HELP!! Reassurance needed re "failure to thrive" baby

[Bigbird71]

My DS is now 14 weeks old. He was 7lb 3oz born. Bf seemed to get off to a good start in that he latched on well and there was lots of milk. However, when we started to get him weighd (from day 10 onwards), it became apparent that something was not going so well as he really struggled to regain his birth weight.

After a lot of tears, hours with a breast pump and a daily bottle of formula he FINALLY managed to start gaining weight when he was 4 weeks old and to get back to his birth weight at 6 weeks. From then until he was 10 weeks he gained weight OK (between 4 and 7 oz gain per week) and was bumbling along on the bottom line on the centiles chart. Then, at 10 weeks, his weight gain has slowed right down and he has gained 4 oz per fortnight. He now weighs 9lb at 14 weeks and has fallen right off the centiles chart (his height and head circumference have also fallen down the centiles chart but he is still on the scale for those measurements).

Before the weight gain slowed down, I requested a referral to a paeditrician as I was concerned that the amount of milk he was taking on should be giving a higher level of weight gain (he is currently on a 7oz bottle of formula, 2 x 7oz EBM and at least 3 feeds on the breast each day) and also because the HV's were making me feel very inadequate that he was not moving up the centiles chart.

The paediatrician who saw DS yesterday is very concerned about the trend in his weight gain. She said she is happy that his health / development is as it should be in all other respects, although we did have a number of blood / urine tests taken yesterday.

I have been prescribed high calorie formula and told to give this to him for two feeds a day, to continue with the EBM for another 2 feeds and to continue to bf him for the other feeds, if I wish to.

As you can imagine, I am out of mind with worry. Any reassuring stories / advice from Mums who have had similar experiences would be very helpful. Should I continue to feed him EBM / at the breast or is there little benefit filling him up with milk that would appear to have little calorific value?

Any suggestions would be gratefully received!!!

Thank you...

I don't know if this will reassure you or not bigbird but I would, at present, continue to give him the breastmilk. I would do this because the paediatrician may be worried about him having some sort of underlying medical problem for his poor weight gain, rather than it being that your breastmilk doesn't have enough calories. If so then your breastmilk with all it's immune benefits would probably be helpful. Hopefully the tests that have been done will give you some sort of answer quickly. When are you going back to see the paediatrician?

Your BM has excellent calorific value. I'd go with the advice of your paediatrician, which I notice includes breastfeeding your baby as much as he wants.

Dd2 (3rd baby) was like this. Having previously had two big babies (9lb and 10lb) who followed their growth curve in the red book like good little porkers, I was slightly nonplussed to have dd2 who was almost 10lb at birth, but took 8 weeks to regain her birthweight, and continued dropping down the centiles until she settled somewhere below the 9th centile, where she still is.

Drs got v. twitchy about her slide down the centiles, which they're bound to do in a way as for some babies than can be indicative of problems. For us the medics' alarm was compounded by the fact that, on paper, dd2's development was delayed (not rolling over, not weightbearing, not crawling). I must have pointed out umpteen times that her development was in fact entirely typical of my babies, who have all been bottom-shufflers and late to walk.

In the end, after endless paediatric follow-ups, scans and even blood tests, they admitted there was probably nothing wrong. She's now 2.5, still tiny, but incredibly bright and active and very healthy.

I was lucky in being able to not get freaked out by her failure to follow the curves because (a) she was my third, so I was confident in my ability to feed and knew that bmilk is a good enough food; and (b) because I had supportive midwives and a GP who were used to looking at healthy babies and were confident that there was nothing wrong with her. Remember paediatricians are used to seeing babies with problems, and that is what they look for. Which is all well and good, except that they sometimes see problems where there aren't any.

If your baby is active and happy, then it is likely that he is getting enough calories for him, regardless of what the charts say. Check the tops of his thighs -- if he has little chunky folds there, then he's unlikely to be underweight. I don't know enough about the science of formula milk to be specific, but human milk is ideally formulated for little humans, and other things being equal, it is going to be a better food for them. Formula looks thicker and more satisfying in the bottle, and EBM does look thin and watery. But human milk is absorbed much more efficiently than formula, so the appearance of your milk is no guide to its nutritional value.

Do you have access to a good breastfeeding adviser? Many orthodox medical staff are not well-informed about breastfeeding, and it would be a shame to lose confidence in your ability to feed your baby on the basis of inadequate or inaccurate information.

hth

just a message of support. ds was labelled 'failure to thrive' at one point and I was in such a panic. not going to give advice as i think others will be better but just to let you know all was very well very soon - ring lots of people for help and burst into tears - if you're anything like me it won't take much!

Thank you for your replies - it is so good to hear words of reassurance.

The paediatrician and dietician I saw yesterday were suggesting that the problem is likely to be that my breast milk was probably very low in calories. Could this be the case?

My understanding was that it was rare for there to be issues re QUALITY of breast milk...I am very confused.

I am more than happy to continue with the bfeeding (in addition to the high calorie formula feeds) but am so desperate to get DS back on the right track that I do not want to jeopardise things with my "dodgy" milk....

I get the results of the blood tests when I go back for my next apointment next Monday.

In a way, I would be glad if the problem was with my milk. At least then we would have an answer and we could feed DS formula and live happily ever after...

AFAIK, BM is fine for calaries, and is best for babies.

DD2 was going to be FTT, as her weight steadily dropped and she flew down the centiles. She stopped at the 2nd centile and remained there untl she was about a year. Now she is less petite than she was, no idea what she weighs thoug. She is almost 2.

Someone on here did say to me at the time that if they had dirty and wet nappies and seemed fine in other ways then not to worry.

But it's hard not to.

I'm another mother of babies who spent their first weeks sliding down the centile chart. It was "suggested" to me that bf was not enough and I should be giving supplementary bottles and although I disagreed, particularly by dd3, I gave in to get the medical professionals off my back.

All 3 are, and have always been, happy and healthy - they are on the skinny side but that's probably going to do their health a favour in the long run.

I would never advocate ignoring medical opinion but do pay attention to your own instincts as well - if your baby is happy then there's less likely to be something to worry about and if your baby is not happy then you will know about it and can seek help/advice as needed.

I'm not a bf counsellor, but from everything I've read it seems unlikely that there would be an issue regarding the quality of a woman's bmilk. This sounds strongly like ill-informed nonsense to me, although I suppose there might be some issue with a child's ability to metabolise milk. Can you phone a bf counsellor from NCT or La Leche League? I know they can sometimes be off-puttingly evangelical about bfeeding, but they should at least be able to furnish you with some proper scientific facts.

If it is a calorie roblem then you should see a change from switching to the high-calorie formula. Don't mess around with stopping breastfeeding now, when they haven't had a chance to see any effect. If he does have some underlying health issue (which he probably doesn't, but just in case) then your breast milk will be very important to him in other ways too.

Bigbird - this is just a quicky, I'm passing through and haven't read the thread just your OP. The paed can give you some powder to add to your EBM to increase the calorific value rather than switching to high cal formula if you are wanting to protect your supply. We used Maxijul (but that was a long time ago)- they may prescribe something else now.

HTH

Bigbird, I can understand how worried you are.

Firstly, and lets get this out of the way, the calorie content of breastmilk and its ability to nourish babies - when breastfeeding is going well - is never an issue. Sadly, paediatricians and health visitors cannot be relied on to know this. Quality of breastmilk is actually pretty uniform across the world and across different mothers. If you're up to sharing an academic paper with them, or just to read it for yourself, click here .

However, if there is a growth issue with your baby, then the volume (rather the quality) of the milk may be worth thinking about.

You are feeding direct 3 times, and presumably expressing to get those two 7 ounce bottles of ebm - and to be honest, that is simply not enough to build up and maintain an adequate volume of breastmilk, at least not for most women. You had a bit of a sticky start with breastfeeding - possibly your baby was not transferring milk as effectively as he might - and this would have meant your milk supply would need even more of a boost to get underway.

To build up and maintain a good milk supply, for most women, the breasts have to be stimulated at least 8 times in 24 hours, including at least once at night. For some women, that 8 times is really not enough, especially if the baby is not a brilliant breastfeeder, or the pump is not that great. Women with small storage capacities (not the same as having small breasts) will probably feed a lot more often than that.

Of course, one other aspect is that your baby may be physiologically small, and that the breastfeeding is actually ok and you have a good supply even on 3 feeds plus (probably) 3 expressings a day....

However, it would be fine to breastfeed as often as your baby will take it - this has the handily double effect of getting more calories into him, and of making you make more milk to get more into him at any one time

I think the paed's suggestion to give hi-cal formula (or the milk fortifier mentioned by saggar may be a good suggestion, too) for the moment is probably justified - but you can carry on bf as much as you want, too.
Keep us posted!

was maxijoule for us then duocal added to bem
FWIW made no difference
My dd was different she ate 3-4 oz per feed every 4-6 hrs she also was dx'd with a heart murmur at her 6 wk check and then a genetic conditon that limited her weight gain
A rapid fall is a worry, our dd went from 7lb 8oz at birth 50th centile to under the 0.4..
I kept breastfeeding as I knew my b/m was ok.
I second that if your baby appears content, alert, sleeps ok and is passing normal poo and wee and development is normal then, you should try to not worry too much.
FWIW the paed said my breastmilk could be low standard as did the HV, the dietitian said absolutely not and to keep feeding on demand, trying to up the feeds to 3 hrly day time.
It is very stressful though worrying about weight gain.

My 2nd DS skidded down the percentiles from his birth weight of 7lb 9oz ( average)

I KNEW he was not taking at much milk from me as the others ( boobs not as full etc) but as he was my 3rd I also knew he was fine.

His weight and height did cause enough concern (not for me ) and at 2 1/2 he was sent for growth hormone tests, all came back fine.

He is tiny for his age (but then my brothers average 5 foot 5) and will be a small man BUT he is full of energy, agile, bright (we think he could be a jockey!)and STILL eats very little and we aspire to the 9th percentile.

Listen to the health professionals but also have confidence in yourself, Keep up with the BF, there is nothing "wrong" with your BM, it is the best for him and a healthy, lively but small child is a healthy child.