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.

[Elizadoesdolittle]

Good luck blonder. Hope you get some way in getting the answers you are looking for. Fingers crossed!

[blonderthanred]

Well there were no quick fix answers unfortunately. They don't think there is any tongue tie and no other problems with his health thank goodness. He had to sit on a little pot to get a urine sample so it looked like we were starting potty training very early.

Interestingly he is 50g heavier so either he has gained that in 2 days or there is a variation in scales. So according to them he is just 10g below birthweight now.

Their conclusion was that either he has yet to find his centile (he may end up staying on a low one or else move back up over time) or he is not getting enough calories from the milk he is taking. Either way they think it is too early to decide so they want me to continue ebf (hurrah) and take him to be weighed in 2 weeks. If he has slipped further then they may advise supplementing with formula but until then I should just carry on as we are. They did say to eat and drink plenty though...

[tiktok]

That all sounds fine (though their repetition of the eating and drinking plenty indicates a lack of knowledge :) ) and sensible. It's very possible for babies to gain 50g in 2 days.

A re-weigh in 2 weeks sounds ok.

[ChunkyTurkeywiththetrimmings]

No quick fixes, but at least no obvious issues. Two weeks of duvet days & eating choc then??!!

Glad you can keep on with bfing, as that's what you want to do, so fingers crossed he goes up by the required amount by the next weigh-in.

[KatAndKit]

Glad you have been given the green light to carry on bf. Feed feed feed and hopefully in two weeks time everything will be getting better.

[catwoman101]

So pleased your dc is healthy and they want you to continue bf ing for now.

You do need to drink and eat lots for bf ing, but it is not for the quality of the breast milk, but the health of the mum. If she is low on fluids or calories the breast ilk keeps coming but mum gets dehydrated and low on energy, and Boone needs that with a new baby.

[Bryzoan]

Hi blonder and Eliza,
Just wanted to say I had similar issues with dd. Working with paeds and a lactation consultant the way we got round it was to keep bf, but also express at each feed and give a top up. That way the paeds were happy she was getting a measurable amount, and weight went up (and if it hadn't we would at least have ruled out not getting enough as the issue). There is still the nipple confusion risk, and it is bloody hard work bf, bottle feeding, expressing, washing and sterilising every 3 hrs (used to take me an hour and a half all in) but keeps your supply, gives them ebm, and you have a really good chance of fully bf later. It took us 3 months to establish bf fully (though dd was prem and had other issues) but I felt it was so worth it - and we kept going very happily till 16 months.

If you do go the expressing route on that scale, hiring a hospital grade machine is a must. I would never have got the volume otherwise. Medala hire them - can't remember costs but around 25 - 45 pounds per month.

I got loads of advice on feeding with dd and the best advice was that as long as the baby is fed well, and you keep your supply going, and keep giving the baby opportunities to bf you will get there in the end. Just try not to loose your marbles competent meanwhile though!

Really good luck, whatever you decide

[hillyhilly]

So glad they've given you two weeks before next weight in, so you don't feel so under pressure. Different sets of scales can make a difference when we're talking 10g as can whether they've just we'd or pooed.
Stick with it, I'm sure you'll be fine

[horseylady]

Great news blonder!!

So annoying it takes so long to see specialists though!

Good luck!

[Elizadoesdolittle]

I have my appoint with the peads tomorrow morning. I'm hoping they will be as encouraging with me as they were with you blonder. Hope you're getting on ok.

bryzoan thanks for the encouragement and for sharing your story.

[blonderthanred]

Oh good luck Eliza! Really hope you get some answers and support.

I have an update - went to bf group at hospital today & saw bf nurse who helped sort appt last week. She got a colleague to look and they think L might have a posterior tongue tie after all! So we are being referred to another hospital to investigate further. She said just because he latches on doesn't mean he can't have a TT and especially as he slips off it could indicate one, along with the heart shape and the fact that his tongue doesn't reach the roof of his mouth. So the saga continues.

[Elizadoesdolittle]

Well I have no real answers. She may have mild broncilities (sp) which they can't do anything for. This is what's causing her to bring back up most of her milk. Advice was to feed feed feed and top up, which I have been doing, she's just been bringing most if it back up. She is very hit and miss with taking a bottle so it's hard to top her up and I'm not finding enough time to express the amounts i need. Am glad it's the Xmas break coming up. I'm going to just sit and feed all day and everyone else to fetch me food and drink

Got to go back on 2nd jan. hopefully her cough will clear up which will help a great deal.

blonder glad you are getting some help and advice re the breast feeding. I don't think this forms part of the issue for us but I think I'll go to my local breast feeding clinic once the Xmas break is over to get it checked out.

[blonderthanred]

Sorry no concrete answers Eliza. Must be so frustrating that the milk is coming back up when you are working so hard to get it in.

Hope you have a restful Christmas break feeding and being fed. I keep telling L I am trying fatten him up like a Christmas turkey!

[blonderthanred]

An update:

Well the end of our ebf journey has come despite finally having his posterior tongue tie snipped on Wednesday. He has only put on 45g in 9 days and has dipped below the 0.4 centile. He is 11 weeks today and just 8lbs9.

GP & HV obviously very concerned and want me to offer a 3oz formula top up after every bf to try and get his weight up. As I'm up to expressing 5oz a day I asked if a couple of the top ups could be ebm but they said no. Which was odd I thought. Not as odd as the GP saying I shouldn't express at all as 'the baby would miss out on the colostrum'. Wtf?! I assume he means hind milk.

Anyway I agree that he needs some extra calories and I'm going to give the formula but also express to keep my supply up and hopefully return to ebf or ebmf in the future. I really hope I'm doing the right thing. Any comments or input very welcome.

[tiktok]

blonder, thanks for the update. I think there is justified concern about your baby's weight, and top ups don't have to be permanent.

You could get a seocnd opinion about the ebm - your doctor is quite wrong about the baby not getting the 'colostrum' (WTF???! indeed) or hindmilk. 5 oz of ebm is the same, calorifically, as 5 oz of formula but you prob need a bf specuaist to confirm this to you, and write it down for the doc....I think you said you'd seen one?

[blonderthanred]

Thanks Tiktok. The TT specialist we saw on Wed is an IBCLC and said I could call her any time. I've also been seeing the breastfeeding counsellor at the hospital where I had DS. So I will ask them. I am happy to do all three bf ebm and ff and see how it goes.

When we saw the paeds before Christmas I asked about TT and they said it was a red herring. But the IBCLC said his tongue function scored 4/14. So I can't help wishing we had had that looked at earlier and perhaps he would have put on weight.

It certainly feels like his latch is twice as strong now. So I am hopeful that he will start putting on weight from bf as well as the top ups. I just need to make sure I increase my supply at the same time. I've hired a hospital grade breast pump so expressing is as efficient as poss.

[mawbroon]

It is very possible that the tie has not been released fully.

Come and join the tongue tie babies support group on facebook.

Just snipping the tongue tie is not enough. It needs to be combined with some sort of bodywork such as craniosacral therapy. The pull of the tie can cause tension in the head, jaw and neck and needs to be released for maximum benifit. Some babies also need suck training to teach them how to use their "new" tongue and mothers also benefit from learning deeper latching techniques. This is something a lactation consultant could help with, but it needs to be one who has taken a specialist interest in ties and understands them well.

Even if you decide to stop breastfeeding, please do not ignore the tie. DS1 went undiagnosed until age 6 and has suffered a long list of problems directly related to his ties, they can affect the whole body.

[MsElisaDay]

Just to say that it's perfectly possible to return to ebf after topping up with formula- I did, after a month or so of giving DS two or three Aptamil feeds a day.
We were forced to top up after DS refused to feed and was still significantly below his birthweight at 4 weeks. The midwife sent us back to hospital, where they insisted he was given formula straight away. He wolfed it down as I cried- I felt i'd failed him.
After returning home I began a cycle of attempting to bf, then bottlefeeding and then pumping, every 3 hours. Over the next few weeks my supply went up and I could cut out the formula, feeding him only ebf.

Now, six weeks later, and out of the blue, we're finally breastfeeding. I'm only pumping to create a freezer stash, and he seems satisfied and happy- as am I!
Of course if you choose to ff then fine, but it doesn't have to mean the end of bfing if you don't want it to.

[crikeybadger]

Glad you've finally sorted out the reason for your LO's slow weight gain- it just shows how hard to diagnose these ties are, unless someone is really specialised in spotting them. Must make you feel a bit upset though that it has taken this long to get it snipped. .

Personally, it would seem madness not to give DS your breast milk, if you have the same quantity as formula available. Formula is likely to take longer to digest for a start, so may increase the gaps between feeds, which is obviously not what you need. Obviously though, you should go with what you feel is best.

I'm pretty sure that kellymom has a list of the calorific value of breast and formula milk. I'll check in a mo'.

[crikeybadger]

Here you are.

Actually, there's more calories in breast milk than formula.

[blonderthanred]

Thanks Crikey. It certainly is harder to fit in as many feeds as I was - a full cycle (left & right breasts + bottle + winding etc) is now taking about 2 hrs!

However I feel sure DS is taking more milk in from bf as the difference in feeling is noticeable. So I am focusing on the quality of feeds.

I thought that was true about the calorie content. I'm currently able to express enough for 2 top ups and I'm not topping up night time feeds at all (still need to sleep!) so formula top ups are 3-4 times a day. I am hoping that with a couple of weeks of supplementing and working on my supply & DS's latch, I'll be able to start dropping the formula top ups.

By then hopefully his weight will have increased to a healthy level and he will be naturally taking in whatever amount he needs to find his own growth pattern. That's the ideal scenario anyway.

[crikeybadger]

That sounds like a good plan blonder. Hope it all goes well for you both.

[city1984]

AI a also wanted to add that it is possible to return to ebf. My ds lost 18 % of his weight on day 5. We were back in hospital where he was tube fed for a couple of day. Was than bf for a week with full formula top up which he took. By week 3 he was up to birth weight and we dropped formula. At 4 months he is now between 25th and 50th centile (born on 75th) and everyone is happy. Good luck op.