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.

deleting -do you need some support with your own situation? If so you might want to start another thread perhaps so your situation doesn't get missed on this thread? An average of 3oz a week weight gain a week from a small birth weight doesn't sound v v low. Did your baby lose weight at first? Are there other issues that are worrying you? Was your dc premature? Like I said, it would probably be easiest to start a new thread, as the issues at 7 weeks might be a little different than with an older baby .

noodlesoup - you asked about high calorie weaning foods. If weaning is suggested then this is probably the sort of question you'd want to ask the dietician. You could also run through the list of questions (remember 'BRAIN' -see above) with the dietician and pead about this option if they suggest it, as that may prompt them to explain their thinking to you. Asking for them to show you the evidence of the effectiveness of a particular intervention or strategy that a health professional is suggesting can be a really helpful way to get extra info to help you decide what to do. This is often best done v politely & gratefully with a smile.

Hope it goes well and that you get some answers.

I hope you get some good advice tomorrow. One option would be a NG tube into the stomach to allow top-ups so that your DS can get extra without the effort of feeding.

Hi noodlesoup. DD was like this. Very slow gaining weight and never actually looked for feeds. I ended up feeding her round the clock trying to get her to gain weight. It was exhausting and progress was really slow. She was prescribed a high calorie milk called infatrini (100 calories v's 70 I think) but she wouldn't take a bottle. No matter what. She finally drank from a cup much later and her weight gain did improve once she got going on the infatrini. Best of luck

Hi grendle, thanks for concern, have got a thread going at the moment. he lost a bit in the first few days, went to 1.73 kg, but put back birth weight in five days. he hasn't lost any more weight, but has been very slow and for a couple of weeks was static. put on 9 ounces though last week which bumped him up a bit, so hopefully he has turned the corner. will see tomorrow when he gets weighed. btw, he was born 36+3, so not very premature, but small for dates.

Just a word on lactose intolerance - anyone who suggests a mother goes lactose-free to change her breastmilk is on the wrong track. It will make no difference - lactose is in breastmilk whatever the mother's diet. The lactose in her milk does not come from lactose in her diet, and hcps should jolly well know this

Tutu - someone should have explained this to you, before you went to the enormous inconvenience of changing your diet.

Good luck tomorrow, noodlesoup

Tik Tok, really? Oh do please expand on this please when you get a chance, as many b/fing moms on the allergy threads are doing this (and I followed this advice also from Children's Hospital) as a panacea to help their (possible) lactose intolerant babies.

If it's an urban myth, then fine.

Not an urban myth so much as a biological impossibilty! It's shocking if hospitals are recommending it.

Lactose is the milk sugar in all milks. Each and every one of them. Cows eat grass, and their milk has lactose....!

Babies who really cannot cope with lactose need a lactose free formula like soya which is not a milk ('cos 'milk' comes from animals only). Congenital LI is vanishingly rare, but more common is secondary (and temporary) LI after a bout of gastro-enteritis.

Some ethnic groups become LI after childhood.

Some babies are cows milk protein intolerant and a very few of these seem to improve if their mothers avoid cows milk protein, which can get through to the breastmilk.

I will seek out and post some references tomorrow. Are you really saying that many bf mothers are being told to change their diets because of LI?

That's shocking.

Should clarify - bf babies who are LI with this temp, condition don't usually need to have a lactose-free formula - mostly they are fine with breastfeeding.

HI noodlesoup, I think i spoke to you on your other thread in sn the other day.

Firstly I would be very surprised if the paeds ask you to stop providinf breast milk for your ds.
What they may ask you to do is to express while they establish, what if anything is the cause. They will store your EBM for you & once they are sure his tummy is able to absorb it OK they will re introduce.
They may want him bottle or even tube fed at first so that they can accurately judge his intake.
I guess they will also test his urine & poo.

There are high calorie formulas that are used for prem babies, eg Nutriprem, these are on prescription.

Thye may just decide that your ds has been through an awful lot & he is just taking a while to recover, as he recovers medically he may improve with his weight gain. fingers crossed, I hope all goes well for you x

Yes, I am saying that many b/fing mothers are being told to change their diets because of a medically diagnosed lactose intolerance and/or cow milk protein intolerance.

Myself included. Of course I would change my diet if it was adversely affecting my child. Didn't work and DS is on molecules split by NASA type prescription formula. And he's on a dairy free diet.

Paediatrician says: lactose intolerant.
Dietician says: cow milk protein intolerant

Confused? Moi?

ilove - the paed needs to revisit his GCSE biology books

I would second others who have mentioned the need for clarity between cows milk protein allergy (CMPA, which affects around 2-7% of all babies and is diagnosed by skin prick test or RAST) and lactose intolerance (diagnosed from a stool sample). The two are very different with a lactose intolerance coming from either a lack of the enzyme lactase or inactivity of the enzyme lactase which breaks down lactose. CMPA on the other hand is an immune reaction and nothing to do with lactose. Lactose intolerance is generally unpleasant, but not life-threatening, CMPA can lead to life-threatening reactions.

CMPA can however lead to anaemia due to bleeding in the gut (a common symptom of this is blood in the stool, which is characteristic of babies with CMPA). Cows milk protein can also be transferred to baby via breastmilk, and symptoms of the allergy (which can include failure to thrive) can be reduced/eliminated by the mother maintaining a dairy free (not lactose free diet). It should be noted that this is not a small undertaking and not advised without confirmation that CMPA is the problem.

It is shocking the amount of HCP's who get CMPA and lactose intolerance confused. I had a junoir doctor do this with me - thankfully I teach biochemistry to pharmacists for a living, so have enough knowledge to be able to correct her .

Oh, I should also add that whilst CMPA can lead to failure to thrive, I notice the OP's baby has a clear RAST for cows milk. Other foods which can cause similar symptoms (even in breastfed babies) are egg, soya, wheat, gluten and fish which it may be worth asking the paed for a skin prick test, at least to rule out allergies to these.

Also, if you are going to go down the offering solids route, avocado's are great as a first food if you want something to put a bit of weight on. Much better (and tastier) option than baby rice.

Sorry I didn't mean lactose intolerant. I meant dairy intolerant . I was very tired last night.

Acedemicmum - my ds was diagnosed with a cow's milk allergy aged 12 weeks, even though the skin prick tests were negetive. They then went on to tell me that skin prick tests are not accurate in babies this young, and that he probably still did have a cow's milk protein allergy.

He is now nearly 10 months and he can tolerate milk in my diet (he is bf), but if he eats anything with diary in including babies' biscuits, then he does come up in a vibrant rash.

noodlesoup - I hope all is going well today.

Belgo, you are right skin prick test is not reliable at that age (can vary very much before about 18 months-2 years). However, the "diagnosis" for an allergy is evidence of a clinical reaction plus a skin prick or rast test. The skin prick on its own is not absolute proof. A clinical reaction on its own may be enough, depending on how obvious it was.

However, the point in my second post was that dairy is not the only food that can cause similar symptoms, others can as well, so don't automatically assume dairy as it may be something else causing a similar type reaction and there is no point compromising your own health by cutting out dairy without good evidence that dairy causes the problem.

I'm back.

Its still a mystery. Fed round the clock and topped up with ebm and he managed to lose weight while we were there. Blood results back on mon so that might shed some light on it.

Sorry to hear there weren't immediate answers for you. What did the paeds and dieticians say about the bf?

I hope you get to the bottom of it and are back on track soon.

pead thinks the quantity of milk is unlikely to be the primary problem although he might not be getting much, he doesn't want any more than he is getting. He might be getting enough milk but not using it properly. She has seen that I am feeding him and he is very content. There is talk of a high calorie formula but we will see what the bloods are like first.

This sounds like the same problem I had with both of mine. There was plenty of breastmilk going in, but the weight wasn't going on.

I just topped up with formula (with the first DC a prescription milk) and this made a huge difference. I think the key to this working is making sure you get help with mixed feeding. I didn't have much option to give in and do this first time just because she was so dangerously small. Second time round I was happy not to fight it even though he was a much healthier weight - just because I had experienced how well mixed feeding had worked first time.

Given that you are close to weaning I would ask to be refered to a specialist health visitor to help with weaning. We got a lot of help with this the first time and I was really grateful for all the help and information we got.

BTW - 10lb 11oz at 21 weeks isn't tiny to me - my first was a lot smaller than that!