Breast feeding / weight gain issues - advice please?

[JillyBaby]

Hi,
This is Jillybaby's DH here, sorry, but this is going to be a bit long -

My DD is now 13.5 weeks old and weighs 10lb 5oz. She was 7lb 8oz at birth. She is exclusively breast fed up to now. Her weight gain has been erratic, but a bit slow for several weeks now. On a good week she might gain 4 oz or more, other weeks she has gained nothing. She's gradually dropping down on the weight curve the health visitor uses, which in itself doesn't worry me too much as I've been told this is based on formula fed babies who normally gain weight faster.
She is bright and alert and seems generally healthy apart from possibly a bit of diarrhoea a couple of times.
I'm really not sure whether I should be at all concerned about her weight or not, but it's been clear for some time that the HVs are not happy with it.
They (HVs) have suggested visiting breast feeding groups a couple of times to check latching etc which DW has done, as well as seeing an NCT breast feeding counsellor. No real problem has been identified except perhaps there is a certain amount of non nutritive (sp?) feeding.
They told DW to start switch feeding, which she did.
Next they told her to add an extra feed every day, which she did
Next they said she should probably stop switch feeding as DD might not be getting enough hind milk, which she did.

DD's been weighed today, and only gained 1oz this week so HVs are arranging for a home visit to check the latch again and have told DW to express more (she currently expresses in the morning and gives it to DD as a supplement in the evening).

DW is quite upset, worrying that she's not doing the best for DD, depressed at the thought of expressing more, which she finds time consuming and wants to replace a feed with formula to see if that helps.

We'd really welcome some feedback on the above from the breast feeding experts please.

Should we be at all concerned about DD's weight?
Any thoughts on the advice given on the breast feeding?
Might adding some formula help? If so, could it replace a feed or would it have to be in addition to existing feeding?

Thank you very much for reading through to here!

Hi, Jillybaby's DH.

I can see why there is a smidge of concern about your dd's growth, but as the overall health and development are fine (I take it) then it's a shame DW is so upset (but understandable).

6-7 feeds is not a huge amount for a baby of this age - most are having more, sometimes quite a lot more, than this, and honestly, I have to say it, scheduling feeds is just not appropriate for any baby whose weight is causing concern. You'll probably know that not many people on this board are fans of Gina Ford, and nor am I , but even she states very clearly not to schedule if the baby is gaining less than 6 ounces a week. So reviewing the schedule might be something DW might want to think about - feeding often is something most of us have to do, to build up and maintain a milk supply and to ensure it gets into the baby!

Switch nursing is an effective way of upping the volume of milk going into the baby - and upping the volume is more important than whether she stays on long enough to get fattier milk, which is not related to time on the breast but the degree of emptiness of the breast. So if switching has helped, then continue it. She can also try breast compression (google, with the name Dr Jack Newman) when the baby loses interest.

But above all - she needs to feed more than 6-7 times in a day. 11.30 to 6.30 is a l.....o.....n.....g time at night - would not be a problem if she was gaining half a pound a week, but she isn't, so if DW can bring herself to wake for a further feed in the night while this issue remains, it will help.

The chart, by the way, is not based on bottle fed babies, but on a mix of babies whose feeding was not differentiated. There's not a great difference between the standard chart used in the UK and the WHO charts used for bf babies, at this age. It's only later that the gap starts to show.

HTH

I've got to go home now and cook DW's tea while she feeds DD . I will have a longer look at everybody's responses later - thanks very much to all of you.

"11.30 to 6.30 is a l.....o.....n.....g time at night - would not be a problem if she was gaining half a pound a week, but she isn't, so if DW can bring herself to wake for a further feed in the night while this issue remains, it will help. "

Sorry, I don't agree with the person who said this - if a baby sleeps so well at night it's probably becuase she is feeding (relatively) well during the day. I have a baby who has been slow to gain weight and I know this from experience. You could end up with the nights becoming more broken, getting more exhausted and consequently decreasing your milk supply even further.

If you can face doing night feeds fine - but if not I would suggest trying to give longer feeds and more frequent feeds during the day, perhaps cutting one of the baby's daytime naps a bit shorter?

I have done all these things for the past 2 weeks and my baby has gained 1 lb during that time - previously she only gained 13 0z in 7 weeks!

I'm also not sure about the advice to switch sides every 5-10 mins, I have always been advised to empty one breast first so baby gets the hindmilk which is richer and fills the baby up.

Hope this helps.