DS lost 9.7% by day three - advice please, what will next step be if not improved by Sat?

[SpaghettiBologneighs]

So, DS2 was weighed yesterday and has lost 9.7%. This day three and is over the max 8% they like to see. We've been put on a 'care path' that involved a discussion of what breastfeeding should look like, what we should be seeing in tms of nappies etc, and booked in for an appt for Saturday (day six) where he will be weighed again. The max they are looking for then is a 10% loss.

DS is slightly jaundiced, although below the threshold for treatment and his ethnicity means he this was always more likely than for a Caucasian infant. The jaundice has definitely impacted on his feeding as he is very sleepy. When awake he is alert, but he goes to sleep very quickly after latching on and won't feed actively for more than about five minutes at a time.

His nappies are slightly behind what I would expect on day four - plenty of wet nappies, but poos are still a mid-brown. He's had three poos since about five this morning.

I'm doing everything I can think of - waking him frequently, skin to skin, doing breast compressions, and expressing what little I can get to supplement with a syringe. His latch is not great but improving. He's particularly poor at waking in the evening/at night to feed even though I can feel my hormones going crazy then.

I'm not worried about supply as I have a breastfeeding 2.4yo just about to come home from a stay at his grandparents to help.

I am very worried about getting enough milk into my little boy, to wake him up and try and avoid any more weight loss. I'd be incredibly grateful for any tips, and if anyone knows what the paeds are likely to want to do on Saturday if he has lost too much weight. I must own to feel very negatively about the possibility of supplementing with formula.

Thanks for reading this far!

I can't really offer much advice except to say that by day 3, your milk may well have not come in properly yet and nappies sound ok to me really. My DD had lost just under 10% of birthweight by day 3, by day 5 was gaining again. My milk didn't come in until day 4.

Thank you midori. My milk came in on Tuesday evening and he was weighed the next morning, so I am hopeful that we are starting to turn a corner. I am pretty uncomfortable and engorged a lot of the time though.

I just find the whole thing so anxiety inducing. He's so tiny and fragile, and I'm so emotional and sleep-deprived. I had PND after my first son was born and am concerned that I will go down the same route.

On the positive side, my first DS had very similar issues (sleepiness, jaundice, slow gain etc) and he is now a great hulking toddler on the 90+ centile :o.

You could try breast compressions to keep him more interested at the breast, but you may well find now your milk has come in that he will get more milk for less work so to speak, and things will improve.

Just had a typical feed - he's been asleep for 90 mins, finally managed to persuade him to wake, five minutes on right breast with some good swallowing and back off to sleep again!

Thanks twatty, I'm adding in some compressions although I have a niggly feeling I'm not quite doing them right - can you suggest any good links or give me any pointers?

Hi spag. I was in your situation 8 months ago. I was a horrible anxious mess and it is not nice! We just escaped having to go back to hospital but I suspect that may be suggested to you if your lo doesn't put on. Mine was jaundiced also and it took ages to go. All I can say is try not to be panicked and don't formula feed if you don't want to. My boy is now a little chubber!

Thank you ilove - it's so nerve wracking, isn't it. When you mention read mission, was that suggested because of the jaundice or the poor weight gain?

There is a good DVD on YouTube, it looks quite brutal, but you will get the hang of what works for you, you will see when it starts working because they start sucking and swallowing again.

My DD also was very sleepy and lost over 10%. Do you know all the tricks for keeping awake when feeding? Feet tickling worked quite well for us (strip baby first), stroking baby's head in a circular motion also encouraged sucking. Also, you need to be mean, if he's fallen asleep after 5 minutes on one side, a brisk nappy change and attempt the other side.
I found if she wasn't interested in latching on, expressing milk onto a spoon and dripping it in her mouth would remind her of what she was meant to be doing and she'd show more interest.
She is now feeding fine :)

Very happy to say that I've just been wee'd over while changing another pooey nappy. :)

Congrats on your little guy.

Breast compression clip from Jack Newman. Hope it helps.

Congratulations on your new baby!

This happened to us - DS lost 17% of birth weight by day five, resulting in admittance to hospital for both of us for two nights. We had a strict three hour feeding schedule and formula top ups every feed. By the time we went home, DS was a different baby - no lethargy, more alert, chubby cheeks again. Luckily he was only moderately dehydrated otherwise he would have needed a drip . Have to say I had no hesitation in agreeing to giving formula, it certainly worked wonders for us and helped DS get back home as quickly as possible.

We too ended up in hospital. DS was/is pfb and I had no idea what I was doing! In our case admission was early enough to avoid anything more intrusive than a bf nurse to sit with us for hours the first day.

She got me to express and do top ups with a little beaker until the jaundice settled down and the lethargy wore off. Plus we were then able to record an actual volume of milk to appease the consultant who did some calculation and wanted ds to take an insane volume of milk every 2-3 hours....

It's normal for the baby to lose 10% of birth weight, but they should return to birthweight by day ten.

If you had a drip during labour, the baby may be born quite waterlogged, so will lose a lot more weight.

Does your baby seem fit and healthy to you?

My DS lost nearly 15% birth weight by day 5 and was readmitted, only having been discharged the day before. He had a slight tongu tie but his latch was ok, just very sleepy and not taking in much.

He was given a nasalgastro feeding tube and I topped him up with expressed breast milk every 3 hours after Breastfeeding. He put on enough weight doing that to be discharged the next day. It was not a pleasant experience but he continued to put on weight consistently and feeding improved. He breastfed for 17 months so we obviously got to grips with it!

I meant to add, I was never pressured into trying formula, although it was mentioned as a back up if needed for a few days, but I was fairly vocal about wanting to keep breastfeeding if at all possible. So don't worry on that account.

We lost 9% and it took DS three weeks to regain birthweight (he was born in Jan and is 8 weeks old now). The midwives came every other day to weigh him and we were discharged when he eventually gained it back. He was jaundiced and sleepy too so had to tickle ear to keep awake and set alarm to wake for night feeds. He did eventually pick up and is doing fine now. Try not to worry (I was frantic), 9% is not that much. Until v recently 10% loss was considered normal it is only that they are a little more cautious now and have dropped the threshold to 8%. No one suggested formula to me, on the contrary they just encouraged me to stay in bed relax and get bf established.

You have BF your eldest so you will get more time to establish BFing because the docs and midwives know that you know what BFing looks like. DS was 4 weeks early and we ended up in hospital for other reasons but he had lost over 10% by day 3 and his weight didn't increase the whole time we were in hospital. The paeds aren't BFing experts, they asked the MWs for advice and the MWs said 'leave the third time Mum to get on with it, she knows what to do', we have brilliant MWs!

If he's a bit jaundiced then that will be making him a bit sleepy, you just need to keep doing lots of skin to skin and offering the boob at every squeak. Wake to feed if he goes too long between feeds. You know what you are doing, it's not rocket science, just emotionally hard, but keep doing what you know you need to do and you'll ge there eventually. DS took a month to regain his birthweight but is now 6 months and is gorgeous and chubby and EBF (first solids tomorrow!). Keep at it and you'll get there.

Oh, and the paeds specifically asked the MWs about expressing and they said they weren't keen on interferring with the natural balance between baby and mother but that is the first option before formula, especially since you are still BFing DC1 and so supply is not the issue. You can feed then express and then cup feed the expressed milk two or three hours later.

10% is a only a guideline. My milk only started to come in on day 4-5 then 6 properly. My dc's also had jaundice as newborns. Feed on cue, expose baby to sunlight as much as possible, drink gallons of water, eat as much (healthy food) as possible & rest! Consider donor breast milk. It is expensive but even a day or two's supplements may help. Don't give your newborn formula it will ruin the healthy, immature gut. Hope things improve soon.xx

Thank you everyone for your support, it's really helping me feel less alone and it's very helpful to hear others' experiences.

I'm hopeful that we may be turning a corner - DS has taken both breasts a couple of times and had a very good feed in the middle of the night. I could hear lots of swallowing. Then he woke me for a feed at 6.30 - first time! We're having more wet/dirty nappies too. I'm optimistic about tomorrow morning, and I also think that based on what others have said above, if we haven't kept it under 10%, I will feel confident in giving it a bit more time.

PS Babyblue, 17% must have been extremely scary. If I was less confident in my supply (ie if I wasn't still feeding a very enthusiastic toddler) I would probably go down the same treatment route if medically advised. Hope you didn't take my feelings as in any way critical of your choice :).

That's sounds really positive.

My little 14 week old DS ended up in SCBU after birth due to low blood sugars. I was paranoid when I brought him home re weight etc as the breastfeeding had been mucked up by our separation and a tongue tie. Second the feeding cup with some expressed milk just to get something in him.

We eventually moved on to bottles of expressed milk from there and DS is now a rather chunky 15.15 as if yesterday!

Sounds like you've turned a corner but feeding cup can be very useful and reassuring if needs be

Glad to hear you're feeling more positive. In answer to your question our readmission would have been for the weigh rather than jaundice. Do keep us posted!

Just a quick update to say he has started to gain :).

Hurrah!