Drop from 25th to 2nd centile ebf

[TinyTwoTears]

Hi
I am having a sudden wave of panic about my 8 week breast fed baby.
He weighed 7lb 6 at birth and is now 8lb 8. This means he has dropped from 25th to 2nd centile.
HV said that I have to wake him up at night, which I am now doing, as he was sleeping 7 hour stretches. I am not to let him go for mor than 4 hours between feeds, so I am waking him rather than waiting for him to wake as I was before.
I am getting him weighed next week to see if he has put on weight as he didn't put on any last week.
I have a wave of fear that it won't be enough and perhaps I should bottle feed. This is dc3 and I bf'ed dc2, who had put on nearly 3 lb by this point. She did slow down later but not till about 3 months.

Similar issue here in that DD has been dropping centimes since birth and now at 0.4 centile. Heal visitor keeps going in about formula which I am not keen on. Have seen GP and paediatrician and both have said that they wouldn't rush into formula as long as doesn't lose weight and is gaining something each time she is weighed. As long as she continues to be alert and had wet and dirty nappies they seem happy. Formula top-up could be the death of breast feeding so something I want to avoid if at all possible.

Forget what centile he was on at birth - that is now thought to be related to the mother's size, incidence or not of gestational diabetes, fluid levels in the womb and gestation.

Instead current research says to look at the centile line the baby is on at two weeks old as a starting point - if you look at the chart in your red book, you will see that there is actually a gap between birth and 2 weeks.

THEN - it is normal for the growth curve to not stick exactly to the centile line. It's an average - it doesn't mean that all babies grow at the same rate. In fact babies (like all stages) grow in spurts so sometimes they will be below a line, and sometimes above. It can help to weigh less often, because the curve will appear smoother and longer term patterns can be more easily observed. Obviously at 8 weeks, you don't have a lot of data to go on in the first place. It's OK for the line to cross two centile lines (which means the 0.4th, 2nd, 25th, 50th, 75th, 98th or 99.6th, there are no in betweens) - if they cross more than two, that should be a red flag for concern bearing in mind the 2 week old start point. Other signs to look out for are dehydration, listlessness, lack of milestones etc, not just the charts.

ignore the charts, they are crap.

both of my children started on 90th centile or thereabouts, EBF and dropped to the very bottom of the charts where they have happily carried on making their own wiggly way up to their current weights.

They are 9 and 7 now and very healthy. I'm about to have DC3 and the charts will be ignored. HV's can weigh them as much as they like if that's what rocks their boat.

DD was born on the 9th and managed to fall off the graph completely by the time she was about 16 weeks.

Would not take a bottle, seemed totally fine in herself. She climbed gradually up to 50% line at a year old once she was given solid food.

My only advice is try not to worry and don't feed continuously give yourself a break.

I should add DD2 is still an exactly average sized healthy 12y.

The charts are not 'crap' - what is 'crap' is taking them as the sole way of assessing a baby's well-being (probably what you meant, nevergoogle :) ).

That charts are a useful part of the whole assessment, and in a baby who is developing well and feeding as expected and thriving, they are not all that crucial.

However.

A baby of eight weeks who is going 7 hours at night and sometimes going longer than four hours between feeds is not feeding as expected. A drop from 25th centile to 2nd centile in a baby who has ceased to gain weight, is worth taking seriously.

This does not mean using formula. It does mean ensuring your baby gets sufficient opportunities to feed - and so the HV's suggestion to wake him up and feed him more often is perfectly sensible.

The easiest way for a baby whose weight is causing concern to gain more weight is to get more breastmilk into him/her. This means

• feeding more often feeding at* least both breasts every time and often more than both
• feeding at night

Also - switch nursing and breast compression.

Hope things work out for you, OP :)

Thanks for the reassurance. DC3 is not listless at all, has wet nappies about one dirty nappy a day which is down from about 6 dirty nappies a day!
He seems happy and it has been commented on that he is long so perhaps he is growing length more than weight.
I will get him weighed next week and then give it a while.
Thanks again :)

My eldest started on the 90th centile and dropped to the 9th.

She is still on the 9th 5 years later.

She just needed to find her right centile, I guess she was born late so her birth weight didn't reflect her eventual size iyswim.

Thanks for your message tiktok. What is switch nursing?

He always has both sides but I have been trying to get him to feed for longer on each side. He seems to go from drinking to only nibbling quite quickly.

yeah, that's what I meant

For switch nursing, google or see here (scroll down):

kellymom.com/bf/got-milk/supply-worries/low-supply/

If he starts to nibble, switch sides.

Just keep doing what you are dong. I got myself really worked up with ds (pfb). Now Dd is doing the same thing (25th at birth, dropped 2 centiles by 5 months) but I can see the bigger picture.

Neither of them lie still when awake, dd is already commando crawling and rolling all over the place.

I agree the growth charts are a useful tool when combined with other things, but ds is now a tall 2 yo who still never sits still so it looks as though I just produce petite babies

Fwiw ds was mix fed. Dd is ebf. So formula top ups don't necessarily change anything.

Please don't tell the OP not to do anything or to ignore the advice she has been given.

HVs and clinics sometimes get it wrong, but in this case, she's been told something sensible and appropriate, the HV has seen the baby and knows the history.....how on earth would strangers on an internet forum know better, or be sure their own experience mirrored the OP's?

PofessionalKiller, there is a real difference between a baby dropping 2 centiles over 5 mths, and the OP's baby who has done this in 8 weeks and who has stopped gaining.

I don't think anyone has told her to ignore the advice she has been given, just trying to reassure her that she doesn't need to be terribly worried about it.

Despite my HV (who was also a BFing counsellor and totally amazing) constantly reassuring me that my baby was fine, I was still very anxious about her dropping centiles.

It sounds like everything is in hand and Tiny is doing the right things, so I'm just trying to say that there's no reason get all wound up and upset about it.

Which you might not be, Tiny, but I know I found it quite upsetting and like I was somehow failing.

I meant for the op to keep going with the changes she says she has already implemented, not ignore all advicee. She has already said she is following all of the perfectly sensible advice she has been given.

I was just trying to give my experience. As has been said by others, the centile lines are an average, anda guide to be used alongside other indicators.

Because with ds I felt like it was my fault. He actually dropped from the 50th down to below the 2nd from 3 weeks old to 14 weeks old. I remember walking from the hv clinic to my gp with tears streaming down my face because the hv had told us to get him checked out that day. Who, btw, took one look at my baby boy with his bright eyes, clear skin, kicking and smiling and reaching out, snorted and said there was clearly nothing wrong.

With dd I am more confident that there is a huge range of normal for everything. I'm very sorry if anyone thought I was being flippant or disparaging of the health care profession.

In fact I think I was trying (clearly unsuccessfully) to agree with your fabulous first post tiktok

Ok, PK, I get you now :)

I had same thing with DD1.
HVs were lost and contradicted each other. (One said top up with formula, another said I should drink Guinness!) GP was worried too.
Ended up with paediatric referral. Consultant said to stay with BF, feed on demand, no formula, but to feed no more than 3 hours apart during the day (and to wake to feed during the day if required)
Bottom line was no less than 3 hours from beginning of one feed to beginning of next feed.
At night to feed on demand but not wake until 4 hours between feeds.
I did feel that there was no gap from end of one feed to start of another but DD grew and milk supply increased hugely.
Bottom line though is that while that worked for my DD, they are all different.
And what drove me nuts was all the conflicting advice every one gave me.(and sorry as I have just done same)
So I was very relieved when referred to a consultant. I trusted her. Followed advice. And it worked.
So I guess my advice would be to find a medic (HV/GP/paeds consultant) that you trust and then go with their advice.
It was a difficult time for us.
Funnily enough she is now a tall skinny teenager who eats vast amounts and sleeps lots!

Thanks for further posts.
I am feeding DS2 much more I hope, but he now hasn't had a poo for 3 days. He is still looking healthy but is farting a lot.
I have googled and literature says that it is an indication of not getting enough hind milk if combined with low weight gain.
I have been feeding him more and yet he has stopped pooing. Argh. How can I tell if he is getting hind milk?

Your posts have been reassuring but the lack of dirty nappies is stressing me again :-(

I think the advice above is excellent - and I'd only worry of wet nappies were lacking, not dirty.

The first few weeks are so hard - no one can make you understand until it happens and a x

No poo at eight weeks means nothing at all, though, Tiny. Not sure where you have looked, but longer gaps between poos is only significant in the very first weeks.

It's to do with the fact that in many babies, the 'trigger happy' gastro-colic reflex that means they poo a lot when very young has matured. No one should expect an 8 week old bf baby to poo frequently (though it is also normal if they do :) ).

It's a good idea to feed more often, as you are doing, but take no notice of poo frequency.

Thank you tiktok and trooper, I seem to be obsessing now! I will keep feeding and calm down :)

unfortunately ds3 only put on 6oz in 10 days so has dropped to the bottom centile. HV told me to see the GP and get him weighed this weds.
I've been feeding him as much as poss so fingers crossed he'll put on enough weight.

Sorry to hijack but tiktok can I ask something? My dd only put on 13oz by the time she was 5 weeks old. She's perfectly happy, lots of wet nappies and the odd poo. Sleeps well and isn't cranky when she's had a feed.
I was letting her drink til she fell asleep or came off and offering second boob if she was still awake. Hv said to try her on first boob again after waking her so she could get more of the hind milk. Is that not right? You said up thread to offer both boobs but my Hv said not to worry too much about that so long as she's fed well off of one boob. I need to get her weighed again Tuesday but pretty sure she's putting weight on as her clothes are snmaller on her but what if she's not put on 'enough'