Fallen off percentile chart but refusing bottle. What next?

[UnicornRainbowSky]

Hello,

My baby is 15 weeks old, 4 months in two week's time.

He was born on the 9th centile at 40+3 so not huge. After birth he had to be admitted to NICU due to severe meconium aspiration. He was tube fed, sedated, ventilated and on a strong medication cocktail for 3 weeks. I started breastfeeding him when he was two weeks old and have been ebf since he came home at 3 weeks old.

He'd been tracking along the 0.5th centile since then, which our pediatrician said was fine given his history. However, I had him weighed yesterday and he's now completely fallen off the chart, still only weighing 4720g.
Another red flag they said is that he's still feeding every 1-2 hours day and night.

He's a happy baby otherwise and has been given a clean bill of health at his 8 week check-up. He is also hitting all milestones so far so no concerns there.

I think the issue is my milk supply as I expressed some after his feed this morning and barely got 5ml out each side and it looked quite watery. I presume he's simply not getting much high calorie milk from me.

So we decided to top him up with formula, as advised by the health visitor, 3x 30ml a day. Unfortunately he's totally refusing the bottle. We tried a syringe, which he also refused. Will try a cup next but I have little hope of him taking that either.

So what's next? The HV said we could look into introducing solids at 5 months but that's still quite a few weeks away. I can't imagine solids earlier than that because he can't sit up yet and just completely refuses anything but boob in his mouth.

What's the dangers of such slow weight gain?
Do I just trust he will catch up in his own time? Do I persevere with bottles? Any advice anyone?

Thank you if you've read this far
X

I would look at trying to improve your supply. If you can go to bed with him for a day or two if you can (not easy I appreciate) bring drinks and snacks and food with you and just offer breast and let him feed as often as he wants...every time he stirs at all. This will really stimulate your supply. Try not to express at all for now as that isn't as stimulating.

I would also get him checked for tongue tie.

Also make sure you are getting as much sleep as you can and eating quality food with 2 litres water per day.

Thanks for your reply! He's already had a tongue tie snipped.
I do feed him on demand as much as I can and spend most mornings on the sofa letting him drink pretty non-stop.
I do need to drink more water, you're definitely right in that regard.

Another thing to consider is are you eating and drinking enough? You need a large amount of liquid in you every day and good, nutritious meals which give you enough calories to convert to milk. Don’t worry about your weight for now, as hard as that may be.

Definitely worth letting him feed and feed, even though it might mean you can’t do anything else for a few days. Even if he’s not actively feeding if he’s at the breast it stimulates supply

Fenugreek? There are other suitable herbs too

How stressful for you. I think it would be worth contacting a private tongue tie practitioner and IBCLC to get him checked for a tongue tie/any oral disfunction

Highly recommend Carmelle Gentle in London or Acorn in Swindon. I say private as I've had terrible experience twice with NHS dismissing both DDs ties and feeding issues

DD2 had a tie and a really terrible latch and I didn't realise and she wasn't getting much milk at all and couldn't take a bottle. Mixture of tongue tie release and osteopathy fixed her feeding problems after 2 weeks and now she takes a bottle no problem and breastfeeds fine

Sorry cross posted, might be worth checking for re attachment and there may be a lot of tension linked to the tie (this is what the osteopath said for DD2 and fixed it)

Could you try a latex teat? My children were breastfed and eldest bottle refused completely when I went back to work, she was 5 months at the time. We tried Nuk latex teats and DH did manage to get her to accept a bottle from him. It is easier if someone else offers it sometimes as they are used to breastfeeding from you.

The amount of milk you express is not an indication of what the baby is getting. Babies are far more efficient than pumps at getting milk from boobs!

Let baby feed feed feed. Consult a ILBLC (that's not the right initials but a fully qualified lactation consultant, not your local nurse who has a million other things to think about and so won't know as much about breastfeeding

Why is him feeding every 1-2 hours a Red flag? My child is a chunky 20 month old and he does the same (,or that's what it feels like)

Feeding every 1-2 hours and not gaining much weight at all is a red flag because it's a sign that the baby is hungry but struggling to transfer a sufficient volume of milk.

Have you tried all the usual stuff OP? Breast compressions when he's on the breast, switch feeding (swapping breasts when he starts to slow and doing it a few times during the feed) is another good way to increase transfer of milk, ditch the dummy if you are using one.

To get formula in you could try a supplemental nursing system? They are a bit of a faff but babies don't seem to mind them at all and it's a great way to top up at the breast for a bottle refuser

If you are under an ibclc you could look at investigating whether you do have low supply, I had my prolactin levels checked when I was struggling with my twins and it gave the answer I was expecting, very low.

I think the feeding every 1-2 hours is a sign that they baby is only getting the fore milk (the first milk that you let down) this is a more light milk the hind milk comes later in a feed and is more creamy and satisfying. At 15 weeks baby should be feeding long enough to get a satisfactory hind milk feed.

I knew going to bed with him for a couple of days sounds like just feeding more often but as a previous poster said if he's on or near the breast he is stimulating supply. The same goes for skin to skin time. Not just that but it rests the Mum too. Your body does nothing for a couple of days but rest and make breast milk. This is what worked for me.

Thank you all for your helpful replies.
I definitely eat enough and plenty of nutritious food (I'm a nutritional sciences student, oh the irony!) but may not get enough water so I'm consciously upping that now.

We've been to an osteopath which has definitely helped with general discomfort he was having after he got out of NICU. May book him in for another session

I did do breast compressions and switch feeding for a while and that did help. Thanks for the reminder. It's incredibly tedious to do at every feed but I'll try my best to do it again as often as I can.

I have an older child as well and my husband is at work during the day so spending a whole day or two in bed is not an option. I will try and do mornings as least though when my eldest is in school.

I just got about 20ml breastmilk and formula mixed together into him using a syringe. He was giggling throughout so it seems he quite liked it even if it was slow progress. I can't do that three times a day though as it took well over half an hour. He just didn't know at all what to do with the bottle. Just kept pushing the teat back out of his mouth.

Have you tried different bottles and teat types. Some babies like some more than others. Maybe he doesn't like the shape of the one you tried?

if you want him to learn to take a bottle, keep offering the bottle. pick one time of day, say 2pm after a nap, and offer a bottle consistently for 10 mins. if he doesn't suck, switch to breast feeding and offer the bottle again tomorrow.

if you are consistent with offering a bottle like that for 7-10 days, he will learn to drink from it.

also, drop the osteopath - they are a waste of money and can damage babies development.

Is there anyone who can look after your other child for you or can your do take a couple of day's leave? Or can you just spend this whole coming weekend in bed with the baby while your dh cares for the other child? Because the relaxing in bed skin to skin with the baby feeding on and off all day can really work wonders. And tomorrow's Saturday. Perfect!

Don't look at the weight but whether he is following the curve of the growth line. As long as he's growing, happy and following the curve he'll be fine, you may need another couple check ins to be sure 💐

He may just be feeding more regularly because his tummy is so small still. Both of mine tracked just under the 0.4th percentile their whole lives 🤷‍♀️ is he fussing for food or an unhappy baby? He may just be small hon.

My youngest was like this, he completely dropped off the charts at 12 weeks and has stayed their ever since. He is also a total bottle refuser. Have you ruled out any allergies? I had to go completely dairy free which helped slightly but still never got him back on the charts. At 4 months he had an Ng tube placed and we topped him up after each breast feed with formula milk. Despite this he still didn't have the gains expected and now at 2 and a half he's still not on the charts and in 6-9 month clothes. He does have other health issues though.

Please know that the amount you can express is not indicative of supply so please don't think it's anything you are doing. There are also breast milk fortifiers that you can add to expressed breast milk to up the amount of calories. A dietician can prescribe this. You absolutely don't need to end your breastfeeding journey if you don't want to, we managed to continue feeding until just before he turned 2 and self weaned.

He was tracking along the 0.4th centile after he came home from hospital but over the last month has dipped slightly below that.
He's a happy baby otherwise as long as he's recently fed and slept. I'd say he goes an hour or so at a time until he starts grizzling and wanting boob.

I'm already dairy free myself but haven't looked into any other allergens.

My gut instinct says that he's fine but that we can certainly optimise his feeding so that he gets more calories and more restful sleep. I also find it so hard to know how much his NICU stay has impacted him and what's normal for a baby who's had this kind of history.

My plan now is to persevere with the bottles and take him to be weighed again in two week's time. I'm also spending today with him in bed as my husband has taken our eldest out for the day.

If he still tracks below the chart in two weeks, I'll ask if we can be referred to a specialist.

Thanks all for your insights!

Hi @UnicornRainbowSky
I was just wondering how you are getting on. Did your restful Saturday help?

I realised I never updated on here. Will do so now as it might help someone in the future.

Little boy is growing nicely but still along his own curve at the very bottom of the chart. But at nearly 6 months he's laughing, rolling, babbling and hitting every other milestone. He's a content baby, albeit one that is still boob obsessed.

However, we may have found the reason for his drop in weight and problems to gain weight adequately. At about 16 weeks he suddenly had white poo so we took him to a&e where bloods showed that his liver markers were off.

A lot of scary talks and various scans later, it was established that his gallbladder was very small and full of sludge. Possibly a result of his NICU stay where he was fed through an IV for some time.This ultimately led to him not absorbing his nutrients very well.

He's been on medication and everything is back to normal. He's got another scan in a few weeks' time and then hopefully we'll finally be signed off for good.

So the morale of the story? If your baby isn't gaining weight properly and you've tried all the tricks of the trade, there may well be an underlying issue that goes beyond milk supply, latch and other regular feeding stuff. Trust your gut and go see a doc if any other symptoms crop up!

X

Oh bless him. You did well then to keep him going with that going on! Glad to hear he is doing better now.

I could never express although I bf successfully so that may not mean anything. I would try not to worry too much if he's happy and alert and peeing and pooing and meeting milestones and not actually losing weight. Some babies are slower to grow than others. I would keep doing what you're doing-but maybe get him weighed again in a week or two, just to keep an eye on it.