worried: bf baby low gain: Hv can't find reason!

[squizita]

Hi all
my bf dd is 7 weeks old. She feeds every 2-3 hours, 15-20 min, both sides, no supply issues.
She is alert and healthy and growing bigger.
Today at HV clinic, they were a bit concerned because she is slipping from just under the 25th percentile line at birth to just above the neXT line down (9th). She is gaining just slowly. They asked me to come fortnightly (at 1st weekly but I pointed out the policy is fortnightly!).

I feel worried now. My baby isn't growing!

But everything that could cause this doesn't apply. Supply, feeding, health ... All fine. The Hv couldn't suggest ANYTHING I could change. Just said carry on feeding 2 hourly. I feel quite helpless now as I want her to gain more but apparently there's nothing to suggest.

Any ideas?!?

Normally they don't worry unless they drop 2 percentiles. If she is happy and healthy and having wet and dirty nappies she is probably absolutely fine.

...oh and no tt. Saw mw weekly for 1st month - weight gain was good then and bf support given.

squizita, sorry you have been made to feel worried about this.

Your baby is growing, by the way :)

The rate of weight gain is within normal - it's only when babies have a sustained drop of two or more centile lines where it is usually deemed worth exploring. Your baby has not gone through one yet.

It makes sense to ensure she has plenty of opportunities to feed - just offer the 'third' side every time, so she has an extra chance for some extra. She may not want it, of course. That's ok.

It is a bit pathetic (IMO) that the HV could not come up with this very simple suggestion - it really is pointless showing concern and then not giving an idea of how to address it, especially when she can prob see she has worried you.

Thank you!! Yes I will offer a 3rd side.
Thanks so much.

As you say - it was like "we're a bit worried but you're doing everything on this here list so off you trot.."!

I know it sounds worrying, but as has been pointed out above she is of course gaining weight and if she is happy and healthy, I'd just carry on as you are.

I did breast compressions a lot at first as my DS was slow to gain weight (he also had tt and we battled thrush). My LC recommended this to me as a way to get extra in during the feed and to encourage further let downs. Google / you tube it, but you are basically just making a sandwich of your breast while baby is feeding and squeezing.

Thanks. My dd is actually quite eager to feed!! But I do wonder if she takes the first breast thirstily then not so much on the 2nd as the urgency wears off iyswim? So compression and coaxing might help there?
I used to do compressions when she was tiny so will re start that.
Thanks!!

I think if the health visitors were worried they would have sent you off to the GP (we were sent several times due to slow gain and sickiness, GP was not concerned and said the health visitors have to err on the side of caution).

So this sounds to me like they're not worried but just want to keep an eye.

OK. SO remove the scales and the numbers a minute.

Are you happy with how your baby is? DO they look healthy and happy? Smiling, crying, sleeping, weeing, pooing, doing all the stuff a 7 week old should be doing? Does she look healthy and hydrated, pink skin, tears when crying etc?

Deep down do your instincts tell you she's fine?

If so, the numbers are meaningless. All babies will gain at different rates. Mine did the same, good weight gain till 8 weeks, plateaued, jumped up again 8 weeks later, plateaued...her chart looks like a series of steps rather than a curve. The plateaus co-incided with a developmental gain.

The easiest way to fix this is to stop getting her weighed, if you have the confidence to be guided by her rather than the scales. I never weighed DD2 and funnily enough she had no issues with her weight gain at all :).

I agree you are being worried over nothing here, it sounds like she is completely fine! Some HV do get very tied up on the numbers though (I had an excellent HV who binned the scales to the uproar of many parents, but he went by eye and picked up problems just as easily). Especially if they haven't had much experience with EBF, which, sadly, very few have.

Thanks all!

Micah funnily enough the HV even said "she looks normal and healthy, alert..." and how she wasn't worried. Then went ahead and worried me!
In terms of behaviour and energy she seems perfecctly normal! She's grinning away at her favourite dangle play arch toy wiggling about!

Just rang the Hv helpline. They were puzzled by it too and said don't worry, just feed on demand and make sure she empties the boob as much as poss.

What centile was she on at 2 weeks old? That's the starting centile, not birth weight.

There is no cause for concern unless they cross two lines - it's normal for them to dip up and down, babies don't grow in a nice smooth curve, they grow in spurts (just like teenagers :)) The reason the graph is curved is because it's an average of all babies. Sometimes she's going to be ahead of the average 25th/9th centile baby and sometimes she's going to be behind it. That's normal. Weighing more often is just going to exacerbate the look of this and make it seem more alarming - the less often you weigh, the smoother the graph is going to look.

Don't worry about "emptying breasts", that's firstly impossible (meaning the HV probably has little knowledge about BF) and secondly it wouldn't help - forcing her to stay on on one side for too long can reduce supply or cause her to become windy/fussy. Follow the baby's cues. If she's had enough, offer the other side, if she doesn't want it, fine. She'll let you know when she's hungry again.

You sound like you're doing great :)

You said that she's moved from "just under the 25th line to just above the 9th line"

So she hasn't crossed any at all And she's alert, meeting developmental milestones, producing wet nappies.

I don't understand why they have worried you totally unnecessarily when your baby sounds perfectly normal and healthy. I also wouldn't bother doing compressions or trying to coax her to feed any more than she is, just keep offering both sides and the first one again if you like and don't worry about it!

She IS growing, she hasn't stopped!

Bertie she's always been between the 25th and 9th ... just closer to the 9th today!

My dd has always been between 25th and 9th too and is now closer to 9th but no one has been worried about it and the hv said she was doing great and she had no concerns about her.

So I can't understand why your hv thinks differently! She's clearly gaining weight and sounds like she's doing really well. I wouldn't stress about it honestly, you know better than anyone whether she's happy and alert etc and I agree with others, forget about the numbers for a while, as they don't tell the whole story. (But I also know that if you're anything like me, being told not to worry is easier said than done!)

If she is otherwise healthy and developing normally I would really not worry. Hv often over-obsess about lines to be on the safe side, but all babies are different. My dd was on the 91st at birth, 50th by 6 weeks and 25th two weeks later. There was much panic but she was totally fine. She settled onto following a line between the 9th and 25th and is still on it now aged 3. Don't worry!

Thanks guys.

DH calmed me down too. Basically said the worst that would happen would be a GP referral. The GP might find something quick to fix (eg invisible thrush) and/or I could consult a bf expert. Or if I did need to top up, so be it. Baby is healthy and we know to keep an eye on her.
Bottom line no way is my baby starving! But oh dear the mummy panic!!

I had a similar experience with my HV. At about 12 weeks I was told to add an extra early morning feed which my DD promptly projectile vomited over my bed so I didn't try again. Bf babies regulate their own intake and I'm not convinced you can do much to increase what they take.

Having said that my DD did drop 2 centiles and we were referred to a paediatrician. She was born on 25th centile and now at nearly 4yo she's hovering on the 0.4th centile with her height below that even. They still don't know why but her appetite seems to reflect her growth rate.

I'm not intending to worry you, I just wanted to share my experience - for which I have no miracle answer, sadly.

Sorry to hear about your dd.
Mine seems to have a big appetite thankfully. I'm just offering the breast and compressing for now.
Would you believe it though today She decides to be fussy and bite for the first time since early days. So of course I worry!
Probably because she's full but just wants the breast in her clamp like little gums anyway! And today mum isn't moving it away for ages!

Mine dropped 2 centiles, (from 50th at birth to below 0.4) was referred to paeds, who rolled their eyes and asked if it was me or the gp/hv that was worried. They then said they completely agreed with me, she was fine, and if I stopped weighing the problem would likely go away :).

So I have no idea what centile she's on now, aged 9. Shes a competitive athlete though and seriously fit and strong, so perfectly fine :)

I came on thread exoecting to say "check for tongue tie" but as your DD is latching on nicely, feeding well and growing beautifully change my stance to "all is well". Well done you :)

Sitting here fretting because she didn't take much from the 2nd breast this night feed.

Furious at myself for over thinking everything.

She's probably less hungry because she's had more during the day. And that's fine.

These babies eat what they need, especially if bf. It can take a while to trust them in that. if I've learned anything it's that!

Fretting makes no difference I promise you - I've tried!

She's back to 2 sides now!

Had a daft paranoid moment in the night. Checked her nappy ... dry. Not like her! So I worry about hydration. .. of course that's the moment she unleashes it all onto my hand holding the nappy open. Duh!

Haha They love to worry us!

FWIW DS was also between the 25th and 9th for most of his babyhood. Dipped below the 9th once or twice, HVs panicked. Totally refused solids except for maybe two (baby sized) handfuls a day between 9-22 months. He is now the tallest 6 year old in his class and eats like a horse. He's going to tower over me and DH!

They do take what they need. Look at the baby, not the scale. If you and DH are petite and slim then she's naturally going to be on the lower end, someone has to be there.