Low weight gain after weeks of good weight gain

[cogitosum]

Ds is nearly 11 weeks. On the whole he's been a good feeder since birth but I've posted before about some problems we've had with my over supply. He gets very windy and has refluxy symptoms (eg throws up after almost every feed.. Often up to an hour and a half after and not just possetting).

He also feeds really quickly. A good feed would be 5-10 minutes. Anything over 10 minutes is almost unheard of unless he's half asleep. I have to repeatedly put him back on as he'll come off gasping and choking midfeed. When he's finished of not hungry it's virtually impossible to make him feed as he'll whinge and spit out milk!

We've had some good advice on the over supply and I tend to feed lying down of leaning right back with him as upright as possible. We tried block feeding but sometimes he wants the other side and nothing else will settle him.

Anyway his weight gain has always been good. In the first few weeks it was exceptional. However yesterday I had my 6 week review (very late) and he's dropped from 25th to 9th percentile so they're not happy with weight gain which was the one thing I always thought was good! In the last 4 weeks he's put on 21oz which I thought was ok as dr sears site said 1-2lb a month but apparently not. The 21 was broken down weekly as 7,7,4 and 3 (I was abroad which was why I weighed him weekly as I was anxious about change in environment). He had a cold the week before last but I thought this week would've been higher.

I have to go back next week. If he hasn't put on a satisfactory amount what are they likely to suggest? Would rather avoid top ups. I can express easily (and collect about 2oz a day from leaking during feeds) and he has taken a bottle once quite happily so could give him expressed but I found it really hard and was quite tearful (pathetic I know!).

I feed on demand but he's put himself into a routine. Does this sound ok?

7.30 wake up and long feed lying in bed
9am little feed and sleep in sling
10.30 wake up and long feed
12 little feed and sleep in sling
1.30 wake up and long feed
3pm little feed and sleep in bed together
4.30 long feed lying in bed
6.30 little feed and sleep in sling
8pm wake up and long feed
9.30 long feed lying in bed
10pm sleep in co-sleeper
4.30 - 5am long feed in bed

Obviously it's not all in neat 1.5 hour time slots but it gives the general idea. Also he sometimes misses the little feeds before sleeping but there are generally the 7 long feeds and at least a few other little ones.

Thank you to anyone who's read all of this epic post!

cogito, sorry you're worried....is there any reason why your baby is being weighed weekly apart from your concerns about being abroad? Normally, it is not considered good practice to do this because weekly weighings have a tendency to mislead....red book reflects this, by advising no more often than monthly in the first six months.

Having said that, it would appear he's been weighed on different scales anyway, and weighed by different people, yes? There's a lot of anecdotal stuff and some proper research that indicates a high chance of 'operator error' in these circumstances.

It is absolutely to be expected that a baby gains irregularly and for large amounts of weight gain to be followed by smaller ones. This is why the chart is useful for tracking the general trend (not a week-by-week picture), and a fall through one centile space (which is what the 25th to the 9th is - it's one space on the chart) is well within normal in a healthy baby.

Usual protocol is to look carefully at the whole picture if a baby falls through two or more centile spaces - and even then, most babies who do this are fine.

If you or your advisers think he needs more milk, though, then that's easy enough to comply with - just feed him more often, by offering sooner. But if he is healthy, and further discussions with the HCPs leave you pretty confident he is actually fine, then from what you say here, you may decide not to do anything except carrying on with what you are doing now :)

Don't be afraid to challenge the HCPs - let them explain to you why they think his weight gain is concerning.

Thank you tiktok I was hoping you might respond!

Yes the weekly weighings were just because I was away in a hot country so wanted to make sure he was getting enough.

It's not the weekly measurements that worried the gp (they were just for my benefit) it was the fact he's dropped a percentile in 4 weeks.

I don't know how I can get him to take more if he doesn't want it. When I try to feed him if he's not hungry he clamps down and then comes off and screams The only feeds he actually seems to want are the 7 a day. The rest are additional and he's not that interested.

At the beginning he was really hungry and did nothing but feed but now he doesn't seem as interested.

Thanks for the further info.

If all that is worrying the GP is the drop of a centile space in 4 weeks, then maybe the GP has to be asked why, perhaps with the support of your HV?

The general rule is a sustained drop of two or more centile spaces:

www.nhs.uk/conditions/pregnancy-and-baby/pages/baby-screening.aspx

Also check out the info for HCPs on the charts from the Royal College of Paediatrics and Child Health - google it, and read Factsheet 6 on plotting growth. It's a pdf so it's hard for me to copy and paste here but it says the same and advises that individual measurements may show 'wide variation' and again talks about the sustained drop of two or more centile spaces as the trigger for concern.

It is certainly possible your GP is not aware of the 'instructions' on how to interpret the charts so you could take a printout of the info and ask to discuss it.

If your baby does not want the extra offer of feeding, then it strongly suggests he doesn't need them.....honestly, it sounds as if you have been made anxious about something that does not warrant it, but of course I'm not a doctor and I haven't seen your baby anyway :) You could do the reading up yourself and ask the GP (and HV?) why there is concern when the info you have read seems to be contradictory. If you are open and polite, and accepting of the GP's goodwill, then it should go ok!

Oh good thank you. And he's only just on 9th centile line so not too bad at all. Dr was lovely so will speak to him about it next week. I know my op sounds like I have a schedule but I really don't! I offer him my boob constantly! I've heard you can't over feed a breastfed baby so I thought offering a lot is better than too little.

I had one great HV who came to the house but one at clinic who every time I ask anything tells me I'm wrong to use the sling and he's too attached so I try to avoid asking her for advice.

If your doc is nice, it'll be fine to ask him!

at the HV and the sling....and 'too attached' WTF????

She needs to go back to college and find out a bit more about what is normal in young babies :(

Something I forgot to put in my op. ds also hasn't had a poo since Friday. I wasn't worried as had read it can be normal and it didnt seem to be bothering him but last night he woke up crying which is very unusual and he's been squirmy and moany all morning.

Could this combined with lack of weight gain signify a problem?

Irrelevant, cogito, because gaps between poos are normal for a bf baby beyond newborn :)

Thank you.
He finally did his poo today. There was a lot of it (6 days worth!?) but it wasn't explosive. It was thicker (and smellier) than normal and came out with less force. Is this normal? (I was wondering if that's because he's been farting so much there's no gas to push it out!).
It smelt different too - more like grown up poo.
Also I thought he'd be pleased and relieved but he's hardly stopped crying since...

It was still mustard yellow

cogito it still sounds on the normal spectrum, and I don't think babies need wind to push out the poo.....it's done with reflexes that act on the sphincter muscles.

He could be grumpy and fussy for a zillion reasons.

But if you're worried, give HV a call. Hope you have a better day today.