"Failure to thrive" - hints to make milk fattening!!!

[BWMum]

Please help!
My DD is 14 weeks old. She weiged 3.6kgs (8 lbs) at birth but has put on weight very slowly since then. She was last weighed at 8 weeks and weighed 4.5kgs, now had her weighed today for first time since then and she's 4.975kgs. So in 6 weeks she's put on 500g-odd and has dropped 2 lines on the growth chart.

The nurse said I need to think about topping up with formula. I am really reluctant to do this. Apart from not meeting the line on the chart DD is a very happy girl. She smiles and laughs, eats well and seems to be developing at the same rate as other babies her age. So I don't feel she is "failing to thrive" - perhaps only failing to get fat! However, I don't want to put her health at risk. We agreed to give it a week with me topping up with expressed milk - I get about 2.5oz a day. If she hasn't put on 150g - 200g by next Mon we will have to top up with formula.

Anyone been in a similar situation? Ideas for "fattening up" my milk? I have gall stones from pregnancy (which is very painful when they move around) and have to follow a low fat diet until I have my gall bladder out so pigging out on icecream and cream buns isn't an option. Would a calcium supplement help?

Thanks in advance for your help!

Hi BWmum, as far as I know you cant improve the quality of your milk. Your body is designed to make the perfect breastmilk for your baby even if your diet is poor (which is why malnourished women in developing countries can successfully feed).

I don't know anything about getting your baby to feed more or gain more weight, but hopefully someone with more advice can help you.

bWMum - there are loads of mums on here who have been told the same rubbish as you, so don't worry there will be plenty of advice soon!

But in the meantime, there is nothing you can do to change the make up of your milk - low fat diet or not - you're not producing semi-skimmed!! You're producing the stuff your dd needs. If you want to make more milk than take her to bed one weekend and feed her every time she even squeaks - some mums call it a "babymoon" - it's great for building up your supply.

Dropping 2 centiles is not failure to thrive AFAIK.

There are loads of other ways to see how you're baby is developing - not just by looking at charts!

You don't have to top up with formula if you don't think you need to.

Havea look at www.kellymom.com to see most of these breastfeeding myths blown clean out the water!!

Stick to your guns and get informed - this nurse clearly isn't clued up At All!!!

All the best

Advice on weight gain for breastfed babies

mum's diet while breastfeeding

How often is she feeding ? The best way to get extra calories into her (if she needs it, which is prob doubtful) is to feed more often, rather than 'topping up'. Is there scope to fit in an extra feed somewhere ?

You don't have to top up at all though - if you hadn't been to have her weighed, you wouldn't be worried would you ? And being told that she has to gain 200g in a week seems a bit unrealistic.

You'd have to be really starving before the composition of your bm changed, so theres nothing you can do on that front anyway.

I don't know anything at all about breast feeding but I would have thought that if she's a happy baby and not always screaming her head off then that would indicate she's getting enough for what she needs. Some people are just tiny people aren't they? A friend has a dd nearly a year older than mine and she's tiny and hardly eats but there's nothing wrong with her thats just how she is and her mum is quite a sturdy build. my dd is a lot bigger than her dd and she eats loads and hv always ask if my dh is very tall but he's not.

I'm sure you'll get help from loads of very knowledgeable people here, but I just wanted to say that you can't do anything to change the composition of your milk - you won't be producing semi-skimmed or anything! . You can increase supply though, if you feel you need to, by feeding more frequently. Top ups, whether EBM or formula, will mean your baby feeds less which will then reduce your milk supply ... so you need to be careful about that.

I don't know anything about weight gains and what's normal at her age but I am sure you would get helpful advice if you were to phone one of the breastfeeding helplines. Their numbers are listed on Hunker's blog.

hi just wanted to add my voice to those telling you you are doing fine. Take no notice of health visitors or nurses telling you your baby is failing to thrive and you need to give topups. They are misinformed and certainly not basing their advice on good research. Bobsmum's links are brilliant and I would always go to that site, or to one of the breastfeeding support groups like La Leche League, for advice on growth of breastfed babies. Basically the best thing for breastfed babies is to feed them as often as they need. Studies have shown that breastmilk is fattier the more frequently you feed.

You say yourself that she is happy and developing well. If she were really 'failure to thrive' you would know about it. (My ds2 had severe reflux and dropped off the bottom of those graphs at one point and he still wasn't labelled 'failure to thrive'. I'm sure the definition can't incorporate children as healthy as your dd sounds.)

If I were in your situation I would not go back next Monday, and if I ever did go back to the same clinic, I would make sure I armed myself with up-to-date information from reliable sources and asked the health profesionals if their advice was based on more up-to-date research that I had somehow missed... I appreciate this sounds quite confrontational but I do think it's shocking how misinformed most health professionals are about growth of breastfed babies.

For what it's worth, the most up-to-date research I have heard of said that 'catch-up' growth (as sometimes happens when babies are fed high-calorie diets to catch up with the 'normal' curves) can lead to serious health risks in later life, i.e. a higher risk of obesity and type 2 diabetes. So it seems to me it is far healthier to carry on breastfeeding as you were, than to try to introduce formula or any other ways of increasing the calorie content of your dd's intake.

mrc report on this research

There is a wonderful mumsnet thread here for babies who are gaining weight, otherwise healthy, but just not putting it on as fast as the charts say they should - has been a massive support for us!

Hope it helps!

Sometimes babies are born 'bigger' than they are meant to be + they will 'catch down' after birth. My dd was born on 75th centile and gradually found her centile over the next few months, which turned out to be the 9th! She has stayed there ever since + is a happy, healthy 10 month old.

Please do see a bf counsellor to ensure that your latch is ok and that your baby is transferring milk effectively.

That said, if your baby continues to grow, seems happy in herself and is making plenty of wet + pooey nappies then there is no cause for concern.

aargh been there, you poor thing

the thread ILD linked to is great, and i got some great advice here

i kept my stupid arse of a HV happy by topping up with EBM in a bottle after each feed for a few days - but pumping to get enough to do that (2oz each time) damn near killed me.

what i know now, but is easier said with hindsight, is that you don't have to do anything, be it top up, or whatever.

if it makes you feel safer, have a paed check your DD over - we did this - he declared her fit and healthy so we merrily chucked away the top ups with much more confidence. like you i was scared not to top up in case she was really ill. she wasn't at all ill, and really i knew that deep down, but as a 1st timer i needed the reassurance from the paed.

oh why didn't lines go through that?? oops!

stupid arse of a

...is what i meant!

C&Ped from VictorianSqualor's profile:

Association of Breastfeeding Mothers

Tel. 08444 122 949

The Breastfeeding Network

Tel. 0844 412 4664

La Leche League

Tel. 0845 120 2918

National Childbirth Trust

Tel. 0870 444 8708

The Breastfeeding Network - breastfeeding support in Bengali and Sylhetti

Tel. 07944 879 759

Tiktok is one of mn's bfing experts.

Do look at hunker's excellent blog.

You are very unlikely to be putting your dd's health at risk by continuing to bf and not top up with formula.

The nurse who told you you would have to give her formula is very likely to be poorly educated in breastfeeding.

lol at Caz but she is right though some hv are a pain. I have had loads of comments about my lo and her extremly slow weight gain she is 11 months old now and weighs 12lb 13oz although she was only 4lb 3 at birth the links to the other thread re weight gain from ILD are a good place for support

Insist on a referral to a paediatrician for a check up before you agree to top up with formula. He/she will probably pronounce her fit and well, and she will have to beak out.

Ugh, another HCP talking nonsense.

As long as she is getting plenty of wet and dirty nappies and isn't actually losing weight then she is fine.

Breastfed babies do not grow at the same rate as formula fed babies and the growth charts are not speciific to any one type of baby, they are based on bottlefed/breastfed/mixfed/early weaned babies etc so are just a rough guideline not anything to follow too strictly.

If you are worried your baby needs more food, then stop expressing and just have a bed-in! Just chill out and spend a couple of days feeding her as much as she wants.

If the nurse continues with this top-up rubbish do as Colditz suggested, ask for a paed referral.

our paed wrote a great letter to the HV too - she used to be round our house every couple of days waving her scales, now I have to ask to get dd weighed

She is happy, healthy, eating well and meeting her milestones. Her health is not at risk.

What you are describing sounds very much like a classic "catch down growth" pattern and not a problem. Your only problem is your HCP who doesn't appear to know much about normal breastfeeding. 150-200g would be a lot to put on in a week at 14 weeks and is an unrealistic expectation, frankly.

If you are worried about how much she is getting, breastfeed her more often and/or, as bobsmum suggests, have a babymoon for a couple of days. There is nothing wrong with your milk and no need to top up with formula.

Worth reading this thread which ran and ran last year and covers a period of about five months where a HV was desperately trying to convince a Mumsnetter that her baby wasn't gaining weight fast enough and that she needed to top up with formula. Again, there was nothing wrong with the mother or baby but plenty wrong with the HV's knowledge.

BWMum, I'm having the same problem. My DS is also 14 weeks. He was 8lbs exactly when he was born, went down to 7lb 1oz at 5 days and at the last weigh-in (at 13 weeks) he weighed only 11lbs 2.5oz (5.10kg). This isn't much heavier than your DD.

I have been bf on demand, he is happy, healthy, continues to grow in length but isn't a massive weight gainer. However, my HV is extremely happy with his progress, I get loads of support and she hasn't for one minute told me to top up with formula. The bf counsellor at my hospital has also told me the same and I've had loads of encouragement. Like PortandLemon says, there is something about a "catch-down growth", but if they are meant to go back onto the original centile, then they will eventually. My DS is on the 9th centile (started on the 50th), but he continues to gain weight slowly but surely. The only person who isn't supportive is my Mum, but that's another story and one I have posted about in another thread.

Are you worried about your DD's progress? Is it just your HV making you worried? Can you talk to any bf counsellors? The one at my hosp says the average weight gain for a bf baby around this age is 3-5oz per week - not a great deal! She got this information from La Leche League. The usual pattern for a bf baby is that they lose weight at birth, then gain quite quickly but then slow down after about 3 months. It would be hard to imagine many babies being consistently able to gain 150-200g per week.

Sounds like you're doing fine. I'm sorry to hear your HV mentions top-ups. If you keep feeding on demand you shouldn't need to top up as your milk supply increases as per your baby's needs.

Hey BWMum, have faith in yourself, you are doing great! Your little one sounds like she is fine from what you say here.

Do NOT be bullied or blackmailed into doing something you don't want to do by someone who doesn't know whether they are advising you to do something helpful or harmful. After you have followed their duff advice you will regret not following your better instincts. They will sleep peacefully without a thought for whether they mucked up a happy breastfeeding relationship through their ignorance.

At 14 weeks my dd weighed 3.91kg. She didn't weigh 4.975 until she was 30 weeks old!!!

I didn't top up because I felt it would do nothing but harm - increased health risk to my dd, damage to my supply, damage to my self esteem, and absolutely no benefit that I could see; merely a different number (possibly) on a random chart to satisfy a stranger whose name I wouldn't remember in a couple of years.

I did consult a paediatrician to reassure myself of dd's good health, and then I carried on as I was. She's the picture of health, by the way!

Thank you everyone!!!!!!! Honestly, I can't say that enough!

Inside I really do feel that DD is fine but I was beginning to wonder whether I was just being overly dogmatic about the breastfeeding. But I also have a real problem believing a cow can produce better milk for her than I can! Thank you so much for all your responses and for the helpful links. I will have a look through it all and go "armed" next week. And useful to know that 150g - 200g in a week is unrealistic.

Also like the sound of a "baby moon" - might just send us both to bed for a few days. I am in South Africa visiting my parents at the moment so I can do that and get my mom to bring us endless snacks!

Someone asked about DD's feeds - at the moment she feeds every 3 hours during the day but goes a bit longer at night - from about 6:30pm to around 1am and then until around 5:30am. Then we start the day around 7/7:30 when all the movement in the house wakes her up. I know some babies are feeding less often than this at her age, but I think with her being so light it's what she wants so I'm happy to go with it.

Thank you all again, it's such a help to get so much support, and to get reassurance that I'm not putting my daughter at risk by continuing to breastfeed only.