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'm wondering what effect my very slow let down has on getting milk into him? I suppose the switch nursing should help with that?

Just looked at the pumpstation website, thanks leo. I think he has a shallow latch, but various bf counsellors have said it's ok and I'm not in any pain at all. If I try to latch him on deeper, he adjusts himself until he has a more shallow latch. I wonder if that has anything to do with the poor weight gain?

My now 9mo was tracking under the 0.4th for the first 6 months of his life (he's now around the 9th as a result of weaning)

It just means he was the smallest baby of that age, and is not an indicator of his health or otherwise.

Is your baby gaining some weight, meeting milestones, producing plenty of wet and dirty nappies etc? Maybe, like me, you've just got a dinky one!

PS try block feeding - sticking to the same side for a couple of hours so you know he's getting the creamier hind milk. Gives the opposite side a chance to refill :)

Purple - block feeding reduces milk supply, so is the opposite of what the OP wants to do! The baby will get the hind milk if it is feeding frequently from both sides, you don't need to limit to one side to get this. When a boob is left to "refill" it means milk stops being produced.

Sorry PurplePidjin, but I wouldn't agree that the OP should do block feeding. That's usually only recommended for dealing with oversupply issues ie it can reduce supply (eg see this article) Not what the OP wants.

The foremilk/hindmilk thing is also not something to worry about, and you don't need to wait for a boob to "refill" as milk is made on demand after what is stored in the breast is removed.

Oops, sorry, i tried it at around the same time and ds's weight gain increased. Didn't realise about the reduction thing! Blasted anecdata

you did well then purple!

More luck than judgement I'm afraid!

OP your baby is having plenty of wet and dirty nappies, gaining 4-5oz a week and if I understand correctly, following the 0.4th centile line? You're feeding on demand, aware of the need for frequent feeds, keeping your baby close to you and switch nursing as well?

It all sounds like you're doing fantastically to me!

Some babies are just smaller. If your baby is now following a centile line and having good weight gain, which 4-5oz a week really is, then I'm not sure what the problem is at all, particularly as he started just under the 25th centile. Some babies have to be on the lower centiles and its fine for them to be.

Can you speak to someone other than your HV for breastfeeding support/help? Maybe start by trying one of the BF helplines or attend a group such as La Leche League?

Hi thanks midori, not sure if DS is following the 0.4th centile, i think he has dropped. But talking to my mum today I was definitely not a chubby baby. I have been going to LLL meetings and the support is great, they think he is fine. Everyone who meets him comments on how alert he is.

I meant dropped from between 9th and 25th down to just above the 0.4th

From everything you've said, he does should fine.

Two of my children dropped from the 50th percentile at birth for weight to just underneath the bottom percentile. That is even more of a drastic drop but they never lost weight and were always healthy and developing well. Height wise they have always been about 50th, maybe a bit more.

My children are now 4,7,9 and all very very slim and strong. I know it's worrying at the time when you see loads of chubby babies around, but for some babies, it's normal.

Thanks kelda, you're right, seeing other babies makes me fret, some of them look like sumo wrestlers!!