Help, newborn lost over 10% of birthweight, v poor feeder

[JollyBear]

Hello everyone,

I'm desperate for some advice. DD was born on Monday and is just not feeding enough.

I can't breastfeed because of medication I have to take so she is on formula. She was five days old yesterday and after her weigh in with the midwife was deemed to have lost just over 10% of her birthweight (6 lb 13 to 6lb 2). She refered us to the pediatric ward so our first trip out of the house since coming home was to go back to the hospital . They checked her over and said she was fine but that she needs to eat more.

The problem is she doesn't really want to eat. We've tried waking her up and offering bottles but she's not that fussed about eating. She plays around with the teat in her mouth for a bit, might suck for a while and then gives in. We bought a different brand of bottle today but that hasn't really made a difference. Today in total since 9am she has had 5oz but was sick after two of the feeds.

Has anyone got any ideas of what we can do? Different bottles, formula brands????

She was slightly jaundiced but the consultant seemed to think it had largely cleared up but she is still sleepy.

Obviously I feel terrible about it and cried buckets yesterday. I'm just desperate for her to put some weight on. Any help would be much appreciated.

Poor you. If you are worried you should take her back to the hospital. New Borns, don't take much anyway, one of mine, was in hospital after they were born, and I expressed, and onyl about a teaspoon cam eout, but they said this was enough. Is she lethargic?
Could you try ringing the hospital and ask to speak to a midwife for advice? I always thought losing 10% of bodyweight in the first few days was normal anyway?! That's what I was told. Is she weeing and pooing a fair sign something is going through. You may know all this already. Is she your first? I would ring the hospital and ask for the duty midwife for advice.
Best of luck XXX

When was the last time she was checked? Agree, ring midwife or take her back to hospital.

Don't feel terrible, it's not your fault!

Up to 10% is normal for most babies, but you can never take risks with newborns and you need professional advice and care for her.

Please don't worry - ds lost nearly 2lb in his first week, and he's fine now.

We used Cow & Gate, which he seems to like. What brand are you using?

You could try cup feeding if she's not getting the hang of bottles yet. Tommee Tippee bottles are good though - most people I know use those.

I'm sure she'll get the hang of it soon.

JollyBear It's horrible to be scared like this - though in fact what the hospital said is reassuring ie the only concern is her intake and there are no other developmental or health issues.

You have some options

• think of feeding her little and often
• taking her back to the hospital/seeing the midwife and getting specific advice on how to increase her intake
• holding her close all the time so you can respond quickly to feeding cues
• exploring whether breastfeeding is possible for you after all - medication is only very rarely a bar to breastfeeding

Hope things get better soon.

Thanks so much for your replies.

She doesn't seem ill or distressed at all, she just doesn't want to eat much. We were feeding on demand but she is obviously not demanding enough as she lost weight. We're now waking her every two hours, if she hasn't woken of her own accord, and trying to get her to feed. She is often just not keen.

She is on Heinz Nurture formula.

How do I cup feed? That is probably a very silly question.

Thanks Tiktok, we offer her a bottle as soon as she starts moving her mouth around or sucking her hands. She usually feeds well then as she is actually hungry.

I'm on immunosuppressents after an organ transplant and they cross over into breastmilk. I really wanted to breastfeed but the consultant said it would damage her kidneys.

Use a tiny cup, or an egg cup (or maybe the lid of a bottle if it's not too sharp) and hold it to her lips and tip a tiny bit in. You could use a tea spoon instead.
She will probably suddenly take off and be feeding for Britain all over Christmas!
Does she seem dehydrated? (Sunken fontenelle etc).
If she is having a little bit every 2 hours she is probably ok, but if you are worried ring the hospital.
When you are cup feeding, she needs to be quite upright.
Hope this helps!

Jollybear - I have three children and wouldn't have clue how to cup feed, it's not a silly question! You need a midwife to show you how to do it, and to tell you if it is appropiate for your baby.

I do really think that you need to see your midwife again, if only for reassurance, that has to be better then being at home worrying yourself silly about you new baby.

oh and congratulations

To cup feed just put a little bit of milk in a small sterilised cup (tops of bottles are ideal) and hold it to her lips so she can drink.

toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/~Yjk2Wb:1

toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/~Yjk2Wb:2

toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/~Yjk2Wb:3

www.ukmicentral.nhs.uk/headline/database/story.asp?offset=630&NewsID=6061

JollyBear - these links might interest you - I am not medically or pharmacologically qualified, but I am an experienced breastfeeding counsellor who hears from many women who have been told they cannot breastfeed because of medication, and it often turns out to be be either not correct, or else not as clear cut as they have been told. Your info may have been correct, I obviously can't tell, but if you read those links, and put your own drugs into the search function at both sites, you may find the information confirmed, or not, as the case may be. Up to you

Cup feeding - if you do this, it's a good idea to be shown how to do it, unless you are very confident, especially with a small baby...there are safety issues otherwise.

Thanks everyone for all your advice and thanks for those links tiktok.

The top three links aren't working but I've been told that it is the tacrolimus I take that prevents me from breastfeeding. I take azathioprine, but that wouldn't present a problem. I did some research into the issue while pregnant and what I read confirmed the consultant's belief that tacrolimus and breastfeeding don't mix. If you know of anything that disproves this I'd be very interested in reading it as I'd love to be able to breastfeed.

DD has fed much better through the night and took two ounces this morning so hopefully we have turned a corner with her.... touch wood.

Hi - the links have expired cos apparently you need to do a new search each time, sorry!

toxnet.nlm.nih.gov

Put tacrolimus into there and you will see that there are other views on safety than the one you have been given.

"Limited data indicate that amounts of systemically administered tacrolimus are low and probably do not adversely affect the breastfed infant. Exclusively breastfed infants should be monitored if this drug is used during lactation, possibly including measurement of serum levels to rule out toxicity if there is a concern."

The references are all there. This is something to raise with your doctors - you might decide that breastfeeding is possible and it would certainly not be too late to start now.

toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT - sorry, use this link as this is the specific LACTMED database.

You can also go to Dr Thomas Hale's medications and mother's milk forums and search (just put Hale Medications and Mothers Milk into google and then click on the medications forum link). I have just done so, and the info is the same (more or less) as in the TOXNET database. You or your advisers can also check out his book Medications and Mothers Milk (get the latest edition - it should be available to your docs) and read what he says about tacrolimus.

It's reassuring, and based on proper evidence of what amounts transfer in milk, and how much the baby would get. The drug has poor oral bioavailabilty (means it does not survive being taken by mouth very well). In the forums, he recommends monitoring the baby.

Hope this helps you have a dialogue with your docs.

Thanks tiktok that is all really useful. I just trusted that the transplant consultants would have access to the latest research, and the research I did seemed to back it up. Both my ante-natal consultant and the transplant consultants were in agreement that it passed through to breastmilk.

I feel a bit stupid for not looking into it more now .

I'll certainly speak to them about it again.

Just to say my DS was jaundiced when he was first born (he went on bilibed for a few days) and he lost more than 10% of bodyweight too.
Even when he was fine to come home and out of any risk with regards to the jaundice, he was still sleepy for a few weeks (it seemed to take a while to 'get out of his system') and feeding didn't come naturally to him as he was so sleepy.
I can't really offer any advice, but just to say that everything you are doing sounds sensible and some reassurance that I am sure things will come together soon. I agree though, do get her checked if you have any concerns. After a few weeks for my DS, his eyes suddenly pinged open, he fed for HOURS every evening and jumped centiles. He just suddenly realised about milk. I think some babies just take a little while to adjust to the world. Good luck

JollyBear....you have no reason to feel stupid. How would you know to dig for that info and to challenge your docs - they are no doubt fantastic with transplants but clearly do not know about finding out about bf and meds.

It's true the drug does get into the milk. So they did not mislead you in that way. The issue is whether it survives the gastric process (apparently not very well) sufficiently to harm your baby (apparently not).

If you want to start breastfeeding, just do it

But do it sooner rather than later, as the sooner you start the easier it will be.

Any questions, just post!