Slow weight gain - what more can I do?

[LadyDowagerHatt]

My DD is nearly 9 weeks and just had her weighed this morning at 8lb 6oz. Her birth weight was 7lb 9oz, she went down to 7lb and it took her over 4 weeks to regain her birth weight following problems with the latch early on. Since it was corrected she's only put on 3-4oz per week, despite feeding every couple of hours (more often in the evening) on both sides plus I am expressing after some feeds for a top up in the evening. I am also taking fenugreek and have been prescribed domperidone, just in case it was a supply problem.

The HV is happy that she is gaining, even though she is moving down the centiles. However if she doesn't gain more quickly she will drop off the chart at some point soon as she is just above the 2nd at the moment. She is settled after feeds and very alert but she just looks a bit scrawny! I'm wondering whether to give formula top ups but don't want it to be the beginning of the end for bf.

Just looking for any advice really on what I can do to get her gaining more? She has been checked for tongue tie a few times.

I am not an expert so hopefully others will be along soon but my tuppence worth:

1. I wouldn't be too worried if she is settled after feeds, alert, happy etc. 3-4oz is ok, it may be that she has a growth spurt later on instead, all babies have their own pace.

1. you say she's feeding both sides at every feed. are you sure she is finishing side 1 (and so getting the hind milk) before you are switching to side 2?

Don't think there is any need to worry about the hind milk, as long as you let her come off side one naturally before offering side two.

When you say she feeds every 2 hours, is that 2 hours from the beginning of 1 feed to the beginning of the next? Have you read How might I increase my baby's weight gain and has she been checked for tongue tie.

Is there a local Bfing support group you could go to? They should be able to check your latch, again, check for tt and discuss weight gain with you.

Have you seen the Dr Jack Newman bfing videos? Have you tried breast compressions too?

How are things today? Did you manage to read the links OP?

I've got twins they are gig now but I had this in the end I gave up feeding and expressed and gave by bottle because one just did nt gain enough weight.It was worse because the other thrived.9 years later and she's still a dinky dot I think she was 6 months old before she hit 10 pounds.Some babies are just small and grow into small or in my daughters case tall skinny people.my biggest regret is that I stopped breast feeding because it made no difference at all.If you are worried about supply leave it till before the next feed and express and see how much you get offWith all the stimulation you have been doing it may be you ve got oodles of milk and she's not reaching the high fat hind milk.A baby needs 150 approx millilitres per kilogram divided by the number of feeds in twenty four hours Do you have a local nct breast feeding peer supporter or la leche league they can come and check your latch etc.

sand I've always been told that the amount you can express has bugger all to do with the amount you produce? Certainly true in my experience asi could barely express a drop while I was feeding dc1, yet he gained weight fine.

Thanks everyone for your replies.

JJJ - I have watched the videos, very useful and also rang LLL which was really helpful. She also gave me the phone numbers of some local LLL consultants so I will ring and try to get to a group. I'm wondering whether there is room for improvement with the latch, plus she doesn't seem to be sucking vigorously for the whole feed, mainly just at let down (not sure how to fix that). I had been going to a different group but she didn't seem to be able to help beyond initial improvements in the latch.

Sandily - that's interesting about your twin daughter. We do have some tall skinny boys on both sides of the family, perhaps she is lucky enough to have inherited those genes!

Just to answer your questions as well, it is 2 hours (3 hours max in the morning) from the start of one feed to the start of the next and she has been checked for tongue tie.

Bit unsure what to do now - I've just had a phone call from the infant feeding co-ordinator who was recommending top ups of 4-5oz morning and night (the majority would have to be formula as I can only express 3oz a day unless I stayed in and expressed all day every day!). Her view was that I had tried everything and if there was going to be a turnaround in her weight it would have happened by now. This was just her advice, I didn't get the impression she was telling me I had to do this as she actually rang for a different reason.

What she is saying makes sesnse, but I am worried about how to do this without impacting on my supply. I am also a little reluctant as my husband has hayfever and eczema so I had wanted to exclusively breastfeed in order to reduce the risk of DD suffering from it. Would a bit of formula mean this benefit is lost?

Any advice appreciated!

DS dropped from being on the 25th to the 2nd, hovered around there for months & around 14 months went up to ninth. I stressed about this a lot.

Now i realise I'm quite petite and he takes after me. A friend DD dropped of the charts and a year in still isn't on them. Her a DH is small & slender guy. Are either of you petite?

Hi NothingsLeft, thanks for your response, unfortunately that's not the case with us - I'm 5ft 7in and DH is 6ft and both well built!

Has anyone measured Los length? Babies can often find their weight centile after birth, whether up or down, but it would be interesting to see what she is doing with her length centile.

Has the IFC actually seen your baby? Personally I would be reluctant to give the top ups without first speaking to a BFC in person. Speaking to one of the local LLL leaders does sound like a great idea. One might be able to offer assistance before the next group meets.

If she seems to be actively sucking just on the letdown, have you tried breast compressions?

My dd dropped down the charts and for a while I was worried about her. I used to feed her every 2 hours in the day and every 3 at night. It was when my mum pointed out that I was nearly 10lbs when I was born and I'm now, well lets sat I'm under 8st, that I stopped worrying. My dd was more than bright and alert and we had plenty of wet and dirty nappies.

If you can't speak to one of the lll leaders in the morning I would try the helpline again, talk to the BFC about the advice given by the IFC and what the impact is likely to be on your DDs potential for allergies and your bfing relationship. I'm not trained but 10floz a day seems a lot of top up.

Do you have any ebm that you could too up with tonight?

I second breast compression. My lactation consultant taught me these and it helped a lot. Could you see someone privately?

Thanks for your replies. The first LLL person I spoke to yesterday mentioned breast compression so I have been doing that and it seems to keep her more interested. Frustratingly she has a cold at the moment though so feeding has been a bit more difficult today as she is a bit bunged up.

JJJ - no she hasn't seen DD. The HV has been liaising with her and she actually said 'I've been told by the HV that DD is lovely, good skin, very alert etc'. I also wondered about the 10oz a day as according to something I saw on the internet the estimated intake for bf should be 2.4oz per pound so that would mean DD needs about 20oz - to give half of that in formula doesn't sound right bearing in mind that she is gaining weight, just at a lower rate.

I had 4oz in EBM for tonight so I have given her that. We've come this far so I think I will speak to LLL and just continue to express and give that as a top up until the next weigh in - fingers crossed!

Think that if you do need to top up, the first choice should be more feeds, then top up with ebm, then if that's not possible formula.

According to this kellymom article at that age babies take on average 25fkoz a day, so 10floz of formula does seem a lot and think you are right to question it.

Agree with nothing, if you are having difficulty seeing a BFC and you can afford it, it might be worth seein a Lactation Consultant.

my lo dropped 13% of his birth weight I had to top up after 2 hourly feeds with ebm but he still wasn't gaining...he dropped off the centile but once I cut dairy out of my diet he banged the weight on on average 8oz a week. He is now 3 months and has filled out and caught up. Hope you get to the bottom of it xxx

I have low supply owing to a physical problem. I am topping up around 3-4oz a day and DS is following his curve, albeit the 2nd centile. My LC is completely happy with him. I think those sound like huge top ups personally if she is gaining weight.

DS is about 11lbs at 16 weeks (think so - haven't had him weighed in a month).

Something I wish, wish I'd known for DD is that all the weighing and worrying were nowhere near as important as was she well and alert and developing?