Baby not gaining weight

[Windywinston]

I'm hoping for some suggestions on how to improve DD's weight gain. She is 16wks and exclusively breast fed on demand. I have tried her with bottles, but she's a refuser and this doesn't seem to be improving (since birth I have tried tommee tippee, avent and NUK). Her weight has dropped from 75th centile to 25th and not showing signs of picking up.

Would it be too premature to start on baby rice/porridge and to attempt formula in a sippy cup?

As a bit of background I never intended to exclusively breastfeed (had trouble with my eldest and found mixed feeding worked best for us), but DD2 simply will not take a bottle.

TIA

Is she not gaining, or just not gaining as fast as you would like? How is she, generally? Is she reasonably alert, happy, developing and changing and all that good stuff? Does she sleep well?

What is feeding like? How often, for how long? Do you offer both sides or just one? Are feeds uncomfortable at all?

What is your health like? Any medications, illnesses, diets?

Thanks for your reply!

She is gaining, but nowhere near what she should and the HV is getting concerned. She feeds for long periods of time with only short breaks between feeds every day and I think this is the problem. My supply isn't great (same problem with DD1) so it takes a great deal of effort on her part to get what she needs. She's bright and alert and she doesn't show signs of dehydration.

My health is ok, but I did break my foot 8 weeks ago and have been in a cast since then. I wonder if the stress of that has had an effect, but she was already dropping down the centiles before then.

Breastfeeding is fine, latch good, but she seems to struggle to latch onto a bottle. I have a dr appointment to get a referral to have her mouth looked at, but in the meantime I couldn't possibly feed her more than I already do, so I'm a bit mystified.

Oh and yes she sleeps well but only at night - rarely naps during the day unless we go out, but that's been difficult with a broken foot.

Bf babies can slow down about this age. They don't always gain in a linear fashion like bottle fed, gains can be stop start.

It sounds like she's doing fine. If she's gaining, and seems otherwise we'll, I wouldn't worry. My dd was exactly the same. She usually stopped gaining just as she hit a new developmental milestone :). I think she started gaining again at about 5m.

If you can stop weighing her, do. You'll find it'll solve the problem!

DS1 was born on the 75th and dropped to the 25th. He fed every 2-2.5 hours in the day and maybe 4 at night. He's perfectly healthy though and still on the 25th now at 4.

I had trouble with weight gain and long/frequent feeds and found that breast compressions (as described on the second link below) really helped make the feeds more efficient, although that was when he was much younger (6 weeks) - I doubt it would hurt to try though? For me the feeds got shorter and more spaced out more or less immediately but there was quite a lag before his weight started going up.
The first link has some general comments about how to increase weight gain - these all focus on breastfeeding so may not be quite what you're looking for, but something might be helpful. It does say that solids tend to have fewer calories and so are unlikely to help with weight gain.
Mine took a bottle when he was young but then started refusing sometime around 4 months ish (can't remember exactly). I eventually found that if I put him down somewhere rather than holding him (eg bouncy chair, propped up on sofa) he was more likely to take some, also that he was more keen to take some from the ikea sippy cup than the bottle.

kellymom.com/health/growth/weight-gain_increase/

www.nbci.ca/index.php?option=com_content&view=article&id=8:breast-compression&catid=5:information&Itemid=17

Good advice above but don't bother with baby rice - it's not as calorific as milk so won't help.

If you weren't weighing her regularly would you be at all concerned? It's right to check if you're crossing two centile lines but important to not take weight gain as the only indicator of a healthy baby.

Breast compressions are a great idea. So is switch feeding - change breasts as many times as you like, throughout a long feed.

Domperidone might not hurt, either.

How does feeding feel? Has anyone observed a feed? Has anyone talked to you about, or looked at, the shape of your nipple at the end of a feed?

Thank you so much for your replies and help, I will try your tips and see how we get on. I'm sure all will be fine, but it's never nice to be told that despite best efforts baby isn't gaining enough. Hopefully your tips will help me rectify this.

I'd love to weigh her less often but HV team are now insisting on fortnightly weigh ins.

Thank you again!

With all due respect yourHV team aren't the police. They can't insist to see your baby every two weeks. That's not how the HV service works.

Also, there's a huge difference between not gaining weight (at all), and not gaining as per the centile baby was born on. Bf babies don't always follow the chart and any weight gain is good.

It's up to you how often you weigh your baby.

I seen this lots. Particularly with large mums that have large babies. The babies slim down to a more natural percentile once out of the womb but it takes a while.

I had a baby who was just over the 75th percentile at birth but lost 9.6% of his birthweight in 48 hours and over the next few weeks dropped to
the 50th and then the 25th percentile. He was feeding well, having lots of wet/dirty nappies and was alert. He was weighed quite regularly but that was because he was jaundiced and they wanted to monitor his weight for that reason as opposed up being concerned about percentiles. DS is 6 months and for the duration of the time he was EBF (the whole 6 months) he remained between the 25th-50th percentiles having random rises and dips. As has been said, babies will lose weight at birth and BF babies do not regain it in the same was as FF babies because BF babies are downing lots of calories as they regulate their intake, unlike FF babies who are given milk with high fat content.

If you aren't concerned then just enjoy your baby. The HV service is optional so you don't have to see them or do anything you don't want to. Just phone them up, state the reasons why you aren't concerned and explain that their close monitoring is making you feel anxious as opposed to reassured. Maybe you could compromise to having her weighed monthly instead which the general recommendation for all babies under 6 months.

Best of luck

My post was supposed to say that BF babies aren't downing lots of calories like FF babies