Low weight gain 15 week ebf baby

[Worriedaboutweight2017]

Hello - hoping you kind MNetters have some advice and words of wisdom for me. My 15 week son was weighed today for the first time in 4 weeks, and has only put on 250g in that period. I am freaking out!

Previously he has pretty much perfectly followed his centile line and put on the recommended weight for each time period - he has fallen for the first time from 45th centile to 20th with this latest measurement.

He is ebf and has always fed well, albeit recently he is starting to scream and arch his back on the breast, and also get distracted (if he is not fussing). He has a posterior tongue tie however a lactation consultant looked at his latch when he was 6 weeks old and said the tt wasn't impeding feeding.

Any ideas as to what could be causing the lack of weight gain? Should I get the tt snipped now?

Tia!

Screaming and arching his back while feeding are classic signs of reflux - can you see the GP and explore this?

My son (who was also EBF) struggled with weight gain just after his birth, but then started gaining well. However, at about 17 weeks he developed reflux - suddenly started screaming during feeds and definitely wasn't feeding as well. We ended up being prescribed ranitidine and then omeprazole, which he took until he was about 7.5 months old, by which time he had grown out of the reflux.

Getting distracted is completely normal at this age, and feeds may take longer or be more difficult, but this shouldn't affect weight gain. It is definitely worth looking into reflux!

Hi mrsd28 - thanks for your thoughts. I have been to see three different doctors about reflux as DS has been very windy/difficult to burp from birth, and I had wondered if he had silent reflux. All of them have dismissed it out of hand - primarily because he is an excellent night time sleeper, but also because he doesn't consistently arch and scream. He probably has 50% of feeds that are calm and peaceful and 50% that are difficult. Doctors also tell me that he is "too happy Lying flat" for it to be reflux.

I most recently saw a paediatrician on the weekend and he said it couldn't be reflux because if it was it would be getting better not worse by now!

I am at a bit of a loss as to how I move forward with the reflux avenue as I have been consistently shut down on that front.

Hi Worried,

I am sorry that you are struggling to get help. Based on my personal experience, I do not think that reflux is out of the question.

My son was also very happy on his back (though sadly he was not - and still is not! - an excellent sleeper) - he was happy to lie on his back at night and to play on his back during the day (though he screamed in the pram).

His reflux only started when he was about 16 or 17 weeks - before that, he had fed very happily - and though it did eventually get better it definitely got worse for a few months before it improved.

Luckily, our consultant (we had already been referred in his early weeks due to his poor weight gain, so were already being seen regularly) diagnosed reflux straight away. I was a bit doubtful at first (for all the reasons above) but I saw a difference as soon as he started on the medication.

I guess the real question is how the doctors you have seen feel about the slowing weight gain. If they are not worried (or not worried for now), then you probably don't need to push for anything more (though keep monitoring it closely, obviously). But if they are worried, and are going to push you to give him top-up feeds (which should not be necessary at this point if everything was normal, because breastfeeding should be very well established by now) then push back about the possibility of reflux. However, since you have only found out about the poor weight gain today, it is probably best to go back to the doctor / see a different one and present the weight gain and your other concerns.

Can you find a consultant who specialises in infant feeding? As I said, we were lucky in a way because the consultant that we were already seeing (because of poor weight gain) was a specialist in infant feeding. I had always though that reflux could only ever get better, not worse, but our consultant told us that many of the patients that she has seen have only developed reflux about when our little boy did - between 3 and 4 months old.

Let me know if I can offer any more info / help - I know how stressful it is when you feel that baby is not gaining weight at the right rate! My boy gained almost no weight during his first 4 weeks - he only regained his birthweight when he was about 5 weeks old.

Thanks mrs d. I can certainly find a paed who is a specialist in feeding and have another go. Perhaps I'll wait another fortnight and see if the weight gain starts again and then take it from there.

It is incredibly stressful! DS has not had weight concerns before - he only lost 2% of his birth weight which all the midwives were oohing over as is apparently rare for an ebf baby, and as I said he has had textbook gain up until the last month.

Worried, all might be well.

The weight is well within normal. I think you must be estimating the centile, as there is no 45th or 20th on chart. He was prob a bit under the 5Oth and is now a bit under the 25th. Normal :)

Distraction during feeding - normal.

Arching back and screaming and coming off - could also be normal. Someone who knows about BF needs to observe. What sometimes happens with babies beyond newborn is they feed in a very short time and want to come off....the mum cannot believe they have had what they need and try to put them back on, offering again and again, until the baby resists and gets very cross (arching back, screaming). Thus makes feeds very stressful.

So don't immediately assume something wrong. Try feeding really responsively. Trust your baby to come off when he's had sufficient. Don't fight him. In particular, don't think he is doing anything 'wrong' with the weight.

Hope you get some good reassurance from real life help.

Hi tiktok - thanks for your thoughts and reassurance!

Yes that's right re centiles - I saw a paediatric gp and she plotted them and that's how she described the fall. She was very insistent that he should return to his "usual" centile - do you not think that's right?

In terms of the screaming, I do think it is partly related to being not hungry but it also seems to be some kind of discomfort in his abdomen. He sort of stretches his legs right out and points his toes and then pulls his legs right in and lifts his bum up. The gp I saw yesterday is a lactation consultant and she watched him feed...of course he had a textbook calm quiet feed for 15 minutes before falling asleep peacefully. So not helpful for diagnostic purposes! I am going to have my DH take a video of him when it's bad so I can show her next time just so she can get a sense of the distress.

My other issue with the "not hungry" thing is that ds is really only feeding every 5-6 hours if I assume that every time he squawks he is not hungry. This just doesn't seem enough!! - that's only 4-5 feeds in 24hrs (and he sleeps 8 hours overnight too!).

It's usual to regard a drop of up to two centile spaces as normal - that would be from (eg) 50th to 9 th. You can check this yourself - Google royal college of paediatrics infant growth charts.

Honestly nothing you have said in the newer post makes me think there is definitely something 'wrong'.....the way he's crying does indicate a cross baby, and you can't be certain it reflects discomfort or pain. It's a good idea to video him and then ask the doc again though.

Yes, his feeding is infrequent. Good to keep an eye on that, too.

Thank you! I have been keeping an eye on the spaces between feeds since you suggested that and it's definitely true he is more relaxed when I leave it a bit longer between feeds. Am worried about the infrequent feeding though - I have a feeling if I let him go with his timings he'd only feed 8am, 12pm, 4pm, 7pm and then once during the night. I don't feel this is enough for him! But I can't force him to eat....

Just to update - I've tried to go with the flow a bit more and let him just have small feeds / stopped and tried again later if he was screaming. I also had his tongue tie (moderate posterior) snipped; he was entirely unfazed by it!

I had him weighed again today and he's put on 200g in the 9 days since I last checked in. So that's a relief! Who knows if it was tongue tie, virus, growth spurt or something else but he seems to be on the mend - with the outcome that he's effectively dropped a feed.

That's great news 😊

Further update - I had another weigh in this week and DS had LOST 50g of the gain of the previous week. I panicked and insisted on a quick referral to a paed, who was great. She reweighed him (and of course had a different reading - he was flat from the week before) and basically ruled out any medical cause. She thinks he is anxious about feeding after we were both ill a few weeks ago so it's a behavioural thing.

My only question is that she recommended starting him on solids - just some vegetables - on the basis that he will happily drink milk from a spoon so may be ready for them. My instinct is telling me it's too soon for him (he is 17.5 weeks old but was 2 weeks early so 15.5 weeks corrected) but am not sure if that because I'm being stubborn about ebf...

Normally you would not start a baby this young on solids. I don't see the rationale for it at all. His weight still sounds within normal. Why does she think veg would be good?

On the basis that ds is still fighting feeds during the day and needs more calories - she thought supplementing with veg (after I have offered milk) might help.

i wonder why the peas thinks offer a low carlorie food will help?

You could top up with some expressed milk from a spoon

IC I think it's more that he won't take milk so maybe he'll take something else.

Yes I've tried that re ebm - he quite likes the spoon but it obviously takes forever and is very messy.

OP, I still think the idea of giving puréed veg off a spoon is odd. How many calories in that? She's not thinking it through. And your baby is having milk. Just you feel it's not very frequently she's taking it. Her weight gain is still within normal limits. Paed says no health concerns.

Tempted to ask the paed 'what do you think is the problem and why would puréed veg resolve it?'

Talk it over with your GP or Hv - it might help you judge whether the paed's advice is what you want to follow.

Yes. I am going to leave it for a couple of weeks. I'm seeing the paed again in 3 weeks for another weigh (she recommended I don't weigh weekly as it'll just stress me out and she doesn't think it's justified) so I might wait until then before I even think about starting.

He's definitely not feeding enough, he basically misses one full meal a day - usually his lunchtime feed.

Further update - he had a TOOTH start to come through on Tuesday. It's only half through but he's been feeding better (not perfect but better) since then. Perhaps mystery solved?? He's so young, can't believe he's got a tooth already!!