8 week old ebf baby diagnosed failure to thrive

[Woolybob]

Help needed! Am ebf my DD and initially everything went very well (born 8lb 1, lost 6% at day 5 and back up to bw at day 10). However when she was weighed at 6 weeks she'd gained very minimally and dropped a centile. HV not concerned at this point as felt was catch down growth but a week later she'd only gained a further 3oz so dropped a second centile (now between 25th and 9th). At this point hv suggested bottle of formula after last feed of evening 'if we wanted'. Over this week dh & I had had vomiting and diarrhea and were fairly certain dd had too (vomited twice and not normally sticky baby plus a couple of watery poos). So we felt had good reason for slow gain plus dd happy smiley baby who seems satisfied after feeds and plenty of wet nappies etc. So basically we carried on as normal.

Saw gp today for new baby checks and first jabs and gp weighed again - weight stayed at 9lb 6 over last week and a half. So basically they've now said this is FTT and are referring us to the children's hospital. He also recommended starting to give formula but suggested doing it before a feed.

I should add that the world and his wife have checked my latch and noone has found a problem, I do get blocked ducts fairly regularly - can this effect supply? I've tried expressing but am rubbish, get virtually nothing after a feed and only 1/2-1oz if I express one side while feeding the other. I'm not keen on the formula as don't want to start on the slippery slope to ending bf but I'm starting to see it as my only option. Has anyone got any other ideas? When is the 'safest' time to top up and if I start will I ever be able to go back to ebf?

Thanks in advance.

[tiktok]

Debs, what you are being told sounds fine to me :)

[Debs75]

Thanks Tiktok I didn't want to cause aggro and take away from the OP. Staying up till gone 11 means I am missing out words, must get some sleep tonight. On the whole the peer support advice is really good, re the 'draining the breast they talk about giving a full feed(however long that may be depending on the baby) on one side then offering the other if baby wants..

OP I hope I'm glad you got some reallife support. Skin-to-skin is a lovely way to help boost feeding. My dc's loved it then and still do now. Are you sure they will suggest formula top-ups? Why couldn't you give expressed bm?

[tiktok]

blonder, start a new thread and put in all the details :)

[blonderthanred]

Well my baby only put on another 100g/4oz this week meaning he is not yet back at birth weight so we are officially 'failure to thrive' as well. Being referred to paed and have to send off urine sample.

If topping up really is the best thing for him I'll do it. But I don't know if it is. I just feel that if he hadn't lost so much in the early days, he'd be back up to bw by now and there wouldn't be an issue. Although GP said 100g a week is slow.

Sorry for hijacking thread but really miserable now. Thought we'd cracked it this week. What am I doing wrong?

[notfarmingatthemo]

I have one (my first) ff baby and one bf. Both are girls. I did get hassle from midwife that dd2 wasn't gaining enough weight but as she seams to be having wet nappies ect she left us and came back the next week. The next week I had found my dd1 red book and her weight gain or rather lack of it was the same. I think some of it may be genetic.
Only you know your baby. Listen to all the advice but and the end of the day do what you think is best for you and your baby. Things that aren't going to do any harm are always worth a try ( rest, eat high calorie food, try not to do to much rushing around).
Try and enjoy your baby don't let this spoil your first Christmas with her

[tiktok]

demisemi, good that you did not feel undermined.

Other women would certainly have done so. Other women might have found the (ridiculous) idea that their diet was producing semi-skimmed milk to be a criticism (ridiculous analogy, anyway - the fat proportion of breastmilk is dynamic and changes all the time!).

I think HVs should ensure they give information to mothers that is based on good evidence, not myth or misunderstanding and I bet you think that too :)

[demisemiquaver]

re 'SKIMMED MILK', Ididn't feel undermined.....just 'allowed to self-indulge' foodwise and enrich my diet a bit more....had been rushing around poss not treat-/feed-ing myself enuf, AND IT HELPED!!!!!!!
Interesting re 'boxticking' at end of "blonderthanred" at 10:12:46 ; can tot believe it

[duchesse]

I don't know the particular circumstances of your particular baby but will just say that I have experience x 3 of perfectly healthy babies gaining only 2 oz a week from birth, dropping from the 50th centile to the 0.2-9th in the first 4 months just because that's what they were designed to do. Sometimes they don't gain quickly. For the record, DD1 (now 17) and DD2 (now 15) are perfectly beautiful and healthy weights and heights and still growing. Some babies just don't grow fast.

[aamia]

I really would give the tongue tie a look. Research posterior ties and normal ones, look at the pics and vids, then have a good look in your baby's mouth. I say this from experience. Both GP and HV also said something that relates strongly to you - if the baby is removing milk efficiently then supply will be good. That was true for us as we went back to ebf after having to top up from four days old!

[Woolybob]

Thanks for all your messages. I contacted our local bf support ppl this morning and a lovely lady came out to have a look. She thinks latch/positioning fine but DD not spending enough time actively feeding. So she's made several suggestions about breast compressions, keeping her awake and switch feeding. Also suggested (as many of you have) skin to skin - she's suggested taking my top off and carrying her round in the sling in just her nappy.

Am not going to put off the referral I'm not totally happy to rule out something else going on. I know they will probably insist on formula - bf lady recommended the medela supplemental nursing system if they do, anyone any experience of this? She went through hand expression as well as thought I might get more that way so will have a go.

[blonderthanred]

This thread is fascinating! I was told by bf counsellor that the hindmilk thing was a red herring and to switch feed, then later the same day was told by mw to keep DS on the same breast to get the hindmilk. I told her what the bfc had said and she replied, oh that's interesting, I always thought the hindmilk thing didn't make sense. So she had been giving advice she didn't believe in!

I was also told by the mw who originally told me I would have to top up that if DS was later referred to a paediatrician and the mw hadn't advised me to top up, she would be in trouble. So it's not always about the best interests of the child, sometimes it's box-ticking.

[tiktok]

Debs - I have no idea why your peer support trainer is saying the breast must be 'drained'. Of course she is right that removing the milk removes the protein known as FIL kellymom.com/bf/got-milk/basics/milkproduction/#fil and that this regulates milk production. But if she is telling you that 'draining' the breast is essential to making sufficient milk she's over-stating it....I suspect she could explain it better.

[tiktok]

Blimey, here's another one :) : breastfed babies don't gain weight more slowly than ff babies. BIG MYTH.

If you compare charts based on bf babies (ie the ones in current use today, all over the UK) with charts based on ff babies (the old charts will do - though they were based on babies whose feeding was not differentiated; or you can find ff charts on the web) you will see that bf babies gain slightly faster than ff babies (though the difference is very small). Then from about 5-6 mths on, bf babies' growth rate slows and by the time the babies are aged 1 year, the 'average' bf baby is significantly lighter than the formula fed counterpart.

[tiktok]

I am shocked at the misinformed HV who said that good protein helped milk quality and that a mother was producing 'skimmed'.

That's a disgrace, to undermine a mother in that way.

Diet can change the components of milk - mainly it has an effect on flavour, and on the type of fat. It does not change the quality of the milk. No one in this country needs to worry about protein unless they are on a very strange or restricted diet. Increasing protein quality makes no difference to milk production of quality.

Sorry about all these posts, but there is a lot of stuff here that won't help the OP or anyone else reading it with similar concerns :(

[tiktok]

Oats and other food items may well have a reputation for helping the mother make more milk - but there is no good evidence that they do. Many cultures have ideas like this, and ours just happens to have oats which is commonly cited. If you go elsewhere in the world you'll find other ideas.

The main driver of milk supply is effective and frequent removal of milk from the breast. Anything else - oats, tea, dairy, chocolate, cake, mars bars, , homoepathy, herbs, keeping your fingers crossed, running three times round the garden before breakfast :) - will have a marginal effect at most, and if they appear to have an effect it is likely to be placebo, coincidence, or actually related to other things the mother is doing.

Keeping your energy up does not make your milk supply more plentiful, either....milk supply doesn't depend on energy levels (apart from certain conditions like anaemia, where the mother may lack energy, but it's the anaemia leading to the milk supply problem, not the lack of energy. And an anaemic mother needs more than dairy and oats :)

Just because a midwife says things does not make it right - and jojane, read the link about foremilk/hindmilk to understand why, as I said, 'worrying about hindmilk is not necessary'. Just because I say something does not make it right either - but I do know my sources and I can back up what I say :)

[tiktok]

Debs you are misquoting me! I didn't say there is no hindmilk. Read my post :) I said 'worries about not getting hindmilk are not necessary' and that is correct. Yes, of course the milk gets fattier as milk is removed from the breast. This does not mean the baby has to stay on the first side as long as possible. In fact, worries about this are not necessary - there is a good and more detailed explanation here www.nancymohrbacher.com/blog/2010/6/27/worries-about-foremilk-and-hindmilk.html

[mmmmsleep]

Centiles are based on bf babies and have been for few yrs. There are things like infections etc that can cause failure to thrive and a quick paeds check could serve to reassure you and give you confidence to carry on i wouldn't delay referral.
Agree with above suggestions for babymoon with lots time in bed with baby with skin to skin. And to get baby checked for tongue tie.
If you do top up i would do at end of feed rather than beginning to reduce effect on your supply.

Best of luck sounds like you are doing the right things

[PeerieMootsMum]

Just wanted to say its definitely worth checking out some of the threads on here about tongue tie, particularly on symptoms as sadly it doesn't seem to be very well recognised / diagnosed by the 'experts' yet. I was struggling with a baby dropping centiles, who pulled off lots and was literally continuously feeding but apparently this couldn't be TT related because he could stick tongue out and I wasn't in pain.

MN told me otherwise so I pushed the issue and ended up with a private referral - one small snip of posterior TT and 6 weeks later and we've jumped back up to 75 centile and feeding now only 20-30 mins at a time.

[demisemiquaver]

sl similar exp myself...Centiles are baseed on bottle-fed babies weight gain pattns...dead annoying how fixated HVs can be on this,esp when see all the fat babes and wee kids around..(I wonder why ?)..lots of tea (to help the 'let-down reflex),relaxation and GOOD PROTEIN in diet...an HV told me my millk may have been like 'skimmed' and to make it richer thru my own diet

[tara277]

Woolybob - I tried to PM you but couldn't for some reason. I'm a LLL leader and would be happy to help you if you want me to. The referral to the paedicatrician shouldn't be like being sent to the headmaster's office. Hopefully they will be fully supportive of the great efforts you're going to to breastfeed your baby and I would be very concerned if they weren't fully aware of the risks associated with artifical feeding. The paediatrician will hopefully reassure you that your baby is fine and then you can look at milk supply issues if that seems to be the problem. In a very small number of cases there may be conditions that are rare but important to be picked up on or indeed ruled out and hopfully your mind will be put at ease and you will be supported. It may be worth getting them to check for tongue tie (do you think your baby might have this?). It sounds as though the GP has been a little swift in the diagnosis of FTT - there is a broad criteria for this a slow weightgain alone would not constitute a diagnosis of FTT.
If possible I would suggest the best thing to do might be to cancel what you can and spend as much time as possible cuddled in bed with your baby allowing free access to milk and cuddles which I feel will do you both good.
Please PM me if you would like me to support you.

[Narked]

I wouldn't avoid the referral. If there are any issues that aren't to do with feeding, the hospital will pick them up.

[willitbe]

If the baby is having frequent wet nappies this is more important than weighing at this stage. Different scales and the fact that enf babies gain weight slower than ff babies should be taken into account. I too found better weight gain with less switching and more hind milk, one breast each feed.