Baby dropping centiles - so scared

[sofierat]

Hello, first post here and not really sure how this is going to pan out as feeling quite hysterical to be typing!
Bab was born at 7lb5 after an emergency induction culminating in emergency c section when the oxygen in his blood started dropping - this was after 36 hours of labour contractions every 2 minutes for me after i reacted insanely sensitively to the induction hormones. He pood all over himself during c section so i didn't get him for over an hour whilst they cleaned him out and sorted his breathing. Breastfeeding he wouldnt latch but i managed to express and finger feed him every hour and a half for the 7 days we were in hospital - he ended up with jaundice and was under lights.
Eventually we were discharged and continued getting lactation advice but he still wouldnt latch so we expressed and finger fed for 3 weeks until he returned to his birth weight. He was diagnosed with tongue tie which was fixed but didnt seem to help his latch.
The lactation advisor suggested we try nipple shields which worked in gettibg him to feed at the breast. However he feeds constantly! We were told this was a growth spurt at around 6 weeks but nothing has changed and he is now 10 weeks 3 days and at the boob constantly. We try and latch him without the shield and he occasionally feeds without it for 5 to 10 mins before getting cross and thrashing so i use it again.
The poor boy never really seems satisfied and is only content for a few minutes before crying - so i feed him to comfort him which stops the crying but means i am doing it constantly!
We thought he was upset because of wind and then recovery ftom having two inguinal hernias surgically fixed, but now he burps really well and the surgery was 2 weeks ago, so we went to the doctor who diagnosed silent reflux from his hiccupping, gurgly tummy and his crying whenever he finishes feeding or is lain on his back (ive been carrying him upright in his ergo during the day - only way he will nap without screaming).

The doctor also weighed him and he has gone down 2 centiles to the 0.4th. Im despairing and so sad and scared because all i do is feed him constantly and he is dropping centiles. If he has silent reflux and isn't posseting or being sick and im feeding him constantly how is he not gaining enough weight? We have been referred to a paed dietician who i am scared will tell me to formula feed him.
Im just so tired and scared :(

Also me and my partner arent small! Im 5'8 and he is built like a blacksmith!

Sorry I can't offer any expert advice on whether he's getting enough, but I just wanted to say that a lot of this unsettledness may be residual from all of the procedures he's been through. I assume he was given antibiotics after his surgery? If so these are hard on tiny guts (Bitter experience). An infant probiotic may help - BioGaia was the one recommended by a MNer here to me. What are his poos like?

Ooooh I didn't want to read and run - first of all you poor thing - you've been chucked in at the deep end haven't you!

I was going to suggest getting him checked for tongue tie as that is so often missed but I see you've already had that done.

All I would say is that I had this issue with both of my babies (they were both tongue tied and both plummeted through the centile charts! My DH is also 6ft1)

With my first I ended up using nipple shields for at least 8 weeks before I could establish a latch without it - and that was after tongue tie was fixed.

Have you got a breast pump - or are you able to hire one (maybe Boots or NCT) It can be used to try and increase you milk supply by pumping for a few minutes AFTER baby has fed.

I truly sympathise - you feel like you are trrapped with baby on the boob for days on end don't you!

have you rung La Leche League helpline? www.laleche.org.uk/content/get-support

Or if you have a good local NCT Breastfeeding group or Breastfeeding Support person.

Oh - also I was referred to a Paed for 'failure to thrive' with both babies which is soooo disheartening but it was ok in the end - didn't end up formula feeding them, breastfed both til they were around a year and they are now strapping healthy 3 and 5yr olds!

Hang in there - it WILL get better I promise! Look after yourself too.. If you are stressed and dehydrated and not eating properly your milk supply is bound to suffer. I know it goes with out saying that you are probably sleep deprived and stressed but try and keep your fluid levels up at the very least..

Hello, not much advice from me but a massive congratulations for managing to feed after such a difficult start honestly you have done superbly to still be BFing and you must be exhausted.

I know you will have brilliant advice from people here but just wanted to say that, and welcome to MN as well.

I hope things settle down really soon. I had a very upset baby with my third and he would never sleep lying down either, it was very hard work to carry him all the time, and no one suggested he might have reflux but I wonder now.

You are doing everything right xx

Another here who has gone through similar and it is SO stressful. What a time you've had.

Has anyone checked your supply? The lactation consultant? Did you experience breast changes in pregnancy and after the birth? The constant feeding sounds as if your baby perhaps isn't getting as much as he needs at a feed.

Just in the middle of bedtime, so just a quick post. I was freaked when DD dropped percentiles too and the health professionals make such a big deal and really cause you to question yourself. My issues were different to yours but some things might help to know.

Firstly bf babies often do not quite follow the curve on the growth chart because it includes formula fed babies. My bf specialist lady who was about 60 and no nonsense said to look around you- people are all shapes and sizes, just like babies, and they are all doing fine. What is important is whether your child seems to be thriving ie smiling or looking around or whatever their current milestones are and that they are gaining weight. The amount of weight isn't as important as the fact they are gaining.

Secondly, stressing in you can cause problems with milk production. So try to take comfort in the fact your baby is doing well and forget the rest. (Easier said than done).

Finally, if you have to supplement with formula it is not the end of the world. You have already bf your baby for longer than most people she is getting all of the benefit. I had to combi feed from day four and it took MONTHS but I managed to get back to ebf. She is 19 months now and currrently BF as I type.

You are doing brilliantly- it is so hard. You are your child's mother, you know then best and you make the decisions- no one can force you to do anything you are unhappy with. Stick to your guns about BF, demand more support from NHS or here. In a years time, looking at your chunky toddler, you will find it hard to imagine you ever worried about each individual ounce.

Hmm... Not such a short post.

sofi so sorry you have been having this struggle :(

The concern over your baby's weight is justified. However do get another weight check just in case the weight has been inaccurately recorded (this happens).

The main reason for poor weight gain is insufficient milk going in, but a few babies have something else going on and it's important that's ruled out. The paed dietitian referral is a good idea. Should happen ASAP and you can then decide what to do. Effectiveness of milk transfer might be one thing to check?

Wow thanks so much for all the quick responses!
@greenstone - he didnt have antibiotics after surgery just a tiny amount of painkillers because he is so teeny
@annielewis i habr a pump yes, havent used it since he was fingerfed back in the early weeks but just used it now and pulled out about 60ml. He refuses the bottle though so not really sure what to do with it?? Cup feeding after his next bf? I dont really want to force a bottle on him because he doesn't latch except with a shield so im worried about confusing him further..
@psipsina thankyou so much! I just feel like im failing him..im trying my hardest and it doesnt feel good enough :(
@toospotty how does supply get checked? Because he feeds so often when i take him for a walk for a couple of hours so he naps my boobs get really full and hard because otherwise he's feeding constantly!! Maybe he doesn't suck hard enough? My breasts have changed loads - from c to ff!

Have tongue tie checked again. It can reattach or not have been fixed enough look after yourself and make sure that you're eating. Take any help that you are offered at home.

@cookiefiend ty also for your kind words. He doesnt really smile but in the moments he is a little calmer he does coo a lot. I feel like he doesnt really make eye contact with me which is heartbreaking but he does look around at the world and since birth a lot of people have described him as surprisingly alert. So not sure about milestones :( he just seems sad or pained most of the time and doesn't like cuddles :(

Sorry you're having such a stressful time. It's horrible not knowing why your baby isn't gaining - my DS also dropped down to the 0.4th centile from the 50th. A lactation consultant suggested something that helped us - expressing a little, 10 ml or so, by hand after every feed (or by pump, but hand expressing is a bit less hassle for a small amount) and collecting it, then giving the total as a top up at the end of the day. It increases the volume of milk going in to your DS, and also encourages milk production as you're removing more at each feed.

Not sure exactly what you mean by finger feeding, but when my DS wouldn't take a bottle, we were shown a technique using an NG tube taped to a finger with the other end in a bottle of milk, through a teat to hold it in place. As he sucks the finger he pulls milk up the tube. A lactation consultant gave me the tube etc.

Also, if you do need to give top ups, persevere with the bottle - DS was having none of it for weeks, but I eventually got him to take one by trying different types of bottle. You could try it as a dream feed when he's asleep - their sucking reflex kicks in but they're not awake enough to be grumpy about the delivery method!

he didnt have antibiotics after surgery just a tiny amount of painkillers because he is so teeny. He poos every 2 to 4 days and they are massive, smell kind of earthy and sweet and are very very soft almost liquid but not watery

i habr a pump yes, havent used it since he was fingerfed back in the early weeks but just used it now and pulled out about 60ml. He refuses the bottle though so not really sure what to do with it?? Cup feeding after his next bf? I dont really want to force a bottle on him because he doesn't latch except with a shield so im worried about confusing him further..

i habr a pump yes, havent used it since he was fingerfed back in the early weeks but just used it now and pulled out about 60ml. He refuses the bottle though so not really sure what to do with it?? Cup feeding after his next bf? I dont really want to force a bottle on him because he doesn't latch except with a shield so im worried about confusing him further..

Sorry i think i havent figured out how to reply properly!!

Sofierat Thats fab that you got 60ml out! I know it is expensive but this bottle here was great for my babies.

It only releases milk when the baby actively sucks rather than the free flow that a lot of commercial bottles do. It was always recommended by the BabyWhisperer for breast fed babies - and personally I found it great for my tongue tied babies.

It would be a shame to 'pump and dump' .. Also I wouldn't get too het up about people talking about 'nipple confusion', I know all babies are different but mine had boob, syringe feeding, medela bottle and nipple shields all within the first 2 months or so of their little lives and they were fine.

Personally I found it useful sometimes to pump and bottle feel expressed milk just to put my mind at rest that they were getting a decent amount of milk.

Second what PP said about breastfed babies not following the curve of the charts - those are the same charts they have been using for years and cover the full range of babies including a lot of formula fed... don't beat yourself up you are doing a great job!!

I think you were given some naff advice at the beginning to be honest. My first daughter had jaundice which was quite severe (involved several dashes to hospital when midwives panicked about bilirubin tests after 5 days under the lamp). With my second I supplemented bf with a few bottles in the hospital and we avoided it completely. We know we were heading towards jaundice etc with her as she was over 9lbs and so was regularly having glucose blood tests which, before the bottles, were getting steadily worse, and after the bottles got much better. We then went on to ebf for 6 months! A midwife at the time told me she had wanted to advise a bottle but wasn't allowed! She wasn't allowed to suggest something that was clearly best for my baby at that time!

If your baby is losing weight to that extent and is at the very bottom of the growth chart you have to do something drastic. Many people will tell you to continue as you are and it'll all be fine. Health visitors will say keep bfing. Lactation consultants most certainly will. BUT if your baby is feeding constantly and is never settled and is not gaining weight then give him a bottle. It won't poison him- it will feed him! You have no need to feel any guilt about this- you have done your absolute best but carrying on when your baby isn't growing as he should be is not the best thing for him.

If your toddler was hungry you would feed him. If you are hungry, you eat. Your baby is telling you in 3 different ways that he is hungry.

Some of what you have said doesn't seem like you have got good advice.

You need the pead referral and to find a good lacation consultant to help you. Also get checked for any issues with milk transfer like tongue tie.

Leaving your baby for two hours so your breasts are full and engorges may lower your supply (when your engorges it tells your body it's making too much milk. You need to be feeding very regularly to try and increase your supply a minimum of 8-12 times a day.

McBaby- the OP has said she's feeding constantly!

SingSong, in my experience of genuine supply issues, both my HV and lactation consultant advised me to top up with formula.

60mls expressed is great, OP. If you can face expressing after each feed, you could top up after the next to give the baby extra. It does sound like you may have a transfer rather than supply issue. Topping up might mean you get a bit more time between feeds as your baby will be more satisfied. Do you still have access to lactation support? A breastfeeding cafe? Someone needs to watch you feed I think.

Singsongsung further down she also says she takes the baby out for a couple of hours so her breasts fill up before feeding.

I agree if feeding constantly then milk transfer needs to be looked at but limiting feeding will also cause issues.

Mcbaby I had a 10-12 session feeder (now 8 sessions with solids) and you can go out for 2 hr with this regime. (My problem ended up being forceful let down as the frequency made for huge supply my petite dd couldn't keep up with, as my increasing supply went too far ... oh well I have a freezer full!).

As PP have said if topping up is needed, it's needed - in addition to things like switch nursing and compressing.

My baby fed for very long periods eg 1.5-2 hours until he wore himself out and went to sleep. We also had problems with weight gain despite very long feeds. In the end I realised that he was only actually swallowing for a small percentage of the time, and the rest of the time he was just faffing about. (In hindsight possibly a mild tongue tie).

What worked for us was breast compressions as described on this page (it's a bit like hand expressing while they're feeding):
www.nbci.ca/index.php?option=com_content&view=article&id=8:breast-compression&catid=5:information&Itemid=17

I found the description of how to spot swallowing on this page really helpful too though as soon as I did breast compressions I could hear him swallow and so after that I just listened for the swallowing.

I only actually had to do it for a few days and then we got into a better pattern of feeding though there was some delay before his weight started going up.

At the time I was inclined not to worry too much about the low weight but with hindsight it was a sign that something wasn't right with the feeding so if we ever have another one I would try to be more proactive about doing something about it. So I would follow the professionals' advice.
Sorry if you've already thought about this but it sounds like you've had a tough time since baby's birth.