Worried about growth of bf baby

[bluepuzzle]

DD is ten days old, and my midwife is concerned that she is not gaining enough weight.

She was born by c-section, I have problems with the wound so am returning to hospital every 2-3 days to have it checked and redressed. So DD is being checked and weighed that frequently.

She was 3.2 kg at birth (38 weeks). 3 days later she was 3.08kg. 2 days after that, 3.1kg; 2 days after that, 3.14 kg, and 3 days after that, at 10 days, she's 3.18 kg.

The midwife seems to think she should be gaining more. She also said that DD's head hasn't really grown - circumference at birth was 35cm, at 3 days 35.5 cm, and is still 35.5cm.

DD is EXTREMELY sleepy (although only very mildly jaundiced). She is pretty much only awake when she starts to feed, every 1.5 - 2 hours. She falls asleep during every feed, and I have to wake her to get her to continue. She feeds from each breast, for about 10-15 minutes on each. Last night she slept for five hours straight, but that was the only time she's gone more than 2 hours without feeding.

Every now and then she will stay awake for maybe 10 minutes after a feed, and she's alert and startles at loud noises, etc.

Plenty of wet and dry nappies - she has about 5 - 7 poo nappies every 24 hours.

I guess I'm concerned because her sleepiness seems extreme to me (DS didn't seem to sleep for two years), and because the midwife seems worried about her weight and growth. Does this sound worrying to anyone else?

I was worried about my DD being so sleepy. DS wasn't anywhere near as sleepy. During the day,she spent as much time awake as he had asleep!

But she gained fine.

DS however didn't gain his birth weight back within the normal time frame so I had to have an extra visit. He ended up being a massive gainer (double birth weight by 3mo).

I though birthweight back by day 10 was ok?

I don't know about the head measurements.

It sounds like your baby feeds well. Frequency and duration sound good. Maybe the milk has been slower coming in due to the c-section?

No one has ever measured either of my children's heads.

Both lost about 8% of their birthweight and took 10 days to regain it.

My youngest wasn't awake between feeds until he was several weeks old. He fed every 2 hours but slept during/between.

If she wasnt being weighed, would you be concerned?

She sounds normal to me. My second slept through her first week, my bloody mother told anyone who would listen "she's going to be a very good baby".

Then she kind of woke up and all hell let loose :)

Measuring that frequently is only going to show tiny changes- different scales or a big poo can wipe out a weeks gain.

You can refuse all the weighing and measuring.

Dc3 gained at a similar rate and was the sleepiest baby ever, very similar to what you describe. She still is at 14 weeks just has slightly longer awake times. Her weight gain is far slower than my previous chn but has never been a problem. So long as baby seems healthy in other respects eg lots of wet/poo nappies, when they are awake they're alert, good colour etc then it may be they just gain slowly?

Oh and all that weighing isn't great really - they fluctuate so much at this age. Like PP says a giant poo could undo an apparent gain

I wouldn't be concerned if she wasn't being weighed so often, no.

Thanks all - it is the midwife's concern that's making me worried. I don't think she is suggesting formula - she just wants me to wake her more often and feed her more often, but I can't feed her any more that she will take. I have plenty of milk, and the amount DD poos suggests she's getting a lot of it. I think it's the sleepiness that worries me more than anything - it's a total shock after a child that never slept and couldn't be put down at all! And the head thing - I'd never even thought about head measurements until midwife mentioned that DD's head hadn't really grown.

I don't remember mine having their heads measured until their 1 year check after birth.
I was constantly worried about how sleepy dc3 was as it was so different to previous two. She'd only ever feed when she wanted to and not if I woke her up. I think if I were you I'd just keep an eye on her nappies and have her weighed in 5 days and see how she is. The head thing wouldn't bother me unless she's obviously got a pin head?! (I'm
Joking but there's nothing you can do about the head thing) maybe measure yourself now then again in a mth and so on? The discrepancies between different people measuring can be huge

Not a pin head, no! :)

Her head looks totally normal to me - just that the midwife made me think it should be growing more rapidly. But yes, you're right about the measuring thing - when DD's length was measured at 7 days she was 4cm shorter than her length at birth, and midwife pointed out that whoever measured her at birth had got it wrong.

I'm not in the UK, and apparently all this measuring and weighing is is sort of normal here (although I don't think it would be happening every few days if I didn't need to visit the hospital that frequently).

And yes, DD won't feed if she doesn't want to even if I wake her. Midwife seemed to be implying that it's because she sleeps so much that she isn't gaining lots of weight, but even when awake she will only feed if she wants to.

The nappies sound good OP, and fwiw both of mine had a similar weight gain. They were fine, just a bit slow to take off, and are naturally small even now.

Weight is within normal. Sleepiness will prob change. I think it's reasonable for midwife to be concerned because of the sleepiness though it's not clear why the frequent weighing is seen as important.

No idea about head circumference. Very unusual for head to be measured like this. Has she said why?

Where are you, OP?

Malta. Head circumference is one of the columns in the baby book the hospital uses, along with weight and height. Now that I look at it, it's a booklet produced by Pampers.

Just not done with healthy babies in uk. Google rcpch head measurement. See if their 'good practice' is what is happening.

Saw the midwife again yesterday, and her concern is that DD is too sleepy to be feeding enough.

She has lost 60g since Monday.

So midwife's advice is to offer her bottles of expressed breast milk (as well as the breast as often as possible). She took two bottles of 60 mls yesterday afternoon, and I'll try again today.

We are back on Friday and midwife says if DD hasn't gained any weight by then, we will have to look at topping up with formula.

(there was no measuring of the head on Wednesday - midwife was just very concerned about the weight loss.)

Weight loss is always concerning. Are you confident her weight was measured correctly? Naked baby? Digital scales? Hard surface?

If the weights are correct, then it makes sense to try to get more breastmilk into her.

There are other things to try, apart from ebm. Switch nursing and breast compressions would be good.

Is there any other possible reason for the weight loss?

I'm sitting here trying switch nursing now :) Midwife advised staying on one breast for as long as possible in order to get to the hind milk - having read around a bit I now realise what bad advice this is.

She is weighed naked on digital scales on a hard surface, yes.

Only thing that comes to mind is that when I was pregnant with her they noticed that her bladder and ureters were distended, on a scan at 34 weeks. They were worried about potential kidney problems, so did an ultrasound when she was two days old, but it was all clear (and no more distension, either). They are doing a follow-up scan when she is six weeks, but no one thinks there is any problem, and she is certainly peeing lots (she wasn't emptying her bladder well at all, when they checked on the scans following the one at 34 weeks). Not sure if this is any way related, but it's the only unusual thing.

When is she being weighed again?

Would that be two days after the previous weight?

You'd expect the weight loss to be recouped by then.

She's being weighed again tomorrow, yes - two days since the last weighing, where we saw she'd lost 60g

Apart from the odd head circumference thing and the incorrect advice to feed on one side, the midwife is justified in keeping an eye on things, I think. Your dd's weights were normal up to 10 days, but midwife noticed she was very very sleepy. She's continued to look at the 'whole baby' and not just figures on the graph. And that's good.

Thanks for responding, tiktok.

So I should expect her to have gained at least 60g by tomorrow?

At the least she should have stopped losing weight, and yes, should have recouped the loss. Hope it goes well today.

Thing is though, she's being weighed so frequently that any gain or loss is so small it's within the standard error. So you cant tell if it's true gain, she needs/had a big poo or wee, needs/had a drink before weighing...

Really she shouldnt be weighed less than fortnightly to get a true picture.

Also ask your m/w exactly the reason for formula. If bm isnt causing her to gain, then if there is an underlying problem, formula either wont make a difference, or might even mask it.