please help - low weight b/f baby!

[ilovemydog]

I know this is not a new situation, but really need help!

The health visitor weighed DS this morning and he's below the 4th percentile .

She suggested expressing before a feed, which I am doing. To be fair to the HV, she is concerned, but not overly....

He's going to get weighed again on Wednesday, and need ideas/suggestions to get him to put on the ounces...

Been there ... just feeding lo will be back with link in a sec

lots of people on this thread

My lo has never reached the .4th centile she is 14 months old and gaining average of 3 ounces a month and she eats quite well..

How old is you ds

Why did the HV suggest expressing before a feed?

Is there some rationale for this?

Need info on your baby's age, weight, rate of weight gain...just being on 4th percentile or below it is not significant in itself

If your baby needs to have more calories, what she has suggested will make no difference at all...unless I am missing some info here!

As Tiktok will say in a minute, if baby needs more calories, they need to feed (directly) more often, and offering more sides per feed. Expressing before a feed is pretty pointless

I would suggest the expressing before hand is to get rid of the thirst quenching milk and getting straight on to the fat milk.

Keep feeding little and often, on demand, when you can, and don't be bullied into formula top ups. Does the baby look in proportion?

True - sometimes, if a baby is to weak to feed effectively directly from the breast, supplementary expressed breastmilk might be used as a top up, to give the baby more calories in order to boost his performance at the breast.

The ebm would normally be got after a feed, too.

As I say, I don't understand the rationale for expressing before a feed, and then no other 'instructions'.....

itati - aha, I see that might be in her mind. Not a useful thing to do, at all, and not a predictable way of getting a fattier feed into the baby, either....HV is misunderstanding fore and hindmilk.

Me too

What about SGK? I know her son was very small and was being hassled to use formula and she resisted and he is huuuuuuuuuuuuuge now

Thanks tik - DS is 4 months. Low birth weight and has been flirting between 4th and 9th since birth. No sudden drops, just slow to put it on. He is very long though.

HV suggested expressing before a feed so he gets hindmilk?

It sounds like it is how he is going to be if he has always been like this.

Ah...itati was right, then.

This is a really, really poor idea.

Foremilk and hindmilk don't work the way the HV thinks. You can get a better idea by going to www.kellymom.com but briefly, the fat content of milk is dependent on the volume of milk in the breast. A fuller breast will have proportionately less fat in the milk; and emptier breast will have proportionately more fat in the milk. It is true that as the feed progresses and the milk is removed, there is proportionately more fat coming out, but this does not mean you need to remove milk first...the less fatty milk is still good stuff and you would never need to 'engineer' the milk content in this way to give a baby a 'short cut' to the fattier stuff. There is no 'cut off' point where the foremilk changes to the hindmilk, anyway. Was she suggesting you discard the expressed milk - I hope not.

If your baby is basically healthy and the concern is just that he is slow to gain, then the reason for her concern is a bit vague - but there is no harm in offering more opportunities to breastfeed...skin to skin, feeding more at night, offering two sides at least at every breastfeed, and then three or four if the baby is happy to have them, breast compression (google) when the baby stops sucking...all of this is easy and natural and does not involve the fiddle of expressing before the feed.

Hope this helps!

Thanks all - just had DS weighed and he gained a grand total of 1 oz in the last week.

However, the GP asked that the graph be replotted minus 2 weeks (as DS was born at 38 weeks).

I also asked that he be measured and he's on the 25th for length....

Seem to recall hearing that babies at 4 months slow down for a few weeks?

why are you still weighing him?

if he's healthy, feeding etc then weighing him only puts undue pressure on you.

DS2 was a midget (9thC) at birth. I refused to go to the baby clinic so HV weighed him every 2 weeks. Saw GP at 8 weeks (for the heart check thingy) and told HV as there were no health concerns I would never have him weighed again. TBF, she wasn't bothered.

It makes me feel angry that there is so much pressure from HVs to egt a baby's weight 'up' if they are small, especially when there is evidence that weight gain can start to tail off at 4-5 months.

itati is right I had a tiny one, who weighed 4lb 8oz at 33 weeks and didn't gain weight well at all. He is now 16lb and 9 months old. Have to do school run now so will reply proper when I get back

Normal for weight to plateau, true.

Difficult to justify frequent weighing with a healthy baby, I agree with Highlander. Current recommendations to HCPs (Hall4, or 'Health for All Children' if anyone wants to check the textbooks) are that healthy babies really don't need to be weighed often at all - I forget the exact number, but outside the usual routine checks (at birth, at 6-8 weeks, at about 8 mths) I think the suggested no. is two (it might be three).

Ask your HV - she's bound to know what Hall4 says.

Ahem.

Thanks again - the advice has been to 'keep an eye' on DS's weight, so I suppose the question is how frequently?

The HV agrees that DS is bright, happy, healthy (gorgeous - am I talking out loud?) with the only issue being his weight.

Tik, oh, and despite being American, got the irony of HV knowing what Hall4 says.