failure to thrive ds being admitted tomorrow. Any ideas before we see pead and dietician?

[noodlesoup]

Ds is 21wks and 10lb 11oz.

His birthweight was 6lb 11oz.

He was 'following the line' until 10wks but has only gained 13oz in the last 11 weeks.

He has 5 (sometimes 6) breastfeeds a day. I tried giving him more on the advice of the bfc but he was much more unsettled and didn't gain weight.

I have tried switch feeding but he won't go back on the first 'side' again.

I do breast compression.

I am feeding him to routine mostly has he does not demand to be fed.

I wake him for his last feed, if I didn't he will sleep 12 hours.

He hardly ever crys or becomes unsettled.

I think my supply is ok.

He doesn't have a thyroid problem, celiac disease, allergy or chromosomal abnormalities. He has had a lot of tests which have shown nothing but he was severly aneamic at birth and is recovering from that. He has slight developmental delay (but not much and he is bright/alert).

He hardly ever poos.

It does look like I am starving him but I really feel like I'm not. I can't make him feed more often or for longer, he just pulls off.

I really don't want to give him formula and I am sure that I will have to have a conversation about it tomorrow.

I am flummoxed so please, please give me some ideas. He is tiny.

I don't have any real advice but really, really feel for you. I went through this with DS who is now 14 months. It was an awful time. Though supply didn't appear to be the problem, things did improve after I started to take domperidone to up my supply. But never enough and we did end up bottle feeding because his kidneys were in a bad way. I really hope it goes ok for you and that you find some answers.

How worrying for you. I don't have any advice, but I wish you and your baby good luck. Do you know why he was anaemic at birth?

When he does poo, is it normal bf poo?

what line is he on now and were either you, your dh or any other family quite skinny babies because there could just be a genetic factor.

Yes, normal poo. He is not uncomfortable or straning either.

He haemorrhaged into me through the placenta. Its called fetal-maternal transfusion, I think he lost a lot of blood quite quickly rather than slow enough for him to be able to replace it (which somtimes happens). He was shinning white when he was born.

tbh, I'd try the formula if he was mine - just in case it helps. (Although I'm very pro-b/f and b/f myself, 10lb 11oz at 21 weeks would make me worry.)

He isn't on a line. He was following the 9th, then it just went flat. Dh is 'normal', I'm short but not teeny tiny, other dcs are under the 50th% but not noticably small.

I know what you mean edam, I would be more comfortable with it if I thought he was hungry and I didn't have enough.

Its almost like he is too polite to say anything .

I'm off to feed him now (one of his rare demanding moments) but I'll be back later.

He is white/chinese so bottom end of the chart would be more normal anyway. Its the flatlining that is worrying.

noodlesoup i am sure have seen tiktok post something very similar about quieter babies sometimes not getting as much milk but this is half remembered.

i'll have a quick search, otherwise hopefully she will be along to say it in person.

DS was admitted to Children's in March with anaemia, high lactate levels, constant vomiting when he was 13 months old. The first thing they did was put up a drip, but that was because he was so incredibly dehydrated.

He was nil by mouth until they worked out what was making him so incredibly ill. They then tried feeding him through an ng (nasal/gastric) tube. Cows milk which he couldn't tolerate at all. I had to stop b/fing him until a diagnosis could be made. He was taking hypoallergenic formula, and not vomiting. My plan was for him to have it until I could b/f him again, but when I did, he was ill I did go dairy free for about a month, but he was still ill.

They need to find out what the underlying cause is as to why he isn't gaining weight. Elimination is a test, but they will want to probably also do blood tests.

You may want to ask about intolerances rather than allergies as this is a very common reason for failure to thrive. Also anaemia means that his system isn't absorbing iron for some reason.

The way I thought of DS formula was that it was medicine, and although would have preferred to have b/f him longer, he needed to gain weight as a matter of urgency and he was obviously having an adverse reaction.

Be sure and ask lots of questions and hope they work out why he isn't gaining weight.

How worrying for you.

I agree that tests to rule out any underlying problem are a good idea at this stage.

You say he doesn't demand feeds and is fed on routine. 5-6 feeds per 24hrs is not a huge amount, so I agree with the suggestion to try to increase this. Compressions and switch feeding are also useful techniques, so good to hear these have already been suggested.

If, for example, he's too tired or weak for some reason to feed for as long or as often as he needs to then expressing after feeds and topping up once a day might be one way to try to increase his intake. Does his anaemia have this effect on him? This would usually be the first suggestion before offering formula. By expressing after feeds the volumes obtained are often low, but it's the high calorie milk. Storing up bits from several expressing sessions may give enough for one top up. Breastmilk and formula are similar in average calories, so that's not a reason to suggest formula above EBM.

Likewise, occasionally introducing solids will be suggested, but first weaning food for babies under 6 months are basically fruit, veg and babyrice which are less calorie dense than breastmilk.

One thing to remember is that lack of weight gain is a potential symptom of an issue, not necessarily a problem in itself. It could indicate a health problem, or it can indicate a problem with breastfeeding. If, however, ultimately all is found to be well and he's just gaining v slowly but with no adverse effects then simply being small/thin isn't necessarily a problem in itself. this is why the referral is entirely appropriate, to help work this out.

I can empathise with the worry of a small baby gaining slowly. Ds was about 7.5lb at birth, but only about 12lb at your ds's age. It's v hard when all the other babies seem so much bigger and yours is still in the same size clothes. (btw, we knew why ds was small, as he had a dramatic loss at the start).

Hope you get some answers soon & do let us know what they say.

Oh and in terms of handling suggestions or advice you may not wish to follow, you could use the following sorts of questions with the health professional to help you assess what would be best to do:

B -what are the benefits of what is being suggested?
R -are there any risks?
A -what alternatives might we consider?
I -what is my instinct?
N -what would happen if we do nothing?

Sometimes asking for the evidence to back up a particular suggested course of action can be helpful too.

noodlesoup - some good stuff already on here. I would agree that evaluation and assessment of just what's going on with your little boy is justified.

Most babies of this age need more than 5-6 feeds a day, and the ones that seem happy with this are often big bruisers....so something's worth looking at.

If they think it is 'just' calories, then somehow or other, he needs more opportunities to feed - that might mean skin to skin holding as much of the day and night that you can manage, if you're happy to do that.

There is sometimes an issue with slow-to-gain babies conserving energy and sleeping and not having the energy to feed often and effectively - they benefit from an energy boost of (first choice) ebm, (second choice) donor milk (third choice) formula. Solids, unless very, very calorie-dense like lots of cereal (which has its own drawbacks), are unlikely to boost his growth unless for some reason he is happy to take lots of them, in preference to milk.

Hope things work out for you.

Grendle What a good acronym. Especially the instinct bit.

Noodlesoup I can't really add anything other than wishing you luck for tomorrow. You can always ask the health professionals for time to think things over before you make decisions. In fact time to think things through should really be encouraged by them.

ilovemydog Can they test for intollerences, or is it only elimination? He has had a RAST but I think just for dairy and it was ok. I have cut out dairy but its only been 2 weeks. He lost weight the first week then gained a bit the second but he is still lighter than he was 2 weeks ago. He does have a tiny bit of eczema but no vomiting or diahorrea or other digestive things you would expect from an intollerance.

He has been tested for celiac disease but maybe he has gluten intollerence or something.

His aneamia is improving. I think its probably not directly related because as his aneamia has improved, his weight gain has slowed down/stopped.

Grendle

I am a bit worried that if I wean him it will be worse but I think it will be suggested and I can see their point. I wonder if there is a calorific weaning food he could have.

I think I am going to have to express and maybe dream feed it to him so something. When I was trying to give more feeds he was miserable. The feeds were so close together that he didn't have time to sleep between them, so he would fall asleep when feeding and not get much, then he couldn't sleep properly because he was hungry so I would feed him and he would be asleep after 5 mins. Maybe the best way to do it would be to express a few times during the day and DH could give him a bottle at about 3am.

Thanks everyone

I haven't had the same problems as you, but at one point the dr's were worried that my ds2 may have a lactose intolerance. They didn't do any tests for it other than I went dairy free for 2 months and then we reintroduced dairy to my diet and it made no difference to ds2. I did also cut out gluten to see if that made a difference, but the consultant said that no gluten passes through breastmilk it has to be ingested through food to cause ceoliacs.

Good Luck tomorrow.

When DS1 was low wieght and the Drs were concerned they gave him Fortinis they are really high cal Milk Shakes, i wonder if they do an alternative for little ones like your DS?

did they check for reflux? pulling off at the feed might suggest that

Grendle, that's a fab acronym.

Tiktok (I am sooo pleased you are here) is it better to top up as a whole feed of a little bit after each bf?

would it be ok try to get 6 feeds in then try to express enough for a whole feed during the night. I don't think I can face getting up at 11, 3 and 7 for any lenghth of time.

Donperidone was suggested a while ago but my boobs are already leaking at night.

He isn't as sleepy as he was a few weeks ago so maybe I can try cramming more feeds in during the day without annoying him.

Thankyou

They haven't tested for reflux.

He doesn't really pull of if he is getting 5-6 feeds a day, its just when I try switch feeding or feeding more frequently.

If he is not getting enough to eat then it is concerning that he isn't bothered about it .

Lactose intolerance test is by stool sample, but there has to be some lactose in the system for it to be accurate, so the fact that you have been dairy free may be a factor, but mention this to the Paediatrician tomorrow.

oh noodle . I hope they help tomorrow.

It sounds like he's had quite a lot to recover from and he's still a wee little thing .

Before we figured out dd's feeding issues, she had started turning down feeds but she did cry and fuss when she did that (was reflux and allergy issues).

Fingers crossed they get to the bottom of it all soon. Will you let us know how you get on?

Hello just wanted to add to this thread. My DD has always been small and I just checked her charts and she was 11 lbs at 19 weeks so fairly similar. However she was formula fed from birth (she is one of DTs, at same age her twin brother was 6lbs heavier). She just gained very slowly and drank a lot less milk than her brother. She dropped from the 9th centile at 13 weeks to 0.4th at 19 weeks.

Is your DS skinny or "all over" small? My DD was referred to a paediatrition but was deemed to be just naturally petite and now at nearly 19 months she weighs just less than 19lbs (which is between 0.4th and 2nd centile). She is however quite chubby looking, just very short!

She crawled 3 months after her twin, and walked 4 months after him, but now can run faster than him .

I realise I am not giving any advice but wanted to say that it may be perfectly normal for him to be weeny.

Having just typed all of this I have re-read your OP and see there are other reasons you are concerned like the pooing and sleeping, we definitely didn't experience either of those (DD would get 10pm feed and still wake up wanting milk at 1am / 3am / 5am at that age, just never took very much each time).

Really hope your appt goes well tomorrow, I spent a few months really worrying about DD.

don't have advice, we're in a similar situation though with tiny, slow gainer. born 4 lbs still only 5 lbs 5 oz at 7 weeks. i hope they give you some useful advice and things improve. good luck

Sorry just realised my DD was 11lbs at 22 weeks and not 19 weeks as they have done adjusted age as she was 3 weeks early.