Slow weight gain & bf - at wits end

[coldofhands]

Hi there, I'm hoping someone can help as I'm at the end of my tether.

DS is 17 weeks (11 corrected) & EBF. We had issues in NICU as my milk took 8 days to come in and he was ff through an NG tube until that point. We established bf with the help of nipple shields & fenugreek, both of which I'm still using (although we now only use the shields to get started, we complete the feed without)

I feed on demand which works out as 2 hourlyish through the day and 4 hourly at night. Although if he wants more he gets it.

Problem is he's not gaining weight - some weeks at all, others just not fast enough. He was on 25th centile at birth and is now on 9th. HV has been heavily encouraging formula - we did try but he vomits it straight back up. He does have reflux which we're treating with ranitidine, but he doesn't respond to breast milk like that so stopped trying.

This week his poohs are green and smell vinegary - which I read could mean he's only getting foremilk, but his feeds are a good half hour to 45 mins which I thought meant he should be getting a good balance.

I just don't know what to do, I'm obviously missing something or doing something wrong and am desperate to make it right but am getting more upset and tired & each week at weigh in when the hv tells me he's not gained enough I could just stand and sob.

Thanks in advance

25th to 9th is only one centile, so well within normal. Lots of babies move up or down a centile. Why is your HV hassling you? Tell her if she thinks there is a problem she should refer you to a paed.

If the HV thinks he needs to gain weight faster (have you asked her why she thinks this?) has she suggested how you can do this? Formula shouldn't be her first/only suggestion or she's not doing her job properly.

Are you offering at least both sides every feed? You can offer 2, 3, 4 sides each time to increase intake, and also try breast compressions.

I wonder if he had a cow's milk protein interance. My DD does and had awful poos and slow weight gain (91st centile at birth to 25th centile at 4 months). I exclusively breastfed but had to cut out dairy in my diet which made a big difference to her poos and she then tracked the 25th centile until solids and she is now just under the 50th centile. The HVs I saw in clinic were quite dismissive of the idea of CMPI which made me question myself but every time I had a significant portion of dairy she would have looser, smellier, more frequent stools and get a nappy rash.

They can cross two centile without it being a cause for concern, so not sure why your HV is pressuring you. Has he been unwell with a cold or anything that may effect feeding? Viruses can cause green poo too.

There are ways of increasing the amount of breastmilk he gets, before thinking about formula. Obviously you can feed him more frequently or you can try switch nursing or breast compressions, both of these will increase your supply.

30-45 mins sounds fine for a feed, do you offer both breasts? Can be tricky with a refluxy baby, as little and often generally stays down better.

Hi OP another one here of the opinion that green poo and dropping a centile are not enough cause for concern. My DD dropped from 25 to 9 and then to 2 ( briefly!) - but then we got back to 25 with no actual change to feeding. She had doubled birthweight by 6 months before we started weaning.
My HV did however make me totally paranoid that DD wasn't getting enough milk and in retrospect I
Wish I hadn't worried so much as all the other signs were that she was flourishing - and she was settled and content.
I thought the advice was no longer to weigh weekly anyway ? it iis known weight gain not linear and can cause unnecessary stress?
I may have made that last bit up but poor DS (DC2) only went to baby clinic twice ever I think ! ( he is fine BTW)
It sounds like you have had a lot to overcome - get some more advice and enjoy your baby!

Agreed. My baby dropped a centile but has maintains it happily since and had green poo which cleared up on it's own. GP said not to worry. The hind milk/fore milk imbalance is only an issue if green poo goes on a loooooooong time. If your baby continues to lose centiles then that is an issue but one is fine.
Make sure you are feeding both sides after first is finished (baby unlatches/falls asleep) and if needs be just take to bed with DVDs and feed, feed, feed.
Having said all that, my first child was formula fed from seven weeks and is thriving so don't view formula as poison either! Good luck