Poor weight gain.

[AnnoyedByAlfieBear]

Dd is six weeks old. Born by cs at 39 weeks. She was 7 lb 1.5oz. By day 5 she was 6lb 13oz. MW was v pleased as she was EBF.

She didn't regain her birthweight until she was 4 weeks despite a fab latch and constant feeding. BF support here is really good and they made sure my technique re switching sides etc was ok.

By 5 weeks the weekly weight gain was increasing steadily but still not where it should be. Until this point her poos still had a greenish tint but were becoming more yellow. The HV suggested 2 oz of formula a day to help with weight gain which I wasn't particularly happy about but DH was keen as he was worried about DD. She'd BF before and again straight after.

So she's 6 weeks tomorrow and she's only 7 lb 8.5oz. (dropped to the 2nd%ile from the 25th but is 50th for length). The HV has now suggested to up the formula to 3 oz and introduce a 2nd one. The HV has suggested that maybe my milk isn't calorific enough.

Generally she cluster feeds from 11 am all day every day til some point around midnight-2am then sleeps til 5/6 am and settles well after a feed for another couple of hours. Not practical at all with a 2 yr old. She also poos as often as she feeds but
the HV isn't worried about this.

Any advice? Is it possible my milks not good enough? DS was prem and received top up formula from birth so BF was never fully established.

Sorry it's long.

Just to add, DD is alert and happy and a nice colour. No signs of anything being wrong or any discomfort.

Has she been checked for tongue tie sounds like could be a problem with milk transfer.

How can a HV say your milk is not calorific enough?!?

They didn't check tor tongue tie as her latch was so good and I've had no BF pain at all.

You may not have pain and latch may look ok from the outside.

Thanks, I'll get her checked.

Any other suggestions?

Does she finish each side of her own accord? Making sure each breast is nice and empty will make sure the order is put in for your breasts to fill them right back up again and will ensure she gets a balanced mix of lower fat and higher fat milk. Your milk is definitely not low in calories, nature wouldn't allow that! Have a look on kellymom.com and La Leche League websites for info on increasing milk supply. Supplementing formula without expressing the same amount can easily affect your milk supply, as it is a basic supply and demand system. But that can easily be reversed by offering the breast more frequently and making sure she finishes each side before offering the next.YoYou're doing brilliantly, you've made it this far and baby seems content and happy, and there's no pain :-) Some babies are smaller than average, but that's OK, as long as weight is increasing not dropping and she is healthy and happy. Don't be afraid to trust your instincts.

Oh and, hard as they are to cope with with a toddler, cluster feeds are good as they mean she's putting in a request for more milk! Night times are when your milk making hormone is highest, so if you can persuade her to cluster feed during the evening that might help also.

It never fails to astound me the nonsense that health visitors come up with. I've never heard of milk not being calorific enough!

Definitely get tongue tie checked asap as it could easily be that.

My ebf baby has been gaining weight slowly too. She's gone from above 90th centile to below 50th but she's doing a bit better now. What really helped her was to get a bit of a routine in place. We had got into the habit of her snacking and falling asleep so she was never having proper feeds and getting the fatty hind milk. Its taken a while to sort out (she's 4mo now) but she has a big feed when she wakes up in the morning, then I put her down for a nap rather than feeding her to sleep. Then when she wakes up she has a big feed etc. Her weight gain has really improved in the past few weeks.

I am guilty of feeding to sleep and being too scared to put her down as she cries after about 10 min.

With taking her lead re switching sides, I wait til she comes off and tend to pop her back on the same side until she fusses. After feeding all day and all evening, she gets like this on both sides.

How can I persuade DH to trust my instinct when the HV agrees with him? He's really worried about DD.

This sounds quite similar to my situation, though we got back to birth weight by 2 weeks. Feeding was never painful, and baby was well in himself, but gain was slow despite feeding for hours on end all day.
Breast compressions as described below helped us by making feeds more efficient: once I did this he had defined feeds rather than just continuous feeding until he fell asleep.

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

I also found this page helpful:

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

The other thing that was an issue for us with hindsight is that he just wasn't sleeping enough. So I wondered whether yours is napping at all during the cluster feeding from 11 to midnight? Because of the slow weight gain I would assume he was hungry when he started fussing, and probably he was, but sometimes I think he was also too tired.

Imeg you're right about the napping. I'm def assuming everything is hunger.

I'll look into compressions.

A few other things that helped me:
If you have a sympathetic GP you could try seeing them for a different perspective on whether to worry about the weight - we were sent a few times and the GP wasn't at all concerned. If this is the case for you this might also help to reassure your husband?
At various times I called both the Cow and Gate advice line (they have breastfeeding advisors) and one of the other breastfeeding helplines (can't remember which one). It was one of them that mentioned the breast compressions, which otherwise I would never have heard about.

Maybe phone one of the breastfeeding helplines for their perspective and information so you can be armed with facts, ideas, reassurance from trained experts? Then you can inform DH of what they say. Speakerphone and have him listen maybe? La Leche League or NCT both have 24 hour helplines. Are there any groups near you?

Very similar situation to mine. Dd born on 25th and dropped to 0.4th due to thrush, mastitis etc. didn't get back to birth weight until 5 weeks. I second going to gp for second perspective. Mine has been very encouraging and reassuring which has helped with DH, who was also worried and wanted to follow hv's advice of more top ups. I did top up 2-4oz per day for about a week, but always at the end of a feed. It was then obvious to me when I know longer needed to do this. The hv had suggested bottle first, but I felt that would be a downward spiral to not being able to bf. I also eat porridge with flaxseeds every morning, which is supposed to be good for supply. As she's got bigger (she's now 9 weeks and 8lb 11oz at last weigh in) I think she's got better at transferring milk and over the last few days she's consistently had milk around her mouth when she pulls away. This never happened before! Please take encouragement from this!

I was also putting all her discontent down to hunger when instead sometimes she's just tired. Ensuring she has opportunity to nap seems to have helped both of us.

Is your dd following a bit of a growth curve? If she is then I don't think it really matters (unless there's problematic weight loss) whether this is the 2nd or 92nd, otherwise those curves on the chart wouldn't exist! There are always going to be lighter people as well as heavier people.

I too have a 3 year old dd and it has been so hard but I feel that things are improving. I'm you but 3 weeks down the line, so hopefully your situation will improve too! I found it helpful to write a list of all the things that I was stressing about and then went through them all and wrote next to each one what the solution/destresser could be. E.g Feel guilty for not being able to spend time with dd1 --> this is only for a relatively short amount of time and soon we'll all be able to play together.

Sorry for this long post, but I can really identify with your situation and these were the things that helped me. Apols for any typos. Baby is napping and I don't have time to proof read!

PS at 6 weeks my dd was also 7lb 9oz. People are shocked when I tell them she's over 2 months old now. Initially this upset me but I am now not letting it!

Alfie, sounds like you would benefit from a close assessment by someone who understands about breastfeeding and how to help mothers and babies overcome problems. A HV who thinks your milk might not be calorific enough suggests you should be asking to be referred to someone else who is better at this....perhaps there is an infant feeding specialist in your area who could observe you feed, check for tongue tie, and can work out with you ways of enabling your baby to optimise milk intake.

Hope you get good support and advice soon. I agree this is a situation that deserves some attention.

Another one with a wee one taking their time to gain weight! Advice from my nhs bf worker was to try block feeding (offering two or three feeds in a row from same side) as this encourages the really fatty milk to be consumed. Also, they weren't in the least concerned with her growth charts, despite HV trying to send me down the route of early weaning/formula top ups. As long as baby seems physically well, is alert and producing lots of wet/dirty nappies try not to worry (easier said than done I know!), but as others have also said, getting a check for posterior tongue tie might help. Good luck!

"Advice from my nhs bf worker was to try block feeding (offering two or three feeds in a row from same side) as this encourages the really fatty milk to be consumed. "

:( :( :( This is absolutely WRONG and yet it is so commonly given as advice to mothers who are worried about their babies' weight gain.

It is the opposite of what needs to be done, and it drives me crazy that people whose job it is to understand the way bf works have so woefully misunderstood and been so badly trained.

Block feeding - deliberately restricting the bf to one side only over several feeds - should only ever be done as a means to reduce supply when mothers and babies are overwhelmed by too much milk. Because block feeding reduces volume and and then supply, that is absolutely what you don't want to happen in the case of a baby whose weight is causing concern.

It is volume of milk taken that drives weight gain and volume of milk removed that drives supply.

To increase both, mothers need to 'switch nurse' - deliberately offering two, three or more breasts per feeding session.

Anyone saying anything about block feeding and fatty milk for weight gain urgently needs retraining so they stop messing up mothers' breastfeeding :( :(