1 month old and failing to gain much weight

[TestingTestingWonTooFree]

I had a baby a month ago and he was 7 lb 7 at birth. He lost more than 10% in the first few days and whilst he started gaining weight we had a blip where he lost a little (or inconsistent scales said he did). Since day 11 he has only gained weight/stayed the same. He had a tongue tie snipped when about a fortnight old. Today is day 32 and he's 7lb 2. He's been combination fed, generally 2 bottles a day (1-2 formula, 0-1 expressed) and everything else breastfed. He seems alert and lively when awake. Midwife is encouraging me to persevere on the same regime and to express as much as I can to increase supply and be able to ditch formula (which I think gives him a bad tummy).

What I don't know is how slow can weight gain be acceptable? My baby has gone from the 9th percentile two weeks ago, to 5th last week and is now on/under 1st. What's the plan B? When should I be concerned?

As a mother of three the only few advice I can offer is get advice from as many health professionals as possible. As ur baby had an operation recently, it is probably baby is healing and will take time to grow but baby is only a month. Give it a couple of months and as he is alert and seems happy, that is an excellent sign. I know we worry when things dont go according to our expectations especially with the most precious thing but gaining weight takes time. I am always for breast feeding for its unmatched nutrients but I also understand why some mothers choose otherwise. Stay positive and happy. Ur baby will feel ur happiness and a happy baby is a healthy baby!

Thanks for your encouragement Resistance. Although the tongue tie procedure sounds like it might be horrible it was less traumatic than ear piercing. I'd honestly say he was fine within ten minutes or so, he certainly cried less than he would for a nappy change! That said, I think the TT might have hindered our progress and allowed bad habits to set in as well as causing me pain/damage to my nipples.

What is his night feeding like?

Tends to have one very long feed in the middle of the night (Up to tie hours in total) but it can be two. Usually has a bottle feed at 10-11 and then he'll sleep for 2-3 hours after that.

Make a gp apt, get real life bf support from a good bfc or ibclc and actually be concerned now. If your plan doesn't change weight might not either and it's not great for a baby to be below birth weight at over a month old. Usually it means the baby needs more milk, ebm or ffs. I would push hard for more support.

toad- I am afraid a GP is unlikely to have the skills to help, unfortunately one of the worst places to go for bf support.
A HV, NCT or LLL counsellor or lactation consultant is the best bet.

I am seeing the health authority's BF expert. She was able to refer us for the tongue tie division. I trust her judgement and have found her advice more reliable than the standard midwives. DH is concerned that she might promote BF beyond all else. I plan to talk to the HV today as I also trust her (so far).

Testing - she won't promote bf over the health of your child!

How are you getting on with expressing? It is very hard for some women to get any decent volume, and it often isn't as productive at increasing supply as directly feeding.

Do you think he is transferring milk well? I know it's hard to tell - does he swallow when feeding? Are you topping up a bf or offering ff in place of a bf? You may find the latter to be detrimental to your supply, although lots of mums do mix feed long term.

It is concerning that baby isn't back to birthweight after a month but hopefully will start to gain quickly now TT is snipped. Hope the bf lady can wean you off the ff top ups (if that's what you want!).

This is really concerning, Testing. It's absolutely right to take it very seriously. You don't say what you have done so far to increase your baby's intake and there may be more you can do. It may even be he needs more formula or ebm for the present. If you have confidence in the bf person, then contact her, and I would say the situation is actually quite urgent.

A bfc would support you, but because your situation is so far from the norm and verging on the clinical, they would def. refer you to an hcp as well.

A GP would be useful to check your baby's health but very few would have the knowledge to keep the bf going well.

Hope you get good help ASAP.

Baby is having ebm/ff instead of a bf but I express at the same time, trying not to compromise supply.

He appears to be swallowing and sometimes there are very loud gulps. Rate of transfer seems to vary. BF person is very keen on getting position right so that transfer is better.

Testing, it's good he swallowing and transferring milk....but seems he's not doing it often enough to gain weight :)

I would maybe move to bf every two hours. You can top up with a bottle if he still seems hungry 15 mins after feed a few times a day.

Best way for supply is just lots of feeding in afraid. After a week or so of this you might find supply is more and can drop bottles if you want

Is he sleeping? Dd took a month to regain her birth weight. She only started putting weight on when we managed to get her sleeping more.

Tongue ties can be problematic and we're still only really beginning to understand how they affect BF. This is really interesting - can you see a diamond shaped wound where the TT was divided?

www.drghaheri.com/blog/2014/3/22/rethinking-tongue-tie-anatomy-anterior-vs-posterior-is-irrelevant

The GP visit is to check baby health, this should be done alongside the bf support.

I would be really cautious of some of the advice here to do more feeds directly rather than to pump. Pumping done on a well planned schedule is very effective at improving supply and it may not be the case that lots of feeding helps if your baby is poor at transferring the milk. I think you need good face to face support to see how this can be improved for you and your baby.

Hope you can access that help today

Agree, Toadtoast.

Testing, whatever is said on this board may not apply to you and your baby....any direct bf has to be effective and frequent otherwise the pump is more effective at removing milk and boosting supply, and no one here can tell (obv!) what the right strategy for you is.

It's good you are seeing the bf specialist....sooner rather than later, too, I think.