Health Visitor worried about DS's weight gain - is this right?

[PetShopGirl]

Breastfed DS (first DC) was born on 17th November and weighed 5lb 11oz. He was 37 + 2 weeks, although the hospital actually adjusted his gestation to 36 +5 after a growth scan the day before he was born. I had pre-eclampsia and the midwife who was at the birth (I had an emergency c-section) said the placenta had been in a very poor condition.

DS dropped then down to 5lb 4oz 5 days after birth, increasing to 5lb 10.5oz by day 9. I was then discharged by the midwives, and he wasn't weighed again until day 18 at the first meeting with the health visitor when he had only got to 5lb 12.5oz. At this point I was only feeding him roughly 4-hourly (he was jaundiced and therefore quite sleepy, and I am inexperienced). HV was very concerned about this, which seems fair enough, and suggested feeding at least 2-hourly as well as giving a few tips re latch etc. I took all the advice on board and when he was then weighed 5 days later he had gone up to 6lb 3.5oz. HV content, I was obviously very relieved.

Anyway, HV has just visited again (8 days since the last weigh-in) and he has only put on 5.5 oz, so now 6lb 9oz (and he had the filthiest nappy ever just before she came - could that have amounted to another couple of ounces if she'd happened to weigh him beforehand?). HV is very concerned about this insufficient gain and has gone off to ring my GPs (not affiliated with my HV at all) to get their advice as she thinks there could be something wrong with DS causing him to not put on enough weight and she is going to get them to ring me as a matter of urgency - N.B. there are currently no other indicators of anything wrong with DS. She also wants to weigh him again as soon as possible because she's so concerned, but because of Christmas this won't be until next Thursday now. Obviously this is all quite upsetting, and I'd really appreciate others' opinions on whether this situation is as concerning as the HV is making out. I appreciate that DS is still very small, and I really want him to get bigger as quickly as possible, if only to make him a bit less vulnerable, but looking again at his red book since she left, he has actually put on 1lb 5oz since 22nd November - is that really so terrible? I know that there was a blip between days 9 and 18, but I'm sure that was all my fault for just not feeding him enough.

Also, HV will not consider DS as a pre-term baby and he is therefore now only on the 0.4th centile of the unadjusted weight chart. It is obviously arguable as to whether or not he was born before or after 37 weeks, but I can't help wondering if the fact I had pre-eclampsia and the placenta was failing ought to push him onto the pre-term scale anyway?

I'm feeling really worried about this now and I'd be really grateful for any advice.

Sorry for the garbled essay - thanks for reading.

I'm not an expert at all, but my DD was slow to gain weight so I know how stressful it can be when the HVs are concerned. 1lb 5oz since 22nd Nov is just about within the average range of weight gain according to kellymom. From what you've said it sounds perfectly possible that DS has just been a bit slow to gain weight because of being borderline pre-term and being too sleepy to feed often enough for the first couple of weeks. This article might help you to think about whether DS seems healthy apart from the weight gain. Does he seem settled after feeds, with some calm alert periods in between? If so I would just continue feeding whenever he seems interested and making sure you offer at least every couple of hours, and fingers crossed he will have put on enough weight to satisfy the HV by next Thurs. Do you think he feeds until he's satisfied (rather than falling asleep mid feed)?

Congratulations firstly on your baby :)

I was induced early, 36 weeks and my DD was 6lb 5 at birth but dropped to 5lb 8 by 4 days later. I was bf. Baby also had severe jaundice, was hospitalised.

Fast forward 6 weeks and she's now a healthy 8lb 12.

Your HV was right that four hour gaps between feeds was too long. You need to wake them if necessary.

Even now DD is feeding every 3 hours during the day, going sometimes 5-6 hours at night between feeds.

I would say though that my DD is still considered small but she is gaining weight now and thriving. I think when they're early they do take some catching up.

You're doing a great job, keep going!

His jaundice has now cleared so he is a lot less sleepy generally, and he definitely feeds until he's satisfied now as opposed to falling asleep mid feed.

Thanks for those links - I would certainly answer 'yes' to all the questions.

My instincts are telling me that he's probably doing okay, but obviously I am seriously doubting myself now. HV has just left a message saying she has spoken to my GP's surgery and they have open appointments this Friday - make sure I attend.

Aw, PetShop, that's a stressful situation for you :(

I think your HV is right to be concerned and to seek further advice from the GP if she is not 100 per cent confident all is well.

On paper, the weight gain is slow, but much of it is explained by the slow start he had, and the lack of help (from the sound of it) from the midwives who should certainly have explained that 4 hourly feeding was not sufficient. The most recent weight is not all that reliable because of the huge poo and because one single weight reading is never enough to draw a conclusion...it's sensible of her to recommend a further weight reading and 9 days away is fine given there are no other obvious health concerns.

It is sometimes possible that babies are slow to gain because of other issues to do with their health ie not just needing more feeding, and it's good to rule these out (hence your HV's response).

Your role at present is to continue feeding at every opportunity :) Feed from at least both breasts as often as you can, day and night, so he has every chance to catch up. A call to any of the bf helplines will offer support, all the way through the holidays.

It sounds to me that you have an informed and sensible HV, who's not over-reacting, and who is supportive of you.

Thanks tiktok. We now have an appointment with the GP tomorrow morning, so will see what they say. I just hope there isn't a more sinister reason for the slow growth.

Should babies always gain a uniform amount of weight per day, week etc? If we were to discount the 9 days when I was doing it all wrong and he only gained 2oz as an anomaly, would the 5.5oz over the last 8 days be a cause for concern in itself?

I should stress I'm just a mum not medical and only have consulted Dr Google (one of my twins is slow gaining so doing a bit of research) but I thought anything between 4-7oz/week was normal - www.askdrsears.com/topics/breastfeeding/faqs/how-much-weight-will-my-breastfeeding-baby-gain.

Good luck with Doc PetShopGirl. I'm off to doc tomorrow too as for some reason my girl has put on 8oz but the boy twin only 1oz in the last week (we think he may have a mild infection as they are being fed for roughly the same time and both seem good feeders). I read somewhere else that as long as they are producing dirty and wet nappies and are alert and waking for feeds there isn't usually a problem so taking comfort in that. Still good to get checked out as tiktok says.

My ds gained 7/8 ounces every week from birth but my dd only ever put on 2 ounces a week and then sometimes none at all. The reason your hv is concerned is purely based on the fact that he is on the 0.4th centile, but it is worth checking with your gp and this is nothing to do with your parenting skills and probably nothing sinister either.

My DD2 got back to birth weight quite quickly but then only seemed to gain 4oz a week for quite a while. The GP at her 8 week check suggested I saw the HV a couple of weeks later but they weren't concerned at all. Obviously it's sensible to keep an eye on it but it sounds like you're doing everything right now.

Congratulations on your baby :)

My LO was re-admitted on day 3 due to weight-loss. I refused to stay in hospital to be monitored (didn't see how staying on a ward with 11 other women and babies would help feeding).
I put his dramatic weight loss down to the fact that he'd just had a MASSIVE poo and wee, and it was 3 hours since his last feed. So he was pretty empty. In fact, by the time we got to the hospital, and got seen, he'd had two feeds and appeared to have no weight loss at all. By day 10 he ws back to birth weight.

I think that what with your LO being borderline pre-term and small to begin with, plus a sleepy baby, it all adds up to looking like he's not gaining weight. Look at your baby. Does he seems alert, feeding well, producing a good amount of wet/dirty nappies? I reckon (obviously, haven't seen your baby!) he is doing fine.
But make sure you go to the doctors, and reassure yourself. Good luck!

Don't worry. Tell them to leave you alone for a few weeks. If you know your baby is doing the right things, alert, plenty of wet and dirty nappies, settled between feeds etc then all is good.

There are many more signs to tell if a baby is thriving, other than weight. Health professionals are obsessed by weight and charts.

My daughter took 36 days to regain her birthweight. She was then ill for 3 weeks and now, at just over 8 weeks old, she is only just one ounce more than when i had her.

Congratulations on your baby :) Tiktok's advice is very good.

All I'd say is try not to worry too much as 5.5oz sounds like an ok amount to gain in a week to me. My DS (BF) only ever gained 3-4oz a week for the first 12 weeks which was on the slower side but right for him.

Feed your lovely baby at every opportunity and take care of yourself too - lots of drinks and snacks.

Thanks for your replies everyone. The GP referred us to the paeds at the children's hospital, and we had an appointment this afternoon. Doctor's main concern was how skinny DS is - he really needs to lay down some more fat. He said his head circumference is following the correct growth curve, which is good, but the rest of him really needs to catch up. They have taken blood and urine samples and will let us have the results on Monday, however he thought that DS was mainly just presenting as a hungry baby, and has advised formula top-ups. DS is also still slightly jaundiced, and the doc thought this may not have flushed out because he hasn't been getting enough breast milk. I had actually been topping up with breast milk over the last couple of days on the advice of the health visitor, but the doctor said not to bother with that as it's too intense to feed as much as we are as well as trying to express.

Feeling quite rubbish about it all now. It was horrible seeing DS poked and prodded - he looked so tiny and vulnerable. I feel like I've really let him down by not providing him with enough nourishment and just desperately want him to put on some proper weight. Also really worried that the tests are going to show something more serious wrong

Poor you Petshopgirl, it sounds like you've had a stressful time of it.
From what you've said though, the doctor doesn't seem to think there is anything physically wrong with DS, just that he's a bit skinny. Hopefully the test results will be fine and you can be reassured that there is nothing else going on here.
How do you feel about topping up with formula? Obviously there are no more calories in it than breast milk but I can see that the doctor was trying to save you some time and energy by not having to express.

Personally I think you should decide if it's too intense for you to express bearing in mind that the expressing will help boost your milk supply and may only need to be a short term measure.

FWIW, the gain you mentioned is in my understanding within the normal range. Perhaps you can take to your bed for the weekend and just have lots of lovely skin to skin cuddles, lots of feeding and resting. No need to eat or drink anything extra or different, just be with your baby and offer the breast as much as you can.

Ah Petshopgirl how stressful for you, I can only reiterate try not to worry. Your situation sounds so much like ours was in the early days, - DS was on 91st centile for length but 9th for weight and he was really skinny but in our case as he was gaining uniformly (4oz a week) and had no other problems no one worried - it could be that you've drawn a set of 'overly worried' health professionals out of the bag and that if I'd had your set I would have been in the same place if you see what I mean.

I personally would avoid formula as giving it so early at this stage could affect your future supply. Assuming your DS seems well and is creating lots of wet and dirty nappies, I would spend as much time as you can before your next weigh in feeding and then see where you're at after the next weigh. And tell your HV that 5.5oz in a week for a bf baby is well within the range of normal.