help - failure to thrive in older baby and breastfeeding (long)

[Academicmum]

Hi I'm looking for some advice out there. DS2 was 6lb 13oz at birth and was exclusively breastfed to 23 weeks. At 16 weeks his weight plateaued and he dropped down the centiles from the 9th (which he followed perfectly from birth until that point) down to the 0.4th where he has now stopped and he currently weighs 14 lb 8 oz at 34 weeks. I wanted to stop breastfeeding at 5 months in order to prepare for my return to work, but when we tried DS2 with a bottle at 23 weeks we discovered he has a severe milk allergy (anaphylactic shock). The gp prescribed a hypoallergenic formula but he won't touch it and come to that won't even drink EBM out of a bottle or cup. So anyway I have had to keep on breastfeeding and he is now on solids too, but still stubornly sticks to the 0.4 centile line . I'm worried sick about his slow weight gain and terrified to return to work in case it grinds to a halt/he starts loosing weight as he is not a keen eater. However, if I am going to combine b/feeding and work, how many feeds per day will be required to maintain my milk supply? I currently feed 5/6 x in 24 hours with 1/2 of these being night feeds (around 11pm and 3/4 am) - this is in addition to his solids. Excuse the fact that I am totally naive in this, DS1 was bottle fed from about 4 days old and by 34 weeks he was on 3 bottles a day plus solids and by comparison he was rather porky sitting on the 25th centile (hey its all relative - I aspire to the 2nd centile these days)...

First off - are you using the WHO bf-baby weight charts? If not, replot him on there - he might not look nearly so bad.
I know he's on a low centile line but if he is following the slope of it then he is still growing at the same rate as a bigger baby following a higher centile line (iyswim).

Re going back to work, the only thing I can offer is my experience:
I went back when dd was 7m and worked on the basis that I could only leave her with as much milk as I could express, and the rest would have to be solids, water, or (if it came to it) formula.
I started off by leaving 3 x 3oz or 4oz bottles, which was as much as I could get expressing twice a day with a manual pump (I bf on demand when I was with her).
This was quickly superseded by one session with a double electric pump, which got out the same amount but in a much shorter time and with only one hand, so I could eat lunch at the same time.
DD necked those three bottles and would probably have taken more, but in the early days made up for it by 'reverse cycling' (ie feeding lots at night) and later by eating more food.

If he's happy and healthy, hitting his developmental milestones etc, then he may just be built small, esp if you and/or DH are petite and as DS1 was a 25th centiler, not a 98th-style whopper.

I plotted him on the WHO charts (you can download this marvelous software off the WHO site which does everything automatically). On there he is on the 0.9 centile, so not quite as bad but not great either. He's doing all the things you would expect from a 7 month old (sitting unsupported, crawling "commando style", weight baring etc) but is tiny. I keep telling myself that this is fine and on weeks where he eats well (and gains well) - I actually believe it, but then he will have other times when he refuses to eat and gains little and then its so easy to get down about it.

With respect to returning to work though, as he won't drink from a bottle/cup is it enough to hope he will make up for it by eating more solids (I mix milk into all his food)? I'll only be going back for afternoons to start with, but will missing those afternoon feeds affect my milk supply too much?

Sorry just a quick reply but my dd is 16lbs now and is 19mths old there is a thread here for support look for mighty oaks from little acorns i think it was called will try link it if i find it. Btw mydd doesnt drink from any cup or bottle and will only bf.

check this thread

you may find he takes a bottle when there's nothing else on offer [hopeful]

And if not I'm sure he'll be fine for an afternoon if offered water and food, though you may find he dives straight for the boob when you pick him up.

If he gets in his normal 6 feeds within 24h even when you're working in the afternoons I can't think it'd have much impact on your supply. Worst case is you'd be uncomfortable by 5pm, but the chances are ds will fling himself at you and drain you in 3min flat

I wonder, if he is happy and healthy, how much value there is in weighing him so often if it makes you worried? I know tiddlers need to have an eye kept on them more than chubsters but every week seems a bit excessive to me. Are these all clinic visits to the HV with digital scales? I hated clinics so dd didn't get weighed at all between her 8wk and 8m checks, and indeed hasn't been since, but she is the size of a bus a sturdy strapping lass.

I guess with work I just have to try it and see how he responds then. With the weighings, the hv told me to go every week, but then she wasn't much help apart from just weighing him and making "oh dear, he's still only down at the bottom of the chart" type comments. I asked for a referal to a paediatrician and after weeks of waiting for the appointment, she(the paed) has been much better than te hv saying not to weigh any more frequently than once per fortnight, not to go to baby clinic but wait for appointments with her instead and that he is always going to be small, but he doesn't look wasted. This is fine and everything until he's either weighed and hasn't gained much, or seeing him at the side of others the same age, or comments from strangers (oh he's how old? oh was he premature? etc). Even just family buying clothes for him at christmas aged 6-9 months when age 3-6 month clothes are still nice and roomy on him only emphasises it and gets me down.

If it's any consolation my DS is v petite too - even at 2.9 he's much smaller than other kids his age and he still comfortably fits into his 24 mth clothes. All babies are built different - just like adults really! There are lots of petite people out there. If your paed is happy with him and he looks happy and healthy try not to let it get you down. Some HV just put too much emphasis on charts. Just remember - in order for there to be an average there has to be a high and a low!

Thanks all. Took a look on the tiny acorns thread and it is good to know we're not the only ones out there (it just seems like it sometimes...)

Chin up I get the LOOK every 4 weeks when she is weighed but as she is no 4 I stood my ground and made an agreement on my terms that resorting to paeds etc was not necessary unless she lost weight! (she hasnt ) I have been there before and wont go there again if possible.

my ds (11 months) was born on the 25th and dropped to the line somewhere between 0.4th and 2nd. But I would take issue with anyone saying he was not thriving. He is mischievous, a real smiler and incredibly active.

One thing I discovered recently though is that I was filling him up with milk when he needed to eat more solids. Since he stopped bf at night (when he got the most milk) he doubled the solids he ate and started to gain weight faster than ever before.

Now that worked for me, but of course the yogurts and cheese and fromage frais that my ds eats in addition to his three meals a day are not an option for you

Madmouse, it is interesting that you say that since I admit to having developed a habit of sticking him on the boob every time he so much as looks even vaguely hungry! I wonder if it is possible that he just needs a break from having a boob or spoon waved at him every waking moment to build up a bit of hunger and stop snacking? I think it is easy to get paranoid about how much milk is getting in (or not) with b/feeding especially as it knocked my confidence in this respect. I went from being really proud that I could do it and it was seemingly effortless as I had no problems and he gained weight really well for those first 16 weeks to suddenly gaining little .