Uneasy about doctor's advice

[PerpetualStudent]

My DD is gaining weight very poorly. She's 11 weeks and has barely added a lb to her birth weight. (3.1kg to 3.5kg. She was born at 38 weeks and has had several colds, poor mite)
She is BF, on demand without any issues as far as I can see (DS had tongue tie so know what to look for there) has wet/dirty nappies etc, though green poos since latesr cold.
Have been in and out of GPs getting her weight monitored since 6 week check. Yesterday DP took her, as I am poorly with mastitis, and saw a different doctor.
His advice was to swap completely to formula for 5 days, barr BF enough to relieve the mastitis to 'check if the milk is the problem' With the assumption that I can switch to pumping, and presumably back to BF if this isn't the problem, without messing up my supply.

To me this feels like very wrong-headed advice? From what I understand a tiny %age of women have real supply issues, surely my DD needs to start getting tests for other issues?
Literally since her birth formula has been suggested to me by midwives, Drs, HV - it feels like for any issue BF is seen as the weak link to be eliminated before other action is taken.
Im not anti formula, DS was mix fed, but I feel like there could be a real problem here which is not being identified due to formula being treated as a magic bullet?

Has anyone else been advised to do this formula check/swap?

To be honest, with that level of weight loss and knowing how difficult services can be to access, I don’t think that a trial of formula feeding is a terrible idea. You say fed is best but at the moment your baby is failing to thrive and needs nutrition. Absolutely push for an urgent referral but in the meantime if you formula feed for 5 days and her weight improves then at least you know it’s unlikely to be a serious medical issue.

My nephew went through some of this (not gaining, green poo, constantly snuffly)

After much prodding the doctor, he was diagnosed with CMPA. I'd ask either your GP or HV about it and consider lactose free milk in the meantime.

Hope you get an answer!

I'd actually consider A&E with this. Mine looked healthy (right up until he didn't) and lots of HCPs dismissed the concerns I had as new mother worries (he was sleeping a LOT) but they just told me it was normal.

For today, I'd try and get a GP appointment and urgent paed referral.

One other question, how much is she feeding? It can be helpful to write down timed and length of feed of feeds. There was a huge disparity with my DS. He was drinking at least double the usual amount of milk for a tiny baby (ebm + formula) and the record I had of his feeds, along with the tiny weight gain made them realise something was wrong.

Not saying this is the case at all, but thought it might help.

I can't see a good reason not to try mixed feeding for a few days. It doesn't sound like there is much wrong with your daughter other than weight. How is your weight? My friend lost a lot of weight herself and had her DD falling through the percentiles. Her thyroid was overactive and that meant her milk was copious but really weak and not nutritious. It settled down at about a year and isn't uncommon post parkrun. Perhaps your GP who can see you face to face has reasons like this for her advice?

My friend switched to mixed feeding, then FF with weaning and baby shot back up and totally back to health. Paediatrics would have been the wrong call as it was the mother having a small health problem.

sheraaagh do you mind me asking what was causing the slow weight gain with your ds?

With us being refered to peads I’m not actually sure what any causes could be apart from cmpa or similar, so don’t know what to expect.

My dc looked really healthy and seemed to be feeding ok but he hadn’t gained weight and the midwives kept saying they weren’t worried because he was really alert. We were advised to give him formula just in case and it became obvious that the poor child was extremely hungry. He gulped down about 500ml as if he’d never been fed before
If your dc is not gaining any weight then it’s worth just trying some formula (imo)
He also had to have blood tests in hospital to make sure he hadn’t suffered any kidney damage.
Looking back, I was too fixated on bf, but didn’t have any support to see whether it was going ok. The midwives knew nothing about it and were useless tbh.

Schmooochy it was a congenital lung defect. He basically had to use all his energy just to breathe. We didn't go down the paed referral route, was an urgent A&E referral.

It's incredibly unlikely it's something similar to my DS though.

Agree with others that a few formula feeds would be a good plan, just to see how she goes.

Goodness sorry to hear that sheraaagh , how awful 🙁

It's OK, he's fine now :)

The infuriating part was the countless HCPs ignoring my concerns when I knew something wasn't quite right.

Thanks for all the advice! And just for listening and emphasising to be honest xx Will try to answer questions.
I did wonder about CMPA, but her poos have gone back to yellow since we started formula yesterday (so maybe it is my milk?!)
My weight hasn't moved since birth (a stone over pre-baby weight as well!) and I'm eating a plentyful but mostly healthy diet and drinking lots of water (carry a litre bottle around everywhere and aim to refill it twice a day)

I'm going to try my HV today for a pead referral, and the BF helplines (though my worry is there remit is BF so will have littlw advice in terms of wider health problems?) Otherwise, will carry on with the formula 'trial' (with regular pumping) and push hard for a pead referral no matter what her weight when we see the GP for the scheduled appt on Mon.

Oh, and Im glad you're little one's OK now, SheRaaargh must have been such a scary and frustrating time!

OP, this is worrying, I agree. There's a mix of suggestions here. The doctor's advice is worth questioning, as you say. A baby whose weight is a slow as this really needs to be checked out thoroughly by a paediatrician - heart function, respiration, major organs, signs of allergy, the whole shebang.

The majority of babies who present with this issue need no more intervention than more calories but an important subset are ill or have a condition that uses up all the calories they are getting to survive, with none left over to grow. Only a proper examination and tests if needed can find this out.

Fixing the breastfeeding - if it is just a need for calories - can be done with help and support of someone like a BFC or BF supportive hcp. In these situations it can be an intense and extensive process and may need supplements of donor milk if available or expressed breastmilk or formula.

Stopping BF just to see what happens is not a great way of getting to the bottom of it.

It seems from the info you have shared here that you need an urgent check from a paed.

Hope you get good info and help soon.

@perpetualstudent glad to see you have started to try formula feeding and using pumping to keep up you supply. That a low weight gain and the implication that the baby is not getting enough calories is more urgent than any other issue. Fingers crossed she starts to gain weight (if so then milk supply or transfer from you is an issue that a lactation consultant or BF clinic could support with) but making sure baby is fed in the mean time is the most important thing.

I can understand why you would want a referral to peads but the truth is up to 20% of women don't produce enough milk (aside from other issues) ... it's more common than people would have you believe, so ruling this out first and quickly is the simplest thing. Obviously if weight gain doesn't resolve with formula then it makes sense to do further investigations at that point.

Good luck with it all, let us know how you get on?

Thanks for all the advice and support.
1stTime could you point me to a reference for that 20% stat? It's only I've read on other threads peope put it at 1%!? But then many mothers (my own mum included) seem to have stories of not having enough milk, so it does seem like it would be a significant minority?

1stTimeRounder, the proportion of mothers who have untreatable low supply is unknown. Evidence is very poor. The phenomenon certainly exists of course but the vast majority of women can fix it. Low supply can result from a number of reasons. We have no idea if the OP is unable to fix it - she might be one of the few mothers unable to make sufficient. She should be ensuring the baby gains weight normally somehow though - hcps should have addressed the slow weight gain many weeks ago.

A proportion of babies unable to gain weight normally have an underlying condition unrelated to milk supply. After 11 weeks this baby definitely needs a paed appointment. Can’t believe you think this is something that can wait until after experimenting with formula.

Couldn't agree more tiktok

That is a really worrying lack of weight gain - I am surprised that that has not triggered more action earlier.

Your mastitis would likely benefit from effective draining of the affected breast/part of the breast (I always found baby's chin to the sore area helped the most).
Mastitis, particularly repeated mastitis, may also imply that milk removal is not very effective. Which in turn could of course contribute to your DD's poor weight gain.

Having said that, your DD need calories - now.
I'd feed as much as you are able to, get support from knowledgable BFing supporter, and give her FF.
I'd also insist on a referral to paeds to have other causes of her not thriving ruled out.

Very best of luck

Many many women who are told that they don't have enough milk, or who think/feel they don't have enough milk, are simply ill-advised and poorly supported.

My own mother was told she did not have enough milk to feed me - 2 hours after delivery What a whole load of nonsense.
I am over 50, I am very healthy and well, so clearly having been FF has worked out ok for me and I don't really care now how I was fed in the first year of my life, but my mum still sometimes mentions it.

@perpetualstudent you can refer to this review in the American Journal of Physiology ... i tend to refer to actual scientific studies and Literature reviews for my information. The 1% stated by many people seems to relate to women who produce no milk at all as opposed to producing insufficient breast milk. That's not to say that a low milk supply cannot be improved with various interventions (speak to a bf counsellor or lactation consultant) but if there is a current issue with supply there are risks for your baby which cannot wait for your supply to increase.

www.ncbi.nlm.nih.gov/pmc/articles/PMC5005964/

Quote;
"In fact, it has been estimated that the prevalence of women who overtly fail to produce enough milk may be as high as ∼10–15% (15, 64, 206) and can quickly lead to hypernatremia (28, 231, 293, 311), nutritional deficiencies (16, 139, 287), or failure to thrive (141, 164, 207). Moreover, the prevalence of lactation “insufficiency” may be much higher, as ∼40–50% of women in the US (1, 162) and 60–90% of women internationally "

That's a terribly written review.

@tiktok a referral to peads could take weeks... a baby cannot wait weeks to receive adequate nutrition as serious complications can result in the mean time. As above the incidence of low milk supply is far more common than the quoted 1% and this is easily ruled out by the introduction of formula first (even a day or two will show a difference if this is the case) before insisting on potentially unnecessary and invasive tests. Obviously if supplementing with formula has no effect then something else is amiss.

Paediatrics in the UK will see ill babies on the day, and significant failure to thrive that seems to be affecting OP's DD would at the very least be seen in the next clinic within a few days or a week.

It takes picking up the phone and speaking to a consultant paediatrician, usually followed up with an urgent referral.

This is bread and butter stuff for paeds.

That RV is so full of holes that I don't know where to start.
It's a shame that there is so little hard data on BFing and its pitfalls.
In my personal and professional experience a lot of BFing problems/'insufficient milk' problems are due to poor support and unrealistic expectations about quite how time consuming BFing can be in the first few weeks (always took me 3 months to crack it).

Thanks 1stTime I'm a final year doctoral candidate, so peer reviewed studies are always my preferred sources too!
That paper's very interesting, and appears to conclude diet, genetics and environment could all play a role in milk production, and that we therefore shouldn't assume all women can produce sufficient milk. However it is also a literature review rather than an empirical study, and stresses repeatedly these are areas where there is a lack of research, and gaps in the knowledge. Crucially the percentages cited are based almost entirely on women's own judgements of their milk production, which the authors themselves admit:

'[as] Many studies use the validated approach of maternal report of breast fullness to assess the onset of secretory activation (52, 176, 255), ...this approach may be somewhat imprecise due to variability in perception'

So I don't think that gives robust evidence of actual supply issues, only perceived supply issues.

However, DD clearly needs calories, and we've been giving formula since Weds, probably 50/50 with BFs. I've not been able to get a referral yet, but we're going back to the GPs on Mon AM, where I will push hard for one no matter what her weight gain, and hopefully get some more specialised feeding support along with some investigations into any wider health issues.

Will report back! Thank you again everyone, my DP tends towards the 'everything is fine, chill out' school of thought, so it's actually been reassuring to read others are equally worried about her weight, if that makes sense!

In my area , the H/V would be following a faltering growth pathway - this includes working out a volume of formula per kg ,plus keeping up your normal breastfeeds and regular weight checks / breastfeeding support . Can't remember if you mentioned baby's tongue checked . As someone else mentioned a 2 centle drop would trigger asking baby /you to see GP for review and referral to paediatrician to what they call the HOT clinic. This is usually within 10 days . Where I work H/V can only refer to community paediatricians not medical / acute ones .