"Switch feeding" - a good idea or not?

[verylittlecarrot]

My tiny 9 week dd is very slow to gain weight, averaging just under 3oz a week. She has a good latch, and feeds enthusiastically for the first few minutes of each feed, but then she settles into lazy sucking with the occasional swallow...this can go on for 20-30 minutes, then repeats with the second breast. In the very early days of bf I worried about this "comfort sucking" but have subsequently chosen to go with the flow, as I believe she's still getting some milk when she swallows, and I guess it's still providing some stimulation to me. Feeds can take a long time but I just let her get on with it. I've never had sore nipples or discomfort from this, and during a long feed I'm aware of at least 3 or 4 let downs which get her gulping again for a little while. I tend not to interrupt her, although I try the usual tricks to keep her awake. Fedds roughly every couple of hors, sometimes goes a bit longer.

I have been advised today by a lactation specialist to "switch feed"; however I've tried this before and instead of awakening dd's interest each time I switch, she seems to get bored more quickly, if anything.

Is it really better to try to switch feed or should I just keep going at dd's pace, allowing her longer feeds on each breast and letting her tell me when she's done before offering the other side?

[AitchTwoOh]

do you do all that business of consciously relaxing your shoulders, having a cuppa, thinking about the baby, even looking at pictures of her, all that stuff? i found it made a difference. and you'll no doubt have read these articles already.
oh i hope it gets better, get thee to a CS person and see if they can identify anything that may be holding back dd's latch.

[verylittlecarrot]

Not only do I visualise, sniff babyclothes etc, today I reached a new height of creativity...dh off golfing so no spare hands to mind dd, so, bub asleep in sling, my boobs popped out on either side of head and electric pump doing it's business next to her ear whilst I stand and sway to keep her asleep. I could draw you a diagram, but people wouldn't believe me. Ladies and gentlemen, I give you...the freaky nursing, pumping, babycarrying, swaying, switchfeeding neurotic woman!!!! I got a bit more milk expressed today than yesterday so perhaps I should patent this method. Today has been a definite improvement on yesterday!

I used to be normal, you know.

Have developed yet another blocked duct today which hasn't cleared yet. Strangely, they always seem to happen after I try to pump. I wonder if the pump stimulates ducts which the baby doesn't quite get to properly. Baby carrot is currently doing her bit to help clear it. I think it's on its way out.

And I am definitely going to find a CO in Cheshire / Merseyside. There's on in Chester that I'll try to speak to tomorrow.

[AitchTwoOh]

i used to be normal too, carrot.

you are doing fucking fantastically well, you do recognise that, don't you? it's so overwhelming but you're sticking at it. you should be proud of yourself. whatever does happen from here on in, you've done your lunatic best. and i speak as someone who scissored the nips off a bra (now that is an odd moment) to better facilitate double pumping...

[welliemum]

verylittlecarrot, you are fab!

respect to aitch too, who really knows her onions as you can probably tell!

[cmotdibbler]

VLC - have you got the soft plastic bits (I think they are called the comfort shields)that fit onto the hard plastic collection thing of the lactaline ? I find that I can't pump without them, and its certainly uncomfortable without them. Fiddling with the suction and rep rate to find one that suits you helps lots. Also doing breast compression whilst pumping increases the amount out. You might want to give hand expression a bash too - some people find it much more effective. Expressing really is a bit of a learnt response, and gets easier each time I found.
Interesting mental picture of you pumping around bub though !
Big respect to you for keeping going.
Normality is way overrated in my opinion. Not sure I ever was though..

[teabag007]

For me, yes, I also struggled with expressing anything very much to start with. I have tried manual pump and got zilch (really nothing) every time so I haven't got the hang of that at all! Hand expressing is what I've therefore settled for as over time I've managed to build up to collecting 4-5oz each morning. May try electric pump at some stage...

I started trying to express from about 3 weeks with pretty pathetic results initially (1-2oz max after expressing all day whenever baby teabag not feeding). I have had to spend a lot of time expressing to build up to current situation - fortunately, with no other children and me being very slack with regard to anything else that needs doing, I have had the luxury of time to spend days pretty much purely feeding and expressing! I worried at times (still do!) that I was expressing what baby teabag would need for next feed. When this has been the case, I have just let her keep feeding (could be hours, but we were doing that anyway!), with constant switching and me pummeling breasts (room for improvement on technique here I'm sure) to try and help with flow.

So in summary, lots of expressing over several weeks to get where we are now.

On the weighing front, I went along once at about 9 weeks to weekly clinic to see HV, more out of interest than anything else, but the queue was out the door and didn't want to wait around. We had seen the doctor at 8 weeks for check up so I had been reassured by that - doctor did ask how much she weighed and I told her I didn't know but she wasn't concerned having checked her over. (I had also seen many posts on here about HV recommending top up which probably made me wary but had I had any concerns regarding her health, I would have taken her in to GP/HV/clinic).

We're off for second jabs today so I might see if I can get her weighed then out of interest more than anything else!

Keep up the good work and good luck!

[verylittlecarrot]

A little update on baby carrot. Took her to be weighed today, mostly because I wanted to see whether upping my efforts over the last couple of weeks had helped her gain a little more. I've been:

taking fenugreek
eating oats
drinking enough water
switch nursing
feeding 2 hourly
co-sleeping / keeping nightfeeding going well
pumping
slinging
breast compressions

And as a result, I've had blocked ducts 3 times so have stopped the herbs/ pumping temporarily. (actually, every time I've had blocked ducts I've been able to relate it to recent pumping; anyone else had this? )

And baby carrot has dutifully gained her standard 3 oz a week - again.

My HV wants to refer us to the GP - again - due to the continuing slide down the centiles. I pointed out to her that since dd has always averaged 3 oz a week, and seems likely to continue this trend, dd is very likely to continue to slide, probably right off the bottom of the chart and I doubt there is much I can do about it. In EVERY other respect little carrot is scrumptious and happy and doing everything you'd expect. Yet although the HV concedes this, she says she is worried about underlying causes of the poor weight gain; when pressed on what these might be, she suggested heart murmurs, gluten intolerances (?) as examples.

DD has seen 2 GPs in the last month, both have been OK with her. I've explained that I don't want things escalated to a situation where I'm potentially being told what I must do by someone not knowledgeable about bf, especially if there isn't anything that can be diagnosed as a genuine problem.

However, nagging doubts lurk as always. How long can we sustain 3oz a week before I really should get things checked out? Or can we just go on like this indefinitely and slide off the bottom of the charts happily as long as nothing else seems wrong?

DD is 11 weeks old today (although we correct this by 3 weeks as she was early) and weighs only 8lb 8.5 oz.

I know there are numerous threads on slow weight gain, so I apologise for being repetitive. However this doesn't seem to have an obvious underlying cause, so I'm at a loss to know what to do next!

[duchesse]

Both my daughters grew 2oz a week. The only difference (for me) was that for the first one I was made to feel paranoid anxious and slightly depressed, and for the second confident and secure in the knowledge that her growth was absolutely normal for her.

My daughters are now 12 and 10. First one is 1m44 and weighs 35 kg, second one is 1m30 and weighs 30kg. Neither is huge, neither is skeletal. They are both in rude health.

I jsut wish I'd been confident enough with the first one to be more laid back about it. Easy to say now, I know. If you believe that your baby is healthy, is having the right number of wet etc nappies daily, please try not to let the HV get to you.

[halogen]

My daughter was slow to gain weight and always has been, even though she seemed to be feeding efficiently and well and I had no pain which people always say is the sign of a bad latch. Are you small yourself? Could it just be that your baby is destined to be petite (hardly the worst thing that might happen to her)? Because we were threatened with doctors etc as my daughter slid slowly down the centiles from the 25th to below the 9th until I threw a complete wobbly and pointed out that I didn't think I'd ever been anywhere near the 9th centile in my life and her father only weighs 9 stone and is a man. There was a bit more shouting involved than that. Also, you know, some people have to be in the bottom centiles, that's how it works. You can't have a chart with nobody below the 9th centile (or whatever arbitrary centile you're deciding means a child is underweight). If she is happy and cheerful and pooing/weeing, then maybe it's time to look at the bigger picture and sod the charts?

I haven't actually been back since she was five months old as they made me so cross and she's perfectly fine.

And so sorry to hear about the funeral. Your poor poor friend.

[purplejennyrose]

Hi
does she bring up much? My DD was similar at this stage - slow weight gain, but in other respects fine except for really bad bouts of 'colic' and she would NOT be put down or even held lying flat - had to be at least semi - upright. She was a very sicky baby which everyone said was normal but at 8 months when she was projectile vomiting continuously she was diagnosed with reflux. Just a thought.
Otherwise, she and you sound fantastic!

[prettybird]

I've posted many times about my ds' slow weight gain and his progression down the centiles from 91st dwon to just under the charts, which he followed for a while until he staerted creeping back up.

Fortunately, my very supportive midwic=ves/breastfeeding counsellors agreed that he was most definitely not a failure to thrive baby, and although they did refer him to the consultant paedicitrican (who I saw wehn he was c. 7 weeks and who agreed that there wasn't a problem), they never gave me anyu hassle, only support.

I'd have killed for a steady 3oz a week gain!

It sounds like you know that your dd is fine, - petite but beautiful. You have more common sense than the HV. Don't bother getting her weighed any more - and look at your dd as a whole to decide if there is anything to be concered about. Two GPs have already given you the answer.

[Mossy]

VLC, where in Merseyside are you? I know fabulous breastfeeding specialist at Whiston Hospital. I am going there on Friday morning. I can also take my red book to show you if you like so you can have a look at my ds' erratic and slow weight gain... he is on 0.4th centile... and show you how healthy he is, meeting all of his "milestones" etc.

And take a look at this article about looking at the baby and not the weight gain. It has given me a lot of confidence about ds' drop down the centiles / slow weight gain.

I am off to bed now but if you are in Merseyside and want to come along, email me msrlmoss AT hotmail DOT com and I'll email you back with times and directions etc. (Well, okay, I am non-driver so rubbish with directions but can do my best).

[verylittlecarrot]

Thanks ladies:

Duchesse, it's so reassuring to know there are others with teeny weight gains who are in great health. Thanks - and congrats on what sounds like two lovely daughters!

And Lucicle, you're right, I think dd is destined to be long and skinny. I'm 5'7'' and was skinny pre-pregnancy(!) and dh is shortish but stocky - who knows what to make of that combination!

The HV's concern is not that dd would be on the lowest centiles, but that she started higher and has dropped, instead of following her line. I think I'd be more confident about this if I didn't keep reading how unusually low her gain truly is from websites whose info I respect, such as Kellymom.

I'm going to try to start lecithin to avoid the recurring blocked ducts, so that I can start pumping again to boost supply (although I'm not convinced I have really got supply issues, still...)

Hi purplejenny - dd doesn't really sick up often, and only tiny amounts when she does. Same as yours re the "don't lie me down flat" though! Thanks for the encouragement!

Oh and Aitch - forgot to mention, took her to a cranio last week! Cranio thought she seemed pretty great, but perhaps was "stretched out" a little . Will try another visit this week. She didn't feel in the baby's mouth though? I'll mention that to her this week.

[Mossy]

You did say Merseyside / Cheshire didn't you? I'm not going mad am I?

Right off to bed before I start assuming everyone on here is near me.

[prettybird]

BTW - ds is now 7, and follwing jsut below the 50th centil for both height and weight.

He continues to be *extrmely healthy, loves running around and is doing well at school.

[prettybird]

The HV is talking through her arsesorry) re her concern about the baby starting on a high centile and then dropping. The centile a baby is born on is more a reflection of maternal health etc (in fact I suspect I was borderline gestational diabetic, as I had a lot of urine sugar but never blood sugar). Once they are born, they then have to "catch down" or "catch up" to their genetic growth curve.

No-one ever boths about high weight gain - but they do seem to get upset abut low weghit gain withut looking at the healthy of the child in front of them.

As you have said - both of you are small (as are dh and I) - so what do they expect?

The probelm with "catch down" growth is that the baby then spends months first of all "catching down" and then, becasue they have slipped of the standard timings, then catching up again.

I alwys knew that ds would end up on the 50th, as they is where I'd have expected a combination of dh and my genes - and gues what? By a year old, that's exactly where he was!!! Actually, it's only approximately about then, as I only inferequnetly weigh/measure him

[duchesse]

Absolutely Purplejenny. I reckon about four months for my babies to regain their natural curve. (just checked their red books)

Both were born weighing 7.5 lbs (about 50th centile), and joined the curve they were destined to stay on at around 24 weeks of age. In one daughter's case this was part way between the 3rd and 10th, and in the other one, below the 0.4th. Yep. And she has hardly ever had a day's illness in her life, is supernaturally bright, and eats like a blooming horse. Only with more meat. Than a horse I mean. Eats more meat than a horse.

[duchesse]

I mean Prettybird.

[verylittlecarrot]

Interesting comment about the borderline gestational diabetes. I scoffed tubs of Haagen Daz daily throughout the last trimester and was spilling a lot of sugar into my urine. Gained 4 stone - OMG - over the pregnancy and consequently still wearing maternity pants .

Mossy - I've emailed you!

[Mossy]

VLC no email yet... it is msrlmoss @ hotmail . com - take out the spaces, make sure it's .com and not.co.uk.

Prettybird I didn't realise that, it makes perfect sense though - I ate so much crap in my third trimester that I put on about four stone and still have to shift the majority of it!

[prettybird]

They picked it up early wioth me and my GP told me I had to watch my sugar. I had only just started drinking full fat Irn Bru (diet Irn Bru is nowhere near as nice) and eating sweets without guilt

However, I decided that Magnums didn't count as sweets!

[verylittlecarrot]

FURIOUS WITH MY HV TODAY - ADVICE PLEASE!!!

We've just had a call. Against my wishes, my HV has referred us on to the GP who has referred us on to a paediatrician - the hospital is expecting us today.

Yesterday I asked her - and she agreed - not to refer us on and escalate things, so she said she would simply "mention it" to the GP - the one who gave Lulu a clean bill of health 2 weeks ago.

Betrayal of my wishes? So now I'm forced into a situation, where, if I'm not lucky, I might find myself having to receive crappy feeding advice from someone "authoritative" who feels we must change things. I feel the need to go armed with appropriate bf medical guidelines/ papers in case IU get told to top up with formula.

HELP please.

I had a bad experience last time with the paediatrics department...The last time we saw a paed was 2 days after dd was born. I went in for bf advice because she was a little jaundiced and sleepy and I was made to feel concerned about her blood sugar by my mw. the paed left us with a crappy SHO who left us sitting in an assessment room for 6 hours till after midnight, and did repetitive heel pricks. I had to search out a mw myself to check the latch, and we left after the SHO told me he wanted to do another heelprick "1 hour PRIOR to her next feed" WTF? When is that exactly with a newborn fed on demand? The SHO didn't even bother to discharge us, he sent a message with a nurse to say it was OK for us to go, but then wrote a letter to my GP saying we had ignored his meical advice. I complained to the paed he worked fgor and she wrote another letter to my GP correcting the situation.

I don't have high expectations. I actually feel sick and angry about this.

Please help - Tiktok / hunker, mears???

[tiktok]

Oh dear.....can I make a practical suggestion? Just assume (or try to!) there has been a mix up in communication, and call your HV, and ask (calmly and politely) what's happening. You do not have to go to the hospital - it may not be convenient at such short notice, anyway.

Here's a sample script

VLC: oh, hi, [name of HV].....Carrot here....glad I caught you, just needed to check something out with you.

HV: Hi, yes, how can I help?

VLC: I've just had a call from the hospital...it's actually not convenient for us to go today, so I can't attend, but I needed to check 'cos we agreed, didn't we, that Baby Carrot didn't need a referral, and we agreed this would escalate things....is that your recollection as well?

HV: yes, I think we agreed I would mention it to the GP....

VLC: yes....I was ok with that. Something's gone wrong, I think, with the communication in this, just thought you'd like to know!

Now, the HV may say her 'mention' has led to the GP making the referral or suggesting the referral is made, and you can calmly, say you feel disapppointed that your wishes were not respected, but you are happy to see the GP again, the one to whom things were mentioned, and to talk it over with him/her, before any further discussion of a referral.

How's that sound?

[verylittlecarrot]

Thanks Tiktok - but now that thw wheels have been set in motion I imagine seeing the GP again will just be a delaying tactic. I have called the GPs(on lunch), waiting for a return call, to speak to the referring GP and see why she now feels this is necessary (without seeing dd). Also my husband thinks we should go as he is convinced the paed will give us a clean bill of health and send us away - I agree that this is what SHOULD happen but am not so optimistic.

Assuming we go- what would your advice be?

[tiktok]

I think you can fairly confidently assume the paed does not know much about breastfeeding. This does not necessarily mean they are indifferent to mother's feelings about it or unaware of the health impact of infant feeding choices - they just have no clue about how it works and how to support it.

This can be a good thing, as they sometimes concentrate on what they do know about - poorly/disabled babies - and when they see a baby who is clearly not poorly or disabled they do indeed send the mum away.

OTOH, they can be fairly cavalier about 'ordering' formula, as when they see a baby who is clearly not poorly or disabled but just small....I think the brain process is 'this baby is fine, but rather small...we can try to fix this by shovelling in more calories.'

So you will need to arm yourself with some questions:

• I intend to add solid food to my baby's diet at the appropriate time, around six months. Will this not permit her to have a more calorific intake then?
  
  
• what do you think I am risking healthwise if I don't give her formula?
  
  
• does this take into account foregoing the health benefits of exclusive breastfeeding and indeed my own choice to avoid formula ?
  
  
• is it possible my daughter's growth is physiological for her?