Slow weight gain, feeling disheartened

[SquedgieBeckenheim]

Don't really know why I'm posting, except I only have DH in real life to talk to.
DD2 is 7 weeks, EBF. She gained weight well in the first 4 weeks, back to birth weight in 10 days and following 25th centile. Then last week at her 6 week check she'd gained weight but dropped to 0.4th centile, having only gained 6oz. I have good supply, and forceful let down so was told to express off a small amount before each feed to ensure she's getting enough of the "fattier" milk. When I express the first bit is basically water then it becomes more milk like so this makes sense. She feeds 1.5-2.5 hours during the day and 3-4 hours at night. If I try to wake her at night to feed her more frequently she just gets pissed off and refuses to feed.
However, a week later and she's only gained 20g! Following the 0.4th centile though. So now I've been told to top up with expressed milk every 3 hours.
What am I doing wrong? Its definitely not a supply problem. Is this just a slippery slope to formula?

I agree this is worth watching. But there may be other options to tackling it. Perhaps talk to someone on a bf helpline?

It would also be sensible to consider weighing error - scales may be wrong, conversion from imperial to metric might be wrong, weigher might be wrong. Was she weighed naked on modern, digital scales?

Just realised i put 25th centile in OP, thats wrong. She was on 9th centlie.
Yes, she was weighed each time naked on digital scales. All 'official' weights are in grams. At birth she was 2840g. 13 days later she was 2870g. At 3 weeks she was 3120g. At 6 weeks 3280g, so dropped to 0.4th centile from 9th. Then today she was 3300g.
Ironically the weeks she was gaining weight well she was having issues with not latching on properly, that's resolved but she's not gaining weight.

Can you access a support group or lactation consultant? Definitely worth a try. I had supply problems and had to top up every three hours with expressed milk and formula (after a BF each three hours) as DD lost huge amounts of weight but it sounds like supply isn't the problem here? Doing the three hour thing is exhausting as you get hardly any time away from feeding/pumping/sterilising to sleep etc.

The health visitor I saw today is the breastfeeding specialist in this area. I've been advised expressed milk top up every 3 hours after a feed. Tried that just now and she isnt having any of it! She's pushing the bottle away. We've got one other brand of bottles here I'll try next time, but she won't take a dummy so not optimistic about her easily taking a bottle.
Going to breastfeeding support group friday.

I had similar with my LO being slow to gain weight and they made me feel fucking awful. I may be wrong but I was once told that the chart are based on FF babies not BF which can make a difference. How is your DD otherwise? Happy & alert etc? Mine was absolutely perfect pfb in every sense other than not hitting the 'right' places on the chart 🙄 Once he hit the 4month growth spurt though omg he piled it on &hasn't stopped

She's a pretty content baby. She sleeps a lot, but has periods of awake time morning and afternoon during which she's alert and makes good eye contact. She's not smiling yet but reaches out for toys and people's faces and hair. She rarely cries.

Will she take it from a cup? Or if your OH gives her it rather than you? I used Lansinoh bottles with mine and she seemed to find it easy to switch between breast and bottle with those (mix fed breast/formula to a year old, and still breastfeeding now at 16mo. She actually still uses the Lansinoh bottle for cow's milk at bedtime!).

Is your DD content, happy etc or does she seem hungry? I have heard that the charts are based on formula babies. It was obvious (with hindsight!) mine wasn't getting enough milk as she was howling and wouldn't settle and obvious signs of dehydration.

No signs of dehydration - plenty of wet and dirty nappies, fontanelles fine, alert. Chilled out baby.
Not tried a cup yet. Will try that if the next bottle doesn't work. We've tried a tommee tippee so far. Have a medela calma we can try. Other than that I'll have to go out and buy some to try.

Be interesting to see what the support group suggests on Friday. Apart from the chart, it doesn't actually sound like there's a problem?!

Just seen GP who isn't as concerned as health visitor. She did offer to refer to paediatricians, but we agreed to wait and see for another week when we have her 8 week check. No sign of a medical issue as far as she can see.

The charts in the red book are based on breast fed babies, I believe it says so in the intro to that section, but I don't have mine to hand to check that it does.

DD2 was like this. HV's assistant said something helpful like "on the 0.4 centile line only 4 in 1000 babies could weight this little and be healthy".

HV later poo pooed this. DD2 was gaining weight (slowly), plenty of wet and dry nappies and alert etc as expected. I topped up with expresssed milk and eventually relaxed. She was fine. Now at almost 18 months she is huge and back up around the 75th centile (which is where she started).

Try not to worry- express to increase production and feed it to her if she will take it (DD2 would never take more that about 30ml at a time). Don't leave her more than three hours between feeds especially the night ones.

If your gp isn't worried then don't worry- just keep an eye on it.

Charts in red book have been based on BF babies for several years now.

0.4 th centile: the Hv assistant is correct in that it represents one baby in 250, but it does not mean out of 1000 babies on the centile, only 4 are healthy.

fWIW, OP, I think the advice to continue doing what you are doing, that is taking action to maximise weight gain, and revisiting in a week or so is fine, as long as your baby appears well and healthy.

Any ideas how to get her to take a bottle!? She cries and pushes it away. She also won't feed if she isn't hungry. When we wake her to feed she just gets annoyed and won't latch on.
Supply definitely isn't an issue, if anything I have over supply.

I'm a HV, hopefully a lactation consultant too (if I pass my recent exam🙏). I was an extended breastfeeder too with several children. I'm a lurker usually but wanted to reply to this.
Although the growth is a little slow, it sounds like you are doing a great job with breastfeeding. Of course weight gain is important but it is equally important to look at the whole picture. It sounds like your dc is feeding regularly, having plenty of wet and dirty nappies and is generally content. Your supply sounds good too. I'm sure you are doing this but just to make sure, baby needs to terminate the feed to maximise the intake of the fattier hind milk. The duration of feeds can vary but if you feel that a feed on one side has been short or shorter than normal, offer that side again prior to offering the second breast, just to make sure. Personally, I'm not sure how helpful offering expressed milk will be. It sounds like a lot of anxiety provoking and time consuming faff to me. I'd concentrate on skin to skin, watching for feeding cues and ensuring that each feed is maximised in the way I've suggested. Expressing a little milk off at the start can be useful and can help if the let down is forceful too but again, don't get in a pickle with this. Just keep going! Your baby sound happy so try to relax into feeding. Fwiw, I struggled with weight gain with my first, it was slow, very slow. But I kept on and it all worked itself out eventually.

Just to add, the centile charts are now based on optimal growth for breastfed babies, not formula. The 0.4th centile means she is at the bottom of a normal range that's all. Still perfectly healthy. Starting off on the 9th means there isn't much leeway before a drop starts to look a tiny bit sinister but if growth is steady from now on, then all should be well. If baby seems happy and content and is feeding regularly and you have a good supply, things should settle down soon. It can be hard to stay positive and I can clearly remember that it took me a good 12 weeks to feel confident in my ability to feed my child. Koko

Good luck with your exam maxxy.
She does generally only have one side at each feed, I offer the other but she rarely takes it. I let her feed as long as she wants.
I've had to wake her for feeds over night last night, as it had got to 4 hours. She's got a cough at the moment joy of having a toddler at nursery so I feel bad waking her, but at least she did feed! The cough is probably not helping her gain weight either.
Thanks to everyone for your advice and reassurance. We'll keep going and hope she catches up eventually.