"failing to thrive" - please help!

[Caz10]

DD is between 5-6wks just now and put on 1lb in the first 3wks. (5lbs 15 at birth to 6lbs 15 at 3wks).

Now at 5wks + 4 she has dropped to 6lbs 11oz.

HV told me she was failing to thrive, said i HAD to top up with formula and basically scared the life out of me.

I have been working with a bfc to improve my latch as i know it has not been great - it is improving.

dd is alert, lots of wet nappies, 2-3 dirty nappies a day and has gone up a centile in length. they did her 6wk check this week for some reason and all was fine. surely she is not failing to thrive?

boxes of formula in the kitchen, not given yet, lots of tears from me. have to get her weighed again tomorrow and feel like i will be in trouble for not topping up.

i know all the things to try to get supply up, but HV has put such a sense of urgency round this that i feel i have to do something quickly.

i think my most urgent concern is, will i harm dd by NOT topping up for a few days while i think this through?

i am aware there are lots of similar threads to this, so off to have a look. thanks

I agree that sometimes hv's and midwives give advise that is not always correct, but as a midwife myself I always feel concerned reading threads like this. I am not someone who suggests formula easily but I have come accross some babies who have been admitted to hospital with dehydration, one of whom died.
Caz10 your baby sounds fine as she is weeing and pooing regularly. I just want to say don't automatically assume that the hv does not know what she is talking about, she has had training, and should have yearly bf updates (at least I imagine it is the same as for mw's)

Ha! Yearly updates on bf for HVs???? I wish!!!

You got that one wrong, maxbear

I am a bfc and I would say that on the whole, HVs are very poor at supporting bf. They are not trained properly and do not get updated.

tiktok... have just had a client's confidence completely smashed by both mw and hv and she is now heartbroken because "she can't bf". Her new baby is now completely formula fed even though he fed so well at the beginning. If that's what yearly updates do then I despair. I have a friend who is a HV and she despairs for the lack of knowledge and training with regards to bfing.

I don't see any mention in this sad (and so frequent) tale of the HV offering to help Caz to stay with breastfeeding. You know like "let me see you feed" or "if it hurts then let's see what we need to do to improve the latch". I just feel so overwhelmed by this as it just does not change. This is a repeat of my experience BUT that was 26 years ago with my 2nd child.
I am a midwife, neonatal nurse, BF co-ordinator and still see it in my practice day after day. It is not enough to excuse HV's or any other professional by saying training or updating is inadequate (it is I know in many cases) as we are all responsible for our practice and the info & support we give to mothers. There is the info out there, current and backed up by evidence for the professional to access. It is more about attitude and power - these are the areas that need to change!!
Caz - you have people here who are giving you the right info and their love and support and more importantly they believe in you and that your body can grow your baby as it did before the birth - this is what you need. Just so sad that you did not get it from a person who you need to trust for much info during the next few years of your baby's life. Stick with it and much love.

Know I'm swimming against the current here, but I'd like to say that I thought my baby was having plenty of wet and dirty nappies...until I started topping her up, and I realised what she should have been having! I think anyone saying 'plenty od wet and dirty nappies' should be VERY specific about what that means, especially with first-time mums.

That should be 'of' of course...

Thank you all so much again.
I really do appreciate all your comments and sorry if i don't reply to them all, am "on the clock"

saw HV again Friday, got told again baby is NOT WELL etc etc, reduced to tears again. Got 48 hrs to "turn it around" or hospital.

Now of course the last thing I want to do is stick to my guns to the detriment of DD. Have been advised to feed every 2.5hrs, top up after each feed with either formula or EBM. Trying my hardest to make it EBM but I had none stored so am chasing my tail -feeding for an hour, changing nappies, sorting bottles etc then trying to pump...never mind eat or sleep!

Been at it for 24 hrs, am tired, confused, upset etc.

As someone said there has been NO offer of BF help from HV etc. BFN have been wonderful, but for them it all comes down to position and attachment - YES i know this is true and I am trying trying trying to improve my latch but I've been trying for 3 weeks now which is when the weight loss (if any) has occured. So scared I will harm DD by refusing to top up and persevering with my latch - I mean what if I never get it right???

I'm so so sad and angry that some of my top ups have had to be formula - but basically I'm too scared not to do it. Trying to pump but not getting much.

Trying to be positive (!) but so exhausted, can't even contemplate co-sleeping which i know might help, as i am sleeping so heavily when i do sleep that i have literally slept through her crying very loudly and thankfully DH was there that night to hear her (he does some night shifts).

redadmiral that kind of thing is my concern - how am i meant to know what "plenty" is?! In terms of milk OR nappies?!

So very confused now....

thank you all again.

also times like now getting me down...DD fed, alert and cooing away , and i can't interact with her cos have to pump..

This might not be a popular POV but if you're topping her up anyway, can you not just give her ff and spend time with her? It saddens me to hear you're not able to hang out with her because you're trying to express. I was absolutely useless at expressing until my DS was about 3 months - I just didn't seem to have enough milk.

I should probably read the whole thread though

Oh and I was in total despair the first few weeks. And I cried when I ended up giving my DS formula once. So I know how hard it is. But I persevered and I bfed until he was 7 months.

You're doing a great job - hang on in there

Hi! mommalove - yes I have been using it. My worry at the mo is that we are waking DD every 2.5hrs - she is so sleepy and having a half hearted feed, not latching on etc, and not really responding to the comrpessions. So I feel like the top-ups are not really top ups but pretty much all she is getting IYSWIM

spicemonster...i am sorely tempted...

Caz - your Hv is out of order here - if your baby is not well !! then she should refer you to a Dr. And she knows this, so if she hasn't referred you then it is not so. I do not want to worry you but there could be other reasons other than BF failure why your baby is not gaining, many of them simple to rectify ie a urine infection, very common. What I am trying to say is if this HV feels this then the focus now should not just be about feeding but to eliminate other causes as well as continuing to support you to BF.
You sound at the end of your tether? but still giving it all.
I know the formula route is devastating when you want to Bf, have been there.

Have you met a BFN face to face? Have you had face to face input on positioning etc?

OK - a few facts - wet nappies 6-8 a day, urine light golden in colour and nappy feels heavy - hold a dry one (presuming you are using disposables) in one hand and the wet one in the other ? the difference. Difficult at times with dispos - put some cotton wool balls in the nappy if you cannot tell. Colour important as dehydration causes dark, sparse urine. They should have no fishy smell. Dirty nappies, a difficult one, as all babies are different in bowel movements, like us; but at 3-4 weeks of age you should have a few a day, most days, colour again, yellowy, mustard, french to english that is! If you have given formula then they may veer to browny yellow.
What were nappies like pre formula? If plenty of wet ones then DD hydrated enough, stools as I said? then enough food going in BUT it could be that because DD is not getting on to the breast well enough she is not getting to the nice, rich, creamy milk that is towards the end of a feed. She may only be getting fore-milk?? were her stools ever greeny and slightly frothy? an indicator of possibly a positioning problem. So, she is getting enough milk to be hydrated but not enough to grow. A bit like you and I going on a diet, we wont come to much harm but we will lose weight. This is all supposition, as I don't know the facts about you and DD, but is the commonest cause of low or no wt gain in BFed babies.
Where do you live? many hospitals now have a BF specialist who may see mums in the hospital at a Drs clinic and give BF help along with a medical evaluation. You could call your Community MW to find out.

To make it easier on your self, you could try topping up every other feed, you may then be able to do this with BMilk? That is if you feel ok at moving from the regime you have been told to do?
Some practical tips - try to get DD to open her mouth wide before giving her the bottle - the same as you would on the breast, giving the same signal to her.
If you can manage to do it then express from the other breast whilst you are BFing - let down should be better.
Keep her at one breast for the feed, to let her get to fatty hind milk.
Enough for this post - you must be overwhelmed with all the advice. I hope some of this helps. And remember you are doing your best for DD.

All my best wishes to you. I know exactly how you feel. It's been 4 years since I had a 6 week-old, so hopefully someone else can give a more accurate description of how heavy or wet the nappies should be. I just know I noticed the difference. I think use your instincts as a mum. You know your baby, and at 6 weeks IMO they are able to express frustration at being hungry, and it should get easier to understand when she's had a good feed (or not).

I can't answer your question which I'm aware has gone unanswered about whether it will harm your baby to carry on trying to BF without too many formula top-ups. I think only a health professional can say if she's in danger of de-hydration, but it sounds unlikely. Did your HV say why she needs to go to hospital? I took DD1 to children's A and E just to get a paediatricians opinion. (They said she was ok, but they were more worried about me!!)
Longer term I did worry that I might have affected DD1's growth by not feeding her enough as a baby, which I think is as valid a concern as worrying whether formula was good enough for her, although in the scheme of things I think it gives way to other worries as they get older

THANK YOU

sorry for rushed reply..

• seeing BF consultant at maternity hosp next week - BFCs have already been a great help, observed feeds, gone over position and attachment

• nappies - wet ones are heavy, no colour, occasionally a bit smelly but pee-smelly if you know what I mean! Dirty - 2-4 per day, not green, varying shades of brown from orangey to muddy, quite substantial down the leg and up the back type ones! never seen green though

• as you say, Doc was never mentioned, in fact baby had been "signed off" at 6 week check (early) just the same day...very quick check though so don't know if anything out of the ordinary would be picked up - i wonder if it's worth me going back?

redadmiral, this was all based purely on her weight loss, which BF people and people on here think is questionable anyway...so confused...

omeofeight, lots of good stuff there, but keeping to one breast per feed is not correct - this is not my opinion, but fact. To increase the no. of calories going into the baby, volume is crucial, and sticking to one breast does not increase volume but decreases it. Switch nursing increases volume and babies who need more calories should be getting a min. of 2 sides per feed.

Caz, this is horrible for you to get conflicting info on mumsnet as well as everywhere else...I am concerned that your HV seems to think your baby is ill, but agree with oneofeight that this should be investigated properly...you need to see a feeding specialist, someone who will look beyond unreliable weights.

Oneofeight, that sounds like good advice. The only thing I'd like to say is that I had that advice and I still believed the nappies were heavy enough because she'd had a wee or two on them, so they were heavier than the disposables. It also varied quite a bit, so some were heavier than others, which I thought was normal. It was only later that I realised that there should be a more or less continuous amount of really quite wet nappies, and virtually no lighter ones, obviously depending on time between changes. Maybe someone could tell us how much water to pour on a nappy to get a rough idea of what they should be like - I really had no idea...

Sorry, I meant 'heavier than the dry ones'.

i am doubting my nappies now...

tiktok when i was purely bf i was always offering 2 sides

now been told to offer one then express from the other then swap, eg feed from left, give top up of whatever, pump from right for next top up. next time, feed from right, etc etc

TOTALLY forgot to say... on fri they said her fontanelle was depressed...scared the crap out of me...but bfc said a dehydrated baby would have a raised one...

I'm sorry Caz, I didn't mean to make you feel worse. I'm not a doctor, but I think the main thing you need to worry about in the short term is dehydration, and it doesn't sound like this if she's getting generally wet and dirty nappies. Longer term you are talking about whether she's getting enough calories to grow and develop, but that is a decsion you can take more time over. If you are worried in the next few days can you take her to the GP os childrens' dept of your hospital? (Say the HV said you had to go there ...)

I'm a bit concerned that your BFC said that fontanelle would be raised if she was dehydrated, all I've heard says it would be sunken.
HOWEVER, I think it sounds as if the HV has made up her mind already as a sunken fontanelle on it's own does't mean dehydration. My baby often had a sunken fontanelle throughout her babyhood, often for no apparent reason.

Caz, if you were my daughter i would now try to get you off this computer and get you to go and try to relax a little - I know easier said than done - and i am not being patronising but it's my maternal streak coming through. Tell me to go............!!! if you want.

You are going to freak yourself out and we are getting in to the realms of diagnosis - not our job and definately not what this site is about. And also our discussions as BF people are not what you need at the moment, as tiktok says, for you to get conflicting info is not right. You need to know that we are thinking of you and hope that soon you get to feel good about feeding and enjoy your new life as a mummy.

If you are at all concerned about DD's health at this moment in time - not easy as a first time mom, as we are all living on the edge with our first, but if you are, then give your GP a call or pop along to A & E . You commented in your earlier post of this eve that she was lying there alert and cooing away so she sounds good but if you cannot rest then do this. Or go along ,as you said, to your GP Monday and ask him to look at her, telling him what has happened - is he BF positive? alternatively call the BF specialist Monday to see if she will see you earlier.

I will continue to think of you tonight (am off to work now) and do let us know how things are going if you feel you can.