1oz weight gain in 3 weeks. Problem?

[evertonmint]

DS is 23 weeks. Got weighed this week and has put on 1oz in 3 weeks. He's dropped down to 9th centile from just under 25th.

He's fully breastfed (apart from one formula bottle - see below). We had weight gain issues when he was about 6w until about 12w when he dropped down (started out at 9lb3 so somewhere above 75th) and then settled on the under 25th. Held that line until now.

He is absolutely fine in himself - a very happy boy during the day, been sitting well for 2 weeks, very active (always kicking and wriggling - so much so that HV commented on this!) He's a real delight But I have a few worries which may or may not be related.

1. often has very green poos
2. in the last month has gone from 1-2 big poos a day to about 6 smaller but more explosive ones, often quite liquid (nappy soaked with poo-coloured liquid and just solid bits left on nappy) or often quite mucusy
3. restless but happy in the day, restless but not so happy at night - leg kicking and stretching, back arching, horrendous to settle, sleep appalling and unpredictable (many previous posts on this)
4. tried a bottle last week, got him to drink for first time after a few days, took 4oz formula. Then followed the 3 worst nights sleep we've had. Not settling all evening until 2am apart from catnaps, unhappy, feeding every hour. May or may not be linked.
5. beautiful peachy skin has gone slightly spotty

Is any of this a problem? HV thinks lactose intolerance? I think possible lactose overload so wondering if block feeding would help. Or maybe it's something different entirely. Or nothing and it's just him?

Just started a bit of BLW with fruit and veg as he's sitting so well. He's taken to it well though not much yet getting in. HV suggested chicken to start getting some protein and fat in him. She also wants me to start giving him lots of baby cereal - basically wants me fattening him up with solids but I'm not convinced these will help where milk isn't given the relative fat content. Wants me to eliminate dairy from my diet for a few days and not give him any, to see if he's LI, but he doesn't have rash or other LI symptoms so I'm not sure.

I feel like there's something going on but not really sure what, and feel daft going to GP (sure ill be dismissed) and think HV knows no more than me tbh.

Any thoughts?

evertonmint, sorry you're feeling worried about this.

Your HV may be wrong about lactose intolerance - are you sure this is what she said? Lactose intolerance is a very rare congenital condition, which shows up long before a baby is 23 weeks old. with a baby who becomes seriously ill. Secondary lactose intolerance can persist after a serious bout of gastro-enteritis, but again the baby is usually very poorly and has other symptoms. I'd wonder why on earth she wants you to go dairy free to cut out lactose - lactose is in all mammalian milks, including human, no matter what the mother eats. The lactose in your milk remains the same, whatever your diet - please don't mess about with your diet because of a supposed lactose intolerance. It's actually shocking the HV does not appear to know this :(

Lactose overload is overdiagnosed - it tends to go with massive over-supply, which you don't mention. In addition, block feeding would not be a good idea if you have concerns about your baby's weight as it reduces the volume of milk available.

The fall to 9th centile: babies beyond newborn naturally slow their rate of growth, and it's not a problem in itself if a baby gains 1 oz in 3 weeks (babies don't need to be weighed as often as this, anyway, really - you get a better picture weighing less frequently). If you or your HV think the slow weight gain is a problem, then the easiest way to deal with it is to breastfeed more often, using both breasts at least at each feed, possibly 'switch nursing' to maximise intake.

Now is not the time to be giving solids, I would suggest - fruit and veg in particular are low in calories, and the amount of chicken and cereal a baby of 23 weeks would need to take in to increase his overall calorie intake is quite large - the probability is he could take small amounts only, and less breastmilk, and actually reduce his calories, and his weight.

Perhaps speak to another HV who has more of a clue???

Thank you tiktok! I needed somebody with breastfeeding knowledge, common sense (and hopefully significantly more sleep under their belt than me) to say this and make me feel a bit less worried, and i was hoping you'd find me. I'm a peer supporter and this is my 3rd breastfed baby so have a little knowledge, but al very sleep deprived so not able to think through if logically. The HV's suggestion of LI sounded way off, though I was a little thrown by the reaction to the formula. If anything, thinking about it, I guess that would be CMPI but he hasn't shown any real signs of allergy.

Lactose overload - again some rings true but not all. He is the opposite of massive weight gain, but I've always had a plentiful supply at the very least - lots of gulping at the start of a feed, leakage still from the other breast, and he bobs on and off a lot pulling away. Often again a gush of milk (bigger than dribble) falls straight back out of his mouth like he's taken in too much.

He is generally healthy and happy during the day (very unsettled at night). I'm only offering a few bits of veg after milk feeds a couple of times a day with no pressure from me - he is sitting, grasping and chewing so ready on the BLW signs of readiness so I'm giving him a slow start to exploring food but absolutely not at the expense of any milk feed. I offer veg once or twice a day if it suits us but not pushing it. I'm confident that I'm not interfering with his milk intake though reluctant to try cereal and chicken on HV suggestion as upping food would.

What I'm left with is slow weight gain - but a happy healthy baby who is chatty, very wriggly and very strong (brilliant head control, able to sit for a few mins already). That I could live with, but it's the green poos and wind/arching back/stretching legs. He farts a lot! The green poos started well in advance of the odd but of broccoli :) His sleep is abysmal too, I think because he can't settle and squirms himself awake. He feeds maybe 5-6 times a night, short feeds, which again had me worried about lactose overload as he's only getting the thirst quenching bit at the start. He went through 3 nappies last night, very loud filling them but not huge output. He slept terribly too.

Anything to think about or that I could tweak, or is green poo/windy/unsettledness just normal for some?

I suspect HV is confused between CMPI (where cutting dairy would make sense) and LI but he has no allergy symptoms so I don't believe it's that.

I was just reading about this on Dr Jack Newman's website. It was related to early oversupply.

m.facebook.com/story.php?story_fbid=408365275981191&id=138141916336863

www.llli.org/faq/oversupply.html

Could this be the issue?

Yes, it's possible your baby is struggling with a generous milk supply - at 23 weeks, for your baby to be still spluttering and pulling away is a clue. There is a strong tendency for this to go with huge weight gains but not always, so you are right not to rule it out. Someone who knows what to look for could help by observing a feed, and seeing if the bobbing on and off is within normal behaviour, or indicative of something else.

Yes, very possible the HV is confusing LI with CMPI, of course - this is a basic error, and not one a practising HCP should be guilty of. It's basic enough for me to wonder if you should pay any attention to what she says, regarding any aspect of your baby's health and nutrition. It's basic enough for her to deserve a complaint, but you might want to think about that later :)

Green poo is on the normal spectrum, as is frequent waking - it's hard to be sure if what you are describing is a sign of anything you i) should be concerned about and ii) you can change. He will prob get better as he gets older....worthwhile talking it over with someone you trust, though.

Thank you both!

Star girl - those links are interesting reading as I see some of these things going on here.

HV was very helpful and supportive earlier with another health issue DS had (not bf related), but her bf advice has always needed a big pinch of salt and I agree she has no clue here. And scarily she's the best of a bad bunch... I will ponder how to phrase a helpful complaint.

I do fear the sleep is just him, although would love to find a way of making him less uncomfortable as I do think tummy stuff isn't helping.

Thanks for your help. You've convinced me that any issue we may have is related to breastfeeding rather than allergy/intolerance. I know a couple of BFCs who I trust so I will get one of them to sit down and observe a feed with me.

You can email Dr Jack Newman for advice.

I am wondering if this may happen to me and DD2 as I've had oversupply. I managed to get it under control once I got the block feeding to just under 7 hours. I read the Jack Newman link and went back to 'normal' bf just in case. Cue engorgement and leaking again. My PJ top this morning was soaked.

I aimed to get to 17 weeks and I'm nearly there. I am trying to decide whether to go on with bf or switch to ff. It's been nothing like I imagined it to be. I only hope DD2 benefits.