Almost 5 weeks, bf, but slow to gain weight - any ideas?

[chatname]

My little boy, A, is 5 weeks tomorrow. He is gorgeous (IMHO) but his weight fell from 3.53 kg to 3.2 kg in the first 10 days. Since then, he has been putting on 5oz a week, approx, in a fairly steady way. He was 3.6kg on Monday (4 and a half weks).

We had been told that I was expecting a whopping babe, over the 95th centile and off the chart, by scan, so it has been a bit of a shock that he's been trailing along the 9th centile or a bit below. He's a long baby - we're both tall - which makes him even skinnier for his weight, though evidently he is getting enough nutrition to grow, and he has chunky hands and feet.

I had gestational diabetes so it could be that he is "finding his centile". Though it does seem a bit odd for 2 fairly tall and well built parents to have such a little baby.

I had a visit from a nursery nurse to weigh him, last week. She suggested that a top up of formula milk, to supplement the bf, would be a good idea () . She also thought I shouldn't be feeding for such a long time at night - he cluster feeds in the evening and sometimes cluster feeds in the early morning. She thought that he might be feeding for comfort as well as for food and that this would be bad, though I'm not sure why. She suggested I should limit the amount of time he fed overall.

I think that limiting the time he feeds might not help us increase his wt gain but the opposite & that frequent feeding might even increase my milk supply. I still don't know what would be wrong with him feeding for comfort as well as food, that seems normal to me. And I would have to listen to him crying and have no way of stopping it, if he wants to feed & I don't let him, which seems pointless to me. Also, introducing formula seems likely to decrease my milk supply. So I haven't done that

Thing is, I'm not sure how to help things along for the best. It's not impossible that there's a problem with either the milk supply or quality or with how he suckles (although various midwives have said that his latch is good). He does feed frequently in the evening, but the early morning feed pattern is a bit variable. I wonder whether having more of a routine would set us up better for an increase in milk supply perhaps. Not sure how to get him to feed if he's not asking for food though, so am not erm implementing a routine very effectively.

He is capable of going from 2 or 3am till 9am without feeding so that's great from the point of view of sleeping through but not so great for getting his weight up. He's in a cosleeper cot which I got so as not to have to keep getting out of bed, but this also means I am feeding him in bed and it might be that our position is a bit awkward, with me feeding him lying down. Also, I have quite big boobs, and I wonder if that is affecting the latch adversely.

Sorry for the long OP, but does anyone have any other ideas or advice?

I think you're doing a fab job, and that theres no need to change anything - he's putting on a nice consitent amount of weight, and if that is accompanied by being happy and lots of wet/dirty nappies theres no problem.

As you've guessed, introducing a formula top up, restricting the amoung of time he feeds, and restricting the number of feeds are all things guaranteed to reduce the amount of milk you make and he takes. A routine will also not help this at all.

Feeding your baby when he wants it, for as long as he wants it is the best thing for you both.

Personally, I'd avoid having him weighed for a bit

Hello chatname

Not sure what to suggest going forward, but I agree with you that the advice you've been given is barking. If your baby is not gaining weight very fast, limiting his feeds seems completely crazy. And you're right, frequent feeding will increase your milk supply, whereas formula top ups will have the opposite effect.

My DS also fed in the evenings a lot, and I know that my supply was lower in the evenings, so maybe your DS is trying to increase your supply with frequent feeding?

KellyMom is a good resource for bf advice, and they seem to think 5oz a week is perfectly good weight gain - see here.
Remember those figures are averages, so half the population will be above those figures, and half below.

I guess it feels uncomfortable that he took so long to get back to his birth weight though (about a month).

Tracey Hogg in the Baby Whisperer suggests that babies that take more than 3 weeks to regain their birth weight are clinically Failing to Thrive. Which is a scary thought!

Dont worry about the weight and keep on feeding there are a few on this thread about slow weight gain here

Hmm, one of the ideas is expessing and giving extra milk. Is 4-5 weeks too early for that? A mum I know had a lot of problems after she tried expressing milk at 4 weeks - sore lumpy boobs and so on.

baby is better for getting supply

oops my helper is being fed and kicked k/b. I would just keep feeding baby as an when needed. They know jow to get milk out best mine does at 13mths old! I would be reluctant to top up I have fought with everyone of my hv over this. Actually my dh said last night that id I hadnt listened to other people years ago my other 3 dc would have been fed for more than a few weeks instead I topped up as was told to and topped up more which did in the end affect my supply. My little one is only 13lbs 10 but healthy

sorry for typos note to oneself do not type and b/f at same time

Failure to thrive is such a horrible term - talk about kicking a mum when she's down!

Soremummy is right, frequent feeding is the best thing for increasing supply.

Keep going, don't get too downhearted

Have been looking at the thread linked to by LittleMyDancing which is indeed helpful. I think though that at this stage it might be that I am doing something wrong with the feeding technique, just because I am quite a new mum and this is baby number one! rather than simply having a normal but petite baby, which seems to be the situation on that thread for many of the parents, who are often pretty experienced, and whose little ones seem to be a few months older, or more.

Perhaps I should mention, I've had a few other probs, including having been induced and had a Caesarian, sore nipples (one bleeding) & a ?blocked duct followed by mastitis (now recovered), none of which has helped the BFing. Thanks to the mastitis and my attempts to persevere with "feeding through" it, I have a very lopsided pair of boobs, esp big on the side which had the mastitis! So I'm wondering whether there might be practical or physical factors still complicating feeding.

Also, has anyone had problems with getting good enough feeding lying down? Or with ahem, generously sized boobs, that Junior is having difficulty latching onto? Could those factors be significant here?

Thing is, chatname, I'm not sure that there is much of a problem. Disclaimer - I'm not a bf counsellor or a HV/doctor, but you say:

• DS is gaining 5oz a week, which is within the average weight gain on Kellymom
• He has exceeded his birth weight, a little late but still he is growing
• He is sticking to his centile, if what you say in the OP is correct - it's a small centile, but he's not deviating from it

Is he doing lots of wet nappies, and some pooey ones?

You say his feeding pattern is very variable - he's still only 4 weeks or so, our DS didn't settle down to a routine until later on.

Is it possible that you're worrying because he is a small baby? Shut me up if I'm stating the obvious, but remember the charts don't mean that you have to be in the middle to be normal - a baby can start anywhere on the chart, it's if they start dropping off their centile dramatically that there's a problem.

I don't want to stop you trusting your instincts, you're his mum, but it sounds to me like you need to relax and just feed on demand, and let him dictate the pace.

p.s. I had an induction, CS, sore nipples and mastitis, so I feel your pain! It's horrible and can leave you quite anxious about things.

I would be less worried if his Dad and I weren't both rather tall (over 6 foot and 5 ft 9). I had lots of concerns from hps about the baby being large for dates (over the charts for largeness) during the pregnancy and it seems really strange that he's suddenly so little.

Me, I was a chubby baby and a rather overweight child, and my side of the family certainly didn't have fast metabolisms! So it seems odd to have a skinny little baby and I do wonder whether some of this might be technique, in which case thinking about what I'm doing and how at an early stage would be wise.

Trouble is, the scans are really inaccurate, and thats what he was born at, so it doesn't matter.

I presume that you are giving both breasts per feed ?

Best thing to do if you're worried is to see a breastfeeding counsellor - depending on your area, this might be at a Baby Cafe, NCT group or another breastfeeding support group.

The thing is, a baby that's born on the small side isn't going to turn into a huge baby overnight - and in fact, that kind of weight gain could be really unhealthy for them. Maybe your DS takes after someone else further back in the family?

This is quite a good article about how to evaluate your baby's weight and general health:
here

It can be odd being told you're expecting a monster and suddenly having a tiny little thing - exactly the same thing happened to my friend, and her DH is incredibly tall, so they were very surprised when their DS was a tiny boy.

The thing is, if he's doing all the things he's supposed to, then he's ok, iyswim.
Our DS was a skinny little thing and I used to look at the chubby babies all around us and wonder why he wasn't like that. But bf babies are skinnier, generally, and also, he just is a skinny little thing!

Have you been around newborns much before? I ask because it can be quite daunting to have this tiny thing depending on you, and it's easy to forget how tiny they are when they're really new. It can make you really anxious!

BUT - if you're genuinely worried about him for any reason, do get him checked out. You're his mum, you know best. Just don't let yourself be bullied into formula unless it's what you want.

Well, he was born the equivalent of 7lb 12 oz in old money, which isn't all that small, and went down from there! I haven't been round newborns that much before, but it is v strange going to meet with other mums and seeing how little he is compared with other babies around that sort of age.

I'd really like to make sure there isn't anything I could reasonably do to improve his weight gain before either accepting that it's his destiny to be little and/or going with formula. Especially when it comes to feeding patterns & technique, which I don't know too much about, being a rather new mum.

In that case, I would go and see a bf counsellor, who can come and look at you actually feeding and tell you if it's all happening as it should be. They're less likely to suggest formula as a solution, too!

Good luck - hope it all turns out ok for you and you enjoy bf your little boy lots.

x

Never seeing that nursery nurse again, is probably the single most important 'action point'!

Firstly: 5oz steady weight gain is fantastic, and should never have been even commented on, let alone used to undermine your feeding.

'She suggested that a top up of formula milk, to supplement the bf, would be a good idea'

This is bad, wrong and dangerous advice for a bf mother!

'She also thought I shouldn't be feeding for such a long time at night - he cluster feeds in the evening and sometimes cluster feeds in the early morning.'

Babies do this. It is normal. It is desirable. It leads to a good bf relationship. It supports your supply and demand.

'She thought that he might be feeding for comfort as well as for food and that this would be bad, though I'm not sure why.'

Babies often do do this, but they are little. What is wrong with a bit of comfort? There are many theories that show that responding to your child in this way is a very good thing and leads to a secure and happy child (not to mention a fed one)

'She suggested I should limit the amount of time he fed overall.'

This is bad, inappropriate and dangerous advice for a bfing mum.

'I think that limiting the time he feeds might not help us increase his wt gain but the opposite & that frequent feeding might even increase my milk supply.'

Yes, you are right!

'I still don't know what would be wrong with him feeding for comfort as well as food, that seems normal to me. And I would have to listen to him crying and have no way of stopping it, if he wants to feed & I don't let him, which seems pointless to me.'

There is nothing wrong (good grief that woman should be retrained, - or struck off)

'Also, introducing formula seems likely to decrease my milk supply.'

Yes, you are right!

'It's not impossible that there's a problem with either the milk supply or quality or with how he suckles (although various midwives have said that his latch is good).'

If you are worried about the latch, phone one of the bf helplines. MWs are very often not epecially well trained in this. However, if your nipples are healthy, and he is gaining weight (which he is), he has plenty of wet nappies then he is absolutely fine.

The quality of your milk is very close to that of a mother in the developing. Very very little affects its quality. Yours is tip top liquid diamond!

'He does feed frequently in the evening, but the early morning feed pattern is a bit variable.'

This is normal.

'I wonder whether having more of a routine would set us up better for an increase in milk supply perhaps.'

No! Restricting or sheduling feeds is more likely to interfere in a negative way with the supply and demand. However, make absolutely certain that you offer both breasts with each feed, and possibly even side one again when he slows! That is the best way to increase supply if you want to try it!

'Not sure how to get him to feed if he's not asking for food though, so am not erm implementing a routine very effectively.'

Please don't. Some people CAN get away with this if they are routine people and need control, but if you can manage not to, then successful bf is more likely if you feed on demand.

'He is capable of going from 2 or 3am till 9am without feeding so that's great from the point of view of sleeping through but not so great for getting his weight up.'

You're right. This is a tricky one! Babies of this age tend to need to feed between every 2-3 hours. AND, your boobs need the feeds at this time to increase supply. This may take a bit of trial and error experimenting. Perhaps try and introduce more feeds during the day, - just by offering. He should be having between 8-12 feeds in a 24 hour period.

'Also, I have quite big boobs, and I wonder if that is affecting the latch adversely.'

Nope! Size and shape makes no difference, but again, if you're not confident in the latch phone a bf helpline and get it looked at by an 'expert'!

'Sorry for the long OP, but does anyone have any other ideas or advice?'

To reiterate the two most important points:

1. Have no faith in that nursery nurse and do not follow her advice

2. Make sure you offer 'at least' both sides at each feed!

HTH

Lying down feeding is often achieved best when the baby is a bit bigger, - particularly for larger boobed ladies!

Some people can only get to grips with it from around 4 months!

Good luck with everything! You're doing brilliantly!

(I am still about that nursery nurse advice and that she is advising other, probably less sensible women than you on feeding)

Just adding support and seconding all the wonderful advice here for you, chatname.
Dp and I are the same heights as you and your dh and our dd was 9 - 25th centile, always very slim and still is at 2. My family tend towards the chubby too, so it's a little odd having a dd who's built differently. Her weight gain was even slower than your ds, we got some of the same rubbish advice, eventually ignored it (after mastitis, etc, caused by limiting feed time and not emptying boobs properly) and she has thrived.
Banish that nursery nurse from your door!

Thank you for the advice!

I did attend an NCT class, which had a bfing counsellor on hand, so I phoned her up and spoke to her. There's a bfing group locally as well; I guess though, the way I bf when I attend the group, ie sitting in an armchair chatting, with someone passing me cups of tea, is rather different from how I bf much of the rest of the time, and I am wondering whether I need to review technique/one handed typing on laptop/paperback reading habits and focus a bit more (does focussing help?)

I always found I had to focus on feeding to get the letdown to work - I could just about have a chat, but couldn't watch TV or read, just had to concentrate, especially at the beginning.

So yes, in my case, focusing on it did help.

Hmm, junior can feed on and off almost contiuously from 5 till 10pm. It's a long time to focus!

Hello sounds like you are very sensible and doing fine! Breast fed Babies put on weight in their own time and really try not to panic too much about it, my dd was really slow to get going in weight gain terms and everyone always commented on how small she was but then at about 3 months she filled out and was fine! Even though I had many people making me feel bad about whether b.f was the right thing to do, have faith and keep going, I did! Also if he is sleeping for longish periods he is obviously nice and full! The baby whisperer (tracy hogg) gives some quite useful advice in terms of introducing a flexible routine that esp in the early days i found useful. All the best XxX