HV has advised me to start ebf 19 week old on baby rice...confused and dont know whats in his best interests

[YouMaySayImADreamer]

I have posted a previous post on my ebf baby's slowed weight gain, so apologies if im repeating anything, but there has been further developments...

My ebf 19week old ds's weight gain has stopped. I wanted to ebf him to 6 months as per current guidelines and as per research ive read on the benefits to baby of having nothing but breastmilk until this age. I found bf quite tough to begin with, so its ironic that now that im really enjoying it and finding it a lot easier, that this is happening.

Basically, my ds has only put 2 ounces on in 6 weeks (none in the past 3 weeks). He started life on the 75th percentile and in the 6 weeks has dropped to the 25th.

I have been asked all the usual questions by hv and bf counsellor...he has plenty of wet nappies, one or two dirty nappies a week, he feeds on demand (which is usually every 3 hours), feeds from both sides every time, seems happy and satisifed after feeds. The bf counsellor seems to think my supply is fine, and the hv is at a loss as to why his weight gain has halted, but does say that some bf babies' weight does plateau for a while. She also says that babies can become distracted around this age, but i havent noticed any change in his feeding behaviour. The bf counsellor has given advice on breast compressions, told me to pump between feeds (not sure why if my supply is fine), and told me to wake ds for night feeds.

DS sleeps through most nights from 9pm til 5 or 6am (after an 8pm feed) and has done since a few weeks before the weigh in 6 weeks ago (no encoaragement from me). He never naps in the day though despite my best efforts and im starting to wonder if he is just crashing out through exhaustion and missing his night feeds if this is a likely sceanrio?

The hv wants me to get him weighed next week - a week after his last weigh in and if he still hasnt gained, she has said that we maybe need to start weaning him early onto some baby rice. I'm so confused because he doesnt seem hungry despite his lack of weight gain, so why would it mean he needed weaning? Is there something wrong with the fat content of my milk? Why do they advise so strongly to ebf until 6 months and then give you this advice?

The main health benefits that i am concerned about are that i have read that ebf until 6 months provides a coating on the intestines which plays a part in prevention of digestive disorders and allergies. Introduction of solids or formula before this, i have read, jeopodises this, so if i introduce baby rice, i worry that 4.5 months of ebf will have been of no long term benefit...i dont know what to do for the best for my baby....

[YouMaySayImADreamer]

Thanks very much, i think i will see my gp then just for a bit of reassurance if nothing else. The gp at my surgery who specialises in paediatrics is male, but ive seen him before when my ds had colic and he is great. He even told me his wife had bf so hopefully he will be knowledgable/understanding. Thanks all again so much

[Mandy21]

No, definitely don't worry about having to go through the right channels and no, definitely don't think your HV is an expert. I agree with Frozen, try not to worry but if you do feel the need, don't worry about cheesing off the HV or having to go through them first, go and see your own GP who will know you, have your records, and those of your LO, all the better is she is female.

[YouMaySayImADreamer]

I cant thank you all enough for your replies, i feel like everyone around me is talking about introducing some formula or solids, but that my instinct is that he is fine and healthy (apart from the worry and confusion about his lack of weight gain). Everything i had read and researched though makes me want to continue ebf until he is 6mo. Is a lack of weight gain dangerous to him in itself though, or more the fact that it could be an indication of something else not being right?

The problem is, with him being my first, im not really sure how the system works and who to turn to. Would i be undermining my hv if i went to the gp? I always thought the hv was the one who was supposed to be most knowledgable when it came to babies development? I do speak a lot to my bf support organisation who have been amaazing but who tend to give me slightly different advise depending on who i speak to! And now that the hv is aware of the situation, i feel under pressure to do something about it (i.e.introducing solids) even though i feel far from happy about doing it. Sorry to go on, just thinking outloud. Really appreaciate all of your words of support!

[FrozenNorthPole]

Didn't want to read and run. First of all, please try and trust your body. If the HV doesn't seem unduly worried, you definitely should not be - they are exceptionally risk averse. The simple fact is that babies do not grow in a linear fashion - their graphs will show stops and starts because that is essentially how weight gain usually happens (rather than resembling the hypothetical 'smoothed curve'). Secondly, if your baby is healthy, alert, eager to feed and basically everything is fine apart from the number on the scales, remind yourself that it is just a number. There is no evidence that babies who gain slowly/not at all for a while are a) less healthy or b) less likely to be healthy in the future. Weight, on its own, means nothing. It can serve as an indicator of other things sometimes (most of which seem to be ruled out in your case) which is why HCPs pay attention to it. It can tell them to check for other things. But achieving weight gain in and of itself has no clear basis in evidence. By the way, do make sure that the same set of scales is used each time weighing happens, and that the scales haven't been moved around lots (can make them really inaccurate is not properly calibrated on a regular basis).

You seem worried OP, which is totally understandable given the massive emphasis that infant health surveillance places on weight gain. Why not pop along to a sensible GP (ideally female, likely to have her own children, perhaps with the DCH qualification) just to satisfy yourself that there isn't any reason to think that something significant underpins the pattern of weight gain? If the GP was unconcerned, would this help?

Sending hugs. Cuddle your baby tightly, enjoy him, marvel at all the brililant things he is doing. Remember all the great evidence about the benefits of breastfeeding for at least 6 months exclusively, and remind yourself that these benefits are not contingent on particular patterns of weight gain. He has benefited so much already and will continue to do so.

NB - if the loss of a teeny bit is =/- a few ounces, that's within the margin of measurement error for a wriggly baby so please don't beat yourself up thinking he is on a weight loss trajectory

thinking of you - I know how horrible this can feel

[Bringbring]

Poor you, I know exactly how you feel because my baby is exactly the same (bf, happy and smiley, active and hardly putting on weight).

It's so difficult because objectively I think my hv is crap but I am worried because he is smaller than other babies, especially those who are ff.

I have bowed to pressure and introduced some ff. I wish I had the confidence to continue but I don't have the support at home. I am seeing a paed in two weeks so will update with their advice.

Realistically I think my baby is healthy and that I have done all I can but the weighing worries me because he is my first baby.

Have you looked for any other support? Breast feeding group, gp, hospital infant feeding coordinator?

Take care

[Mandy21]

I didn't want to read and not reply. Firstly don't question your supply - its unlikely to be down to a poor supply or that you're somehow not good enough. I always thought there should be a gauge on our boobs so we could monitor milk levels. Just keep with what you're doing, maybe speak to your GP (as above with my low opinion of HVs) but if they're not overly concerned and everything else seems fine, try not to worry too much.

[YouMaySayImADreamer]

Hi, just wanted to provide an update on the situation. DS is 21 weeks now and i got him weighed today and it wasnt good news. Still on 25th centile, but he hasnt gained any weight still (actually lost a teeny bit). I am so stressed and upset.

The hv who weighed him had a chat with me and asked me all the usual questions and didnt seem massively concerned, but wants to monitor him 2 weekly. I havent spoken to my own hv yet. But at what point should we become worried? He has gained no weight for 5 weeks now, and in the 3 weeks before that gained only 2 ounces.

I feel like my body is letting him down and isnt working properly. Everyone tells you to trust your body when bf, but how can i? I have followed every 'rule' in the ebf book...fed on demand, followed his lead, no formula top ups, no dummy until 4 weeks. Is there something wrong with the quality of my milk? I have always been slightly nervous of my supply as i never had that massive rush of milk at the beginning, felt overly engorged (except when missing feeds if he had some ebm), and never leaked at all...i always thought it was possibly because im quite small breasted, but at the same time i was told my supply could just be well regulated. This is making me really start to question my supply though.

Everything about him is telling me he is fine - plenty of wet nappies, the 'right' colour poo, he is alert, bright and happy - everyone comments on how alert and smiley he is. He is very active and just wants to be on the go constantly.

Someone please tell me what i could be doing wrong and how to fix it!

[YouMaySayImADreamer]

Thanks chunderella and mcbaby. Thats reassuring mcbaby and i think you could be right. My partner was tall and slim and as a child was incredibly skinny despite eating normally, so im wondering if ds is just going to be the same, especially as so many people have told me hes grown, and i feel he has too despite so weight gain...perhaps hes slimmed out but grown longer and he'll stay where he is now.

Hi frozen, im ok thanks, have just decided that i will wait until next week to get him weighed to give time to see a proper difference in his weight. I have just been concentrating on bringing him to the breast frequently, doing breast compressions, and night feeds, to get more calories into him. Luckily he has had a "bad" few nights where hes been really fussy and awake on and off every hour so ive been taking the opportunity to feed a lot (may even have been a growth spurt, not sure). Thanks so much for all your support...i will post back next week after his weigh in

[FrozenNorthPole]

How are you doing now OP? Hope the panic faded a bit; it's really hard keeping one's head in these circumstances

[McBaby]

Just my opionion but the centile drop seems gradual and not to dramatic. We stated above the 99% line and dropped to between 50%-75% in the first couple of months and we are still in the same place at 10 months. It's like she was too big to start with the found the right level and followed the curve, I was never overly concerned as she was always happy, alert and meeting all other milestones.

It seems HV have to worry if two centile lines are crossed although it make sense to have this is a guide to spot issues it doesn't always mean there is

[YouMaySayImADreamer]

Hi poppet, the vitamins is good advice and not something id considered so as you say it is best to rule anything serious out by taking such a simple step. I have been racking my brain for any possible reason...i was very anaemic after the birth and was given iron tablets (which i stopped taking as i kept forgetting) so i had a blood test last week to check on my iron levels asive read this can impact on milk supply (not sure how true that is).

I am quite small and slim (apart from the horrendous mum tum im still holding on to!)...dont really see myself like this but ive been described as petite, so he was a pretty big baby for me i think. My DP is tall and skinny...the type of person who can eat what he likes and not put weight on. For what its worth ds is also his dead ringer so maybe he will have the same build..

[Poppet45]

Right dont panic OP, as I said DD's case was v rare and prem related - they put on mineral stores in the third trimester and she only had 10 days of it. The vitamin supplements are just belt and braces so you can rule anything untoward out. What's your build and that of dp? Some women build v big babies at birth who then take the next year or so to find their true place on the centiles. Could it be something like that?

[Mandy21]

OP - you sound very sensible and you've been given very good advice. I just wanted to give you my experience. We were advised to wean at 19 weeks (by a neonatal paediatrician) just to increase weight gain as they were on the 0.4th centile to start with (I had twins at 27 weeks, completely b/f and gaining weight). We did it very gradually and it didn't really affect their interest in b/f (still good feeders) but it did increase their weight gain (albeit only slightly). They are now 8yrs old, very good eaters, and hasn't affected them negatively at all. Just wanted to reassure you that if you did do it, it wouldn't necessarily be disadvantageous.

BUT - and this is just my opinion - knowing what I know now (I have 3 children now) including a very low opinion of HVs unfortunately, I wouldn't do something you're not entirely happy about on the advice of a HV. I'd want to speak to a GP or a specialist.

[YouMaySayImADreamer]

Thanks Poppet - have googled and it looks horrific. Glad to hear your dd is a lot better now, it must have been horrendous for you. Definately something worth knowing and i will start taking some multivitamins after seeing this.

I have just had a more detailed look at ds's growth chart and it actually goes as follows...

7 weeks - mid of 75th centile
10 weeks - on the line between the 75th and 50th centile
13 weeks - top of 50th centile
16 weeks - bottom of the 50th centile
19 weeks - top of the 25th centile

So he hasnt dropped centiles as quickly as i initially thought, but hes been dropping steadily each time i have had him weighed by looks of it. Although i was told that him following across 2 different centiles was fine, so i suppose it is only now that hes dropped off onto a third is whats concerning? Really panicking.

[Poppet45]

Just to add to the heaps of useful comments here a sustained drop across two centiles would tend to trigger a reassurance paeds appt here. Dd started on the 50th centile (albeit of not much as she was born at 27 weeks weighing 1040g) fell to the 0.4th and is now up at the 25th and has been closely followed. Although v many healthy babies dont follow the lines they can be invaluble early warning signs too. Dd stopped gaining weight after doing v well when she became acutely deficient in zinc, then she her alertness faded and then got the most appalling rash, google acrodermatitis enteropathica rash if you dare, she was hospitalised and we nearly lost her. Op this was a v rare complication of bfing such a prem baby who was also given diuretics that washed away her mineral stores but it cant hurt for you to consider taking multivitamins while bfing so you have no doubts about the goodness of your milk, mine was unfortunately a bit low in zinc which certainly didnt help dd.

[YouMaySayImADreamer]

Not good at these smileys evidently!!

[YouMaySayImADreamer]

Oh sorry i didnt realise that was the envy smiley! [Grin] but yes i am very lucky i know, there were times when i thought i would never get more than two hours sleep in a row again! Although he keeps me on my toes during the day with his lack of napping!

[YouMaySayImADreamer]

Thanks all again for your replies and experiences, it is much appreciated.

Johnny, it is very reassuring and comforting to hear of someone who has been through the same thing. I really want to continue ebf him, so it is good to hear that this is possible with the right steps.

Thanks tiktok. I have been as open, honest and forthcoming with info as possible and have mentioned anything that I feel may be relevant to the situation, as I want to get the best possible 'fix' to allow me to continue ebf. Feel free to ask me any more questions that you feel may be relevant though. In answer to your other question, the hv is literally only concerned about his weight. It was actually a midwife who weighed him, and had apparently just wanted to mention the situation to my HV. But my HV did say that she is happy that he is a very lively, happy, and alert baby (she even said that he developmentally advanced for his age), so it really is just the weight. As I said in my OP she did make reference to the fact that babies of this age could plateau in weight gain, but she did also say that it was unusual for a bf baby not to wake for any night feeds. I thought the same about the baby rice because I thought at his age, breast milk was the most nutritional thing he could get.

Twitchy, thanks, i thought the night feeds might be playing a part, so waking him or dream feeding him could be a good idea. I have already been setting my alarm for a middle of the night feed which I started last night. The thing is, I have always took his lead on everything, so I honestly haven't been trying to get him to sleep through - if he wakes, I always feed him. The only bit of routine I have in his whole day is that I take him up to do his bedtime routine at 7.30, give him a feed at 8.00pm and put him in his cot to sleep.

[tiktok]

Liz - it's ok :)

It may be the OP's HV is saying stuff that could be ignored (wouldn't be the first time , but who knows.....?

[LizTerrine]

Sorry tiktok . You are more sensible and generous than me (plus a proper expert). Dreamer, I would definitely listen to tiktok over me, apologies :).

[tiktok]

Not right to tell you to 'ignore' the HV or her advice (how can a talkboard know for sure we have the whole story???!) - but you can certainly ask questions about it. I do agree that on the info you have shared here, it is questionable.

Here are some considerations:

• is it only the weight the HV is concerned about? If so, you can increase your baby's weight by getting more breastmilk into him - feeding more often, basically, in your case (I don't understand the point of expressing, either). The baby's own needs and appetite adjusts intake to what he needs - so if he really does not need more breastmilk he will either refuse or take in the same amount over an increased no. of feeds
  
  baby rice is* more calorie dense than breastmilk (not sure where people get the idea that it isn't....a teaspoon of baby rice has more calories in it than a teaspoon of breastmilk) but the amounts of baby rice you would give to a new starter are tiny, and will make very little difference to calorie intake...except negatively. So a baby might fill up even with (say) a tablespoon of baby rice and take less breastmilk as a result 'cos he s not so hungry. That's bonkers....and one of the reasons why early solids in a baby who is feeding well and sufficiently are not a good idea
  
  
• a sustained drop of two centile spaces (which is the drop between 75th and 25th) does indicate a need to check out what's happening not clear it this is sustained or not) but that's all. In a well-feeding, healthy baby it is not a cause for concern
  
  So basically - see if your HV would be satisfied with you feeding more often? And ask her if she is worried for any other reasons?

[johnnycomelurky]

My DS (EBF) followed an almost identical weight gain pattern to yours. Born on 75th, was up above 75th at two months then from around 3.5 months his weight gain slowed and by 4.5/ 5 months he was just under 25th centile. He was very bad at napping during this time and I think he'd got lazy with BF and wanted to switch sides as soon as milk slowed after letdown, I tried to keep him on same side for longer but he just refused. HVs (was a clinic so dealt with three) were nice but said had to refer to GP as crossed two of the major centile lines and that was policy. They also made me come weekly to weigh him for a month. They all commented that he was clearly well in himself, alert and happy so nothing major likely to be wrong. GP was fab checked to make sure all vitals were normal and saw nothing of concern. I asked her if I should consider topping up with formula, she said not if I didn't want to and to just continue EBF. We were followed up and his weight gain picked up when he started solids as he fed just the same but started to eat other things as well (a lot of avocado and banana!). TBH it was a pretty stressful time but he is a very robust, healthy 2 year old now. Good luck with it and don't be too worried if they suggest referral as I found it reassuring rather than punitive (which is how it initially felt). Oh and agree with others that baby rice probably not the solution!