Baby off the charts (bottom) need to supplement

[LadyDowagerHatt]

Bf has not gone well for us. My 15 week old DD was EBF for 10 weeks then had to supplement due to terrible weight gain - took 4.5 weeks to regain birthweight and at bottom end of acceptable increase ever since. Finally a PTT was spotted and we got it revised at 12 weeks.

I was supplementing with 3.5oz of EBM and 3.5oz of formula - in the first 2 weeks of doing this DD gained 11oz so that seemed to be working. Then she got the tongue tie revised, latch seemed to be better and she was doing more long sucks but over the 2 weeks following this she only gained a pathetic 2oz and fell off the charts. I have no idea why - the only thing I can think of was she had a bad cold but that shouldn't effect the weight that much surely, especially as the latch etc seemed to be better.

Strangely through all of this DD has always been the most happy, contented little thing, sleeps well and very alert - there is no sign of hunger at all except for a fussy period in the evening but that's normal I understand. I almost wonder if she is taking enough to satisfy herself but not to grow. She was feeding every 2-3 hours with a 5-6 hour stretch at night.

So I am now supplementing with 2 x 6oz bottles of formula - 1 at lunchtime and last evening feed.

I'd really like to carry on bf as despite the poor results we both enjoy it. I know these large volumes of formula aren't very conducive to that but obviously first priority is to get her weight up. An IBCLC I saw said she knows others who have swapped the formula for solids once they are established - sounds like a good plan if we can last that long!

Thanks for reading this far. I guess I just wanted advice/experience on how to make the mixed feeding work.

And also thoughts on the tongue tie revision - if it is to improve the weight gain would I have seen that by now? Or does my supply need longer to catch up? I am taking domperidone so I was hoping that would have helped.

:( LDH ....what a story :(

The first thing that leaps out at me is the infrequency of the bf - every 2-3 hrs and a 5-6 hour stretch at night is prob not sufficient to promote 'catch up' growth - by my reckoning it's only 8 times in 24 hours. Sometimes, laid-back, placid and basically healthy, happy babies need a bit more proactive offering of the breast to encourage them to feed more.

If all that's worrying your caregivers and you is calorie intake (and not some underlying health concern) then the answer to that is to increase her milk intake, which you have done - and alongside formula (which you rightly say wont help the bf, but is needed in order to ensure your baby gains weight) can you discuss with the HCPs the possibility of reducing the formula slightly andat the same time hugely increasing her breastmilk intake? This would mean switch nursing, breast compression, and lots of instant response to any feeding cue she gives you...what do you think?

Thanks for the reply TikTok.

Pre formula it was probably a bit more than 8 times a day as she was cluster feeding in the evening and sometimes in the early hours of the morning as I bring her into bed if she doesn't settle after her 3am feed. But I take your point, I could offer more instead of waiting for her cues. Would you say every 2 hours with the cluster feeding as and when required? She usually sleeps from 10pm to 3am after her bottle - should I also be waking her up to try to get more breastmilk into her at night when my supply is highest?

There doesn't seem to be any underlying health concerns - I am waiting for a paed appointment but the GP has checked her twice and all is fine. My HV says she is not worried about her either and I don't have any concerns. I think it is a bad combination of TT not spotted until late on and a very placid baby!

I would like to reduce formula gradually and increase BM - I will obviously do the latter as per above but I want to wait until she climbs back up to maybe the 9th centile before reducing formula as otherwise we have no room for slower growth, she would be off the charts again.

I think because of all the problems I don't trust my milk quality/production and/or DDs ability to transfer it. My HV even suggested I produce low calorie milk although she admitted that the general consensus is that there is no such thing.

at the HV suggesting low calorie milk - way to go, undermining a mother's confidence in her bf :( :(

It's not the 'general consensus'. It's science. Human milk is the same high level of quality throughout the world, across populations and across individuals. As long as the baby removes the milk effectively and sufficiently frequently, the milk will be just fine. If you want a paper/papers to wave under your HV's nose (or your own), PM me.

Your baby had a TT, and this may well have interfered with effective feeding, and when milk is not removed effectively, volume decreases.

'A bit more' than 8 x in 24 hours is still not sufficient for most babies - so it may well be that as well as the TT, your baby needed more frequent feeding.

You ask 'every 2 hours plus cluster when needed' - it's not so much a question of 'every x hours' as overall frequency. If you aim for every x hours, you will be trying to feed on occasions when she does not really respond. You need to be watching for early feeding cues - even when she appears sleepy. Any mouth, hand, facial, eye, arm, movements show she is not so deeply asleep, and she may well respond to the offer of a breast. Just try it, and don't persist if she rejects.

10pm to 3 am is a long time to go without a breastfeed - but you need to assess whether you need the rest/sleep yourself in order to function. If she has the bottle after a breastfeed (and not instead of) this makes it better. How about you increase (a lot) the times she has a breastfeed at other times of the day?

Hope this helps.

That does help, thanks TikTok. I will definitely offer more - I must admit with a toddler DS and contented baby I was probably wasn't been proactive enough about offering boob.

I've mixed feed both DDs. It is more of a hassle but in order to try to get your milk supply up would you consider top ups of formula after a breast feed as opposed 2 big 6oz bottles? Ie offering a couple of oz after each feed? That should mean she'll be hungry to try to BF every couple of hours where as she won't after 6oz formula.

With DD1 we introduced formula for terrible wt gain at 6 weeks but substituted breast feeds because by that point I was an emotional & physical wreck. we were fully ff by 14 weeks. With DD2 we started at 2 weeks because it was very obvious we were headed the same way. For the first 10 weeks of it we topped up if she seemed unsettled after a BF (usually after 4 sides). I think this was a better way of ensuring my supply and at 20 weeks I'm really proud to still be breast feeding probably more than half her intake (she has 18oz of formula and is above the 91st entire).

I'm in a similar position. Little one is 17 weeks and a very happy contented baby. However she has dropped from the 75th percentile to below the 25th percentile. We've just been prescribed Gaviscon as it is possible that reflux is the problem. She's neve screamed after feeding since she was 4 weeks old, no back arching, no problems bringing up burps but she does puke. A LOT.

So we've been referred to paediatrics to check her over in case it's something more serious.

We're topping up with a bottle of formula before bed in the hope that it will up her calories. Plus it's the only feed she never sicks up.

Feel for you Lady. It's a rubbish feeling thinking your baby isn't thriving as well as they should be.

1. Charts are averages not what a baby "ought-to-be". My ds is a happy healthy 10.5mo. He spent the first 6 months dropping off the bottom of the chart. He followed what looks like the -2nd percentile line! He's just little, like his short-arse parents.

1. Whatever TikTok said, she's Da Guru when i was dealing with sleep issues, i offered bm every 1.5hours during the day (to a then 8mo) he took it every time. If you can, have a few pyjama days with your favourite tv and lots of snacks to hand. Snuggle up skin to skin and offer every hour or two.

1. You need to be well rested and well nourished. Are you getting your extra 500 calories a day? Are they from healthy sources like eggs, whole grain toast, cereal, fruit, veg etc? I was eating 2 breakfasts until very recently - porridge first thing (oats are meant to be good for milk production) then toast with jam/egg/bacon etc around 9. Plus full lunch and dinner with pudding and cake. Make sure those around you understand that your job is to care for your baby - theirs is to help you do that by doing the housework and not demanding dinner on the table at 6!

Mixed feeding is fine, and doesn't mean the end of breastfeeding. It's up to you what you're comfortable with. I well remember the hardship of the early days, and how it feels like it'll be forever; then one day i realised that feeds were 4 times a day for 10 minutes

Thanks everyone for your replies, good to hear about other experiences of mixed feeding. To be honest I'm a bit confused with it all!

When I had my DS at 36 weeks we ran into problems as well (wasn't sucking well, given bad advice about making him go 3 hours rather than feeding on demand etc, FTM I didn't know any better). Anyway I was topping up 1-2 oz after each feed, managed to do this from about week 4 to 20. It was a bit annoying having to remember bottles and formula when out for such a small amount.

This time round the HV said the advice had changed to giving the formula instead of a feed rather than as a top up, hence the 2 x 6oz bottles. An IBCLC I have been seeing suggested other women had done the same and I guess it is then easiet to replace the formula with food eventually. To be honest I have been trying to feed then giving the bottle afterwards. Although DH has just stressed me out by telling me that she only took 3oz last night and then fell asleep and he couldn't wake her.

Also I have been trying to offer bf more often today but she just won't take it. She latches on, sucks a bit then pulls off with my nipple still in her mouth - they are red raw after a couple of sessions of that. It's not wind (she does the same when it is but none coming up) and she just looks at me and smiles! This was all before I gave her a bottle today so it's not that interfering with the breastfeeds by filling her up.

Sunny L - I have been on weight watchers so not going crazy eating loads but they give you a lot of extra points so that must cover the extra 500 calories. I am not following it too strictly, it's just helped to stop me shovelling bags of chocolate into my mouth! Hopefully that isn't

Posted too soon - hopefully that isn't effecting milk production, it certainly doesn't feel too severe.

Sorry for the rambling post, just helps to get it all down. Any thoughts/advice on any of the above much appreciated!

Is the fussing worse after a particular food? I've been caffeine free for 9 months and it virtually cured his colic. Other people find they need to cut down onions, garlic, dairy, egg, tomatoes... Keep a food diary for a few days, see if there's a pattern.

PS that's tea, coffee and chocolate luckily i can't abide fizzy pop!

Pidjin, thanks for the complement about me :)

Happily OP's baby is not causing concern with fussiness etc, so no need for her to do a food diary :) Fussiness which eases with cluster feeding is 100 per cent normal.

Charts are not averages - the only average bit is the 50th centile line. Charts reflect the range of normality, and healthy babies usually stay within 2 centile spaces as they grow.

LDH, your weightwatchers diet will not interfere with milk production at all.

Mothers don't need loads of extra food to bf, or pay attention to what they eat in terms of quality - though of course you should eat to satisfy hunger, and good food will make you feel good (without having the slightest effect on quality or quantity of breastmilk) :)

Have you seen a paediatrician? This would be to rule out any possibility of an underlying cause ( not because it is likely). Slow weight gain is not a problem in itself, necessarily, it is more that it may unusually be a symptom of something that might be.

Some babies are small and grow slower than others.

The old saying is "look at the baby not the scales" .

On a practical note, keeping your baby close to you, preferably in some skin contact encourages frequent feeding. A sling might help .

TerrorMeSue - we have been referred to a paediatrician. The GP has checked her and all is fine. Everything else is just perfect - I'm no expert but I would be surprised if there is an underlying issue, I do think it is a combination of the TT so not transferring milk efficiently and being a very contented baby.

I carry DD in a wrap quite a lot of the day as it is the only place she'll nap for longer than 20 minutes!

As for naturally being a small baby, myself and DH are above average height (5ft 7in and 6ft) so no reason genetically to be small.

SunnyL - sorry to hear you are in a similar position, hope the gaviscon helps for your little one.

Thanks Lady. We've also been referred to paeds to check. One thing they wanted to check for was malabsorbtion. Also to look at the reflux some more.

Fingers crossed we both get the all clear and when we start weaning our babies will chub up and we will forget this worry.

So if there's medically nothing wrong with her and she's happy and contented, why does it matter if she's small?

Much sympathy, DD2 fell off the chart at 3-5 months old. She totally refused to take a bottle and didn't climb back onto their precious graph until she was 6 months old and happily devouring toddler pots of yoghurt.

When even his best nurse couldn't get her to take a bottle the paediatrician said "sod it, if she'll eat real food forget the baby rice first and feed her what she likes".

And so ended what was a horrible stressful time as she sailed up the graph to the 50% line at 12 months and there at 12 years she still is.

She carried on BFing long after starting school and still won't drink milk.

StarBall mine jumped a load after weaning - was up to the 25th at 10 months despite feeding well when ebf. Unless they're showing other symptoms maybe some babies just like food? I'm fully expecting a fussy toddler now though

Thanks for all your replies. Just to update, a lovely paediatric nurse came out this morning to assess Baby LDH before referring to Paed doctor. She said baby definitely didn't look like an unwell baby (which I knew obviously) and commented on how alert and animated she is. The nurse weighed her and she has put on 5oz in 5 days so is back on the charts - on the 0.4 centile line! She said she didn't need to refer, all seems fine and she will just come out next week to weigh baby LDH again to make sure she is still gaining well. Very relieved and glad common sense has prevailed.

Hurrah and well done BabyLDH :)

Oh well done. Fingers crossed we've got the same result on thurs. last week we only managed 5oz in 3 weeks so your weight gain is über impressive.

That's great news, Now babyLDH you just stay on that pesty graph!

Thanks SunnyL, obviously helped condiderably by the extra formula but needs must. Fingers crossed for you on Thursday, hope you see a good gain.

Thanks StarBallBunny! Loved your story by the way - always good to hear about babies who fell off the dreaded charts now doing great. Really interesting that your DD made her choice about not drinking milk as a baby.