4 week old breastfed baby not gaining weight

[plusbump]

My DS is 4 weeks old and still has not regained his birthweight.

I struggled with my milk supply for the first week and he lost 15% of his birth weight (8lb to 6lb15 in 5 days). I was determined to breast feed so started expressing after every feed and things improved. But now he doesn't seem to be gaining much weight, last week only 1.5oz, which makes him 7lb8 at 4 weeks. I am loathed to give him formula but he feeds for 1hrish every 2hours day and night so not sure what else I can do except start expressing after every feed again which I can't do indefinately as I need sleep.

Any thoughts/ideas would be greatly appreciated, thanks

there are lots of people on here, who are very good at offering help and advice. i'm sure they will be along soon.
just bumping for you, and well done for sticking with it.

Poor you!

Someone will come along who knows more than me, but I wanted to say well done for keeping going so far - it's not always easy.

You have to remember "supply and demand" so to get your supply up, you need to feed the baby more. Babies are way more efficient than expressing pumps.

My DD used to feed for hours and hours, and eventually something clicked. Not quite as little as your DS but she stayed the same weight from 6 weeks to 12 weeks. Then she rocketed up.

Have you tried feeding lying down so you can snooze a bit? Co-sleeping might help with the night feeds. I was reluctant to try it but when I did, it changed my life!

I mean co-sleeping changed my life, I could actually get some sleep for a change. You just have to have the confidence to do it and read the guidelines to be sure you are doing it safely.

Hi
Sorry to hear you are going through this, I did too and I know how very stressful it was. My dd went from 10lb 12 to 9lb 9 and was very slow to regain wt. Didnt get to birth wt til she was 7wks. I managed to avoid formula but only via a huge amount of stubborness and some very anti formula MWs.

How much are you feeding? Do you feed to a schedule or demand? Looking back my mistake was to only feed every 3hrs and not more often- I never let her feed as much as she wanted to increase my supply and I think that was my biggest error (I was very deluded in the haze of the early days!)

Could he have a tongue tie? Its possible to have a deep tie that isnt that obvious and will cause slow wt gain.

Also, your DC could be finding his intended centile for growth. E.g my DD
started at 99th centile (at birth) and then dropped to her intended centile which is now between 25th and 50th- so she was getting to where she was meant to be.

For us, things improved when the stress was lifted at about 4wks when the MWs signed me off- I saw a GP who declared DD as very healthy, we stopped weighing and things improved.

HTH

sorry, seen how much you are feeding- are you giving him back the expressed milk?

what is happening at the nappy end? a wet nappy, poo etc??

I wouldn't give him back the expressed milk, cos it's a lesser quality milk. And, if you haven't sterilized something by a mistake you could end up making him ill and that's the last thing you want. Babies are much better at sucking the goodness out than a breastpump or by your hand and also there's the baby suckling sight signal going to your brain releasing better quality milk and better let-down.

My best advice is don't let him get hot, cos if you are hot for example on a summer's day you eat less don't you? Take him to bed with you in just his nappy and have few topless duvet days! Plenty of skin to skin contact and do absolutely nothing but feed and feed. Get someone to look after everything else if poss. Babies do latch on when they are sleeping next to your breast and co-sleeping at night times works too. Cos, babies stir awake more easily cos they smell and feel you move nearby and think of your milk. This wills them to feed more.

Good luck with it. Try and not to worry my 1st baby didn't regain birth weight till end of 3 weeks and the BFG experts say allow yourself 6 weeks to sort things out. Don't panic you still got time.

He's probably lost 15% through the stress of being born, not because of you.

why is expressed milk lesser quality out of interest? Surely expressing after a feed means any milk is rich of good quality.

Gabreille Palmer's book Politics of BFG suggests that a baby might get a different balance of nutrients from pumped or expressed milk than from sucking directly from the nipple.

The foremilk and hind milk will be all mixed up in the container and we don't know what affect this has. And does expressing changes the amount and ingredients and make the milk come out differently? More research needs to be done.

Safer bet is just to let your baby suckle at times like this.

oh yes. Agree its best straight from the breast but surely its worth giving any ebm as top up would be silly to throw it out. Has to be better than formula top up if you are keen I exclusively bf.

plusbump - this is something you need real life help with. It's very unusual for babies to take this long to reach their birthweight, and you are right to be concerned about it.

Please don't withhold the expressed breastmilk - the quality is fine (it may be not the same as the baby setting the scene for himself but it is not of poorer quality) and if he is having probs getting the milk out directly for whatever reason, then in the case of a baby with this sort of weight history, it's important to get these extra calories in. He is still a full half pound below birthweight - he needs the ebm.

Someone needs to observe you feed to ensure he's feeding effectvely, and it would be a good idea to 'switch nurse' to increase the volume of milk going into him - that means backwards and forwards on each side, swapping when the baby seems to lose interest. Also google breast compression.

But seriously, this is something beyond a talk board's scope - you and your baby need to see someone who knows what to look for, as well as getting a medical check on your baby to see if there is any other reason he is not gaining weight. What does your HV say?

(Hoppity - babies don't normally lose 15 per cent off their birthweight through the 'stress of being born'. This is a large amount of weight to lose, and should always be taken seriously. )

pookamoo, I have tried feeding lying down but find he doesn't latch properly so we end up sitting up.

GYo and tiktok I have been giving EBM when I express it.

tiktok, I have been switch nursing and try to feed him in just his nappy or nappy and vest. HV has been very good at not stressing too much she is going to weigh DS before and after a feed tomorrow to check what volume he is taking. He is a very alert and wriggly little boy so he is healthy in that respect.

I think I will see if the HV can see me today and then depending on the outcome think about the formula I want him to be healthy and growing afterall and not just me being militant and stubborn about breast feeding

Thanks all for your replies

I forgot to mention I have had 3 people watch me breastfeed so I am pretty sure we have no problems there.

hope you can get something sorted today

good luck plusbump.

I had trouble lying down feeding at he start due to the latch thing. A rolled muslin under my feeding boob helped a little bit to get the nipple in the right place but it was still hard. Now Dd is bigger its much easier so perhaps its an option for later.

Hope you can get something sorted. You sound like me in that you've tried everything obvious to help - it must be v frustrating for you.

Hope you find a solution that works for you but do get hem to double check for Tongue tie

Keep us posted and congratulations by the way ))

plusbump - the HV is going to do what's called a 'test weigh' (weighing before and after a feed). This is no longer considered to be good practice and has not been done in the UK at least for many years - decades, in fact. The reason is that one feed does not show anything meaningful - your baby may take more than usual at this one feed, or less than usual. We have no way of knowing how much breastmilk a baby 'should' take at any one feed (one recent paper showed that healthy babies vary hugely in the volume of breastmilk from something like 0 mls to 450 mls - I can get a reference for this if you want. There's also the fat content of breastmilk, which varies.

Your HV might like to check out this paper:
Accuracy and precision of test weighing to assess milk intake in newborn infants
O E M Savenije and P L P Brand
Arch. Dis. Child. Fetal Neonatal Ed. 2006;91;330-332

I'd worry that your HV is test weighing 'cos she has no clue of what to do, and worries that she should be seen to do something .

Whatever the results of the test weigh, it's clear your baby is not getting enough breastmilk to grow as fast as the vast majority of babies do....this is the issue, not how much volume he gets at any one feed.

Hope you get some good help.

plusbump i did not get off to a good start with bf and my ds was frankly rather thin for a little while.

i did get very good support from a breastfeeding counsellor and all was well - but the gp and hv did just not know enough to provide the help to get the latch right to get more milk in.

please do call a helpline as well as seeing hv and gp to make sure everything else is ok.

i'm sure it'll be ok - just need to pursue the right help.

Good luck and I sincerely hopes everything will work out. Make sure you look yourself as well, I got myself into a right state with my 1st baby, I almost passed out in front of my HV. Cos I was so nervous about what those damn scales were gonna say!

Plus bump I don't really have any advice for you. But I had a very similar experience myself. At the end of the day you have to do what's right for you and your baby.

I put my daughter onto formula after two weeks . I have found it really hard, but she is thriving. Unfortunately, at the time I was scared to death that there was something wrong with my baby. I don't know whether it was the right thing to do or not.

I think though that this is a very common problem from what I have read since. MWs IME were obsessed with sore nipples as being the main problem people face with BFing. Rather minor in comparison to being worried about the health of the baby. I was told in the hospital that bfing was going fine, then 12 hours later at 3 day weigh in was told otherwise. It's really difficult isn't it and I really hope you can sort it out. Whatever though, you persevered longer than I did.

And I hope everything works out for you too!

I went to the HV this afternoon and DS has put on no weight . So I have decided to offer formula top ups after each feed. Thanks for for all your replies, they are much appreciated.

Had the same problem and actually sank into a very deep depression about not being able to feed my baby myself so I know exactly how you are feeling. I had the same problem with my 2nd baby despite knowing exactly what I was doing, feeding very regularly, drinking & eating well and resting well.

I know you must have tried very very hard and it's so upsetting when things don't go right. Being a good mum is about making the best decisions for you, your baby and your family as a whole.
Hope everything works out ok.