Slow weight gain in ebf 4 month old

[geekaMaxima]

My ds is now 4 months old and has slow weight gain from the start. We asked for a referral to a paediatrician and tests have ruled out more serious underlying conditions.

I'm worried because the paed is very gung-ho about wanting to admit him as an in-patient soon to monitor his feeding (and mentioned stopping bfing and giving him formula to see how much he's taking in), but I don't feel in my gut that this is necessary if weight gain is his only problem. Am I deluding myself?

He was born full term on the 25th centile at 3.24kg (7lb 2), hit 3kg at the lowest point, and weighs 4.65kg (10lb 4) at 17 weeks, which is below the 0.4th centile. His average weight gain has about 100g per week, and he has always gained steadily if slowly. He is more or less tracking a curve below but parallel to the 0.4th centile for the last 5 weeks. He had a tongue tie snipped at 3 weeks, and a nasty dose of thrush after that, but his rate of gain didn't really change afterwards. Breast compressions, extra feeds, switch feeding, domperidone, topping up with my expressed milk haven't made a dramatic difference either. We even started topping up with donor milk (via hm4hb) when the paediatrician insisted on supplementation, but it also hasn't made a huge difference.

However.... His length and head circumference are tracking the 25th centile no problem. He feeds on demand about 12 times a day - including 3-4 feeds at night - and seems contented after feeds. He is bright and alert with a lovely mischievous grin, is active and strong, and is nearly able to roll back-to-front. His fingernails are growing. He has plenty of wet nappies and poos 1-3 times a day (though they have been more green than yellow since he had a bug last week).

Can a healthy baby show this pattern of weight gain? In the "look at the baby, not the scale" sense, I wouldn't have been worried if I hadn't seen how he plots on the growth charts. My GP and the local infant feeding coordinator both think he seems fine if a bit skinny, but tend to defer to the paediatrician's judgement.

have you rules out tongue tie yet?

Yes, he had a tongue tie alright - it was snipped when he was 3 weeks old. It helped with his latch but not with his weight gain

sorry, I didn't read though!

definitely check again, tongue ties can "reappear" (I don't know correct word) and he might need it cut again!

I have been on a few threads here, astonishingly 2 babies needed the op 3 times as the skin can fuse back over time!

I guess somebody has to be on the 0.4 th centile - but a bit more weight would be preferable.

I think at his age 12 feeds a day is way too much, it should be max 8 times ( 3 hours to start)
I honestly think that he is not gaining weight because he is at the breast too much, weird as it sounds, because by being awake he expels a lot of energy!
it's almost as if he is sucknig constantly just to "break even" energy-wise IYSWIM.

I understand you are reluctant to give formula, but I do wonder if just on bottle per night would give him a break, fill his tummy and help him have long sleep to aid weight gain.

Agree about checking the tt, but I don't think we can say so definitely that 12 feeds is too much.

You say he's a happy baby, meeting his milestones and has obviously had a bit of a rubbish start ....perhaps he is just going to be a slow grower!?

Regarding the paed, personally they are showing their lack of breastfeeding knowledge in many ways by suggesting you switch to formula. Is that the best they can suggest?

crikey

the thing is baby can not possibly be sleeping enough if being fed every 2 hours. sleep is essential to weight gain, especially at night.

we had the same problem with DD she was born on 75th centile and dropped down to 0.4th.
she took 6 weeks to gain enough to get back to her birthweight - that is not normal (she had TT and an unusually high arched soft palate)

at 4 months she was fed every 2 hours during the day (mixed feed by then) as HV she needs to be fed as a much younger baby would.
when we managed with 3 or 4 hourly feed at night she always put on more!

in comparison my DS2 was my best feeder and best sleeper - he was 2 stones on his 1st birthday!

I don't suggest for a second that you should switch completely to ff geeka, but I do believe that one bottle at night would give him a break and help him sleep =conserve energy=gain weight.

good luck

Zing - he does go 3 hours at night between feeds, sometimes longer, sometimes shorter if he's feeling under the weather and is looking to feed more often. The 12 times a day isn't evenly spaced because it's entirely on demand. And each feed might be for 5 mins, or might be for half an hour (more of the latter).

In between feeds, he sleeps plenty, and naps better during the day now than he did a month ago. I don't think it's a good idea to schedule feeds or refuse his requests to feed if there are weight gain issues - he'll just take in less milk.

I will ask to get the tongue tie re-checked, though the paediatrician was very dismissive of that during the consultation, saying tt doesn't affect feeding, end of discussion.

So it's not going to change her desire to see ds in a hospital bed...

As an anecdote, my ds has gained 100gm a week since he was born. Mostly he was ebf but I did succumb to pressure an ff at least one feed a day. It made no difference except to bung him up. Top ups had no effect on the weight gain. He wasn't (and still isn't!) a sleep but a very active happy baby who met his milestones early. He was born on the 91st and dropped down to under the 9th.

Now he's 8 months and enthusiastically taking in food he is back up on the 50th percentile. He's followed his own line and if I had another baby I would trust my instincts that my baby is happy and healthy and not bother to get them weighted.

Hope that helps op.

Bringbring - thanks, that does help. Even if it only happens occasionally, it's good to know that a healthy baby can have this kind of weight gain pattern.

Our current hope is that some high-calorie solids on top of bf when he turns 6 months will help to nudge his weight upward again, which sounds like the story with your little one.

Zing, I don't think you can be talking from knowledge. While it is true that babies need sleep to grow, a baby feeding 12 x in 24 hours does not have to be short of sleep. Anyway, this baby is growing - just not width-wise :)

geeka, I think there is a concern about your baby's weight. A paediatrician is concerned enough about it to monitor him in hospital, and that would help ascertain if he is healthy despite the low weight.

You could ask the paed why he wants to stop bf - I don't get the logic to this.

Tiktok - i asked why stopping bf was necessary if he is admitted to hospital, and the only reason the paediatrician gave was to measure intake. As in formula can be measured out but you don't know how much a bf baby is taking in. In fact, measuring intake is the only reason she wants to look at hospital admission since all other tests came back clear.

But couldn't bf intake be measured by pre- and post-feed weighing over 24 hours? Not sure if that's done much in this country.

well, clearly I have quite different ideas about bf, so I don't think I can be helpful to you geeka

all the best, I hope things will improve soon

Zing, thanks for taking the time to post, I do appreciate it. Glad all worked out well with your slow weight gainer. Hope things do here too.

I think I need to quiz the paediatrician more closely about her logic because she's said a few things that I know are contrary to NICE guidelines, like discounting tt as a source of bf problems, repeatedly calling it "failure to thrive" instead of "faltering growth", and wanting to stop bf just to make it easier to measure intake. It makes me wonder what else of her recommendations might not be according to guidelines, especially when other HPs don't agree with her. I don't have much confidence in her judgement at this point.

no worries!

obviously if we see things differently I'd rather just leave it at that - bf is a very personal thing and opinions differ wildly!

I still think, however, that it's worth checking about the tongue tie situation - and if you are so inclined take her to an osteopath and check his soft palate.
poor DD'S was too arched so like a faulty pair of pliers no matter how hard or long she pressed on boob she just couldn't get a "good grip".
2 sessions sorted this.

stick to your guns and if you don't want to ff don't let yourself bullied into it.

oh and thanks, she was back to 75th centile on her 1st birthday and now ,almost 20 months, she is a goid eater and is sporting a lovely round belly!

Sorry I offended you zing. It's just not right for someone to make a statement like you did - that op's baby could not possibly be getting sufficient sleep to grow because of feeding 12 x a day. That sort of dogmatic statement is wrong. You are entitled to your own opinion but not your own facts. I said you could not possibly be speaking from a position of knowledge and I stand by that. A bit of bluntness may offend but your statement needed challenging.

tiktok

you did not offend me at all, please don't worry.

I'm slowly learning when to back off, which is good for me!

:)

DS1 was born on 25th percentile, lost more than 10% of his birth weight, never fed very well, dropped two percentiles and took 5 months to get back up to the 25th percentile. He was sick a lot (poss reflux... Never really got anywhere with GP on this..)

HV would say to me that I may need to give up breast feeding if he didn't put on sufficient weight. I was never worried as he was physically meeting milestones and very alert and active.

I gave him a very occasional bottle of formula when breast feeding got too much mainly due to how sick he was after every feed.

I breastfed him for 8 months then switched to formula. At one year old he was on the 50th percentile.

I'm glad I stuck to my guns and breastfed initially but I'm also glad I moved to formula when I did.

Only you can make the right choice for your little one but if they continue to put on weight and seem ok it may be worth persevering a bit longer before being monitored. They may catch up a bit in a month or two like mine did.

Good luck.