Poor weight gain in an EBF baby

[Monstersaurus]

My wee one is 6 weeks old, and has been EBF since birth. Feeding established well, although he initially lost 8% of his birth weight. Since then however we've struggled to gain. He's still sitting below his birth weight and has only gained 150g in the past 2 weeks. We've tried gaviscon as he was vomiting lots of his feeds which seemed to help. Given that his weight has now plateaued the health visitor has advised a bottle of formula a day, and I'll express that feed to try to keep my supply up. I haven't been yet, but do plan to go along to a BF support group. He's very long which accentuates how thin he is.

Does anyone have any experience of similar with their babies? All advice welcome.

Can understand your concern, monster, but it's disappointing the HV has no other suggestions than formula. If she thinks the only thing behind the slow weight gain is lack of calories then the far more easy, far more obvious 'intervention' is to ensure more breastmilk gets into the baby :)

It's not clear if there is a weight issue, but lets assume there is.

To increase intake these are the first and basic steps to take :

• feed more often, day and night, without worrying about the length of the feeds

ensuring at* least both breasts are offered every time (really vital - too many women are told they should only ever feed one-sided - WRONG)

• breast compressions (google it)

• switch nursing (google it)

If these interventions don't work, then you can supplement your breastfeeding with a bottle of expressed breastmilk - this is for babies who seem to be unable to take sufficient direct, because if the baby is transferring milk direct efficiently, it makes no sense to express instead, obviously.

Thanks tiktok . I'm off to do some googling.

There is quite a weight problem - he's dropped from 91st centile at birth to 9th now with very little gain in the past few weeks. He's almost off the chart for height (99.6th centile). I've been offering both sides for the past wee while (and in the evening when he cluster feeds we just seem to go from one side to the other).

How many feeds are you doing a day? How long are the feeds? How do you feel these feeds are going?

That's serious, monster - might be an idea to check transfer of milk, by having a thorough check for tongue tie, plus positioning and attachment.

If you have already been doing the first two on the list - extra feeds, ensuring extra sides - then you could move to supplementing with your own milk (given you will be expressing anyway).

During the day I feed roughly every 2 hours, with a lot of cluster feeding in the evening. Overnight he feeds less (we're up probably every 3 hours) but for longer. Each feed lasts between 20 and 40 minutes, and it feels as though he feeds well. We're getting plenty of wet and dirty nappies.

I'd see your gp and ask for a paeds referral.

When my dc had similar issues we were sent straight to paeds for blood tests and assessment for underlying disease.

I was give advice such as tik tok has given to maximise breastmilk intake. At no point was formula advised, and it was mentioned that formula can mask a real problem by calorie overloading and causing an "artificial" gain. If there is a real issue it won't make any difference, and might interfere with your breastfeeding.

Just to add paeds could find nothing wrong, said dc was just small, and advised stopping weighing and going on gut/wet/dirty nappies/behaviour etc, which did indeed solve the problem :)

That all sounds pretty good and suggests there may be a problem with milk transfer or simply too much vomiting. I know you say the vomiting is better with gaviscon but is there still lots of milk coming back up. Is it worth looking at ranatidine instead.
How is your baby at the end of a normal feed (not the cluster feeds). Does he seem settled? Does he fall asleep whilst feeding?

Just wanted to add that I had almost exactly the same experience as micah (although in my case it was bf midwife/counsellors at the maternity hospital who referred me via the senior registrar to the consultant paediatrician - not becuase they though ds had a problem, but just in case).

Ds' weight pattern was almost exactly the same as yours - although he dropped more than 10% in the first few days. He also had jaundice and had to go under lights in the first few days.

We were never that concerned as he as happy, healthy and alert throughout (after the initial jaundice induced sleepiness). I do from about 2 weeks supplement every feed with ebm - but it actually made no difference to his rate of gain (50g in a week was good ). He never actually lost weight - he was just very slow in gaining it.

The consultant paediatrician told me to stop the faff of expressing and just to continue feeding him. He told me that ds would start to climb back up the charts and would probably end up on the 50th (at this point he was running parallel with the growth curves, but just underneath them ). With hindsight, he was describing "catch down" growth. Dh and I are both small, relatively slim (and as youngsters, very slim), so he was never going to be a 91st centile kid.

FWIW, the consultant was right - and ds is now a healthy slim active boy of average height. :)

Yes - this could be catch down, though catch down is more usually assocaited with babies born heavier than 91st centile.

Thanks all.

I've been trying switch feeding and breast compressions and he seems to feed better for longer. Hopefully we'll see a difference soon. Paeds referral is the next step.

His vomiting has got a lot better, we still have the odd posset after some feeds but it is only a mouthful. If I miss a dose of gaviscon then he brings up most of a feed.

This sounds a lot like us, and we are still having problems eleven months later. This is not to scare you, but to hopefully encorage you to follow your gut feeling and demend referral if you feel your baby needs it. I was sadly fobbed off by the bf clinic, hv, GP etc., until we demanded a referral, and thankfully we are now being properly treated for reflux.

The advice your hv has given you is dreadful...if your baby is refluxing feeds, formula will come up too...and is actually more likely to make it worse as it doesn't digest so quickly.

There could be underlying issues as mentioned, such as tongue or lip ties, a cow's milk protein allergy or intolerance, "simple" refluxing that your little one may or may not grow out of, etc.

What are feeds like? Do they take a long time? Does your LO seems satisfied afterwards? Any arching or discomfort? What are the poos like?

If you get referred you might be able to get hold of breast milk fortifier...I wish I had been given this option instead of chucked on high calorie formula.

It's really improtant that a number of things are checked to make sure your baby is feeding efficiently, so definitely get to a bf cafe. If they aren't feeding effectively they will be burning more calories than necessary to receive their food, which just compounds things when they chuck it all back up!

If you are using gaviscon, you could ask to try carobel, which can be used when bf as well. It's a thickener also, but will add a few calories to each feed too.

Definitely get referred if you feel that things aren't right. There are lots of people in your boat, so don't worry about being alone with it. X

Hi,we have just been referred by our gp as my 8 week old is gaining weight but not enough, that is according to the charts in the red book. The referal was made at his 6 week check. The gp did not seem too concerned as all else seemed fine and we were told that it was just routine, however we then had a routine visit from the HV who implied that it was a problem with breast feeding, even though I informed her that he is feeding well. I was told that I should go to clinic to get him weighed weekly and have since been receiving calls from bf support workers wanting to watch him feed. She basically put the fear of god into me and I feel like I am on trial. Have not yet received appointment from the hosp, am just keeping a close eye on baby behaviour, nappies and feeding while waiting. Thinking of supplementing bf but don't know with what.