Day 14 newborn not at birth weight

[EveMoneypenny]

Thus is day 14 for DS2. He was born weighing 3.87 kg (8 lbs 8 oz) and he is now 3.74 kg (8 lbs 4 oz). He had lost 11.2% of his birth weight on day 4 and his weight has been a little up and down since then but the general trend is he's gaining. The midwives I've seen have said they're not concerned - he's gaining, although he's a very sleepy baby and often needs woken for feeds or encouraged to continue feeding. I'm also topping up most feeds with ebm in a bottle. Each midwife I've seen has different opinions on how often and how much to top up, and I'm feeling a bit confused about what I'm doing and worried that he's not back at birth weight. I have to admit, I'm thinking longingly of formula feeding at this point (I ff DS1). Is this weight normal for this stage?

It's so confusing and demoralising when you are unsure what to do for the best :(

The majority of thriving healthy babies start to gain weight after day four, and they are back to birthweight by now.

Their weight does not go 'up and down' - weight should be upwards.

They are not sleepy to the extent they need to be woken for feeds - but you are doing absolutely the right thing in waking him, and giving him ebm.

You can ask whichever hcp you trust the most about your next step - ask about breast compression (which keeps the baby feeding), switch feeding (which gets more volume of milk into the baby and also boosts supply) and feeding on both sides at least whenever possible.

The precise volumes of ebf are not important though - it's more important to keep feeding frequently, expressing when you can, and getting whatever ebm you get into him :)

It would also be good for someone who knows their stuff to really observe a feed and check milk transfer is effective.

I don't think they are right to be unconcerned - it does not sound like a case of 'panic stations' but a baby well below birthweight at two weeks with a history of slow weight gain who's sleepy is a baby whose feeding needs to get better.

Hope you get good real life help. Many babies in this situation turn around beautifully once these problems are addressed :)

Thanks, Tiktok. I think it is to do with the volume of milk I can get into him due to his sleepiness. He is active and alert sometimes, but he tends to fall asleep on the breast quickly. The more topups I give him, the more sleepy he seems to become and the longer he tries to go between feeds (I don't let him go more than 3 hours but waking him after 3 hours can be a struggle, whereas with fewer topups he's more interested in breastfeeding for longer and more frequently). One midwife said he could be in a food coma with the extra topups - he doesn't need to wake up for food because he's so full. However any time I've tried to reduce the topups he's lost weight.

His weights have been:
Day 4 3440g
Day 5 180g gain - not sure how this was possible overnight?!
Day 7 70g loss - he'd perked up a bit and was breastfeeding well and I had really struggled to get any top ups into him. I'd hoped the breastfeeding would be enough but clearly it wasn't.
Day 8 - 80g gain.
Day 10 - 10g loss.
Day 12 - 40g gain
Day 14 - 80g gain

I've been doing breast compressions. I'll try the switch nursing, thanks for that suggestion.

Any time I've been observed feeding the midwives have all been happy with positioning and attachment. He latches well and he is clearly glugging down lots of milk - when he tries that is!

Hmmmm those weights are not reliable, IMO!

Weighing is not always done accurately. The scales are unreliable or the operator is unreliable or the recording of the weight is unreliable.

180g overnight is not possible, I agree. I think it's more likely he gained 110g in three days.

I would ignore the 10g loss - weighing cannot be that accurate really - and look at the overall trend, which as you quite rightly say in your first post is up :)

So he is not up and down, not really.

It's good he is being checked on.

It does sound that you need to keep up with the top ups of expressed. It's not the time to be dropping them, from what you say; wait until his weight is what it should be. His weight gain at present seems ok, but he needs to keep this up :)

You're doing the right things to make it all work.

Thanks for the reassurance. Topping up as much as possible over the past couple of days. He's getting weighed again tomorrow so I am crossing my fingers he's put on weight.

I'm finding this pretty tough. The cycle of feeding (interspersed with trying to wake him up/changing dirty nappies), expressing and topping up if necessary can take up to an hour and a half, by which time it's sometimes nearly ready to start again. DH is back to work on Monday and I cannot see how this is doable when he's back, since I also have 3 year old DS1 to look after. I will see how the weighin goes tomorrow, but I don't think I can carry on with this for more than another week or two.

I had similar with my ds4 he wasn't back at birth weight at 2 weeks but the midwives didn't seem concerned. They just basically dumped us on the hv. The hvs weren't much help either and despite having successfully fed 2 dc before him for ages I ended up with him on bottles by 10 weeks after he was only gaining 1 or 2 oz a week.
I wish now that I'd involved the proper infant feeding team. Do you have an infant feeding team in your area to come and observe a full feed?

Sprogletsmum, sorry to hear you had struggles too despite being an experienced bfer. I'm not really very sure of the breastfeeding support here. I'll ask the health visitor on Wednesday when she comes.

Good news today - he's put on 100g over the past two days. So he's 30g or 1 ounce under birth weight on day 16.

I've been topping up most feeds with 60 ml ebm in a bottle. He doesn't always take it all, and I don't offer it if I feel he's fed well from the breast. I've been told I can gradually reduce the topups, but not by too much. The health visitor will weigh him next Wednesday.

I was thinking the following for a plan: at the moment he has day and night reversed. He is very sleepy all afternoon and into the evening and very wakeful between about 2am and 5am. So I was thinking of cutting out afternoon topups to encourage him to wake more in the afternoon and hopefully help the process of distinguishing between night and day. I'd still continue to offer 60 ml ebm at all other feeds when he hasn't had a good feed from the breast. Does that sound OK? I just feel like I need a bit of structure as to how I reduce the topups.