Weight issues

[puddleduck16]

Have 8wo DD who is EBF. Since week 3 there's been some weight gain issues that it's quite erratic. There's been weeks of 2,2,4,5 oz. last week gained 8oz but this week 2oz. As she's on bottom centile HV is worried and today suggested formula top ups.

Got quite upset that things aren't going right eve. Though I'm feeding every hour and half on average for a good amount of time, doing skin to skin, switch nursing, breast compressions. Plenty if wet and at least 3 dirty nappies a day. DD is bright, alert and happy. Although I would say she never really seems satisfied and booba never feel totally empty.

As this this was a bank HV I explained that even though I tell my normal one all this no one has really discussed my feeding never mind watch a feed and that's even with me going to a breast feeding cafés. Just feel so frustrated.

Anyway, as I was the only patient in the clinic this afternoon she spent tons if time with me watching whole feed. Latch is great but turns out DD isn't doing the deep long sucks when it gets to hind milk stage. So has suggested we keep offering same side when normally would switch to try abd empty breast as much as poss.

Is this what we should be doing?
Have pumps so should I express too (haven't as yet). Nothing against formula but would like to give EBF my full go, but not to detriment of DD.

thanks for reading this massive essay but didn't want to drip feed!!

By the way, we are trying same side till empty till Monday and reviewing.

As far as I'm aware the whole fore/hind milk thing is a myth anyway - as long as baby is feeding well he/she should be getting enough. What do you mean by saying your breasts don't feel empty - are they engorged at all? One easy way to tell whether or not the latch is good is how your nipples feel before, during and after each feed? Are they sore at all? Has your baby stayed on the same centile or dropped at all?

Nipples feel fine, no pain before, during or after. She was born on second last line, dropped to bottom in first week but been tracking it since.
Breasts aren't engorged but I think I'm expecting a deflated bag after feeding!!!

Arghhhhhhhhhhh!!! So in the last two weeks the baby has put on 5oz a week averaged out. Which is perfect. But they still suggest top ups.

I'm far from being a certified lactation consultant, more an enthusiastic amateur. Here are my thoughts:

• not every baby follows a standardised growth curve. Mine did small gain, small gain, big gain. If you think about it bf babies have to demand to make more milk, is growth isn't standardised.
• this chat about hind milk is outdated. Babies start sucking and then do deep swallows on the letdown. Breasts don't actually make full cream milk after 10 mins. Keeping a baby on one breast will not increase milk supply and frustrate baby.
• honestly, honestly, honestly if you hadn't had your baby weighed would you be worried? Are they happy? Are they pooing and weeing? Maybe just get weighed every month?

It doesn't sound like you've had the best advice. I think you could feel more comforted by calling the breastfeeding helpline. And they will echo me in saying you are doing everything exactly right

Agree - if baby is tracking their centile then you shouldn't worry. Formula top-ups will only affect your milk supply anyway!

Thanks bring bring. I'll give a helpline a phone. But you're right, I wouldn't be concerned if she wasn't weighed.
What's your thoughts on the fact she doesn't do big deep sucks?

Just want to add that what the HV advised about sticking to one breast is called block feeding, and is normally what is advised when there is over supply. I don't understand why she would have suggested this where there is a possible concern over slow weight gain.

There is a fab website called Kellymom (US site, but excellent evidence based bfeeding advice despite the odd name). It has lots of info about how to address slow weight gain without formula top ups.

Just want to add that what the HV advised about sticking to one breast is called block feeding, and is normally what is advised when there is over supply. I don't understand why she would have suggested this where there is a possible concern over slow weight gain.

There is a fab website called Kellymom (US site, but excellent evidence based bfeeding advice despite the odd name). It has lots of info about how to address slow weight gain without formula top ups.

Forgot about Kelly mom in my worries!! Thanks!

The important thing to remember about centile lines, is that someone has to be on every one. It doesn't sound like your dd is doing badly, she's just small. I think 3-7 oz a week is good average growth for a newborn. Note "average" - every week will be different. The overall curve is important.

And yes, pp is right to ask how you would feel if baby hadn't been weighed. The scales are only one indicator.

Thanks for all advice. As per pp I phoned nct helpline. And you were all correct (not that I doubted). So till her next weigh in just keep doing as much skin to skin as poss, breast compressions and switch nursing. Am to ignore health visitor advice of block nursing.

Hiya.

You sound frustrated by all this and hope I don't add to your feelings when I tell you your hv is wrong on both counts. some babies are expected at the bottom of the chart it isn't a fault to correct and She can't telll the fat content of your milk or the type of suck needed at a specific moment by watching a feed. Long slow sucks are most often at the start of a feed but honestly she sounds like she has had an update she has only half understood. The hv has given you info that will reduce weight gain and your supply, it is a technique used for mothers with over supply. Switch nursing, regular feeding, compressions...you were absolutely right that these are techniques that can increase weight gain.

I can see why the baby cafés haven't focused on watching a whole feed because it is correct and normal for some babies to be at the bottom of the centile charts and your baby is gaining an appropriate amount of weight. Weekly weighing tend to tell us what you have found- that babies gain differing amounts weekly hence the info in the red book that much less frequent weigh ins are fine for healthy babies back to birth weight and not giving any concern.

Can you go back to the baby cafe explain youse worries and get them to watch a feed. Your recent average is above the lower end of the minimum gain expected (4-7ozs) and babies that can do 8oz in a week haven't got a problem with feeding:)

Ha cross posted, fab:)