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...

Can't offer any practical help I'm afraid, but jsut to say that my ds (second child) was a very slow weight gainer. But he was gaining, if only a little bit, and was alert and responsive and happy and pink and healthy looking. So I stopped getting him weighed - which took the pressure off me to 'perform"! He hasn't been weighed since, but is now a sturdy, robust healthy 6 year old.

I think if she actually gaining weight - even a ittle bit-and not losing, then I wouldn't worry. Just make sure that she's showing all the other signs of thriving, then relax and enjoy her.

My ds was taking in loads of EBM when I was giving him every second feed as EBM - and he often only gained 40g a week - some weeks it was nothing {shock]

His growth curve was only very slightly above a flat line for the first three months - he dropped for the 91st to just underneath the curves and stayed following that "line" 9ie just underneath" for about three months before creaping up to the 25th and then some time later (don't know when, as I finally stopped weighing him) moved up tot he 50th where he has roughly (I assume, as he is not weighted frequently - he looks healthy and slim and that is all that matters) he has remained - now a healthy 7 year old.

Some babies just have fast metabolisms. If she is healthy, happy and alert, don't worry! Enjoy her while she is this small - soon enoguh she will be a toddler and all this will be a memory

This is something to keep a watchful eye on, I think, and to ask yourselves 'is she really feeding often'? I think 4 hours is a long time for a 6 week old with a slow weight gain to go at night, too, sorry, unless she is feeding a lot in the day.

Can't work out from your post, sorry.

If the only question mark is the weight gain, then I would also ask how accurate is the weight? Is she being weighed naked on good quality digital scales with accurate translation between metric and imperial?

Milk quality in terms of fat content will be fine - this varies between feed to feed but overall, women produce remarkably similar quality of milk and this has been shown in many studies. There is no 'condition' whereby a woman only prduces semi-skimmed Even women on poor diets produce milk that's absolutely fine....if they are chronically and very badly under-nourished there may be some minor vitamin and mineral differences and they may have a harder job sustaining the quantity without feeding v. v. often....that's all. Quantity can sometimes be an issue with underlying illness eg anaemia, and there are cases in the literature of PCOS leading to probs with supply, too.

Ok, thanks Tiktok. We don't think it's a quantity issue due to good "yields" with expressing - but hey, we are keeping an open mind!

During the day DD "tends" to demand feeds more regularly than once an hour (often within 30 minutes of feeding) - but occasionally makes it to 2 hours max.

At night, she really doesn't wake herself up for food, though she is really alert once she is woken up, and then happily chomps away. What kind of frequency would you advise? We tried co-sleeping yesterday which was really good (in terms of helping us sleep), but DD still was happy to snooze away. Obviously we want to feed her regularly through the night if that's what she needs - but with DD's preference for not napping during the day - DW obviously needs to get some rest!

Definitely being weighed naked - and I assume that HVs scales are accurate and translate the weight properly (it's recorded in kg anyway - we translate into imperial for posting here! ;) It was a different set of scales yesterday (and we've rarely had the same set used between weigh-ins) - so could be that I guess - but doubting the scales somehow seems like a cop-out to me - the low weight gain has been fairly consistent now.

No, prob not a quantity issue at mum's end of things, but just possibly a quantity issue at the baby's....ie is she getting enough of the many gallons available?

With that sort of daytime frequency, it doesn't appear to be an issue, though....she may just be 'meant' to grow slowly

Prob not necessary to wake her more at night than you are already doing - in my opinion.

Check your maths on the conversion from metric, just in case. Weight even on good scales can be inaccurate, anyway, which is why looking at the whole baby is more important.

Ok, I've updated on the slow-weight gain thread - but I thought i'd pop here too - mostly for some more advice.

DD put on 2oz this week (despite a 13-day poo - IYSWIM - the day before), which given the previous 4 weeks had had 1 oz per week rises, was pretty good. HV was pleased anyway.

She's still bright eyed and bushy-tailed but we've noticed that she is still really bad at consistently feeding from the breast. It tends to be 5 minutes of good slow sucking and swallowing followed by purposeless sucking, or sleep. When she comes off, she then starts rooting and sucking her fingers straight away (often crying too) and then goes back on - but this time without as much of the decent sucking/swallowing motion - ad infintum.

This happens during the night when DW breasts are v.full, or during the day when she never seems to NOT be feeding. She seems to be hungry almost all the time and hardly ever sleeps during the day or evening.

We talked to our local BF counsellor who tried to provide phone-support, but without seeing her wasn't able to advise too much - but seemed to think we were doing ok. DW can never make the local BF clinic/cafe thingy.

DD's latch is good (just like the textbooks - we have the NCT one) and head is sufficiently tilted back to allow her to swallow). We've tried breast-compression but it doesn't seem to improve the situation.

At night, she'll happily wolf down 5oz of EBM without pausing (much) and still looks like she wants more even then! Is it something to do with the ease at which the milk flows? If so, is there anything we can do to improve the situation?

Any ideas?

Hi...you say "she is still really bad at consistently feeding from the breast".

I don't know why inconsistency is 'bad'!?

The pattern you describe is on the normal spectrum.

Babies feed, stop, mess about, want feeding again....'tis very common and as your baby is thriving, not sure why it is something you want to 'improve' except as a confidence thing for you, the parents

I guess, deep down whilst I'm happy that she's doing well - I'm just worried that because she takes a bottle so much more efficiently (and seems "full" afterwards in ways that she often isn't from the breast) that we are causing her to be smaller by sticking with the breast. Does that make sense?

We are massively pro-bf and don't want to stop it (and aren't even considering realistically the alternative) - but I guess we just want to know that we aren't selling our daughter short because we are being too stubborn...

Have you experienced a strong let down reflex?? a few minutes usually into feed a slight or strong tingling, or feeling of pressure as the more calorific hind milk comes down .
Baby could possibly be filling up on fore milk and not taking much of the better hind milk.
sometimes relaxation, change of position, or even expressing a little off before baby starts a feed has helped mums in past help their babes get an even better feed .

Hmmmm...trouble is, some people never feel the letdown! And there are several in a feed. Judging the quality of a feed or the milk by letdown is very misleading indeed!

'Filling up on foremilk' ? That only tends to happen in cases of over-supply....when the mother has a huge volume of milk (fuller breasts = less fatty millk)....and I don't think this is happening here as there are none of the other symptoms.

ILD - if you are 'causing her to be smaller' by sticking to the breast, then why would it not be that staying smaller is physiological for her?

She may well get more in a 5 oz bottle than she gets at the breast - it doesn't matter.

Hmmm, tiktok, I'm not sure I understand.

If DD isn't very efficient at getting the milk into her system via the breast - and this inefficiency is causing her to receive less calories than optimal and thus not grow to her full potential - isn't this something to be corrected?

We are definitely not keen to overfeed - but we desperately don't want to underfeed either!

Ah, I see what you mean, ILD. But I don't understand how you can judge how efficient/inefficient she is at getting the milk out...if she appears to be well-attached, if she has no tongue tie that might be interfering with milk transfer, if your wife is not sore/cracked, if the baby feeds and is then content (even if only for a short time - lengths of the gap between feeds don't matter, and 'cluster' feeds where she is on and off over a period of some time don't matter, either), if she is gaining weight and developing appropriately, then one has to assume the removal of milk is being done efficiently

The 'inefficient removers' are the ones who consistently fail to wake for feeds, are too sleepy to get much, who show by their growth and development they are not doing well.

Your baby is feeding often. This is a good thing