Slow weight gain - any advice appreciated

[Dollydaydream2829]

Sorry, this is a long one guys but bear with me please.
DD is 4 weeks old, however born 5 weeks premature so technically shouldn't even be here yet (little madam!) She had a birth weight of 5lbs 11oz which was very decent considering how early she was!

I breastfed from the start however DD became jaundice on day 5 and had a 12% weight drop from her birth weight. We really struggled with feeding and she was admitted to the special care baby unit. It was there that i continued to feed 3hrly with expressed milk top ups. Fortunately, she began to put on weight and went from 5lbs to 5lbs 2oz, and we were discharged and advised to continue with the top ups.

Over the course of the following week (week 2) she only maintained her weight, which still wasn't at her birth weight. I was starting to get seriously down and stressed about the whole thing. I was finding feeding difficult at times and I was sore constantly. I was diagnosed with thrush and DD and I were started on treatment. It was suggested by my HV to start looking towards formula feeding. I wasn't keen to give up bf entirely at that stage but agreed to give DD a ff on settling at night to see if that made any difference.

Fortunately, she then started to pile on the weight. It was maybe a combination of the thrush being treated, me feeling more confident and the formula, but I was relieved. She'd gone from 5lbs 2oz to 5lbs 10z in a week!

Since then, although there have been the couple of odd days where I feel feeding has been a bit of a challenge, on the whole, I was confident with her. Feeding on demand which during the day means feeding every couple of hours and has a fussy period in the evening where I can be feeding every hour, has her formula after I've fed and usually sleeps for 3-4hrs between feeds in the night. I never let her go past 4hrs at night and 3hrs in the day.

The HV came back yesterday and she has only gained 2oz in a week. I can't understand why as I feel like she has been feeding A LOT! The only new thing has been that she's been a bit more sicky than normal. She regularly has possets but yesterday she had a few projectile milky spews. She arched her back and was distressed and agitated at a couple of the feeds but otherwise normal.
She is alert when awake, has plenty of wet and dirty nappies and is content and sleeps well otherwise.

Am I getting unnecessarily stressed about the weight thing?! She's been weighed every week - is this too much? It was only after the HV left that i realised she weighed her on scales on the carpet instead of the wooden flooring as normal - could this have an effect?! She's put on 10oz in two weeks in the bigger picture....

I am going to contact a breastfeeding advisor today to double check latch etc as I do still get pain at times but the HV said my latch looked fine. I'm so close to giving up on breastfeeding and I really don't want to but I want to do what is best for her.

Could you try expressing milk and giving it to her from the bottle so you know exactly how much she’s taking in? It’s really difficult I understand when I was bf’ing in first five days dd had a 7% weight drop and it scared the hell out of me. But your dd’s needs are priority so if the bf’ing isn’t quite going as planned it might help to increase the ff you give her :/ you’ve done the first couple of weeks bf’ing which means dd has got all the wonderful things passed onto her.

The straining and arching of the heck when feeding could be down to taking back too much air or slight reflux both these things can cause babies to arch away as it’s a bit sore nothing horrific but it’s new to them too.

I would say if you’re 100% wanting to only bf with the exception of the night feed then see the bf’ing consultant, express for a while and see how much milk you’re producing ( the more you express the more you’ll make ).

You’ve just got to do what’s right for you and baby but in the early stages it’s hard to really know what it is, try everything at least once and you’ll find a method that works for you both. As long as she’s happy and still gaining weight ( even if it’s slowly) that’s still a positive so try not to get too worked up.

Good luck with everything! Take care :)

Has she been tested for dairy allergy? It often presents with reflux (that’s what the back arching is often a sign of) and grunting.

Thank you wiggles - when I was expressing the top ups, I was getting a really decent amount after every feed. It may be a case of starting the top ups again as id stopped them when I saw she was gaining weight then gained her most weight without them so thought we'd be fine. Like you say, it's a way of seeing she's definitely getting something.

I've not done anything yet roo as it was only yesterday that she started doing it. Do you reckon it could have just started so suddenly?! I've been having dairy since she's been born and she's been fine up until this point!

It could do. Nephew didn’t start reacting until 6 weeks (he was premature too). Started off just like this which is why I asked.

Ah ok, Thanks for the heads up roo - planning on phoning the HV this morning so will mention this. Might cut out dairy for a couple of days and see if it helps?

Don’t do or change anything until you’ve talked to the doctor. As it can give false negative results and your dd won’t get treatment.

Weighing on the carpet instead of hard floor could have made a difference especially if it's thick carpet. A friend had this and got sent back into hospital but once weighed there was sent home again.

Oh really? That's interesting bluebell
I'm going to make sure she's weighed on the hard floor again next week!

Dolly, what's the situation regarding her weight on the charts? She should be on pre term baby charts www.rcpch.ac.uk/sites/default/files/asset_library/Research/Growth%20Charts/Education%20Materials%2001092010/FS5_Pre-term%20InfantsV.pdf

and you'd be looking for some catch up growth by now, and you are right to be concerned about the apparent slow weight gain....bearing in mind too that any weight has to be recorded accurately!

The overwhelmingly likely reason for slow weight gain is insufficient intake - you have to rule out this simple reason before thinking about less common possibilities such as allergy. If it's insufficient intake, then discussing with a knowledgable person in real life about how to make BF work better for you both would be your next step.

But do work out her spot on the chart first. I haven't done it - maybe the problem is less than you think (or more!). Get a proper picture of it and then work out what to do.

Thanks for your input @tiktok
She started off in the 50th centile and then dropped to the 9th with the massive loss post birth. She's stayed in the 9th since. I've attached the chart - don't know if it's good or not?

How do you know if her intake is enough? I was always advised to look out for wet & dirty nappies - she has both with every feed just about (at least 8 of each)
She's alert when she's awake. When she comes off the breast, she is more often than not content but if she still appears hungry, I'll offer the other breast.
I keep her on one breast and she usually spends between 12-15mins on it. She'll sometimes come off it and then go on again. I've sometimes massaged my breast when she comes off midway through and it's often a different consistency - creamier and almost thicker, I presume it's the hind milk. I reassure myself when she goes back on that that is what she's taking then but maybe that's not accurate??
When she's latched on, I can see and hear her swallow at least for the first 5 minutes but then nothing after that.

My HV has often advised me to switch breasts if she gets sleepy or fussy but I wasn't sure of that.

She always has possets as well which I take it that she is getting milk?

I'm so unsure about breastfeeding and it's a huge worry of mine that she's not getting enough!

The chart shows she is heading downwards but no need for panic esp as all other signs are good. But you should certainly take steps to increase her intake. Your hv is right - switching breasts when she stops sucking and swallowing boosts intake and this can be done more than once ( it’s called switch nursing ). Breast compression good too. Putting her back on the same breast after she stops likely to reduce intake.

HTH

Thanks for all your suggestions @tiktok!
Had the breastfeeding support worker come out to me today and she was fantastic! She really reassured me. My latch appears absolutely fine - DD seen to be swallowing and stays latched for a good while. Like you mentioned, She also said about switch nursing and also mentioned DD might benefit from breast compressions.
She reckons my nipple pain could be down to thrush still so has advised me to go back to the GP, which I will do as soon as I can get an appt.

She'd said not to get too hung up and stressed about the weight yet - all other signs were great and she was lovely and alert when she was there. She's for a repeat weight on Monday so will see how she gets on then and reassess.

All in all, a positive experience and something I should have done far earlier to put a bit of my mind at rest.

Sounds good :)