20wks old, not gaining enough weight, should I introduce formula???

[MumToAPiglet]

My 20 week old DD is exclusively bf which I am really enjoying and she seems to like. She was on 98th percentile when born (9lbs 4oz). She quckily dropped to 91st but then followed that line until 6 weeks ago. In the last 6 weeks she has dropped to 50th centile (never losing weight, just gaining v slowly). She still wakes at 10.30pm and 4.30am for feeds but during the day she is so interested in everything around her that it is hard to get her to feed for long periods. My breasts were really engorged and leaky until 6 weeks ago but now they are much less so - I am not sure why.

Our HV says I must start formula top ups or solids. I wanted to bf exclusively for 6 months but maybe that is not what is best for DD. I really do not want to introduce solids for at least another 4 weeks. Do you think my HV is right that I must introduce formula? If so which one and how? DD hates bottles and will not suck them no matter what.

Any advice would be very welcome.

mtp no no don't. she is still gaining weight, 50th just means she is AVERAGE. unless she is really dropping weight or is otherwise not doing well i don't see why you should worry. less leaking is probably your supply settling down. hopefully somebody like tiktok will be along soon with more precise info for you.

You don't have to start formula top-ups or solids at all - don't be pushed by your HV into doing anything you don't want to do.

The fact that she doesn't feed for long periods doesn't necessarily mean she's not taking enought milk - it may simply mean she's become more efficient at feeding, so feeds take less time. Similarly the fact that your breasts aren't engorged doesn't mean anything is wrong - it can be normal for this to happen as your milk supply settles down.

Is she otherwise happy and healthy? Because that's really far more important than anything the centile charts say.

I think she has become more adept at feeding so doesn't take as long and your breasts have adjusted to make just what she needs so that is why they aren't engorged and leaking anymore

being on the 50th centile is perfectly fine, no problem at all. Please ignore your HV introducing formula will cause your milk to reduce and then you will have to up formula or start weaning. she sounds like she is doing fine, don't change a thing..... except maybe your HV

All this sounds normal, piglet - not just your baby's growth, behaviour and your breast changes, but also your HV's crass approach to the situation. 'Must' start formula top ups or solids......I ask you

Your baby is young for anything but breastmilk on which she is thriving, from what you say.

However, if there really is a case for thinking she may be needing extra calories, you have them - in an unlimited supply, in your breasts

You can maybe squeeze in an extra feed or so every day (more effective than trying to get a lively 20 week old to feed for one second more than she wants to!) - easier than messin' about with formula and a quicker and more effective way of getting more calories into your baby.

Perhaps your HV could comment on this idea before she starts telling you what you 'must' do.

Whaddya think?

not a b.f expert

however...if you do not wish to introduce formula or solids...DON'T...and your HV should know that solids should not be introduced until 6 weeks

my DD ( formula fed )dropped weight and wavered between centiles for months..so formula is not the answer IMO.....she was just a rubbish feeder, who could not be bothered with her milk and if she was ill, would go off her feeds for days

luckily, my HV is very sensible and when she had periods of weight loss... told me not to bring her in for weighing!

don;t worry ! you are doing just fine

this is a brilliant website

kellymom

for all of your breast feeding and weaning dilemmas

I am so glad that you all think that this is normal. Deep down I know DD is fine as she is very happy and lively. However the fact that my breasts seemed less full had begun to worry me as I thought maybe that was a sign that I could not give her what she needs. Is it really normal to go from constantly leaking bosoms to never leaking and only feeling full in the middle of the night and first thing in the morning? If so then I am not going to push formula. We did try it yesterday but she just kept gagging on the bottle and refused to suck. I will also try TikTok's suggestion of adding an extra feed. I just hope she dows not drop below 50th. As long as she does not I will ignore HV and keep doing what we are both really enjoying.

Thank you.

Just to add that tiktok is one of the Mumsnet bf experts, so her advice is always worth listening to. And the Kellymom site is very good too.

(and that I'm sure lulumama meant to type that solids should not be introduced until 6 months rather than weeks)

I can only tell you my experience:

Somewhere around 15 weeks my DD who was trundling along somewhere around the 50th centile dropped off her line to below the 25th centile. She then followed that line for a number of weeks before creeping up a little bit. My HV tells me this is normal in a breastfed baby and not to worry. As 50th centile is average, it stands to reason that a significant number of babies will be below that line and still in the range of what is normal.

My breasts haven't felt engorged on a regular basis since DD was about 3 months old. From whast I have seen on Kellymom, this is because they have adjusted and I no longer have an oversupply - they are just better at providing the right amount for my baby. Having breasts that don't leak is a great relief to me - means I can leave the house without embarassment! HTH.

We had a similar situation - DS dropped from 50th centile to 0.4th over a few months - the drop started at around 5 months. Just when he started losing interest in daytime feeds! I wasn't told what I HAD to do, but a referral to a paed was mentioned when he was 8 months and still dropping. He was by then a much more frequent feeder but, as the HV unhelpfully described him, a 'snacker'. He was also on BLW solids. So I stopped getting him weighed. He was developing normally, doing all the things he should have been. He just burns up calories at a rate of knots! Even at 15 months, when he was eating like a little horse and I had started getting him weighed again for the next stage car seat, he was still only in the 9th centile. By then, I'd stopped worrying, and had started envying him instead. Wish I could eat as much as him and still look skinny...

26 weeks 26 weeks 26 weeks !! sorry !! posted without previewing again!!

I really feel for you, MTP - my 11 mo ds's erratic weight gain started at about 16 weeks.

At about 10 weeks I caved in and offered formula (on specialists' advice) which ds rather gratifyingly refused to drink. It sounds to me like your baby is just fine. If your instincts are saying she doesn't need formula, you are probably right...

That should read caved in at 20 weeks. And I previewed it too!

weighing is optional

I would be tempted to write to your HV's boss complaining about her lack of training and directing them to the WHO's guidance and asking why they are not training their staff properly and why they are sabotaging breastfeeding.

FFS. This sort of stuff makes me so angry. How is it possible for the NHS to be so ignorant about breastfeeding? Wankers.

Congratulations on doing so well with the BF, MtaP. Don't listen to your HV, you're doing fine.

Sounds fine - lots of babies drop down the centiles a bit, as they find their own curve. My two boys have dropped from 98th to 9th and 99.8th to between 9th and 25th (via the 2nd centile line!), and dd dropped a bit as well, though not as dramatically! If you and dh are not particularly big then you wouldn't expect your child to carry along the 98th centile.

I'm coming to distrust the centiles at birth - I know SO many babies born on the 98th centile upwards, I don't believe it is the 98th anymore. But that's a different thread - who knows, I might start it! Well done for what you've done so far - you're giving her a great start!

Definately carry on with the breastfeeding. If you want to do anything more than try to squidge in an extra breastfeed during the day. Like tiktok says - you've got plenty so why give something else. Breastmilk has MORE calories than formula, so is more likely to to put on weight (apprx. 72 cals per 100ml in bm and 65-67 cals er 100ml in formula). Exclusivley breastfed babies tend to start following a different line at around this time and gain perhaps 2-3ounces a week - but then again babies of this age shouldn't be weighed regularly except by choice or your personal information, or if something wrong is suspected - ditch the scales!

One of the reasons that your breasts feel less full apart from the milk 'settling down to need', is that your prolactin levels have started to return to pre-pregnancy levels and instead of the milk production being hormone driven (you'll get breastmilk whether you want it or not in the beginning), to 'autocrine (automatically make the milk, but only if you ask!).

And as for solids......don't think about it until around 26weeks and as a suggestion go for 'baby led weaning'. Any solids that you give should be in addition to milk not as a replacement. As the first foods babies tend to try are fruit or veg which are naturally 'low calorie' don't expect a bit increas here either.

Also, is your HV still using the old centile charts (those based on bottle-fed babies)?

Because they updated them, but I don't know if everyone uses the new ones now.

Calig - you pressed my buttons there! Charts are not based on bottlefed babies - babies are not differentiated. See a zillion posts by me on this very myth if you search the archives

What, you mean the charts were based on an average of all babies? (Have obviously not been concentrating! )

Here are just some threads where I have come on and explained about the charts, Calig - hope they'll help. Please excuse them not being made into links - I am in a hurry : )

www.mumsnet.com/Talk?topicid=1364&threadid=191240#3953388

www.mumsnet.com/Talk?topicid=1364&threadid=252533#5110906

www.mumsnet.com/Talk?topicid=1364&threadid=194160#3988385

Last thrwad listed has a link to an academic paper which explains it all, too

link

link

link

tiktok's links!

will be reading them too !

my dd is 22 weeks weighs 15.8 has only ever been on the 25th centile is exclusievly bf and ive never bee n told to give solids or top ups ever they tend to take the line ss long as baby is gainging weight and is content then getbon with it

Thanks again everyone. I feel much more confident about following my instincts and continuing with the bf. It is good to hear others have had the same experiences and not had other problems. It is funny because since my last post I took DD to her first Little Dippers swimming lesson. All the babies were in swim nappies only and DD's tummy was HUGE compared to the others - it made me laugh that I had been worried about her weight.

One question for TikTok though. In one of those links you say it is not normal for bf babies to go several days withough a poo. I had thought it was normal. Although DD has pooed everyday this week she has had a few periods of not pooing for up to 7 days. Could that be a sign that something is wrong?

Finally I just wanted to say to Tortoises Shell that I too have wondered how come sooo many babies I know are born above 91st centile. 6 out of the 7 babies in my NCT group were above 91st - I am no mathmatician but surely that is statistically odd???