weight down to 0.4th centile - what can I do to improve bf?

[tasmaniandevilchaser]

DS is 12 wks old and is now 4.56 kg, which means he is on the 0.4th centile. He is obviously small and quite thin (no chubby legs ) but incredibly happy, alert, smiley and very strong. He rolled front to back at 6wks and back to front at 11 wks, so no worries for his milestones.

He breast feeds on demand during the day and night and never goes more than 3 hrs without a feed. We have started giving one bottle of formula in the evenings at bed time, which is usually about an hour after a bf, to try and make sure it's in addition to the bf. He does tend to empty both sides so I suspect I don't have an awful lot of milk in there. I have a slow let down so I've been trying to do compressions.

The HV told me to give more formula and when I told her it was giving him constipation, she said to give him water.

I don't want to give up bf, we were all really ill over last winter and I'd like to carry on until Spring if possible.

What can I do to produce more milk? I'm thinking of asking the GP for domperidone.

I am sure someone will come along soon with very good advice. Here is a link that you might find useful in the meantime.

Good luck!

kellymom weight gain

I've been where you are now and my ds is 22 weeks. In summary the things that helped were:

• seeing a bf coordinator who confirmed "I was doing it properly" and helped me believe in myself again
• seeing a paediatrician who agreed ds was light but healthy and happy and discharged us
• changing to comfort milk for formula, less constipation
• telling hv that I only wanted suggestions and solutions involving bf not defaulting to formula as our only option (had some truly awful advice)
• taking domperidone (but has to get infant feeding coordinator to sort with gp)

Do you have lots of wet nappies? Healthy poos? My boy is loads better now he's bigger, can drink more and I can't force any more milk into him. He never stops moving so he must burn up more energy. I only get him weighed monthly and I get him measured too. He's tracking on a higher line for height so I know he is growing in length if not in squishiness! Be strong, get independent support and don't let yourself be intimidated. Xx

Domperidone def works- am on it for second dc. Keep going, including the top up and it'll creep up. Both dc started string beany and are now absolutely fine.

What is his weight gain like? Has he actually lost weight?

Two of my babies dropped to below the centiles for weight, but they were all doing well and never actually lost weight.

I wouldn't give him water. He needs milk and only milk at this age.

I have low milk production because I of a breast reduction a few years ago. I will never have full production, but I've got a system going that is so far working.

I use a Lact-Aid to make sure that the breast is stimulated at every feed. It's a hassle, but worth it for me (its a supplemental feeding system so you put a small pipe with milk into baby's mouth with nipple. Baby gets your milk and formula at the same time).

I have also just started (last Thursday) taking Brewer's Yeast. It's AMAZING and I don't know why nobody told me about it for DC1. My milk production has definitely increased, I can't recommend it highly enough (for morale too - was amazing getting squirted in my eye for the first time when I squeezed to see if I had any milk!). I use the Solgar powder and it's debittered and actually tastes ok and not too strong so in a flavoured yoghurt I can't taste it. I take about 3 teaspoons sprinkled on toast before going to bed and have loads of milk in the night/morning. The first few days baby had more gas. Not sure if it was coincidental or not, but it's not a problem now.

There's also a recipe for lactation cookies here, which I haven't made because eating it on toast is easier/quicker!

I was also told by a midwife when newborn DC2 was having hard poo to mix the formula I was using in the Lact-Aid with a small amount of extra water, not to give extra water neat. So three scoops of formula would normally mix with 90ml water, but I should add 100ml instead. You might want to check if something like this would work in your case before doing it, but so far so good for us.

Has he been checked for tongue tie? This can mean he takes ages to get the milk out, he doesn't quite get enough and your supply isn't enough.

Supplementing with formula will mean you make less because that is milk he never gets from you and will therefor mean your boobs don't ask for it.

So speak to a lactation consultant or bf counsellor who knows their stuff about tongue tie (I saw a few who didn't and failed to diagnose it).

What were you and your DH like as babies?

thanks everyone,

dyslexic I've had a look through that kellymom article thanks, I'm doing a lot of the things she recommends

bring yes lots of wet and dirty nappies. My DS also never stops moving! My HV/GP have never talked about length, but there is very little room length wise in his 0-3 vests and babygros so he is growing lengthways I think.

kelda no he definitely hasn't lost any weight, he puts on around 4-5oz a week. I agree he doesn't need calorie-free water, I did bring that up, but I've never got any particularly sensible advice about bf from a HV so I just smiled and nodded.

DD was also very petite (hovered around the 2nd centile around this time) and by about a year was up to the 50th centile.

I've ordered a herbal supplement that a few people have recommended, and I'm on my own with DS tomorrow so I might just keep him on the book all day!

keep him on the boob not book!

i'll try brewers yeast as well, thanks!

I've had him checked for tongue tie but maybe worth trying again, he can poke his tongue out

Dd could stick her tongue out too - just not very far!

Sounds like my DD1, she was on the go the whole time, didn't sleep much and had very slow weight gain (and some weeks where she lost weight, luckily I went to a very supportive Bfing group who helped lots). I think some babies do need more calories than others, I had a 'baby honeymoon' with her when she was 4 months old where I sat on the sofa for a whole day with the TV controls, laptop, magazines, books, lots of water to drink, and snacks. If she was awake she was put on the boob. It seemed to kick start both my supply (which had been knocked back by a bad case of mastitis) and her demand. She started asking for milk much more often (and I started offering the boob every time she sqeaked, rather than thinking 'but it's not been 3 hours yet'). She started piling on the weight and climbing the percentiles within the week.

I say I think some babies just need more calories because when we started weaning she ate masses of solids right from the beginning. We did BLW and a week in she ate an entire banana for breakfast. She ate constantly for the next 6 months, nursery actually asked if we gave her breakfast because she would demand food as soon as she got in. She is now 5, eats like a horse, and is a skinny wee thing. Just like her father in fact.

Oh, if he's putting on 4-5oz a week don't worry and keep away from the interferring HV. Not all babies stick to the same percentile line all the way through their first year. DD1 was a large baby but like I said is a skinny wee minx now. If she has stuck to her birth percentile she'd be one of the biggest in her class, as it is she's the shortest. I just make efficient placentas that result in babies that are large at birth but settle down to a smaller size as they get older. Which makes sense because DH and I are short.

vilewoman, yes my DC are always on the go and were quite small as babies, with slow weight gain. DH is quite tall and thin, so I think I DS is taking after him. I also think that I have efficient placentas and end up with small babies once they settle to their size.

I'm having a day at home with DS on the boob today, hopefully that will help. Thanks for all your advice.

4-5oz a week sounds reasonable. Has he dropped centiles?

When you say he takes both sides, do you offer the first side again after? Feeding more often and more sides each time will improve supply.

Try feeding both sides of each boob at each feed so he's emptying the whole lot.
You can then help by taking a turbo multivit or continuing with pregnacare, and eating / drinking vast amounts. A couple of litres of water a day, plenty of good healthy food and lots of oats - which are usefully found in hobnobs... Take snacks with you when you're out and have a snack of your own at each feed, even in the night.

If the concern is calories going into your baby ie he needs more to gain weight, it is truly madness to offer water...I don't often say this about HVs as there is often more to stories than we ever know, but if an HV really suggested this, then she badly needs some top-up training.

The best way to get more breastmilk into a baby is to feed more often. 3 hrly feeds is prob not enough, though I hear you that this is the longest he ever goes. When he feeds he needs to switch feed - back and forth on both breasts so when he has done with side 2, put him back to side 1 and then back to side 2 again. If you're reading kellymom, I think all that is there.

Your baby sounds fine, though :)

What's the logic behind having a snack at each feed? Why eat/drink vast amounts?

There's no evidence that eating or drinking more or eating anything special helps in any way - but if if makes you feel good, do it :)

hi maja, yes he was born just under the 25th centile. And yes I do offer the first side again, I think having a slow let down means the flow stops mid way through and I just keep switching sides when the flow stops until he either falls asleep or is happy enough to finish.

leo I'm very happy to keep eating!

Having said that.....I agree with maja :) What is the point of the snack at each feed and drinking more than a mother is thirsty for? Snacks with every night feed, too??? If you want to do this, then ok, but that's the only reason!

Some babies are just born bigger than they're supposed to be. I had one born on the 75th who quickly slipped down to the 25th (or just below) and stayed there.

have a look at the resources on pumpstation.com - a site I find really useful. Proper maternal nutrition definitely a factor.

Proper nutrition just means eating well and not starving yourself though - eating loads isn't going to make a difference to your milk.

thanks tiktok, I know it does sound like madness to offer water, I think DS wouldn't be impressed either, he has this "wtf look" that I'm sure he would give me! It just doesn't make sense. The NHS bf expert in my area is on holiday this week but I'll call her next week. It may be worth getting a second opinion on the tongue tie.

I don't really look at the clock, just feed him whenever he peeps but we were trying to stretch out the feeds while on holiday 2 weeks ago when he was horribly colicky and we were aiming for every 2 hrs, so that tells me he feeds more often than that. I'll continue with the "back and forth", not sure if what I'm doing is exactly switch feeding, but I often do normal cradle hold on one side, then switch to the other side, then back to the first side, then change to rugby ball style on that side, and so on. It's fine at home but if we're out it's less practical. DD is on holiday with grandparents next week so I'll have a 'babyfeedingmoon' and try and chub him up a bit.

Leo I have looked at the site and can't see where it talks about diet but I have only skimmed it. It looks a useful site.

Whatever.

Eating more, eating extra, eating more often, eating at night, eating special foods, drinking more than you want to drink....NONE of it shows in research (and there has been a lot of research into this) as making one scrap of difference.

Even mothers on marginal diets make sufficient good quality milk for their babies. The big difference to milk supply is frequency of effective milk removal.

there's no way I can have a snack at every night feed, I don't wake up properly for a start, we co sleep and I just pop him on when he squawks. But I am definitely eating well, lots and lots of fruit and vegetables - I'm very roughly following the Low GL eating plan, plenty of protein and small amounts of slow release carbs (though I'm eating more carbs than they say to), also lots of water and fruit/herbal teas, some de caf coffee (and some treats!)