3 week old slow weight gain

[Afsgh]

3 week old weighed yesterday and still not returned to birth weight (born 7lb9, dropped to 7lb1.5 on day 10, yesterday 7lb8.6). FTM and something doesn't feel quite right with feeding, some days it is quite painful but then that clears and other days it feels as if my supply has dropped, so I'm worried that he's not getting enough milk. Several midwives have observed feeding and said that latch looks fine. LO will feed for over an hour and despite falling asleep, wakes and wants more food almost as soon as he's been put down. The last few days, and at night in particular, he has also started having long bouts of hiccups and grunting and he seems to be in some pain. Midwife did not seem overly concerned as he is alert for periods during the day and has plenty of wet and dirty nappies so they've just said that they'll be back to weigh him next week.

Can't help feeling that something isn't quite right and that I'm letting him down. Really want to get to the bottom of it and make sure he's getting the best start. Any advice welcome!

Are you able to pay for a lactation consultant? I'd be concerned about the lack of weight gain. How are nappies?

There is something not right here, and your midwives' non-chalant attitude really annoys me, as a midwife and lactation consultant myself!

I echo the above poster. You need professional advice- someone to sit with you for a long period of time, assess a feed, assess oral function (tongue tie etc) and go over the entire history with you.

Is there an infant feeding team at your trust? Could you pay to see a lactation consultant? Are there any BF clinics nearby?

I have a 5wk old and struggled with latch and pain at the start and though there were no weight issues the midwives were still bringing me in yo clinic every 2/3 days to check on baby's weight and how I was doing. The best help I had was from a local breastfeeding group on a Zoom meeting. Maybe check if you have a group and try the National Breastfeeding Helpline 0300 100 0212

Also, could the extra feeds be cluster feeding?

Has anyone checked for tongue tie? That can lead to inefficient feeding. Is there any sickness or anything to indicate reflux, which can also mean poor weight gain? If it's reassuring at all, both my DC took 6 weeks to regain birth weight! They were a bit heavier than yours at birth though.

Thanks all. I went into the birth centre to have feeding observed by a midwife on Friday to make sure that we weren't doing anything wrong/there wasn't an easy fix. They were generally happy with latch, position, length of feed etc. and gave a few tips to try to ensure LO is getting as much hind milk as possible towards the end of a feed. Overall, they did not seem concerned, so I'm focussing on feeding and hoping by Wednesday that he will have put on more weight, otherwise will definitely consider going to see a lactation consultant.

What tips did they give on making sure baby gets the hind milk? A constant worry of mine!

@Afsgh make sure they check for tongue tie as that can hinder successful latch, milk transfer and increase pain.
@Funauntienowmummytobe if you keep baby on the boob long enough they will get the hind milk. Also breast compressions during feed. If you need to burp baby in between feed and baby isn't long enough on one side, I'd put baby back on the same side. Sometimes green frothy poo can indicate foremilk and not enough hindmilk so I take yellow seedy poo as sign of hind milk intake. Kellymom is a good website for breastfeeding related issues.

Is your baby hungry?
If so, supplement with formula until you increase your supply.
Midwives may say no to that, but when it happened me, a Dr. advised it. I resumed breast feeding once my supply increased and dropped formula. Do both

Thank you @mishmased I do all of those tips but gad slight green in ppo anout 1.5wks ago, only in the morning for 2 days so made me worry!

LO will feed for over an hour and despite falling asleep, wakes and wants more food almost as soon as he's been put down.

^ my baby is still exactly like this at 14 weeks. She will basically want to sleep feed for comfort on me . The real feed ends after 5-8 minutes as she's a real snacker, but she can easily sit there doing butterfly sucks in her dozy sleep state for another hour if I let her.

She is gradually learning to come off herself after about 10 mins of butterfly sucks. If she comes off herself she will stay asleep. If I take her off I have to keep her upright for 30 mins at least and do some rocking and shushing initially or she'll definitely wake up.

The other thing is our babies need to establish our supply which takes about six weeks if all is well. It took 9 for us as we didn't have tongue tie assessed until 8 weeks after I felt things weren't right. Their best way to do this natural process is to feed feed feed, so I'd take your baby off, let them wake up if they do, and then feed on demand again. This stage won't last forever 🙂

I am in a similar position with my second baby - I fed my first for 2.5 years with no issue so this is a very different experience.

I have an almost one week old who has lost more than 10% and am seeing a lactation consultant later who I’ve already spoken to on the phone a couple of times. Despite regular feeds and plenty of wet and dirty nappies, he’s just not gaining weight. A traumatic birth via crash section didn’t give us the best start and I’m sure that some of the drugs /interventions I was given have made things harder. DS was initially very sleepy and not interested in feeding. He has perked up but weight gain isn’t following and I’m concerned both about supply and milk transfer.

I’ve been advised by the midwife to give top ups - expressed breast milk if possible but formula if not. So first a 30 min feed then a top up. Now also waking baby every three hours to feed whatever and doing as much feeding skin to skin as possible.

I was also advised to limit time in the breast to 30 mins (10 per side then return to the first side) as any more then this means they burn more calories than they are taking in.

I’m also trying to express as much as possible to help drive up supply and support top ups. I have a hospital grade rental pump coming in the next day or two.

Hopefully these will work together with an assessment of latch and tongue tie. Then I will drop the top ups and carry on just breastfeeding.

To be honest though, everything I’m being told is going against my instinct to just feed on demand. It’s really hard trying to implement a regime but the weight loss is too much of a worry and DS is now being weighed daily so it’s being taken very seriously.

Good luck.

OP where you've said that some days it's quite painful and other times it feels like your supply has dropped, can I ask if your breasts are feeling hard/full between feeds and if you're leaking milk?

When breastfeeding was going well for me (and baby was putting on weight) there was a constant feeling between feeds of a build up of pressure, so it was a relief when baby woke up to feed.

When things weren't going so well (a couple of bouts of mastitis) I was aware the full/pressure feeling wasn't there and I was getting through fewer breast pads.

I was advised to feed more often to get the milk supply going again - that the more you feed, the more milk you make.

Also, are you getting enough rest yourself? And eating and drinking plenty? If there's anyone on hand who can give you some help through these first few weeks (partner, mum, friend) do take them up on it so you can have the odd break.

@Afsgh how are you getting on?

Thanks for checking in. Midwife came today and DS has passed birth weight, although with a pretty small weight gain in the last week again, so we've been discharged. Hard to know what to make of it all, the midwife said that as he's happy and alert, with plenty of dirty and wet nappies, and is ultimately gaining weight even if it's slow weight gain, then I shouldn't be concerned and shouldn't look to top up feeds at all. She was of the view that the charts and weighing can make new mums stress unduly and that we both seem to be doing well (the pain when feeding for me has gone the last few days and I feel like feeding is going better in general). I'm still very conscious though that DS is still only gaining a little weight (60g over the last six days) and I want to be sure that he's getting what he wants and needs.

I'd see an expert and get checked for tongue tie. It took 5.5 weeks for my baby to regain birth weight....dr's midwifes etc all said he's fine, stop the top ups, he'll get the hang of it, etc etc. He didn't, I'm still topping up with expressed milk after each feed if I don't he stops gaining weight. We've had tongue tie snipped no one was able to diagnose until saw lactation expert. Make sure baby is weighed once a week, maybe health visitor would do it now? My baby was never hungry and upset he just took enough and no more, all his energy went in to feeding and not growing! Without regular weigh ins I didn't know how he was getting on. 10 weeks tomorrow, still struggling on with expressing...

@birdglasspen why do you think he isn’t getting it? Was it the tongue tie? How’s your supply?
It sounds a lot like where I am now with DS at 11 days old and I’m wondering if he will carry on struggling and never click with breastfeeding, or if my supply is just not enough. The constant expressing is such hard work too.
I breastfed my first for 2.5 years without any of these issues!

Sorry, have managed to make a new account instead of signing in! Oops. There are several reasons I've been given for my baby not putting on weight without top ups, he has a recessed chin, had tongue tie till 8 weeks and isn't latching on as well as he should. We are now at 10 weeks and although I am expressing less it is still a faff compared to bf my other two. I still believe things will get better as time goes on so will stick it out, I just wish I'd seen someone who really knew their stuff earlier on as we both probably have bad habits now! It is so frustrating but as I am learning every baby is different and our experience hardly counts when faced with a baby who can't feed efficiently! My supply has been fine thankfully, we have been doing top ups since day 3 and expressing since about day 5/6. I feel like the HV doesn't care now his weight is going up but I know if top ups stop then it will come down/stay the same again so I'm hoping infant feeding advisor has some more advice this week coming! Good luck!