Dropping Percentiles

[PigglePuggle]

Hi all

DS is 12 weeks old and I am EBF. I’m using nipple shields as I have quite small nipples and struggled with flat nipples when my milk came in but I am in the process of weaning him off them.

He was born on the 58th percentile but has been slowly dropping since:

Birth - 58th
Day 5 - 38th
Day 10 - 49th
2 weeks - 51st
3 weeks - 39th
7 weeks - 26th
8 weeks - 22nd
10 weeks - 19th
11 weeks - 15th

so although he is gaining weight, it’s slower than it should be. Length at 7 weeks was 48th percentile.

I feed on demand, usually every 2 hours but sometimes shorter and will wake him from a nap if it’s been 3 hours or longer. Feeding times are varied, sometimes it’ll be 6 mins from just one side, other times it will be 12 minutes on each side.

Other than the slow weight gain I have no concerns, he’s extremely alert, lots of wet nappies, very happy, meeting his milestones and sleeps well at night (4-5 hour stints) but I’m just so worried that if he continues like this he’ll drop right down and be diagnosed with ‘failure to thrive’.

Would you be worried, and is there anything I should try doing differently? TIA

Have the midwives/ health visitors not given you any advice? My DS was born on 75th and has now stabilised just below the 50th so I think it can be a case of settling into their correct percentile. However your baby is dropping rather than stabilising so I would seek medical advice to be on the safe side.

At 12 weeks your milk will be fully established so it's worth checking what is going on. We ended up being advised to do top up formula feeds in the initial first weeks when DS wasn't gaining weight. I found it quite distressing as I had EBF both my older children without issues and I felt like I was failing but I'm now quite pleased that I know he will take a bottle at nursery and I can also leave him for short periods with DH without worrying.

They also suggested top ups of expressed milk which would probably be better for milk supply but I didn't feel there were enough hours in the day to BF, pump then bottle feed!

He’s already in the failure to thrive category…..he’s dropped 2 centiles….surely your HV has referred him to faltering growth clinic.? What have they said?

And referred to infant feeding clinic?….I meant to add

Where are you having him weighed - at a HV clinic? Have they made any suggestions?

Thanks all for confirming that I’m not just being irrational with my worrying.

HV hasn’t said anything, just suggested I take him to be weighed again in 4 weeks.

I have an appointment with a BF specialist next week to help with weaning off the shields so I will discuss it with her then.

I do have a small freezer stash if expressed milk so I can start offering those as top ups too.

I would advise you to seek some more urgent help. If he continues to drop centiles as he has been doing then he will be off the chart in another 4 weeks. This needs some rather urgent investigation/support!

Has a specialist checked for tongue tie?

I was about to say have they been checked for tongue tie. My DS was dropping like your baby and even thought his tongue tie was cut (twice!!) his latch was still rubbish and we wasn’t transferring milk efficiently enough

He wasn’t *

I would not be waiting 4 weeks
This needs urgent investigating

This needs looking into before the 4 weeks OP. Your milk supply should be fully established now. Can you try topping him up with formula before your appointment, starting tomorrow?

I'd either top up with formula ASAP, or get urgent help ASAP. In fact even if you start topping up with formula I'd still get it looked into ASAP.

You're doing a fab job. But he shouldn't be drastically dropping centiles as drastically as that. Would you consider formula top ups?

I started formula top-ups with my first around 12 weeks for a similar reason. I was worried about it ruining breastfeeding, but quite the opposite - we mixed fed long-term and it worked well for us.

It sounds like something needs to change. In my case, the HV referred the case to a paediatrician. Could you request that? You might not see the doctor in person but they will give advice on something to try.

Hi @PigglePuggle,
I'm in a very similar situation! My LO is 13 weeks, was initially EBF and dropping centiles. It was a bit more drastic here though, with no weight gain at all for 2.5 weeks (between 7 and 9 weeks old). He was otherwise well though, meeting milestones etc.

We saw a lactation consultant privately who was super helpful (make sure they're IBCLC) in working out the issue - for us, a tongue tie has caused poor transfer and my supply had dropped. We moved to triple feeding - BF, expressing and giving bottles on top. It's important to have some support if adding formula though, as you don't want to risk your supply.

We didn't get referred to Paediatrics as felt to be BF issue, and had good weight gain once we changed up the feeding (PP are right that you do hit faltering growth criteria so it should be considered - this was fully discussed and agreed with me).

At 13 weeks we're now combi feeding and it's working well. Breastfeeding struggles are really hard though, and I felt really rubbish that he wasn't gaining weight - you feel very responsible as the person feeding them!!

I went to a weigh in clinic this morning and voiced my concerns but she insisted he’s tracking the 25th percentile and that I have nothing to worry about. When I put it into a calculator online it says todays weight is on 18th percentile, so up slightly from Thursday’s HV appointment where he was 15th. She said they’d only be worried if he dropped down to 9th!

I have an appointment with a breastfeeding specialist on Thursday so I will discuss tongue tie with her then, and weaning him off the nipple shields as I suspect these are a factor too.

In the meantime I have been giving him bottles of expressed milk a few times a day and then I express whilst he has those to keep my supply up. Would it be better to give formula over expressed milk?

I'm surprised at the HV, better to address it now surely rather than wait for it to become a bigger problem.

You don't need to give formula if you are happy with expressing but make sure you feed first and then give the expressed milk as a top up. I'm sure you are but just for supply purposes. Don't be afraid of formula though if you're finding all the expressing overwhelming, you are nice and established with BF at 12 weeks so do whatever is best for you.

Good news that you are seeing the BF specialist for advice on the shields and tongue tie. Sounds like you're being really proactive ☺️

Hi,
This is almost the exact same story as mine. My LO was ebf and dropping percentiles. He did have a tongue tie which was correct at 1 1/2 weeks however still struggled to feed, constantly on and off with his latch - I think due to his high palate and recessed chin, the tongue tie I think was only a partial factor in our feeding issues.

When I was EBFing he gained but very slowly, started on the 75th and started dropping, we are currently just below the 25th (91st for his length 😑). About 6-8 weeks I started adding in expressed milk, about 40ml after each bf session. Felt like I was constantly feeding/expressing, it was miserable not going to lie. So I decided as I was expressing anyway I would do that exclusively so I would know exactly what he was getting a day. Even on roughly 27oz a day he still was only gaining 23g a day so he now on 30oz+ a day. Takes 3-4oz every 2 hours.
Technically Im overfeeding however considering his weight gain is so slow I'm ok with that, I just don't think my milk is very calorific 🤷‍♀️

Expressed milk in a bottle is 100% fine ofcourse OP

Expressed milk in a bottle is good because you can see how much little one is taking

Don’t look at online calculators as they might not be the most recent WHO centiles, look at the points in his red book. If he’s crossed over two centile lines, I would definitely recommend topping up (as should HV have done). Have you heard of switch feeding and breast compressions? The infant feeding specialist will be able to help further hopefully. What happens without shields? There is some evidence to suggest that they may decrease milk transfer.

Looking at the UK WHO charts, I’m guessing your baby has dropped one centile space which is completely normal growth and weighing in 4 weeks is perfect advice. What are his actual weights though? If they confirm that then it seems all is fine.

If he drops two centile spaces that is a concern and needs investigation. Birth centile can be completely disregarded as it is a different data set. Getting breastfeeding help is always great though.

In addition to tongue tie, let the specialist check for lip band tie.

Thanks for all your advice MNers, I saw a feeding specialist today and it was so helpful!

Turns out I have been reading the graph wrong and he is indeed tracking the 25th percentile, I feel so much better now that I know how to read it properly!!

He does have a very mild case of tongue tie so I have another appointment to assess this next week before a hospital referral for correction if needed.

I’ve also been using nipple shields that are too big so although I’m trying to wean him off them at least using the correct size will help ensure he’s getting the correct amount of milk.

@PigglePuggle I’m in not too dissimilar situation and the graph gives a much better picture than a list of centiles alone.

I have a steady but slower gainer due to tongue tie (getting it cut made no difference) and generally just being a terrible feeder! She was born on 91st, settled on 50th when she regained birth weight and is now between 50th and 25th.

I get a bit bogged down with the centiles and grams per week but actually looking at her chart the HV, GP and lactation consultants are all happy.

One of my DC gained weight perfectly, the other so slowly I switched to formula, and this one is somewhere between! I actually give her a small formula feed each day as puts my mind at ease.

But anyway, just some solidarity. It’s really hard and totally preoccupying when weight gain isn’t straightforward.

Have you had the TT divided yet @PigglePuggle? If not, I'd urge you to as our experience with TT was awful.