Breastfeeding Baby has not gained any weight

[chelsea2704]

DS is 8 weeks old and I have been EBF. He had tounge tie until 3 weeks and then we had a nipple shield so did not have the easiest start to BF. We have today had the 8 week check and doctor tells us his weight is 8lb 7oz which is less than his birth weight :( (8lb 9oz).
He feeds usually 6 times a day between 20-30mins, using both breasts. Very rarely sick, plenty of wet nappies, sleeps well, has grown since birth and outgrown newborn clothes.. the only issue we have is that towards the last 5 or 10 mins of feeds he latches on and off every 30 secs which I thought was because he was full! I now feel like a crap mum as he clearly isn't getting what he needs :( I really don't want to stop BF yet...How can I help him to gain weight???

@QualityFeet I don’t feel attacked at all, it is a rare issue to have come to that conclusion, but nonetheless I hoped my story would encourage the OP to trust her own judgement somewhat and not to scare her into thinking her milk was the issue. We had many many issues that went along with my daughters failure to thrive, and plenty of observation and daily weigh ins etc. It was a long and hard road that would have been made slightly easier by me trusting myself and my judgement over a professional health visitor. It was a very stressful period, and I felt I was doing the right thing by listening to her tell me to just keep doing what I was doing.

Try with an extra feed during the night as he’s going a long time from 10pm to 3am, so try one around 1am as during the night this is when prolactin is at its highest (milk making hormone), and the more you empty and remove milk from your breasts the more milk is produced.

During the day try and feed him every 3 hours, and let him feed on one breast until it starts to feel empty before swapping to the other (probably about 20 minutes or more) then start on the breast you finish with at the next feed. The first part of a feed is more of a watery drink so if you swap too early to rye other breast your baby doesn’t get the fattier more calorific milk.

Most babies do prefer one side, and some women indeed do just feed from one breast. It could be when you start on the breast he doesn’t prefer that the flow is too fast, so you could try hand expressing a bit off first to see if that helps.

I’d agree with the posters recommending more calories and more frequent feeds but I’d also add that you need an urgent medical review. I had this with my daughter and we had full paediatric review and an echo as it turned out she had a heart murmur. I’ve also known babies where slow weight gain was the first sign of a rare metabolic disorder.

No weight gain in 5 weeks is a huge red flag and suggests either faulty weighing or insufficient calories for his needs. The question then is are his calorific needs particularly high for any reason.

@chelsea2704 try feeding your baby every 3 hours, and add an extra feed during the night as he’s going a long time from 10pm until 3am. Also try feeding on each breast until they feel empty like I mentioned above.

Babies are meant to wake during the night for feeds due to the breastfeeding hormones are at the highest over night.

Speak to your HV or local breastfeeding support group if you need some support as GPs generally aren’t great with breastfeeding support.

If you feel your supply is low and you feel empty when feeding, you could try expressing, however please don’t worry if you don’t express lots of milk babies are generally more efficient at getting milk than expressing can achieve. Also make sure you’re eating and drinking properly, you can eat 200 extra calories per day when breastfeeding and this will help with your supply.

www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-help-support/

I absolutely agree that your care should I have respected your opinion. You felt you needed to supplement and should have been supported in doing so.

Your care sounds busy but again makes me feel that women don’t get the right support. The most important principle is that it should I be mother led. Well informed should be the other part and it sounds like your hv failed on both counts.

Your baby had ‘faltering growth’ rather than ‘failure to thrive’ which hasn’t been used as the official term for at least five years. Those logs that were kept don’t give as much info as a conversation with the right questions. A baby that only feeds in one hold very rarely has a good latch and fat ratios in milk are determined by many elements but happen reliably as an intrinsic part of the process that allows milk to be made. Actually fat ratios don’t even correlate to weight gain - counter intuitive as that sounds- but volume is the key predictor. That in itself speaks of the reliability of milk formulation as does the reliability of breast milk as a driver of good eye sight, cognitive development and vitamin delivery - it’s the fats that deliver on all of these. Your baby wasn’t getting enough to have happy guts and slow gastric transit - there are lots of clues as to why. And I emphasise this as part of the same objective that you had to reassure women that there is nothing up with their milk or with the decisions they want to make about how they feed their babies. I will shut up now:)

I had a failure to thrive baby. The HV lent me some scales. I had to weigh her before and after every breastfeed. I wrote down the amounts, which was the weight gain from the feed, and she had to agree that my baby was getting enough milk.

@QualityFeet I think we are agreeing to disagree, but absolutely failure to thrive is still used, as least as of 18 months ago and in my daughters medical records. Like I said. I can only state what reasons were given to me, her latch was checked repeatedly in many positions but unless it was a rugby hold she wouldn’t happily settle into the feed. She would still feed but with squirming. Laying down in bed at night was also successful, and when she could stand so was the bouncing all over my knee method babies seem to enjoy with their little bums bouncing around. My whole point is I can only go what is on our medical records, and yes my health visitor was questionable but I had plenty of other good medical support around me.

OP trust your instincts, and insist on further help if needed. I can’t imagine going through this in a pandemic and you’re doing amazingly.

Yup am sure it is on the medical records but areas more in line with NICE guidance would have used the term ‘faltering growth’.

And OP the references to metabolic disorders/heart issues and other things like missed smaller palate clefts are something that is sometimes found to be the issue but what you are describing presents as a feeding issue not a health issue. The history is consistent and your hcp was happy with your baby’s health. The real worry is with babies who have are feeding brilliantly but still faltering - the most common medical reasons are still relatively minor.

OP, there is an awful lot of information and advice on this thread and unfortunately a lot of it is completely wrong. Following some of it, however well intentioned, could actually make your situation far worse.
If that weight is accurate (are you confident of that?), then the bottom line here is your baby urgently needs more calories and medical attention. You don't mention dirty nappies? A lack of these would be another sign that LO isn't getting enough.
Please don't leave this until Monday and another visit to the GP. Call your health visitor first thing in the morning. Get in touch with a local IBCLC. Personally, I would be taking LO to hospital.
Don't be fobbed off, don't take no for an answer. You have been horribly failed by the people who are supposed to be caring for you and I feel desperately for you - the fact you don't appear to realise how serious this is, is another example of how you have been let down.
But you are going to need to take charge of this and get you and your baby the help you need.
Good luck.

@QualityFeet they used failure to thrive with my son too. That was 3 years ago. It's all over his records and was used by more than one of the doctors we saw

Yeah it speaks volumes about how slow some places are to take on NICE guidance and updates. Where I would have been working then it would have been a red flag that you were a bit shit and behind the times

I agree with previous posters, try feeding more often, wake to feed at night if necessary and try breast compressions. You could also try a ‘babymoon’, go to bed and have lots of skin to skin and feeding.

However, I echo what previous posters have said about getting a medical review. Slow/lack of weight gain can be caused by something as simple as a UTI.

My third DD had not regained her birth weight by 6 weeks. My elder two were fed until they were two so I knew it was not a supply issue. My younger one appeared to be feeding well but just was not gaining weight, dropped from 75th to 2nd percentile. Turned out she had a rare genetic condition. Once on medication she rocketed back up to the 75th with a month and we continued to bf until she was 2.5.

How are you getting on @chelsea2704 ?

Hi all. After a very stressful and worried week, he now weighs 9lb 3oz! A huge gain.
He wouldnt take the breast by weds last week so we moved to expressing then added formula too as I couldn't express much - probably due to stress! He is doing 7-8 feeds a day now half expressed milk and half formula. The GP spoke to a pediatrician who does not think DS needs any tests and we should just continue weekly weigh in's. He think the weight loss occurred after tounge tie cut due to DS adjusting to change.

To all to advised adding formula feeds, thank you.
I am so so sad that I am not continuing with breastfeeding and felt so disconnected from him over the weekend, the stress of it actually made me ill yesterday and partner had to do all feeds, the GP said we can keep trying to get him back on breast which I will do but I also think I need to just accept he is a bottle baby now as I get so emotional when I think about breastfeeding being over for us which I don't think helps my supply for expressing!

Any tips for keeping the formula down?? We keep him upright after feeds for 20-30 mins but at least twice a day he brings a good amount back up!

ALSO can I pre boil the water for making up powered feeds and keep on the fridge??
(It says on powder box to boil kettle and wait 30 mins but I don't see how that's going to work when baby wakes up hungry in the night!)

Hi, Chelsea. I’ve been alerted to this thread as in the past I have contributed quite a lot and maybe I can help. I’m a former BFC.

It is good news your baby has gained weight. You’ve had a hard time since the start, from what you say - poor support and confusing info. Some of the replies on here are a bit contradictory and sometimes incorrect though obv all well meaning. Your head’s prob been spinning.

When babies don’t gain weight as they should, there’s usually no underlying issue, though it’s always good to check that out in case there is. Usually, it’s a question of milk intake. If milk intake needs to increase then obv formula or expressed is an option, if I take can’t be increased quickly by direct bf. Expressing is difficult for many, and this is where formula alongside bf can help, as you’ve found.

If you’re keen on continuing to bf, then it will be important to have a plan. It’s not correct that giving formula at this stage will not impact on your supply. Breastfeeding needs to happen a lot - prob 8 times min in 24 hours. Both breasts at least once each time - it’s called ‘switch nursing’ and you can look it up. Some of the info on foremilk and hindmilk on this thread has been wrong, I have to say. Don’t be too hung up on it - feeding often and effectively is the way to go.

More than this, though, it’s good to get one consistent informed person on board to help. I’d suggest an experienced BFC or a lactation consultant, someone who knows about bf challenges and who can also gauge if your baby needs a clinical assessment, too.

Post again if you need help to find someone like this if your HV or other local contacts can’t tell you.

Best of luck. Armed with a plan, and support, is best 😀. Too many voices, inc mine, are less likely to give you the right help at this stage, I think.

Your HV should help with the formula instructions. The key is to add hot water (no less than 70 deg C) to the formula and then let it cool to drinking temp. No, don’t boil and keep in fridge - it has to be hot for safety’s sake to nuke the bugs in the formula. You don’t have to cool it for 30 mins - just no longer than 30 mins. You obv need to wait until the milk cools, in the bottle, before giving it to your baby 😀

Oops, sorry, me again! You can use ready to feed in the night, when your baby wakes and can’t wait.

But you don’t need to give up on the idea of bf, if you don’t want to. It’s not too late. Clearly you will need to maintain ff though until your baby ‘s weight is not a concern.

Just wanted to add a virtual hug for you OP and a voice of support for TikTok - she was absolutely brilliant for both my kids, fantastic advice. Eldest is now 12 and at secondary school :)

Ooh ta, Bertie 😀❤️

When we did mixed feeding, we made the bottles up from scratch with hot water about an hour or so before the feed, as we found that was enough time for the feed to cool and you weren't stressing trying to get one done.

Earlier when we were still doing top ups after each feed we did ready to feed formula, which we tended to use about half a bottle/carton of at a time, and would leave the other half in the fridge, dated, for next time.