"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

hang on - so you saw a doctor that morning and your baby was fine, yet by the afternoon you were being threatened with hosp admission in 2 days time as things were so not fine?? that is bizarre. what did the gp say when they did the 6 week check, were they worried about the weight loss/dehydration? can you change hv and get a different opinion, find out where the nearest drop in clinic is with a different hv and pop along there instead? if you have children's centres near you, you can go to any in your area to their weigh ins. or go back to the person who did the 6 week check and see what they think?
very for you, this all sounds so stressful

hi caz
really sorry about all you are going through
FWIW i'm a Gp not a bfc but a few points
dehydrated= sunken (not raised as suggested) fontanelle but is quite a subtle sign so she may well be wrong. there are other signs though - nappies as discussed but also more sleepy, dry lips not much saliva - skin that doesn't spring back when pulled
2 breasts not 1 - or indeed superswitching

in what way did the HV say your baby was unwell? did she give details?

it is so so difficult with your first baby, even if you have a bit of medical nkowledge and you are paranoid about EVERYTHING. Ds now 4 months and i found it difficult too at the beginning.

as suggested if you have even the slightest concern take her to A+E and ask to see paeds. make sure you see registrar and not SHO (they may be very junior). explain the HV said she is not well and you are worried she is dehydrated/FTT. paeds won't (or shoudnt) they are used to mums bringing in young babies. sunday mornings are usually quite quiet in casualty. at least you will then have peace of mind and then you could change HV

I do think there is a bit of an anti HV rant on this thread. often they are senior nurses first and certainly the ones i work with are excellent, and one is also a bfc. there are always good and bad eggs in every job but don't think we should dismiss them all outright. someone earlier suggested FTT is bollocks - maybe it is too easily labelled and shouldn't be after 2 or 3 weights on different scales, but it does exist and for a reason - to detect if there are any underlying medical problems. i'm sure your baby is not FTT but none of us here can say that as we can't see and assess her - which is why it might be worth seeing a doc/paeds to rule it out. the most immediate concern however is dehydration so if you are at all concerned get her checked out.

good luck! we are all thinking of you (even if we all have conflicting advice) and can feel your pain. why don't babies come with instructions??
x

Second Luvaduck's post. The doctors at my hospital didn't mind at all that I took dd1 in to be checked out. Hope you get to feel better about this soon.

oh caz i really feel for you.
i know how you feel to be trying so hard to bf as you want to do the absoulte best for your dd and be made to feel like your actually harming here or doing something to her detriment.
im so cross about both of our experiences that the hv has offered no other soultions or offers of help other than to top up, as if that the only thing anyone can ever do.
she could of at least refered you to a dr or pead or a bfc

how are you feeling yourself?
are you getting support at home?
have you spoken to your gp about your concerns about dd?
have you tried any of the bf support lines?

im going to bump my thread for you,as you find many similararitys, as i was also told constanly to give formula and mad to feel as if by wanting to bf dd i was being selfish and harming dd
my story in brief is dd was born on the 75th and dropped down to just above the 9th
i stuck with the ex bf, but was made to feel totally shit about it and tbh it did spoil the first few months with dd
and many times the hv had me in tears
i was also worried that dd may not develop properly but now at 7 months bf is going better than ever and we both enjoy it, and dd is a happy and very healthy bundle of love and is mting all her developmntal milestones
we both enjoy the bf now and its great

i think you are amazing to carry on bf and pumping and your dd is one very lucky baby indeed
hang in there girl you are doing an amazing,wonderful and supurb job

ps caz forgot to say,if you do get the chance to look at the other thread, i used to be kittenbaby

Caz - I feel for you. My boy hadn't put on his birth weight after losing weight in hospital with jaundice until he was 6 weeks. I ended up topping him up with formula against MW advice but bf help centre said I'd done the right thing. I think you'll get conflicting advice wherever you go, so do what you think is best. You know your baby better than anyone. The phrase 'failure to thrive' cuts through you doesn't it. It made me feel sick when I first heard it in relation to DS.

Caz, I agree, seeking help from mumsnet is not helping you at the moment!

Babies of 6 weeks do not get dehydrated without a whole load of other symptoms - your baby would be listeless, sleep and recognisably ill and forget about the fontanelle, please! It's not a reliable sign, raised or sunken, in a baby, because this is a natural soft spot and pulse spot. Diagnosing dehydration from the fontanelle is not for amateurs Take your baby for a check if you are worried, but remember that the worst place to get bf advic would be from a doc in A&E They are good at assessing whether a baby is ill or not, though.

You say you have 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,"...ok, if you do this, then you and your baby and your breastfeeding will not be harmed, but it sounds like the advice of people who are floundering about what to say. Ask them for their rationale. On the other hand, sticking to one regime and then staying off the computer may give you a break from the confusion!

tiktok, I am sure that you are right about Caz's case and that she will be absolutely fine. We don't want to go in for scaremongering.

However, I do have to say it is not necessarily the case that babies under 6 weeks who are dehydrated will always appear ill to the untrained eye; that was what fooled me about mine- she seemed alert a lot of the time and I didn't know how wet a wet nappy was supposed to be. Even the hv did not at first see anything strange in her demeanour; it was only looking at her undressed that showed that she wasn't getting the nutrition.

The rationale of expressing from one breast and then feeding from that (if that is what is being suggested) is that the baby will then go straight onto the richer hindmilk.

I ended up feeding my daughter hindmilk with a syringe to get her strong enough to suckle(in reply to the poster who said I should have been able to top her up with a bottle- she was unable to suck from that either, having very weak jaw muscles).

There was a happy ending though- noone ever suggested giving up bf; once dd had regained her strength, I carried on bf'ing until she was nearly a year. Thanks to the supportive hv

Curious as to why the paediatritions in hospital would be 'the worst place to get breastfeeding advice'?

I found the ones that I went to supportive of my wish to carry on breastfeeding. They said that the fact that she had crossed 3 centiles was a concern, and I could consider giving formula, but that she was in good health and in no immediate danger if I wanted to continue with bf alone.

Of all the advice I got in that period theirs was the calmest and definitely the most objective.

Read my post, redadmiral....I referred to doctors at A&E, who not paediatrician...they may be SHOs, or specialist A&E docs, but none of them will be paeds.

Having said that, paeds differ wildly in their knowledge or and support for bf.

Cory, you say your baby 'seemed alert a lot of the time' and 'it was only looking at her undressed that showed that she wasn't getting the nutrition. '

I am not a medic, but this does not sound like proper dehydration, to me, but under-nutrition.

True dehydration is a serious condition, and my understanding is that a baby of 6 weeks who was dehydrated would show signs of weakness and illness with it.

"The rationale of expressing from one breast and then feeding from that (if that is what is being suggested) is that the baby will then go straight onto the richer hindmilk. "

Ah! I did not understand that this was being suggested, but I see now that this is what Caz meant...this will not harm the baby, but I still think it is unnecessary and very fiddly

Caz, haven't read the whole thread, but would you consider getting your own scales? When ds was ftt I found that having my own scales, and the ability to weigh him at the same time, in the same place and on the same scales each time allowed me to feel much more confident I could identify the problem properly, rather than keep asking myself whether it was measurement error or what.

I also did before and after weighing, which allowed me to tell how much milk he was getting off the breast. It's not perfect and can be painful to do for a whole day, but sometimes it helps to just check whether your impressions of a feed are reflected in the weight or not.

Er, I have read your post... Have you read mine and Luvaducks?????

Sorry, Tiktok, didn't mean to snap. but when I suggested going to A&E to see Paeds, I would have been more specific if she had to go elsewhere. At my hospital there are Paeds in the AandE at all times. I'm not sute why you are so sure there aren't?

or 'sure'

Thank you all again! And you are right I probably should just turn off the PC!

Have been feeding/topping up/pumping for almost 2 days now and it is truly exhausting, also when she gets weighed tomorrow I can't see that it'll have changed all that much.

I just can't believe that in the same day, after being told how ill she was (but then no referral to GP?!) I got so much differing advice:

• HV - top up with 2oz formula after every feed - (MUST do this!) - no mention of sides etc, feed every 2.5hs
• GP - offer one side, then 2oz formula, then other side
• BFC - don't top up, improve P&A, feed regularly on demand, but don't let her go long between feeds
• midwife -as per HV but use one side at a feed, express from the other for top up (this was because I had said I hated the idea of formula)
• another BFC - as per BFC but DO top up using whatever amount of EBM I can get,not necessarily 2oz

This was all in ONE afternoon!

I have been feeding every 2.5-3 hrs and always topping up - with EBM where poss but formula once or twice when I haven't been able to pump, too tired.
Going to take her to GP tomorrow after HV sees her and make sure there are no actual health concerns other than slow weight gain/loss.

Hi wizzska sorry i didn't realise you were going through this too. Are you still topping up every feed with formula? Is your wee boy still BF ok? Hope he is ok.

Own scales a good idea - but I may become paranoid compulsive weigher?!

I don't THINK she is ill - lots of nappies, cooing, smiling etc - BUT i don't feel confident to trust that judgement...GP was NOT particularly bf, so I won't be looking for that from her, but at least she should be able to tell if my baby is well?

Have noooo idea whether paeds are available at my A&E - but DD was born at a stand alone maternity unit so presume there would be someone there?

I suggested paeds at AandE not to scare you (God knows first-time motherhood is scary enough!) but because if you were seriously concerned about a 6 week-old baby there's not a lot of point messing about with a gp (sorry gps.); they'll just send you to a and e.
The other reason is that once you have had her checked out by an experienced paed you can be much more sure she's ok, and can have more of a conversation wwith hv.

I would think if you feel that she's well, the gp should be able to check her out for you. They can also refer you to the hospital if you are still unsure. I am a little concerned that you said hv said she was 'NOT WELL', but maybe she meant poor weight gain not de-hydration. Did she tell you what she meant?

no, she really didn't, and it seemed only to be based on her weight and head. THEY said she was alert and had a moist mouth.

my gp is the paed at the practice so she should be ok??

i saw two different paeds during my interesting time with bf and hcps. one said i absolutely must top up and was horrified i would even consider bf. the other was really cross at the utter waste of resources in hounding me.

reading your list of advice given makes me want to scream. why can't they just leave you alone? i mean i know you are seeking advice because you are being told there is a problem, but this is ridiculous.

Hi Caz, sorry to hear what you're going through. It sounds very similar to my experiences with dd1 who is now a very healthy 4 year old. She dropped from her birth weight of 7lb 13oz to 6lb 7oz. I had all manners of problems breast feeding, and it took 6 weeks for her to regain her birth weight but she got there in the end through lots of tears and perseverance. I had far fewer problems with ds, and I now have another girl who is 6 weeks old and although I haven't had quite as many problems with her, it hasn't been easy. I had a fantastic midwife this time who had similar problems with her two children and explained that breast fed babies can take longer to get going than bottle fed babies, and that all the graphs are based on bottle fed babies. Also, whilst babies should be producing lots of wet nappies, there is so little waste with breast milk that they can go for days without producing a dirty nappy (dd1 used to go 10 days between dirty nappies but would then explode with the mother of all nappies )

As for contacting your GP, I was told by my GP to always err on the side of caution and that a mother knows their child the best. So if you feel that would help I would definitely make an appointment, if only to put your mind at rest.

I hope things get better for you soon.

Sorry you are having such a rough time of it.

Glad to see tiktok has posted here. She really knows her stuff

Caz, I'm so pleased to hear that! I'm sure your gp will be fine to check her out.

I was just a bit worried in case your health visitor had spotted something wrong - as seomeone else said, we haven't actually seen your baby.

I'm sure everything will be fine - either the breastfeeding will improve, or you will top her up after feeds for a while. I had to top up and I still managed to breastfeed for 9 months - it can be done! xx

Hi Caz, I just wanted to post and lend my support and, for what its worth, share my experience with you.

I had similar problems, was having LO weighed weekly, at first it was, "she's bf, happy and alert, don't worry" This was fine for some weeks, but she was dropping centils (not losing weight, but not gaining enough intheir opinion). Then the HV got in a tizz and told me I MUST give formula. I told her I'd bf for another week and up my gain. The following week I went back and she was huffy that I hadn't taken her advice and told me to see the GP as she wouldn't see me anymore.

GP was massively supportive of bf, and looked after me through this. She suggested expressing after every feed and using this to top up in the evening. (I have a manual pump and kept it in the fridge inbetween feeds with the lid on). The GP said "As a mother, I know she's fine, but my training tells me I have to refer you". So off to the hospital we went, and the Consultant confirmed what we knew already - that she was fine. Once we got the all clear, we were told to stop weighing her. Her head circumference was 75th, but her weight was around the 9th BTW (but we have big heads in this family).

It IS exhausting and hard work, but stick at it. Rest and relax as often as you can, drink PLENTY of water, stick to a good diet. Co sleeping has helped too as she feeds often in the night too. Get yourself checked out, it was suggested to me that I may have a yeast infection in my stomach which could prevent absorbtion of nutrients - so have yourself checked out too.

Sorry for the long post, but I hope some of it helps.

Cor blimey what a debate!!

If the health visitor said it was just weight/head then she's probably not acutely unwell just not gaining weight as often as they'd like. It sounds like she didn't know what she was talking about with regards to the fontanelle, as she would have referred you asap if she was really worried.

I was suggesting A+E as an option if you were worried about dd because its an easy way to access paeds - esp in the morning as its quiet. (and a good way to cheat the system if you do want to see paeds) The majority of hospitals have a protocol that all babies under 6 months or even a year are seen directly by paeds not by a+e docs. NOT for advice on how to bf (!) but just to check that she's hydrated and well, as your HV has worried you by suggesting that she was ill. Then =you can go back to your silly HV and say - look she's fine, leave me alone and let me get on with bf my beautiful daughter!

However, I'm sure the GP tomorrow will be just fine, but i think you had a bad experience with her before over the thrush debate? Unless shes a complete numpty she will know perfectly well how to assess a 6 week old baby. But if you don't get on with her/trust her thats a different story. You need to be sure she is listening to your concerns and taking them seriously. If you don't like/trust someone whether it be your HV/GP/dentist/bfc then change them! its really important to deal with professionals that you trust as they all vary in their knowledge/manner/personality. If you don't like yours are there others in the practice?

best of luck x a million. its such a tough time and you are doing a great job for your dd.