably isn't true but I'm reluctant to have a posterior tie snip done at this stage to be honest, I have a lot of health/hospital related anxiety/OCD and I think the risks outweigh the potential benefits.

So, I don't really know what to do. I don't like the fact he has started to look really skinny and I'm not happy about this going into the winter, I want a bit more meat on him in case of coughs and colds and things like that, especially the dreaded RSV. His length and head circumference are around the 75th centile and his weight is 18th so I know he's really not getting the nourishment he needs.

What is best? I find expressing is really tough, can't get much out and the pump really hurts my nipples (lansinoh double pump). I didn't want to give him formula really but I'm not willing to let him plummet off the charts like his brother did, he was really skinny at six months and that was the middle of the summer. Are there tips for expressing that would make it easier? If I do supplement with formula, how do I manage it so that I can keep breastfeeding, is this possible? I fed ds1 until 2 when he selfweaned as I was pregnant but he had a bottle much sooner than ds2 and I used to feed him before a formula feed and express through the feed. Is this necessary?

Many thanks x

As someone who's ds went with undiagnosed tongue tie until he was 6yo, I would say that you should get it dealt with.

DS1 is suffering the consequences of untreated tongue tie and I wouldn't wish it on anyone.

15 weeks is not too old.

I would echo getting the tongue tie sorted. We have had our 9 week old baby's snipped twice (posteior) and have had no hesitations.
My friends 4 yr old has just been diagnosed with tongue tie and she's not having it snipped under general anaesthetic after it caused speech difficulties and had also meant she has seriously choked on food twice

She IS having it snipped under general anaesthetic!

Look, he's not getting a snip. I have a friend who is a superspecialist in speech and feeding/swallowing disorders and she has looked and says there is no reason to believe it will cause any problems as he gets older.

Perhaps I should have been clearer: I nearly ended up in a mother and baby unit with my OCD when he was born, I have three appointments a week at the mother and baby unit so I can stay at home and I am in any position to fight with the local services to have his tongue snipped (I had a fight on my hands with my older boy even though his tongue was clearly tied down and he had a corniculate tongue, I got my superspecialist friend involved AND he was much younger - they don't do it at my ds2's age and I didn't pick it up soon enough this time). So that isn't going to happen.

My question is about supplementation and I would be really grateful if anyone had any advice about this.

thunksheadontable you asked about supplementation, I'm afraid I don't have any experience of that.

But what I do have experience of is the mix of fighting with hcps, tongue tie and mental illness.

DS1 is 6yo and last year I discovered that many of his problems were related to his tongue tie. Reflux, bloating, sleep apnoea, fussy eating, pain in ears and hearing loss, mouth breathing, bedwetting, dental problems etc etc.

I was trying to convince the medics that he needed his tongue done and was getting nowhere. Eventually, the stress of having an unwell child coupled with unhelpful medics, tipped me over the edge and I developed psychosis. I was almost sectioned. As most people with psychosis do, I went on to develop post psychotic depression which thankfully has now lifted. I know how crippling mental illness can be, even though I haven't experienced the same type as you.

But I also know how important tongue tie revision is and how far reaching the consequences of untreated tongue tie are. Depending on where you live, you may not have to go near any doctors or hospitals. There could well be a lactation consultant who can come to your house and do it there. Milk Matters would be able to let you know the options in your area.

I don't want to dis your friend, but she cannot say for sure that there will be no problems in the future. A baby who is displaying the symptoms that you mention in your OP most likely does not have the full range of movements required to breastfeed. A tongue that does not have the full range of movements cannot function normally and compensation for the lack of movements can lead to problems throughout the whole body.

I would hate to think that a few years down the line, you might find yourself in the position that I was in last year over ds1.

Just to say we've supplemented for DS with formula. He's STILL not gaining weight, despite drinking serious amounts of formula + still feeding from me. Having tried with the supplementation though, the pediatrician is willing to investigate further for digestive issues/allergies etc. Without supplementing first, they weren't willing to investigate. If there is an issue there, could your Ds2's dad take him for the appts?

Re the tongue tie, the lady who's going to do my DS's tie comes to people's homes and is private. It's about £100 but there's no fighting with the NHS to get it done and it's all calm and easy to arrange. She's a lactation consultant who trained to do this. I bet there'd be one near you if you wanted your DS's done. No hospitals, no stress. Just a thought that the option would be there.

thunk, what a difficult situation :( You;re right to be concerned about a baby who looks skinny, and where there is a discrepancy of length and weight of this size. Some babies are naturally slender of course but you would need someone experienced and knowledgable to decide if this was the case.

If you are not happy about getting his TT dealt with, then you need to explore other avenues but with someone you trust in real life such as a doctor, a HV, a dietitian or other HCP....I think it's beyond a talk board's ability to make suggestions about how much to supplement to be honest, though of course a board is great for support and encouragement.

Hope you get some good help soon.