Does anyone have some advice

[excitedbutsick]

I'm wondering if anybody has any advice/solutions please? Lot's of background included.

DS is 16 weeks old and we are currently being monitored every other week at the GP's for poor weight gain. DS was 3355g and near the 25th centile at birth and seemed to settle at the 9th centile. He had d+v for 2 weeks but wasn't showing signs of dehydration, the stools returned to normal and he was diagnosed with reflux and prescribed gaviscon which seemed to make an instant difference. Since then he has been between the 2nd and 0.4th centile but slowly drifting towards the 0.4th.

We rarely go more than 4 hours between feeds, usually feeding between 1 and 3 hours. The latch is good, no pain feeding and he seems satisfied at the end of the feed. I feed him to sleep and he usually takes both breasts and I feel empty afterwards. He is developing well and is able to grab toys and move them around, is very alert and curious when awake.

After a gain of just 110g in 2 weeks on the 24th September he has been referred to peadiatrics, the appointment is on the 21st. His last weight was 4730g. I am taking Domperidone 3x a day and have been feeling engorged after each tablet, we are doing lots of skin to skin too. I have bought a hospital grade electric pump and supplemental feeding system. I pumped tonight but was able to get less than 20mls total from both breasts. I have been told by the GP he will need to be topped up but I want to avoid formula as much as possible, and DS doesn't have a clue what to do with a bottle, he just rolls it around his mouth. At a breastfeeding cafe I was told that as he empties both breasts well from them being engorged I should only need to pump for my comfort.

DS is currently teething but until Thursday was feeding fine. Since then he has not liked feeding from the right breast, he stiffens cries like he is in pain and turns his head away and won't let me turn it back. The only times he has fed from the right has been overnight and early morning. I have tried the rugby ball hold which has limited success. He still feeds well from the left breast. I saw the HV on Friday who said to persevere with it. I am going to book a GP appt in the morning for him and can usually be seen the same day. I don't want to put him off breastfeeding by making him stressed at the breast.

Does anybody have any suggestions to improve feeding and weight gain?

tiktok will doubtless be along with expert advice soon but I'm not scared by what you've written.
I have no formal training in breastfeeding FYI.

My story / some thoughts:

DS born heavy after a traumatic labour - lost 11.8% at day 5 - forced to top up. (We stopped the top ups after 3 days)
Gained well by my reckoning but eventually fell from just below the 91st to just above the 50th.
The main thing is that every time he was weighed he had gained weight never lost any (after the 5 day weigh in).
He always had satisfactory nappy output and developed well.
If you had no scales I think you'd be happy with your baby. Stop weighing so often and take a step back from the healthcare lot.
Expressing is not an accurate reflection of milk production so don't worry there.
Now of course if he shows any signs of dehydration or never seems satisfied or falls asleep at the breast due to lethargy rather than satiety then you likely do have a real problem and need to continue to seek appropriate support (LLL, BfN, NCT etc).

Meant to say my DS 'caught down' in his growth. DH and I have a combined weight of 18st so there was no way he was destined to stay on the 91st.
Oh, and www.kellymom.com is worth a browse.

Your ds is falling off the charts. Does he honestly look gaunt?

I had this with dd and everyone said keep breastfeeding, it's best for your baby etc. When l look back at photos of dd before we introduced a few bottles she looks very thin. She too was an alert, otherwise well child.

Sometimes breast (only) isn't always best.

Similar experience and formula top ups were the only thing that made a difference for us. Not much help if you have a bottle refuser I know!

Is there any way you can add in any more feeds? My dd's weight gain started slowing down so I added another feed in during night (increased from 2 to 3) and tried to feed every 1 to 2 hrs during day (basically feeding her when she wakes and before she naps). It seems like its helping to keep her weight gain on lower side of average range.

Not sure what refusal of one side could be. My dcs have all had preference for one side (think my let down is slower on one side and consequently volume less - which i know is fairly common). When ds feeds from that side does he drain breast ok? I ask because i can suffer the occasional clogged duct on my slower side which doesn't hurt but causing back up of milk so one half of breast feels engorged (and dd reluctant to feed on that side). I have to use football hold and massage/compressions to clear it.

Thank you for all of your replies.

Stepping away from HCP's isn't an option as we are under the Early Intervention HV due to my depressive history and current PND. Plus each visit is booked with the GP before we leave the room. And I am a HCP

He doesn't look gaunt to me, just slim. He doesn't have any chubby rolls but at the same time by looking at he doesn't seem too lean.

Mostly he feeds every 1-2 hours but occasionally will go longer. Overnight he feeds at 11pm, 2am, 5am and then we get up between 6-8am on average.When he feeds on that side he drains the breast really well. He isn't refusing the right side as much at the moment and we are trying all manner of positions with varying degrees of success. I massage each breast with every feed to make sure that he gets as much as possible.