5 week old bf baby not putting on much weight

[ILoveDigestives]

Hi, been lurking for a while, but decided to post for advice. It's on behalf of my dw, who is too tied up feeding most of the time to post!

Our dd is 5 weeks + 3 and was 6 13oz at birth - this dropped to 6 5 oz and gradually crept up (4 days ago was 7 1 oz) but so slowly that she dropped from 25th centile to somewhere between 2nd and 0.4th centiles. Always gaining, but never more than about 60g (2oz ish) a week.

She's feeding well (every MW or HV has commented on what a good latch she has) and she feeds often - feels like constantly during the day - she rarely sleeps during the day, but if left to her own devices would gladly sleep through the night (we don't let her go more than 4 hours - she never wakes herself). We never let her go more than 3 hours during the day on the rare occasion that she sleeps, but she often wakes within the hour, hungry. She posits a bit, but rarely any more than a mouthful or two (often an hour or so after a feed). Plenty of wet nappies, and the poos were very frequent until recently when she went a week without one (though it was soft and mustard coloured when it came). Other than that she is happy, strong, alert often, and was smiling (sporadically) from 4weeks.

We noticed that she tended to suck and swallow a lot for the first 5 mins or so of a feed, and then get in to a pattern of fast sucking (with no swallows heard) - often for 20-30 mins - she also tends to fall-asleep mid-feed. We tried breast compression and this improved it a bit, but only for a minute or two, and then the same. Still with no improvement on weight gain. If she finishes, then wants more within, say 10 mins, we offer the same breast first, than the other.

HV is concerned at the slow gain and the 2 centile drop and wants us to (everybody now) supplement with formula, which we are VERY resistant to. HV indicated that she thought we were starving our child if we didn't take some action so, after reading stuff here we decided to give expressing a go, since we are already feeding on demand. We got referred to GP, but GP was v.supportive of us, and encouraged the expressing approach.

So we started off trying to express after each feed to get any fat-rich milk left over, but never got much, if any. So added in an extra pumping session overnight to get an extra feed in (where we could see how much she was getting) and dw generally gets 3oz in one sitting (both sides) and tops this up with another session during the morning to get 4.5oz (ish). DD wolfs this down in about 10mins during the night (when she is normally really sluggish at feeding from the breast).

Now I know that some babies are just "slow gainers" - but what we are worried about is how we know whether ours is doing ok, or whether we are selling her short by sticking to bfeeding when she doesn't seem to be thriving. We don't want to go down the formula route but are worried that her feeding patterns from the breast are causing the slow gain - we don't really want to go with 100% expressing as dw is really enjoying the closeness of bf, and we don't want to lose that.

So, any advice, reassurance? Are we doing ok? We worry lots...

What a lovely DH you are posting for your wife. Firstly can I say that you are doing the most important thing ever by supporting her in her wish to bfeed - this is essential when faced with MWs and HVs with little bfing knowledge. At least your GP is suppotive.

You are right, some babies do gain weight slowly, especially small babies like yours. The important thing is that she is gaining consistently and getting the wet nappies. Frequent feeding is always going to be your best bet to put weight on and establsih supply. Your baby also sounds very active during the day which may slow down her weight gain - would she sleep if you took her for a long walk in the pram maybe? Worked with mine.

Anyway Tiktok will be along soon with technical advice but I think that you are doing all the right things and that you are right to not top up with formula.

BTW most babies will gulp down ebm from a bottle as it's quick and easy - not always because they are hungry.

What do other people think about the expressing idea?

Kind of bumping for Tiktok, hunker, et al, but wanted to agree with ll - babies breastfeeding will often be slower than bottlefeeding - it's quicker and easier, but also is not warm, cosy and skin to skin - the sluggishness is a kind of pleasant sleepy slowness - like lingering over a good meal rather than wolfing down a sandwich...

ILD, it can be worrying when a baby seems to need encouragement to wake and feed, and to grow slowly, but there's nothing in your post that makes me think there's anything actually wrong and if the HV thinks the only thing that's a cause for concern is lack of calories then you are dealing with this, with the extra ebm.

EBM is fine in these situations as long as it is in addition to lots of direct breastfeeding, and from what you say (I think) this is indeed the case....your wife should always bf first, and offer ebm afterwards when the baby's 'performance' at the breast seems to be faltering.

Babies sometimes do feed every hour, and a baby whose weight gain is a bit slow really should feed often, often, often, and often more freq than this, even....this is close to the physiological norm, by the way, and only unusual culturally!

I don't understand why you think she isn't thriving - at least, I do understand, because you have been made to feel worried about the weight. She is smiling, she is active, she is growing, she is excreting, she is relating to you, she is healthy. I do agree it is justified to give her every extra opportunity you can to take in more (breastmilk) calories, which you are doing (breast compression, freq feeding, ebm) and it seems to me to be sensible to give these measures time to work before assuming the only option is formula or 100 per cent ebm (and I really doubt either of those things will be needed). There's a slow weight gain thread here on mumsnet which might give more ideas, too

Also some tips on eating porridge to boost supply which is always worth a try, esp if it has lashings of golden syrup.

ILD you are a great dh for supporting your wife in bfing and not bowing to HV pressure

ds was born very early and very small, and did gain but slowly and steadily. he was bf'd. we also expressed in addition to very frequent bfing as he would wake up hungry for a feed in the middle of the night but if bf'd just went straight back to sleep, but we found that he would stay awake for ebm better. this helped us, but it was in addition to normal frequent bfing.

as tiktok puts it very well - your lo is thriving in all the ways she mentions, as long as she carries on this way, wet nappies, good stools etc then just keep an eye on the weight gain. she sounds very active so may njust gain slowly.

you sound like you both are doing really well!

ILD have replied to your msg on our slow weight gain thread.

I was in exactly the same position a few weeks ago. My HV refused to deal with me anymore as I ignored her advice to give formula. As with you, I had a fab GP who advised me to express after every feed and give the ebm in the evening to top her up.

We had to go through the process of a hospital referral and saw a consultant (we all knew there was nothing wrong 'failing to thrive is an awful term). The consultant explained to me that for whatever reason babies come out a certain weight, they then have to 'find' their weight.

Other things to try:
Fenugreek (available in Holland & Barrett) is a herbal supplement said to help milk supple. Also used in curry (a great excuse to eat lots of them).
More Milk (a potion available from Breastfeedingheaven.com)
Kellymom.com - all you ever need to know about bf.

Hope this helps, and good luck.

also meant to add that in the future if you are really worried (although it doesn't seem as if you need be at the moment) you can get breast milk fortifying powder, which ds had to have added to ebm which helps them gain weight - it's proteins and minerals. but ds had to have this being 8 weeks prem and only weighing 3lb2, so nothing like your lo!

Breastmilk fortifiers are made mainly from processed cows milk proteins and maltodextrin - they have a useful place in the nutrition of very pre-term babies who need to gain weight, but they are not really suitable for older, term babies whose parents want to avoid formula....they are 'formula' under a different label, really, jacobetc.

Thanks all - that's great reassurance! Will keep you all posted on how we are doing! Next weigh-in is on Thursday - though I'm not optimistic...

Two of us on June post-natal thread had 'slow-to-gain' babies. Her HV told her not to have her lo weighed, whereas mine wanted to see me weekly. Even my GP said we were in danger of weighing too often, so don't get too hung up on it - it puts you all under huge pressure.

Make sure DW gets plenty of time to 'babymoon' too! Works wonders

Let us know how the weigh in goes but don't get down about a small gain - little babies rock. Mine were tiddlers.

thanks tiktok i never knew that. i guess you don't as a first timer with a 8 wk prem baby!

i'll be passing that info on to dh for when we have ds2, due to be born early again in about 7 weeks as we were really anti ff and it's rather annoying to now find out we unintentionally ff'd

Jacobetc - read the ingredients on the pack, and you'll see! Main ingreds are maltodextrin (a sugar) and hydrolised milk proteins. Where do you think they get the milk proteins from?

Eoprotin contents are:

Maltodextrin, hydrolysed milk proteins,
calcium glycerophosphate, calcium lactate,
magnesium citrate, vitamin C, sodium
chloride, vitamin E, nicotinamide, vitamin D,
vitamin A, zinc sulphate, pantothenic acid,
vitamin K, riboflavin, vitamin B12, thiamin,
vitamin B6, copper sulphate, folic acid,
manganese sulphate, potassium iodide, biotin.

While I think the evidence is that prems may benefit from fortifiers, I have never met one mother yet who has been told what they are - I spoke to one person who thought 'human milk fortfier' meant it was actually made from human milk. Nope - it's formula!

Ok, Tiktok I have a couple of questions!

It normally takes a couple of pumping sessions to generate a decent overnight feed for DD (of about 4.5oz). Indeed DW can get about 3oz in one session, completely emptying both breasts if they were full to begin with.

So, if DD seems to be needing 4.5oz (she downs it with abandon in the night) for a feed - is that more than she can get in a normal (breast) feeding session? I know babies are much better at getting milk than a pump - but surely when they are empty, they are empty, no?

Also, as DD seems to be feeding almost constantly and not giving the breasts a chance to refil, does that mean that DW's breasts are running on empty most of the time?

Thanks!

ILD - I've posted often abut my experience with a slow weight gain baby who was not a "Failure to Thrive" baby. He sounds just like your dd.

I was fortunate to have excellent support from the breast feeding counsellors at the maternity hospital as I attended their support group rather than seeing a HV.

I did go through the top ups with EBM and froa w hile even did every second feed as EBM - and it made no difference to ds' weight gain. he was just following his own growth curve.

Like yuor dd, he was happy sleeping though and fro a while we woke him, but once we realsied it wasn't affecting his weight gain - and as he got older anyway - we stopped bothering.

Throguhout all this, he was happy, healthy and alert. At the end of the day, that is all that matters, not the bloody blooming centile charts.

If I were you, I would stop getting her wegihed and just enjoy your baby. Therw would other signs if she genuinely wasn't well. But I know you won't, as she is your PFB - as ds was mine. I knew I shouldn't take him to be wieghed every week, but I had a sort of morbid fascination with it IYSWIM, even though I genuinely wasn't worried 'cos of all the excellent support I was getting.

FWIW, when ds was checked by a cusntultant paediatricain (since I was goign to the support group at the maternity hopsital, it was an easy referral, just in case) he was more interested in what my dad (who used to be a radiologist at the same hopsital complex) was doing than worry about the manifestly happy, healthy and alert child in front of him. And he also told me stop the faff of expressing and enjoy my baby! No pressure to introduce formula.

ILD, you wrote:

"It normally takes a couple of pumping sessions to generate a decent overnight feed for DD (of about 4.5oz). Indeed DW can get about 3oz in one session, completely emptying both breasts if they were full to begin with."

She is a good expresser

"So, if DD seems to be needing 4.5oz (she downs it with abandon in the night) for a feed - is that more than she can get in a normal (breast) feeding session? I know babies are much better at getting milk than a pump - but surely when they are empty, they are empty, no?"

I don't know if it is more than she would get in a normal direct breastfeeding session. There is no way of knowing - even test-weighing is inaccurate and misleading. Babies can glug down a bottle of ebm, and it could be more than she would normally have. On the other hand, they like being at the breast a lot and may stay there a long time and get more....I have no idea what a particular baby might do at a particular time and in any case, it might be different the next time It doesn't matter.

"Also, as DD seems to be feeding almost constantly and not giving the breasts a chance to refil, does that mean that DW's breasts are running on empty most of the time?"

NO! NO! Breasts are not like bottles. The whole process of making milk is dynamic, happening in direct response to the rate at which the milk is removed. It does appear that less milk is made when the baby is actually on the breast, but the shorter the gaps between sessions at the breast, the more quickly the replacement milk is made. Breasts are never totally empty, but they are certainly emptier or less full at times, and the less full they are, the more milk is made....the best way to increase milk production is to ensure the breasts are as empty as possible for as much of the day as possible! I know this seems paradoxical but it is perfectly logical and if you look at this website it will show you how it works.

Hope this helps!

Thanks Tiktok, that's grand. I suspected as much - and also DD is around the 6week growth spurt phase, so hopefully the near constant feeding my slow soon and settle in to a pattern. Though it's grand to know that she's still getting a goodly feed (and presumably richer in fat if breasts are emptier?)

Out of interest, do you think we are right in still waking her every 4 hours at night? The last time we left her to set the period, she went >6 hours, and when we woke her (out of concern) she was v.unresponsive to feeding for a bit - and it kinda spooked us out and we haven't let her go for as long since. But seeing as she doesn't like sleeping much during the day - DW could really do with the break at night!

Any thoughts?

ILD, it is normal, physiological and beneficial for young babies to wake and feed at night. When co-sleeping, bf babies are observed to feed several times, often without waking mum

Any baby whose weight has caused the least concern should be feeding in the night, because it is so normal to do so....the opportunity to feed often in the day is there all the time, less so at night if the baby is not in the same bed.

Your choice, but 6 hours without a feed is physiologically too long for most babies of this very young age and she may not be 'asking' for a feed because the right stimulus (ie co-sleeping) is not there. If you're not co-sleeping you have to do the stimulus for her, and a four hour gap at night is the maximum, I would say....

thanks tiktok - that's so helpful! i know it's a learn from experience issue - read the pack but you just don't, you unfortunately trust someone when you say "but i don't want to use formula".....

i know for next time

tiktok, I wanted to thank you for your concern about my nephew (on tongue tie thread). Was difficult to respond on there as had sent a link to my SIL! I too was concerned about his lack of feeding and was trying to be light handed over the phone. He's her second baby and I felt she should trust her instincts a bit too. Anyway, sounds like he's feeding more often now and like I said weeing and pooing. I think his latch will be tested when her milk comes in so will see how she goes.

Thanks again and sorry for hijack!

LL - that's fine!! Often, these babies who don't feed much on day 1 or 2 are ok, and pick up just fine, but a few of them 'drift' and we don't know which are the ones that will drift....they actually become dehydrated and lacking in energy and there's a crisis on day 4-5 or later. Good to hear he was one of the majority who are perfectly ok!

It's difficult not to sound like I'm nagging if I phone too often IYSWIM? Will give her a call later and see how he's doing.

Ok, had DD weighed today and she's only put on 40g this week (=1oz). HVs not concerned, but I just want to know where she is putting the milk she is drinking!

We've established that DWs supply is good. Check.

Checked with NCT BF counsellor that latch is good, and DD has, over the past few weeks, become much better about sucking and swallowing for longer. Check.

DD is being demand fed, and demands it often during the day. No longer than 4 hours between the start of feeds at night. Check.

We know that she's capable to taking a bigger feed and keeping it down (4.5oz the record). Check.

She's not pooing it out, since she hasn't pooed for a week (having gone a week previously). She does perhaps wee more than the guidelines hint at (perhaps up to 8 cloth nappies in 24 hours). She does posit up after a feed, but really not in any kind of quantity that would worry us.

So, where is she putting it?

I know everyone says that breastmilk has more calories than formula - but is it possible that DW is producing low-fat stuff? Kinda like skimmed milk vs full-fat? Her EBM always has a nice layer of cream on the top after it's been standing in the fridge for a few hours - that's a good sign, right?

Could DW's diabetes (well-controlled - which she's had since a child) contribute?

I'm just at a loss to figure out how an otherwise very healthy baby can seemingly take in more than she's "producing" out - and yet only grow in weight so slowly.

Oh, we did some DIY measurements (though DW is a paediatric nurse) and her head and length measurements are tracking the 25th centile, so evidentally she "seems" to be growing...

Hmmmmph, frustrated - being a bloke, I just want to fix this