Slow weight gain - difficulties topping up

[ElusiveNinja]

Hi everyone,

I have a 10 week old baby who was born 8lb 4, managed to get back to her birth weight by day 12 and it all seemed to be going great. At the 6 week check it transpired that she has not put on much weight and weight gain has been slow since. She went from the 86th percentile to the 21st and has been referred to a paediatrician, who suggested topping up with formula. I am ebf and agreed to try and top up with expressed breast milk rather than formula and keep weight in check. They believe it is an issue with my milk supply. I am also in touch with NCT and a breastfeeding counsellor who doesn't believe I have a supply issue and we are working on improving latch and squeezing in one more feed. Currently feeding every 1.5 -2.5h daytime and 4h nighttime about 10 feeds a day.

I have tried offering the bottle after feeds but baby only plays with it most of time and doesn't drink. So my milk goes down the drain! She only took it a couple of times when she was fussing at the breast with little milk coming out during a cluster feed and she actually was still hungry. I am confused and not sure whether the top ups are necessary if she refuses them but also want to support her weight gain. She is cutting through the growth chart and I am hoping she will settle on a curve and start following it soon...

I have very stressed by all of this and unsure what is going on and who to listen to. I feel like I am failing my baby for not being able to provide her with what she needs to thrive...

My instinct is that she is fine and doing well but concerned she is not getting enough calories through the breast and I am struggling to top up. Any ideas about what I could try to encourage her to take the top ups? Or just follow her lead and let her be if she refuses them?

Baby is producing 5 nappies a day and seems alert and active, not a great sleeper during the day so probably burning plenty of calories! She has reflux and throwing up milk after some feeds adds to the problem I am sure.

Thanks for your suggestions!

I was going to ask if she had reflux, but I see you said she does.

It is very very common for ftt due to reflux to be ascribed to a supply problem. In my case, I gave myself mastitis twice trying to increase my supply. My supply was fine, but because ds had reflux he never filled his belly as he associated it with pain. So he had a million feeds, but never had enough.

Have you tried cutting out dairy and soya? That can help, as can all the reflux management techniques. But if it doesn’t, don’t let them fob you off, get the reflux treated. Ds went from being off the percentile charts he was so thin to the 90th percentile in six months once we finally found a doctor who understood reflux and got him the treatment he needed.

Thanks @CatherinedeBourgh, I will try cutting out dairy and soy and see if that helps.

I am glad you finally managed to find someone who could help. The Dr told me to burp and keep her upright and I am now pretty much living with her on my shoulder or sling but that doesn't seem to make a big difference. They mentioned Gaviscon may be an option or thickened formula to help stomach content to remain down. Was this what was prescribed to your son?

A couple of things that might help are:

Getting her checked for Tongue Tie-

This article from Kelly called how might I increase my baby's weight gain and

Dairy and other food sensitivities

My DD was born at 8lb 3oz and dropped a couple of centiles but then stayed there and has done ever since. She's a teen now. Sometimes they just find there natural centile and stay there

Very good articles, thanks @BunnyRuddington! No one has checked for tongue tie...the breastfeeding counsellor said it may be worth investigating if bf management alone doesn't improve things.

I really hope DD settles soon on a percentile like yours!

He was put on omeprazole and metaclopramide (sp?).

With ds2 we managed to avoid the meds, but he wasn’t dropping off the charts.

Not nice to give meds, but when you need them, you need them.

Ds1’s consultant also made us give him a little bit of thickened expressed milk before every feed, to provide a bit of ballast for his tummy. Gaviscon did nothing. We also weaned him early (under the consultant’s supervision).

I’m sorry you are going through this, I know how tough it is. Don’t let them make you feel guilty, I don’t know why some hcps do this, it’s not your fault your baby had reflux!

Few things: how was baby born? C-section or did you have any fluids in labour, it can inflate birth weight?
How big are you and baby’s dad? Catch down growth is a thing.
So reflux tends to be a symptom of a problem rather than the actual problem itself.

Did you HV refer you to the infant feeding team? They should have over a paediatrician who often isn’t trained in infant feeding at all.

My first thought on reading your post was tongue tie, milk transfer and positioning and attachement. Tongue tie will affect all of those. Often tongue tied babies do well at the beginning when milk production is hormonal and mum has a good let down, they start to struggle when milk supply regulates. Reflux is really common with TT as they take a lot of air in when they feed.
I’d ask for a referral to the infant feeding team, they often have an IBLBC who can spot a tie. Do not take the word of a GP, midwife, health visitor or even a paediatrician if they say baby doesn’t have one, they just don’t have adequate breastfeeding training.

If you have the funds I’d contact a private TT pracitonner and see if they can assess baby. There are some good and not so good ones, I’d join an Fb group and see if anyone can recommend someone good in your area

@Kanfuzed123 thanks for your response. DD was a natural birth at 41+3 so had some extra time to fatten up and had a growth spur in the belly around 38 weeks going from the 50th to the 86th percentile (not an exact science I know but confirmed by scan). Both Dp and i are on the small side 5ft 3 so there may be indeed some catching down to do!

I am not sure which team I was referred to by the GP but the paediatricians kept saying that they are not experts in breastfeeding so doesn't sound very hopeful if this is the infant feeding team and there is no one else they can refer me to for support around breastfeeding they said. Formula top ups were their first suggestion. not against them but looks like there are other options worth looking into in the first instance.

I was told there is a tt service at another hospital and will ask for a referral at my next appointment, if waiting times are not huge, otherwise look at private TT specialists in the area.

Thanks for your supportive words @CatherinedeBourgh, so difficult not to take it as a personal failure - especially when the paediatrician tells you that the baby has reflux because you are not burping her properly and that you probably didn't realise that your baby is still hungry after feeds due to your low milk supply!

When I was eventually able to get to my consultant, who was from a different country (I was in France) and I told him what I’d been through, he said ‘oh, yes, French paediatrics. If in doubt, blame the mother.’

It was all I could do to avoid bursting into (relieved) tears.

I doubt it was the infant feeding team you were referred to, they tend to be midwives or other health visitors. The health visitor might be bullshitting you on them, most areas have them. Could try just googling xyz hospital infant feeding team. I just had my second and in discharge I asked to speak to the infant feeding team and the midwife came up with some much bullshit to not let me see them and they literally were at the end of the corridor. I struggled with my first breastfeeding too and the HV never suggested the infant feeding team.

Nhs tongue tie waiting times are insane and often the service is subpar too, if you can afford I’d go private. There are some decent Fb groups, post in their and ask for a recommendation. Where août are you based? Maybe someone on the thread can recommend?

The more I read your posts the more convinced i am your baby has some oral restrictions and you need support with latching.

My dd was severely tongue tied and my family apparently heal like crazy so it re attached. She was never satisfied after a feed, due to her ties she was only ever able to get the letdown and not the thicker fattier milk that comes towards the end of feed, she was gassy, refluxy and static weight. No one ever mentioned a tie until I posted in a group and I was recommended to get an IBLBC

I checked on Google and there doesn't seem to be an infant feeding team at that hospital...not one with the best reputation in general I am afraid. The hospital where I gave birth has an infant feeding team and could ask for a referral there. Looks like it may be best to go private for TT assessment in any case to speed things up as it would be good to know if it is an issue at all asap so I can start to eliminate potential factors. I am based in North London, if anyone knows a practitioner. I am also part of a NCT feeding fb group and I am sure I can find someone reliable by asking there if no one on the thread knows someone local.

Have a look at this list of Tongue Tie Practitioners, if you haven't already.

Definitely sounds like it's worth ruling out