Breastfed baby slow weight gain advice

[MrsLR]

Hello! Apologies in advance for the essay below but it’s helped to get it all written down!

My baby boy was born on the 9th percentile. He didn’t lose any weight initially and for the first 4 weeks, gained a steady 7oz every week. Thought BF was going well but it became very painful, saw IBCLC at week 4 who corrected latch and spotted mastitis. She was happy with how baby was feeding. Unfortunately, the doctor did not give me correct dosage of antibiotics so it took another 4 weeks to be rid of mastitis and pain to cease. Continued to breastfeed on demand throughout this time.

At week 6, he hadn’t gained any weight and had fallen close to the 0.4 percentile so was advised by HV to add 3x2-3oz top ups per day of EBM but if not, formula ☹️I was hesitant to introduce bottles as I was worried this would affect his latch and cause further pain. ( wasn’t aware at the time that all the pain was due to the mastitis)
Tried expressing but got nowhere near enough to provide the requirements for the top ups. Decided to continue EBF and offer even more regularly. Baby gained 2oz that week. Got some bad advice from a paediatrician we saw at A&E when we visited due to vomiting who said we should space out feeds and make sure he sleeps more. Ignored the spacing out advice but tried more sleep. Baby gained 1oz that week so reluctantly introduced the formula top ups and baby gained 11oz! I thought brilliant, we’ll be back to the 9th in no time. HV thoughts were that the mastitis had affected my supply and all would be well soon.
Continued to give top ups but gains weren’t as good ranging from 4-6oz weekly but HV were pleased so dropped to 2x3oz and weight gain remained in the 4-6oz per week range. Dropped to 2x2oz and that week only gained 1oz so back up to 3oz with any EBM I could offer. Since then weight gain has been some weeks 4oz, some weeks 1oz. Poos have been very mucousy since starting the formula but no one seems concerned. Nappy output has always been very good and has remained consistent.

Have since seen IBCLC again who was happy with milk transfer and my supply. She advised switch nursing and breast compressions to try and up weight gain but last week, he still only gained 1oz

Baby boy (now 15 weeks) has seen paediatrician who said he’s just found his line on 0.4. She said he was perfectly healthy. HV continue to appear uneasy and concerned about his weight and it is starting to get us all down. I feel like I’m
not good enough for him. Each week the HV asks how much I am able to express and seems disappointed. I’m able to get 1oz in a 15 minute session after BF.

I am keen to continue BF and would ideally like to get rid of the formula top ups. I don’t feel like they’ve had much impact on his weight gain and are difficult to fit in/get him to drink without throwing up whilst BF so frequently. However, I am also quite worried about baby being on lowest percentile and am fed up of HV and feeling judged.

Part of me thinks shall we just increase the amount of formula and accept combo feeding to push his weight up but then I’m worried that will affect my supply.

Baby is happy, alert and meeting all milestones. If we didn’t get him
weighed we wouldn’t know anything was wrong.

Apologies again for the rambling post. Congratulations if you made it this far! Any advice/ thoughts/ experience would be appreciated.
Thank you 😊

I personally wouldn't listen to the HVs, my 1st lost alot of his birth weight and it seemed to take forever for him to get it back. He is now 4 years old and bang on 50th centile. My 2nd was a covid baby, he was weighed once and as he was back up to birth weight they didn't ever weigh him again.
As long as you have no concerns health wise I wouldnt get so caught up on the weights. If you want to BF then stick to it, feed every hour if you can, it's hard work to start but easier in the end!

Personally, I wouldn’t gamble with feeding at all. I combi fed, and I’m very glad I did. Too many people I’ve heard of had a diagnosis of failure to thrive because of EBF issues. Fed is best, there are benefits to breastfeeding but you get most of that benefit through combi feeding, and even if you didn’t the benefits of breastfeeding are highly unlikely to outweigh the drawbacks of a failure to thrive diagnosis. I’m not saying that diagnosis is probable but it is possible, and often by the time people realise what’s happening the situation has gone too far to easily reverse the trend

Supply is trickier but it’s a lot more elastic than people think. I would recommend an electric double pump if you can afford it, try pumping as often as possible near the time baby is getting the bottle, this keeps your options open.

How on earth are most of the benefits of breastfeeding attained if you combo feed? Completely ridiculous statement to make with no backing evidence.

@Rowen32 maybe you’re right, could you share the research evidence you are drawing your conclusions from? Ideally research which shows the differences in effect size between EBF & PBF in terms of beneficial outcomes. Also if you have any recommendations for research evidence which compares the potential benefits of breastfeeding with the risk of harms of systematic underfeeding in infancy I would be interested to see that too. Thanks

As a general principle though @MrsLR , I stand by my original recommendation to prioritise adequate nutrition over striving for ideal nutrition. My understanding of the literature is that while there are benefits to breastfeeding the effect sizes are often modest and difficult to disentangle from confounding factors such as socioeconomic status. Even longitudinal studies which follow up on breastfed babies over 30 years are flawed because the nutritional composition of formula has changed significantly over time (it’s now typically more nutritionally complete than 20 years ago).

Have I read this right that he's following the 0.4 line?

Are either you or your husband quite petite?

He was born on the 9th so already was not at the higher end of the scale?

In general if a baby is following a percentile line then you don't need to worry about weight gain. Some babies are just petite, like some people are petite.

Is he alert, wet and dirty nappies and looks healthy?

All of this could be that he's found his line and is now following.

Number of oz gained per week can be misleading as well. Factors like illness, growth spurts or just doing a huge poo can all impact what the scales say.

You aren't taking a gamble if you're following advice given to you by a paediatrician. Take their advice over the HV and certainly over anonymous unqualified people online. Best of luck x

Thanks for your responses.
@Twizbe thats what the paediatrician said that he’d found his line on the 0.4. I guess I’m just worried he falls off it!
I’m only small so was never going to be a big baby, it’s just hard to trust your gut when every week you get disappointed vibes from the HV who all have also made scathing noises at the paediatrician’s advice. It’s making me doubt my ability to feed him! But I had read somewhere on here about a mum in a similar situation and she switched to formula but the baby still grew slowly.
TBF he’s always just done a huge poo before he gets weighed! 😂 It would just be nice to not be under constant scrutiny from the HV.

In that case follow the paediatrician. HVs like to see babies on the 50th but not every baby can be bang on average. If it helps, one of mine was at the opposite end. She was on the 91st from birth and the HV told me to cut back on the formula (she was totally breastfed)

If you're petite too then chances are baby is just petite.

You can decline the weigh ins if you want and if you feel confident that he's happy and growing.

Have a look for a breastfeeding group in your area. It might help with your confidence.

My daughter was in a similar situation and was diagnosed with tongue tie at 4 weeks by a tongue tie specialist. Public health nurses and midwives insisted she didn’t have a tongue because she could stick out her tongue and pushed me to introduce formula. I went to the specialist and she’s been thriving since 😊

I was completely afraid that the formula top ups would ‘break’ breastfeeding but it wasn’t the case for me. We went with the formula top ups (DH did her nightly bottle to avoid BF confusion and it was lovely for them both).
Still breastfeeding successfully at 16mo.

She shot up in length first and her weight didn’t catch up until later, they don’t grow following a perfect consistent line and your HV is daft to put that expectation on you.

best of luck to you.

@BeastOfBODMAS thats good to know, thanks. Luckily the top ups haven’t caused confusion here either. I just wished they’d put a bit more beef on him.

@Crunchygrass thanks, will keep on expressing when baby has a bottle.

@Number17 glad your little one is doing well. We’ve been checked twice by specialist for tongue tie and all seems fine there. They couldn’t understand where he was putting all the milk when they observed him feeding.

Thanks @Twizbe I’m bolstered by the lactation consultants having faith in my supply and his transfer plus the doctor’s opinion. I’ll have a look for a group, I think there’s a LLL one.

Thanks for taking the time to respond everyone 😊

@MrsLR you’re welcome, best of luck! It’s stressful trying to manage it all at first, but once you get in the groove that suits you it will likely be plain sailing. Just take it easy on yourself, and trust your instincts, if you’re worried- keep following it up