14 week old not gaining enough weight - what should I do?

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Hi everyone - I have a 14 week old DD and when we weighed her this morning, she's on the 26th centile. Until week 11 she was tracking the 34th centile, then she was 28th a week or so ago, so it looks like her growth is faltering.

She is exclusively breastfed (we've tried and failed for weeks to give her bottles of expressed milk but she's not having it) and although she has reflux, otherwise seems healthy and happy.

Should I take her to the GP? Speak to a health visitor? I'm worried she's not getting enough milk from me - sometimes she seems frustrated and pulls and twists at the breast; and she feeds often (at least every two hours) but not for long each time. I'm getting worried . . .

How often are you weighing? I'm sure they say at that age don't weigh more than once a month.

Have you ever had your latch checked by a BF specialist?

We see a lot of babies in this scenario. They can just be exhibiting regular 12 week old ish behaviour (often feeding better at night, easily distracted etc). But sometimes what happens is BFing hasn't caused any real problems and mum has a seemingly abundant supply, so they've never sought help. However their latch may not have been the most optimal, so when baby gets to around 3 months they are still feeding really frequently and maybe not getting quite as much per feed. This is correctable but might take some effort.

TL;DR - make a BF support group your first port of call.

1. Seek some breast feeding support from a specialist for their professional opinion and advice.

From what you have said then it would suggest there is a problem with your baby transferring milk from the breast. A breast feeding specialist will really be able to help you with this. In the meantime, have you looked into using breast compressions?

2. Visit the GP if weight gain continues to falter despite putting in place any changes the BF specialist advises you on.

My second son had really poor weight gain for the first 4 months of his life and things only improved after numerous consultations with an IBCLC, two tongue repairs, me removing dairy from my diet and three sessions from a cranio-osteopath.

If you can afford it, seeing an IBCLC would be really beneficial but if not then you need to a find a Breast Feeding support group and speak to a Peer Supporter.

Thank you - I'll contact a feeding support group/IBCLC.

She does have a tongue tie but they weren't able to snip it as there's a prominent vein too close to where the divide would need to be. The practitioner said that feeding would get easier as she got older so I elected to push through and carry on BF, and sure enough it's not painful anymore, no issues other than reflux, but obviously the slow in weight gain could be linked to this.

We weigh her every few days but I never worried about small fluctuations, it's more the steady-34th centile until week 11 and now 26th in week 14 that worries me.

Oh and I'll also try compressions - thank you! She does have a tendency to fall asleep quickly at the breast so I have to wake her. Sometimes I feel like a human dummy! (She won't take one of those either )

DS went from the 63 to 49 centile over a similar period. I spoke to HV and they only worry when you go over two lines in the red book. Eg he was between 50-75, they would only have worried if he’d gone below 25. By contrast I know a baby who went from 42 to 2, so 3 lines, and the infant feeding team only got involved at that stage. ETA: I’m not saying don’t seek advice, I would direct that query to the HV, but wanted to give some reassurance that it’s not as big a drop as you may feel.

Thank you @PurBal - that's reassuring; makes me feel like things aren't out of control. Will be contacting relevant support tomorrow.

OP if you switch to monthly weighing you'll likely find it will even itself out. You're only going over a 3 week period, baby could have a massive weight gain next week (as mine used to) and shoot back to the 34th centile. By all means contact the HV but unless there are other factors they'll likely ask you in to get baby weighed and then again in another 4 weeks.

Also what centile was baby at 2 weeks old?

Thank you, @mummyh2016 - I honestly can't remember what centile she was at two weeks. It was all a bit of a blur! From 4 weeks onwards she was hovering around the 34th.

This might be old advice...my youngest ds is 17! When he was brand new, he was EBF. We were referred to the paediatrician because he was not gaining weight in accordance with the red book.

Took him, Paed said his chart was the perfect example of a breast fed baby. He said the red book was based on bottle fed babies.

No idea if that's still right, so you'd better take advice from someone who has had more recent experience, but try not to worry too much.

Feed on demand, don't limit feeds, let the baby get plenty of milk from one boob at a time to get the calorific hind milk.

I'm sure you're doing a grand job x