Baby dropping below centile line

[YouAndMeAreGoingToFallOut]

My DD is 7 weeks old and is exclusively breastfed. She only weighed 2.7kg (5lb 15oz) at birth, and was on the 9th centile. She was still tracking that centile when she was last weighed at 3 weeks.

She had her 6-8 week check today and she now weighs just 3.9kg (8lb 9oz). This means she has just dipped below the 9th centile line. The GP was initially fairly unconcerned about this, but I was told to take her to the clinic to be reweighed in two weeks, instead of leaving it for four weeks.

However: she is still having a large number of dirty nappies. The frequency has not really reduced much since she was newborn - we are talking in the region of 10 per day still. They are usually mustardy coloured, but occasionally can be slightly greenish. Some are quite small. The GP seemed to feel that this was a concern in combination with the lower weight gain, especially as my mother has coeliac disease.

So I'm taking her to be weighed again in two weeks, and if she hasn't regained her line and/or the frequency of her nappies hasn't reduced, we will be referred to the hospital for further investigation. I'm beside myself.

Is it really so abnormal to still have such a large number of dirty nappies at 7 weeks old?

It's understandable you're concerned, OP, but nothing in what you say indicates anything serious - the nappies are within normal, both in frequency and colour, and while it may be sensible to keep an eye on your baby's weight, it should be a simple matter to ensure she gets more calories if she needs them.

Your hcps should probably have discussed more about how you can make breastfeeding more frequent and effective - maybe they did? The first steps to take would be

i) feeding more often by taking the initiative more when it comes to feeding - small babies sometimes need this

ii) feeding on both sides at least whenever you can, so you increase her intake and your supply

It would be reasonable to do this and then reweigh, and then add in the breast compression technique if the baby is losing interest at the breast.

Having said that, it doesn't sound at all that she is underfed - her weight gain is within normal, too. It is usually insignificant if a baby drops below her birth centile a little bit. Just feed her more often, get her weighed again as they have suggested, and ask the hcps if they are truly concerned.

My DS is also 7 weeks and I would say he often has around 10 dirty nappies a day. He tends to poo with every feed, and feeds at least 10 times, which as far as I know is all completely normal. Here's a link where it's mentioned -

www.babycenter.com/404_is-it-normal-for-my-baby-to-poop-after-every-feeding_3652446.bc

I've been told by midwives and breastfeeding consultants that dropping under a centile line is not in itself a problem, and that it only becomes a concern if the baby crosses two lines, but that's just what I've been told, and I don't know if it's different with a smaller baby. Could you phone your health visitor for advice?

Thanks both. I suppose the GP is probably just being over cautious, but it was a bit of a shock. I felt like she was gaining weight well, and was happy with how the feeding seemed to be going. I had a fairly rubbish pregnancy and a crappy labour and birth, and was feeling positive that at least I was managing to breastfeed properly. Now I feel like I'm failing at that too.

Hi, youandme. My DS is also 7 weeks old and was also 8lbs 9oz when he was weighed on Friday. He started at 7lbs 1oz though so has moved down the centiles more than your DD. We also have lots of smallish dirty nappies throughout the day.

The weigh-in was at a consultant appointment, a follow up from having been in SCBU at birth. The consultant wasn't really bothered about his weight gain and has made an appointment for 3 months time just to check how he's doing. I'm surprised that your GP is worried about a slight deviation from the centile line you started on. It seems very over cautious to me. Hopefully the weight gain will be ok at the next weigh-in and everyone will take a step back!

They just keep saying "as she's so small..."

I mean, obviously she is small. But there were no particular concerns about her health at birth or anything. She's just little I think.

When I was still on the postnatal ward they were desperate to get me to give her formula and seemed to be generally hysterical about her being small, but there doesn't appear to be actually anything wrong with her. She's alert, and meeting her milestones, such as they are at 7 weeks. She's a pretty poor sleeper, and sometimes cries quite a lot when she seems to be overtired, but nothing that I thought was in any way outwith the bounds of normal.

Just the nappies, and the fact that she seems to have a lot of wind. To put it bluntly, she's a very farty baby.

I have a family member who had a small baby, weighed a lot less than your DD at birth. She was seen regularly by consultants basically because she was so dinky but they didn't identify anything else wrong with her. She was just small, and is a perfectly normal 3 year old now. I guess it's just caution in case there's something underlying the smallness, even though that's very unlikely.

Honestly, those nappies are normal! Plenty of perfectly healthy, thriving babies have nappies like that.

Yes, she's small. Yes, it makes sense to ensure she grows normally, and you could certainly ensure she is offered frequent feeds as per my previous post.

But what's wrong with the nappies? What's been said to worry you? Perhaps you are worried because of your mum's coeliac disease, but your baby's poos are normal and don't indicate anything wrong at all. And that includes coeliac.

Sounds normal to me, a bit like my DD! She's between 9th and 2nd percentile and apart from once being asked to weigh her weekly for a couple of weeks we haven't been referred anywhere. It's horrid to feel that breast feeding isn't going well, we had lots of issues at the start so I know how that feels, but it honestly sounds like you are doing fine and she is just like my dinky DD!

tiktok it was just that the GP seemed to think it was concerning, really. She did say that guts mature at different rates and it might be nothing to worry about, but seemed to suggest that in combination with the "poor weight gain" and the family history of coeliac disease it could suggest a problem.

The more I think about it now, the more likely it seems that my baby is actually fine. Would so many dirty nappies be more unusual in formula fed babies? I don't think breastfeeding rates are that high in my area (or anywhere I suppose) so imagine GP doesn't see very many EBF babies. She didn't seem massively au fait with breastfeeding: her first suggestion was that I should make sure to be drinking enough fluids so that I would be confident of making enough high calorie milk. I'm pretty sure that's total rubbish isn't it?

Yes, that is rubbish. You should keep hydrated, obviously, but what you drink will have no effect on the calorie content of your milk.

I would agree that it sounds like the GP doesn't know too much about breastfeeding. How about ringing one of the support lines, just to get some extra reassurance from a friendly voice about the pooing and I weight?

Agree with Orsono. Hope you get reassurance.

Saw the Health Visitor today who was very reassuring. She also said the nappies sounded normal, and that the tiny drop to just under the centile line wasn't anything much to worry about. She seemed to think the GP was a bit mad.

So we're going to keep a close eye on DD's weight to make sure this isn't a trend, but there's no need to panic. Feeling much better today!

Yay!!!

I wouldn't worry too much about her weight gain (doesn't sound like you are anyway) my little girl is 11 weeks and only weighs 9lb 15 and has also dropped below the line a few times...and just recently. She was only 6lb 3 at birth and I think she is just going to be a small little thing. As long as she is feeding well, gaining weight and happy in herself I don't see a problem..x

I wouldn't worry too much about her weight gain (doesn't sound like you are anyway) my little girl is 11 weeks and only weighs 9lb 15 and has also dropped below the line a few times...and just recently. She was only 6lb 3 at birth and I think she is just going to be a small little thing. I'm forever being told she's small for her age. As long as she is feeding well, gaining weight and happy in herself I don't see a problem..x