Four month old only breastfeeding drowsy and losing weight

[Kathryn3711]

At my wits ends. My 4 month old baby has been having major breastfeeding struggles now for almost 6 weeks, since she was 2.5 months. Prior to that it wasn’t exactly smooth sailing as she has a high palate and I have a fast letdown (lots of clicking and dribbling.. awful latch) but it was manageable. She then started only feeding side lying, presumably because the flow was slower. Now even that’s a struggle and she will only feed if drowsy, so I’d say it’s now a full on aversion. She’s lost 9 ounces in the last week. Trouble is, there’s nothing I can do to get rid of the root cause which essentially is, I think, choking (thanks to high palate / fast flow etc.) I have tried all positions (she won’t even entertain any except side lying) and tried expressing a little before feeds but nothing helps. Sometimes I think a feed has gone well, whilst drowsy, and still she will choke!! Any thoughts v much appreciated.

Have you considered giving her a bottle given that she is drowsy and losing weight....? Even a bottle of expressed breast milk? Assuming you have consulted a doctor.

That sounds really distressing for everyone. Could you speak to your doctor or midwife about it?

As soon as she starts to come out of a really regular suckling rhythm unlatch her, let her catch her breath and then relatch. Both of mine were chokers and splutterers. X

If she's lost 9oz in a week you need an urgent GP appointment, first thing tomorrow.

And yes, you need to see a GP, but presumably you're already under the weight clinic if weighing that regularly?

Has she been checked for a tongue tie OP? The clicking can be a sign.

In the meantime how do you respond to a pump? If OK then pump and store in 40-60ml and you can give her a top up.
A hakaa first thing can be good as well.

Definitely also speak to your HV.

Thanks all for your replies. I’m sitting here in tears as I can’t really believe it’s all come to this.

We have tried on and off with a bottle (lots of different bottles) since she was born, and really tried in earnest over the last couple of weeks but she won’t take it.

Weight-wise, until recently, that was fine and she was gaining normally. She was born 9,5 and is still a big baby. But the aversion has got worse recently and it’s just in the last week that she’s actually begun losing - going from 17,3 to 16,10 in 6 days.

And yes she’s been checked for tongue tie and apparently she doesn’t have one at all - just this high palate that’s always made it difficult for her to latch and deal with the flow.

I requested a GP appointment this morning and they’ve messaged to say she’s on tomorrow’s triage list.

Who checked her for the tongue tie? A high palate and tongue tie often go hand in hand as the restricted tongue isn't able to press against the roof of the mouth at rest.

Have you tried nipple shields? That could reduce the flow a little?

@kscarpetta she was checked by an NHS tongue tie practitioner although I wonder if we should get a second opinion. My husband does have a very high palate himself and i understand it can be genetic, when tongue tie isn’t also involved.

@FeelingSadToday1 yes have tried and she wouldn’t feed through them - maybe I should try again.

Feeling at this stage like I’ve tried everything and she will end up on a tube at this rate 😔

Do you have a breast feeding support/drop in clinic in your area? They may be able to help. They helped me when I was struggling to start breast feeding with my first.

How many different bottles have you tried? I’ve heard some babies are very particular. Maybe try some other brands or styles. If bottles don’t work, what about a calpol syringe/dropper?

Definitely get in touch with your gp/midwife/health visitor. I hope you find a solution quickly! Good luck!

Call health visitor, they should have an out of hours number? Im really pro breastfeeding but it maybe worth trying bottle/shields again - its all new to baby so she may just need to practise. Is she having lots of wet nappies? Thats key to her getting enough too. Ive had friends who are similar & they'd express to begin the feed to get rid of the overflow first.

I would definitely get a second option on the Tongue Tie @Kathryn3711. The clicking is usually a dead giveaway.

There’s a list of TT practitioners here

@TinyMouseTheatre thanks I think I should get a second opinion too - problem is most private services will only treat babies up to 12 or 14 weeks, and she’s now almost 17 weeks. I’ve asked some of the mum WhatsApp groups locally to me (Reigate Surrey) x

Don’t panic OP. At 4 months old there will be options. They actually start weaning at 4 months in some countries (apparently it helps prevent allergies to start earlier than 6 months) so I think it’s likely there will be things to try other than jumping straight to being tube fed.

You could totally try to give her extra milk (expressed or formula) from a spoon while you wait for your appointment.

Yes or try a calpol syringe slowly

My daughter has a feeding aversions due to severe silent reflux and multiple food allergies.
I had a fast letdown too and she only fed lying down for ages. We co slept overnight so she could feed as much as she needed and this helped her maintain her weight. She fed for a total of about 2 minutes during the day time with lots of 10-15 second feeds.
As soon as she went on high dose reflux treatment and I took dairy and soya out of my diet she started to feed better.
My son had a 100% tongue tie and his feeding before the release was similar and I think my daughter possibly had a small tie too. She was nearly 2 before she could lift her tongue to the roof of her mouth although she had good in out movement.

@Superscientist this is really interesting, I think we may be having a very similar experience. We started DD on omeprazole on Wednesday and I cut dairy/soya/eggs from my diet - there has been a definite improvement. We are back to happy, enthusiastic feeds - albeit still lying down (!) but one step at a time! Can you remember how long it took for it to get completely better for you?

You might not want an answer to that question!

It did take quite a while but she was/is quite complex. She has pretty severe reflux and it took a long time to get it under control, she is 5 and hasn't outgrown it. The omperazole only makes a difference at high doses but she reached the maximum for under 2y at 6m so we had to explore other options so she was on 3 medications until recently. She's been settled on just omperazole for the last 4 months.

Allergies wise, she had 20 at her peak which took a really long time to identify! I think she was about 15 months when we stopped adding to the list. It's only since she's turned 5 we have made any progress with reintroductions.

That said, I saw a difference in about 7-10 from removing dairy and soya from my diet and her going on the maximum dose of omperazole, we did both the same day. From then we had about 4 months of ups and downs as we identified the main culprits in my diet that she was reacting to. The feeding refusal turned out to be the first sign I had eaten something she couldn't have which was handy in the end. She struggled to feed within about 20-30 minutes of me eating as beef burger. I fed her not long after eating it and half way through the feed she pulled off and screamed and then would struggle to feed. It wasn't until the following day that the other symptoms started and by 24h after me eating it she was back in screaming mode and refusing feeds and could only be held and paced.

I had the mattress for the travel cot under the sofa to help with lying down feeds.