6wo ebf baby failing to gain weight

[blonderthanred]

I'm so upset and don't know what to do for the best.

My DS was born by CS after a failed IOL at 38wks due to GD. He was 8lbs0 at birth or 3635g and had lost more than 10% of his birthweight at day 5. On day 7 he had lost a tiny bit more and I was put under pressure by the mws to top up with formula but I asked for a few more days. At day 9 he had put on 20g, since then he has gained weight slowly (80-100g/wk) but has not yet returned to birthweight.

Last week the mw referred us to the paeds and said we should hear from them in the next few weeks. I've not heard anything yet. We also saw the GP for the 6 week check who was also concerned in case he wasn't strong enough to withstand catching a cold but said she thought I was 'doing the right thing' by continuing to ebf. She ordered a urine test which came back clear. Everyone we have seen says he looks healthy, alert and is meeting his milestones (lovely smiles this week). He has big feet, hands and head circ like his dad who is 6'3.

This week I was so hopeful as he seemed chubbier but he had only gained 10g. He is now 3.57kg. The HVs were very concerned and keen for me to start topping up. I asked them to check on how soon the paed appt is likely to come through so they are doing that.

I am bf on demand, average every 3 hrs although it's not as regular as that. He seems to have a good latch and I can hear him sucking and swallowing, although he is fussier during night feeds and sometimes in the latter stages of a cluster feed so I sometimes have to help him more with compressions etc. I try to offer both breasts although he prefers the left. If he is sleepy I remove a layer of clothing or change him, unless I think he really needs a nap.

He was checked for tongue tie at birth and we were told he was fine. He sticks his tongue out with no probs, maybe a very slight heart shape at the end.

I've worried about supply (as anyone would) as I have never felt really engorged but he comes away with milky chops and doesn't seem hungry or dehydrated. The HV today said maybe the milk wasn't good enough quality and asked a lot of questions about my diet (which I didn't think affected milk). He has plenty of wet nappies and generally at least one full dirty one (apart from 5 days when he didn't go but he made up for that after) although they are sometimes on the greener side of yellow. I don't get much from expressing (only a few ml from 15 mins each side) and find it quite stressful although I'm willing to stick at it if needs be.

I just don't know what I am doing wrong. In every other way motherhood is fantastic, exceeding all expectations. I am just so scared I am doing my son a disservice by declining to top up. But my instinct (and understanding) has always been that ebf is the best start for him.

Sorry this has been so epic but I've tried to include everything. Thanks to anyone who has read this far and for any thoughts and advice.

[KatAndKit]

I think you might need to bypass this HV - try ringing the hospital yourself to chase the appointment and going either via LLL or a private lactation consultant for the TT. Sounds like your HV is not at all supportive of breastfeeding and just wants you to pack it in and go onto formula.

[crikeybadger]

Hi blonder, sorry everything seems like a battle for you right now.

I just wanted to add a couple of things, hopefully without overwhelming or confusing you...

-being able to poke a tongue out, does not always rule out tongue tie so it's good that you are trying to get hold of the breastfeeding specialist.

-Sometimes a small adjustment in the latch can make a big difference to milk transfer so again, that's another one to consider.

-I'm not sure if this was mentioned before but what you eat and drink has no effect on your milk quality or quantity. You obviously need to eat well for your general wellbeing, but your HV is barking up the wrong tree with that one. (and indicated a clear lack of understanding of bfing).

• Great idea to have a babymoon- just feed at every squeak and do lots of skin to skin. Then as you say, see where you are next week.
  

One final thought....are you happy that the scales are correct and the weights have been accurately recorded?

Let us know how you get on anyway.

[WLmum]

Hi, what a stressful time for you. Dd1 did not gain weight as expected even though I fed her almost constantly. Sounds as though it's a bit different to your ds though as she cried loads and hardly slept. Despite being assured at bf clinics that she was feeding ok, clearly she wasn't as when I switched her to ff she piled on the weight. I too had little success with expressing but I do think that was largely because my supply was low, and I had a crap expresser. When I got a better one, and had a bit more rest after dd had had some bottles, I started to be able to express much more until I could get 8 oz in a sitting. In hindsight I wish I had tried mixed feeding earlier and replaced bfs with expressing to get my supply up - fenugreek is also great for boosting supply but it does make you smell like maple syrup!, and then moved back to ebf when I was confident about supply. I think dds problem was that she had a very weak suck so only got a tiny bit if milk at each feed but stayed on trying for more/comforting.

Good luck with whatever path forward you choose.

[ChunkyTurkeywiththetrimmings]

Really hope you get some (pro-bfing if that's what you want to do) support to get him gaining weight at the correct rate. It is very difficult to keep perspective when it is a) your boobs/milk/body that is perhaps perceived to be "failing" and b) your baby & all you want is that they are healthy & happy. Best of luck.

[blonderthanred]

Thanks again to those who've taken the time to post.

Spoken to HV (again), locum GP and (hallelujah) breastfeeding specialist who has arranged appt on Monday to check again re. tongue tie or other issues. So a weekend of intensive bf and then we shall see.

Does the fenugreek really work? I wasn't sure if it was worth getting some.

[SpanielFace]

This sounds so similar to my DS. He lost 11% of his birthweight, and had still not returned to it at 4 weeks. He was also incredibly fussy, constantly hungry and unsettled. He turned out to have a tongue tie which had been missed, it was only when we saw the breastfeeding specialist that it was picked up. If your baby has a heart shaped tongue I would say its highly probable that is the problem. DS had his snipped at 5 weeks old and it's been smooth sailing ever since, although he's still on the 0.4 centile line! I really hope that you get the help you need, I was so stresses and worried about DS so I feel for you.

[StuntNun]

I wonder what the effect of the GD is Blonder? If he was 8lb at 38 weeks then he must have been getting a lot of extra glucose in utero. It is possible that some of what you are experiencing is an adjustment to feeding on his own after being oversupplied. Hopefully the next few days will make all the difference. Honestly it's amazing humans survived for hundreds of thousands of years without scales or formula milk. The way the midwives tell it we would have died out as a species without formula milk.

[blonderthanred]

Stunt I suggested that to the mws but they dismissed it. He was measuring 3 weeks ahead on ultrasound. Also the person from LLL said CS babies lose more weight in the first 24 hrs because they don't have fluids squeezed out during birth. If he had weighed 7lbs8 at birth he would have regained bw at 3 weeks and we'd only be weighed monthly - I wonder how it would have worked out then. He'd still be a slow gainer but perhaps without this panicked response.

Spaniel Sorry you had to go through it too. I kind of hope it is that for us as it would make sense of what is happening and is a relatively easy fix. HV insisted TT impossible if he is latching but it sounds like that's not always the case.

[SpanielFace]

I was told that it couldn't be a tongue tie as DS was latching & I had no pain. It's rubbish. Have a look at milkmatters.org.uk/2011/04/15/hidden-cause-of-feeding-problems-however-you-feed-your-baby/

Obviously there are lots of other possible explanations, but tongue tie is underdiagnosed - apparently it affects 10% of babies!

Has anyone suggested breast compressions to help with milk transfer? That did make a difference to us before the tongue tie was snipped.

[KatAndKit]

My DS had a tongue tie and still has a lip tie. He latched on, he was able to take in milk enough to gain weight ok and I wasn't really in any pain. He did keep bobbing on and off and took ages to feed and his latch was quite shallow but nevertheless it proves that even if the baby is latching a tongue tie is quite definitely possible.

At the BF group I go to there was a woman with a teeny little girl who was taking ages to regain weight and guess what, it was TT.

[ChunkyTurkeywiththetrimmings]

blonder my DS was tt and has been growing like a weed. He latched on ok although shallow, so it was uncomfortable but didn't cause me severe pain or trauma. He had a severe (90%) tie with little to no lateral mobility. Essentially, it doesn't follow that because he can latch, he's not tt. It could be why he isn't efficiently feeding...

According to the Lactation consultant at Kings, 1 in 7 babies are TT & 2:1 ratio of boys to girls affected.

[mamaonion]

Hi op it sounds like you're doing a great job and I would echo advice to talk to bf expert in rl who can help you deflect negative inaccurate info about bf with good, evidence based factual info about bf. So many hv and GPs are poorly informed and this can so easily undermine your confidence.

Just a thought, when I saw a paed we sons allergies at 6 months he looked at my red book and dismissed my concerns about not tracking the bands in the book. He said 'drs are more concerned with an infants weight gain from 6 weeks onwards as it can be very misleading to track from birth, from 6 weeks we get a more accurate representation of babies growth, birth weight is more influenced by efficiency of placenta..,' (paraphrasing here).
He is highly respected allergy specialist at guys in London.

Could your gd gave lead to baby being bigger than maybe he would otherwise have been and maybe he's evening out to his natural weight? Maybe someone more knowledgable on here can advise on this.
I was just so surprised to hear him say this as hv in my clinic are very obsessed with the growth charts and always track from birth.

[StuntNun]

I was told the same Mamaonion when my DS1 had problems, that the nutrition he got in the womb was very different to how he fed when he was in charge of feeding. With DS3 it is the opposite way round as I had a placental abruption he was very small at birth but since then has been gaining half a pound a week so he's making up for lost time now he's out.

[Shelby2010]

Just wanted to empathise with you, my dd stopped gaining weight at around 2 months. I spent a month going to bf clinic, expressing, switch feeding etc etc but still very little weight gain. In the end I reluctantly started topping up with 1 feed of formula, she started gaining weight almost immediately. And despite the predictions we then continued to combination feed until she was over a year old.

I do feel a bit guilty that I hadn't given her formula sooner, but I thought it would mean the end of bf. So be reassured that if you decide to then you can quite easily do both! Afterwards I wondered what I'd been so worried about, it really isn't the end of the world!

[blonderthanred]

Thank you, those are really interesting thoughts re the GD and people's experiences of TT. I really am grateful. And slightly overwhelmed.

Strange that he sleeps quite well (but is also v alert at other times). You would think if he was not getting enough milk he would be either restless or overly sleepy. He does get quite grumpy/screamy at times but that's usually if he needs a burp/poo or at the end of a cluster. Oh well. Going to try and get some sleep now till the next feed.

[StuntNun]

I'm the same as Shelby, with DS1 I topped up with formula from 4 months (due to supply issues caused by using nipple shields) but continued mixed feeding until 8 months when DS1 self-weaned.

[Elizadoesdolittle]

Well as predicted the dr didn't find anything wrong with my DD so has referred us to the peads. Think I'm in for a long wait for an appointment though.

blonder you are doing a great job. If you don't mind I will follow this thread with interest. Although I'm sorry to see others are having the same issues its nice to know I'm not alone iyswim. i thought it was all going so well and that DD had taken to bf very easily.

I too don't understand as DD seems happy. Is very alert and doesn't cry often or seem in pain so I don't think she is going hungry. Think I will get myself to the bf clinic to see if I can get any answers there. I do think I could feed her more often but as she wasn't asking for it I wasn't feeding her as I thought I was just bf on demand but she obviously needs more than she thinks she does.

Good luck blonder I hope you get your answers soon.

[blonderthanred]

It's good to know that people have topped up without giving up bf, as I worry one will lead to another.

I said to the hv if I did top up and ds put on weight I still wanted him checked out and I wanted support with bf to make sure I could continue to mix feed or aim to return to ebf. She seemed completely flummoxed by this - I get the feeling I'd definitely have to fight for this.

Eliza I'm sorry about your dd, I haven't posted much on the nov thread lately as I didn't want to sidetrack it & so many people are having their own bf/ff issues but we can always update each other on this thread. I know the paeds are busy people but seems funny it's such a concern yet appt takes weeks to come through. I guess if they really thought we were in danger it would all happen more quickly so that's something. I'm going to try a few different bf groups to see if I can get to the bottom of this. Ultimately from what I understand, bf should be enough for most babies & we are working hard - so we should be able to make it work!

[tiktok]

Eliza, interesting point about your baby not seeming to ask for more feeds....this can happen, that the baby for whatever reason does not 'insist' much and takes sufficient milk to tick along ok, but not really to grow as he/she might. All this with the caveat that some babies are physiological slow growers in infancy (and some are fast!) and they are just fulfilling this 'destiny' .

Some babies are laid back and have the sort of relaxed personality which does not lend itself to much asking/insisting/demanding. I have seen this happen in busy households, typically with a third or subsequent baby, where there is often something interesting to see, watch, or react to; the baby gets a lot of socialising and emotional connection from being with siblings. I've wondered if this sort of baby gets to be able to 'manage' on less frequent feeding.

We know that in societies with no strictures or ideas on how often babies 'should' be fed, and where babies are with their mothers more or less all the time (99.9 per cent of human existence has been like this - we certainly evolved that way), babies feed literally dozens of times in 24 hours - many, many more times than the 8 x or three hourly that the OP has learnt/been told is normal. 8 x in 24 hours may suit some babies just fine, but some would benefit from being enabled to feed very often from the beginning.

I hope you get good help soon.

[Elizadoesdolittle]

tiktok you make a very interesting point about some babies just taking enough to coast along. She is a very calm baby and I have a nearly 3 year old DD who is very loud and active so DD2 does quite often get left a bit longer than DD1 would have been as a baby. But as she seemed content to watch the world go by I let her.

But that will change. I will feed her more regularly even if she doesn't appear to want it.

Thanks for your insights everyone. They've been interesting and most helpful.

[WLmum]

Yep, fenugreek really does work! It gave me a real boost after just a couple of days and helped with my confidence. You could always use the boost in supply to try a bit more expressing. It's nice to hear success stories of mixed feeding - I think i waited too long for fear that it would mean an end to bf. Sadly for me it did, but I do think if I had temporarily mixed earlier it would have given me a better chance.

[Elizadoesdolittle]

blonder I'm very sorry that you have a very unhelpful hv. That's one way our situations differ. Mine is very supportive and has said there seems no reason at this stage to top up with formula as I'm doing a great job. Having her on my side has made a great deal of difference as every other person I've seen has just said ff top up. She's given me the confidence to carry on ebf. She was my hv for DD1 so think that's helped. And just to add DD1 was ebf till 3 months. After that I went onto mix feed as I couldn't get on with pumping with her. It worked well so can be done. I intend to do that at some point in the future with DD2 but not ready yet. I'd like to make it to 6 months if I can but just taking it a day at a time at the mo. this thread has given me the confidence to carry on and up the feeding and pumping so thank you for setting it up.

[blonderthanred]

Well I just had a call from the bf consultant and she has spoken to the paeds who are going to see us at 11am! So I am really glad I pushed rather than just accepted the crappy 'paeds won't talk to HVs' line.

Just to say in terms of feeding, I've fed totally on demand which for my son has been fairly sporadic but involved lots of cluster feeding as well as focused shorter feeds. I've carried on as long as he wanted & not had a problem with comfort sucking if he wants that too. It's just that at the weigh ins, the question we've been asked is if he is feeding 8/24 which I thought it worked out at an average of (not that it's been regular intervals or even exactly the same each day). So it's not that I've been aiming for this figure, it just seemed to work out as that on average. Sorry if that sounds defensive but I just wanted to add that!

[tiktok]

blonder hope you get good help today.

I know that this '8 feeds in 24 hours' is often used as an official benchmark.

It shouldn't be!

[catwoman101]

Mono one is judging you blonder, some babies do feed 8 in 24. It's just that lots also feed 20 in 24, like mine!

Good luck today, let us know what pads say. Don't be upset if they do advise ff, you have given the good stuff exclusively for 6 weeks, and that is the optimum for all the yummy antibodies etc, and better formula than unhealthily low weight. (although obviously hoping for you that they say carry on with bf ing )