10 week old not putting on much weight

[Loofs75]

This is quite complicated but I’ll try to keep it as concise as I can – any help or thoughts would be appreciated….

Our first child was born 8lb10 (induced; forceps at 42 weeks) but since then she has dropped down the weight centiles. She started near 85th percentile at birth (probably inflated by her being 2 weeks late) but now, at 10.5 weeks old, is near the 15th percentile and weighs around 10lb4

She has never been particularly hungry and slept a lot especially in the first few weeks (possibly ascribed to her difficult birth with forceps). She has never really cried too much for food

After a few early breastfeeding problems, she was not really gaining weight until we started giving her a lot of topup in addition to regular breastfeeding – for example we were giving her as much as 275ml a day in topups (c.30ml per feed) to even get her beyond birth weight, which took us 3 weeks (note: top ups are a mixture of mainly expressed breast milk but also some formula)

I breastfeed around 7 times a day now (roughly 3 hourly) for 15-30 mins a time, plus we feed her a bottle of EBM at 1130pm. It is sometimes hard work and she never appears ravenously hungry after a day of breastfeeding, but she takes on average 125ml EBM at that late time and then sleeps to somewhere between 330 and 6am. It is rare for her to really scream for food including in the early mornings.

Between 3-6 weeks she grew fairly well but this was with topups of 125ml-275ml per day (generally decreasing over time) in addition to regular breastfeeding. The topups normally resulted in some vomiting suggesting we were perhaps giving her too much

However, since we have dropped the topups in early September (as recommended by health visitors etc) then her weight gain has slowed again and she has only gained around 350g in 5 weeks. The latest gain (today) was 120g in 2 weeks, despite seemingly breastfeeding well in that fortnight. In the previous week she gained nothing. Im at a loss about what to do next as this doesn’t seem enough.

She is otherwise a very healthy looking little girl, a GP recently described her as “thriving” and she is active and increasingly alert. The only problem was some jaundice (never acute enough to need treatment) through to about 8 weeks but this now seems to have disappeared. I think this general healthiness is why the health professionals haven’t got too concerned about the slow weight gain but we are now worried about the viability of breastfeeding without topup, and wonder what to do next

A couple of other points:

• My milk supply seems ok and in the mornings I tend to express about 125ml milk in half an hour
• I have had to breast feed mostly with nipple shields due to pain but have had various health professionals and breastfeeding counsellors tell me that she is breastfeeding satisfactorily and that if the nipple shields work for me then they are fine.

Today our health visitor suggested introducing an extra topup after an afternoon breastfeed (c.60ml) in the hope that may be enough to get her growing again in the forthcoming 7 days. 60ml doesn’t sound a lot to kickstart her growth (??) but we intend to go ahead with this but then to potentially take radical action next week depending on whether her weight increases.

With a low weight gain next week we are considering:

• Dropping breastfeeding altogether - although I don’t want to do this if I can avoid it, as I feel my breastfeeding routine is now fairly well established, after a lot of work in the last 10 weeks!
• Introducing combination feeding with perhaps 3 formula feeds of 125ml per day in addition to c.5 breastfeeds, although not sure how many breastfeeds I would need to do to ensure that my milk supply is maintained?
• Continuing with the existing regime (or something similar), which is what we really want to do, doesn’t seem like a real option if she has had really low weight gain over 4 successive weeks….

It would be great if any of you could comment with any thoughts or any of your own experiences along similar lines. Health visitors try their best but I never quite feel that they have sufficient expertise to truly advise me on the best course to take given what has happened. Is she never going to feed well unless we bottle feed her and effectively force more into her, or is it “normal” that she is choosing to feed to a level she is comfortable with and over time it will level out and be ok?

I can understand this is concerning, and your options are not crystal clear - it's great your dd is healthy and not giving any of the HCPs real worries, though.

Even so, I think you might want to consider getting an expert, real life view. Her weight gain is quite seriously below what it 'should' be, and you might want to consider or rather get into a discussion about whether she is 'catching down' to her own, physiological weight, or is actually underweight.

If you want to continue breastfeeding as much as possible, then it would be good to increase the frequency of feeds - 7 x in 24 hours plus the ebm top up is not very often, and you could think about ways to increase this...perhaps by fitting in more feeds, definitely by increasing the number of breasts she has each time (switch nursing should do this). If there has ever been a time when you deliberately kept to one breast only a feed, then this could have had the effect of reducing your supply and her intake....best way of boosting supply and intake is to offer at least two breasts each time.

I think you are in the clinical realms with your dd - a breastfeeding counsellor would be great for support and for helping you decide among the options, but the options should come from an infant feeding specialist with an interest in babies whose weight is causing concern (could be a paediatrician, or a lactation consultant, or another HV). I agree with you, by the way, that on the face of it, 60 mls extra once a day is unlikely to be sufficient to help your baby gain weight....but you do need to be sure how serious the weight issue actually is.

Hope this helps.

Thanks for your thoughts.

It is hard to make sense of it all, as our daughter does most things according to the book (as i understand it) - she breastfeeds pretty well as far as we and HCPs can tell and doesnt seem unhappy when she comes off the breast; she poohs a fair bit (average 9-10 per week); wees a lot; seems active and engaged; HCPs never find anything wrong with her, despite us being in hospital a fair bit in early weeks (for jaundice and lack of weight gain)

Yet the evidence would suggest she doesnt know how to eat enough to grow normal amounts (>100g per week) - and that we almost have to force some extra into her to generate growth (much of which she appears to vomit back anyway, which often makes it seem counter-productive)

As per my initial post, we have decided to give it one more week of trying before switching to bottles (which, of course, arent guaranteed to work anyway but i am guessing they will make it easier for us to generate growth?)

We are trying a few tweaks this week before we give up on near-exclusive breastfeeding:

• I am feeding a bit more frequently (even though she rarely screams for milk)
• We are trying to give her top-up after some daytime feeds, only amounting to c.60ml per day unless we really think she has breastfed poorly on occasion. She is tending to not take any topup after a breastfeed anyway - this is why it is so frustrating for us, as youd like to think this meant she was getting enough breastmilk to develop and grow, and yet she normally produces poor growth figures in spite of this feeding behaviour and apparent satisfaction with what she's had
• I am trying to feed without nipple shields although vasospasms mean im not sure how long i could continue with this. Do you think the shields could be stopping her getting enough milk? HCPs have tended to suggest they shouldnt be a problem but of course im not 100% convinced

If we feel we want to speak to a true feeding and weight gain expert then how would you recommend we go about finding someone with suitable experience and authority - as HVs and GP etc dont have the necessary experience. We are based in Bournemouth area.

Any thoughts appreciated

Thanks again

Loofs, I can hear the worry and doubts in your post - what a difficult situation.

It seems to me that it would be better to increase the frequency of feeds - it doesn't matter that she doesn't 'scream' to be fed. More frequent feeding is a more efficient way of getting volume into her than increasing the volume at each feed - she may well bring back excess if you use top ups, but more frequent feeds allow multiple, smaller volumes which won't be brought back.

Nipple shields are likely to have made a difference - I can't understand why your HCPs are so convinced they won't. We don't have masses of research on this (though there is some) I know.

Have you checked out lactation consultants in your area?

Your baby may be fine but you need someone in RL to confrm that the slow weight gain is physiological.

Ok. Firstly if there is something wrong, then formula likely won't make any difference, or if it does, it could be masking an underlying problem.

So continuing to breastfeed is probably the best thing to do :). I went through similar, and was always advised to stick with bf.

As others have said, it could be th 15c is where she's supposed to be, and will track it nicely from now on.

The one thing you could do if you are worried is ask for a paeds referral. They will check bloods for liver, kidney, thyroid issues, plus a few other metabolic disorders. If nothing pops up there they do a baseline review, check development generally, and take it from there. We were clear, so we're sent away for a month, and on the re-review it was clear dc was just diddy.

My first thoughts are is she was jaundiced for so long, this could effect her frequency of feeding.

I would try feeding lots more and see how you get on. Switch nursing and breast compressions will help increase the amount of milk you get into her at each feed. It will take a few days for you body to adjust, so may be have a bit of a baby moon and just concentrate on feeding for a bit.

Breast milk has more calories than formula so is the best milk for weight gain.

That's not correct about the calories, Superworm...they are about the same (round about 70 cal per 100 ml). Some tables will give breastmilk as having a tiny bit more, but this is within the variability of sampling.

Hi, I thought I would update you all....

My daughter put on 220g last week which was a great result for us, and is as much as she has ever put on in a short period. At 11.5 weeks she is now basically 1kg up from birth weight

Over the last week, as previously reported, I had tweaked by giving an average of 60ml topup through the day (often difficult to administer!) plus by doing 85% of feeds without nipple shields (100% in last 2-3 days), plus by feeding a little bit more regularly.

Without nipple shields i found the feeds took less time, which i guess is normal? I was worried it might mean she wasnt getting enough

Since we have given topups (often markedly higher volumes) at various points in the past, without necessarily recording great weight gains, then I am assuming the shields were the main constraint and reason for the good recent growth. However, I am wary it is only one week and plenty of room for randomness/"noise" in such a measurement. So we will continue and hope that next weigh-in in a fortnight shows another good gain. Any thoughts appreciated

A couple of related questions:

1. Would you consider using medication to combat the vasospasms which I suffer quite badly, and is it generally effective?

2. Since I am now breastfeeding more through the day, I find less time to express and only expressed once or twice last week. This means our 1130pm feed is formula. Given this, plus the lack of expressions then is there any way I might not be doing enough to maintain my milk supply effectively?

3. At what point do paediatricians begin to worry that lack of weight gain in a young baby may affect their general development, cognitive etc? (I am asking this question mainly out of interest)

Thanks as always

This is all good news, Loofs and brilliant work done by you and BabyLoofs!

I think it's especially great you have reduced the nipple shields - yes, feeds will take less time, totally normal.

I can't answer the Q about vasospasm - you'd need to see someone with clinical expertise on this one.

Weight ditto - but my understanding though is that a baby has to be way more slow to gain and actively losing weight consistently before there is any real concern about long term effects on development/cognition. The main concern in your own situation that a baby who is skinny and failing to grow is they become more vulnerable to illness and lack energy to grow at an appropriate pace and development might be affected as a result (though babies in these situations catch up).

Hi

I wanted to update you on this and interested in any advice....

BabyLoofs is seemingly thriving in all areas other than weight gain. She is now 20 weeks old and still weighs less than 6kg (from 3.9kg at birth).

After good weight gains after I got the nipple shields off (when she was perhaps correcting for past slow gains), then things have slowed down post October

7 Oct 4.66kg
14 Oct 4.88kg (the good weight gains, after previous problems)
28 Oct 5.28kg (the good weight gains)
24 Nov 5.64kg (the slowdown)
17 Dec 5.85kg (the slowdown)

So that is

FYI we do wonder if her slow weight gain could be partly due to the fact that she is always fidgeting and flailing her arms around - certainly more than other babies!

Any thoughts appreciated