Slow to gain wt baby: ?panicky midwife

[mrsbean78]

Hi

My baby son was 4025g (8 14oz) at birth on the 1st of December. At a week old, he was down 3620g (8lbs. He was weighed 36 hours later and had put on 50g (3670g). However, he was found to have dropped down to 3650 (although he was weighed immediately after weeing a huge amount in his nappy).

The other concern was that he wasn't stooling - he hadn't opened his bowels in 5 days by the last weighing. He was having 10 heavy wet nappies a day, though - one for every feed.

The midwife watched me feed and said he was well latched on with a good strong suck. So she was worried about supply. She advised feeding feed two hourly (which I was doing, plus on demand anyway) and to express each breast and feed this in between. I was a bit concerned about this as I didn't really feel there was a major milk supply prob (I've been leaking and engorged as expected) and also I felt we'd all wear ourselves down for no real reason..

So we were sent to the GP who examined him and said he was well hydrated, had good tone/reflexes ("handles beautifully" - like a car ) and bright and alert. The GP also watched him feed and pointed out that he didn't fuss at all at the breast and that she could hear a good strong swallow - she also showed us the muscles he was using to feed and said he was using these efficiently. She examined his oral structure/tummy/anus and said everything was normal. The GP said that breastfeeding was a 'physiologic process' and that there might be peaks and troughs in the early days re: weight gain and that, anyway, because he was a forceps baby it might have been slower as he might not have fed efficiently for the first few days which might have slowed things down. She advised against expressing as she said it was more important to be available to feed on demand given that there was no physical cause for concern and just wait and see what happened over the next few days.

The midwife came back later in the day and she said she felt that he did need 'intervention' and advised I should be syringe feeding after every feed.

I expressed about 2.4 fl oz and fed them over today and yesterday but didn't express at every feed or anything like it - baby just needed me and dh was out at the pub for the baby's head wetting last night.. so I just couldn't manage. Baby has had 3 bowel movements in the last 24 hours. I think it is still a little darker than true milk stools but is more or less mustardly/seedy.

The midwife is coming back today and I don't want them to make a huge fuss if he's lost weight (which I guess he might do if he's now stooling?). I don't think there's any need and I trust the GP, she's a senior partner in our practice and was very moderate and sensible about it all.. Also he is just SO awake and alert and with it, showing no signs at all of distress but not lethargic or anything suggesting weakness..

Also, I was on IV fluids throughout labour and I've read this can artificially increase birthweight?

Any advice on what to say if the midwife panics me again today? I am happy for the m/w to refer me to a lactation consultant but I don't want to be sent off for scans and whatnot and be down at the hospital with my tiny baby open to infection if it's a matter of a few grams and the GP saw no cause for concern?

These are difficult situations to judge, mrsbean, and it is quite possible to have two informed, sensible, supportive people disagreeing. Why can the midwife and the GP not talk to each other about this?

Now he's producing poos, your baby is showing good signs of sufficient intake and this will not show as weight loss, so you don't need to worry that a loss of weight is physiological...it would be a real concern if he had lost weight in fact and I think it is sensible for him to be weighed at this point to see what's happening.

His behaviour, his 'look', his feeding, his eliminating...all seems normal, so I think it's likely the weight will be good news.

If not, then can you get the midwife and the GP together to discuss, with you, what to do?

It would be a real concern if he had lost weight.. a real concern in what way? The midwife was all on about 'suspicious' signs and 'concerning' this and that and it irritates me! I hate this NHS pussyfooting about.. I am going to demand today that I am told what the concerns are exactly because I find this veiled 'concern' far more worrying than true information..

Sorry to be irritating, mrsbean . I can't assess your baby and I can only use words like 'concern' in this context (ie a talkboard)...

The 'concerns' would include:

• is this baby unable to gain weight because of some underlying metabolic condition?
• does this baby have a condition that means all his energy is being taken up in survival rather than growth?
• is this baby unable to bf effectively (even when bf is on offer frequently and without restriction)because of oral anomaly (like, eg, tongue tie)? That seems to have been ruled out by the doc
• has there been a mild and transient illness like a gastric bug that's caused it?

Healthy newborns do not continue to lose weight - it's as simple as that. There is always a reason if they do - including not enough calories going in, and there might be many reasons for that.

If you are concerned I would ask for a paediatric referral.

I had dreadful experiences with my HV (missed out on MW because ds remained in hospital for a while). I found the advice I was given to be completely at odds with that from the GP (who was also a paediatric registrar). It got so bad that the HV was banned from seeing ds.

Seeing a paediatrician will sort out if there is anything to be concerned about and hopefully put your mind at rest if there isn't.

Tiktok, I didn't say you were irritating. I said that I find that general discussions about 'concerning features' by health professionals in the absence of clear information about the meaning of that concern irritating. I was clearly feeling anxious and I was stating it in relation to my own situation. I don't recall asking you to 'assess' my baby. I am a new first time mum and I am worried about my baby. Sorry if you feel that was offensive to you to the point you had to use some 'cutesie' emoticon to show your 'scepticism'.

It is interesting that you say that you cannot assess, yet you seem somehow doubtful of the GPs advice in this instance (although she did see and assess my child). I think it is a major leap from a couple of grams loss/plateau in gain to a metabolic disorder in a twelve day old infant.

You also clearly misunderstood what the GP was saying about the process - the GP was saying that it is, in fact, normal to go up and down a few grams as it is a natural process in which both mother and child are learning about breastfeeding. The GP mentioned the trauma of the birth as a factor and the artificial inflation of birthweight due to IV fluids.

Yet you feel, on a 'talkboard' that you can suggest, in all good conscience, that my baby has, potentially, a metabolic disorder? FFS. I work in the NHS, thank God, or else what you have said would be extremely concerning indeed - bear in mind that my response was a bit panicked and also was directly related to the health professionals dealing with my child's care. You chose to take this as some personal slight and suggest a METABOLIC DISORDER to an anxious new mum. Way to go, tiktok - very responsible and informed.

From my understanding from a brief trawl of the literature, the MOST likely reason for reduced weight gain in the neonatal period would relate to breastfeeding difficulties, most likely to be latch or supply. All the other more serious reasons you suggest would be likely be combined with other markers of failure to thrive and would, in any case, be picked up without you just diagnosing my baby on a forum.

If you had merely shared the information, then fair enough. But you were 'slighted' by what I wrote and deliberately opened up the worst case scenario in your pique. Shame on you.

To OP if you know the answer already I'm not sure why you posted in the first place .

mrsbean78 - you have come on here asking for advice - and TikTok has given you some of the best possible advice that you will find on an internet Talkboard.

She is not suggesting that your baby your baby has a metabolic disorder. She is suggesting reasons why a baby's weight loss may be of concern, which you seemed to want to know.

Good luck with the breastfeeding, and I wish your baby well, but I think it's unfair on TikTok and her well intentioned and sensible advice, that you have responded the way you have.

OP that was more than a little rude tbh. Tiktok is one of the best informed people on BF that I have ever 'met', and was simply responding to your desire to have any 'concerns' spelled out clearly.

You are worried about your baby, and thats fine and understandable. You posted on mumsnet asking for advice - you got some very good advice IMO.

Good grief MrsBean - I understand why you are stressed about this. Life with a new baby is often stressful but I really dont think there is a need to have a go at Tiktok.

She is just trying to help you!
You posted on mn asking for help, tiktok is trying to help!
She gives her time (hours!) on MN freely and entirely voluntarily - no need to have a pop at her.

I hope you work out how to help you baby asap - it is a difficult and trying time (My Healthvisitor mentioned social services involvement if I didnt consider introducing formula..............)

Woah! Calm down mrsbean.

All tiktok said was that, at this stage of your baby's life (ie not immediately after birth when weight does go down and can be slow to catch up) weight loss needs to be investigated and then she gave the reasons why, which included the common (not transferring milk effectively) and the rare (metabolic).

I'm sure everything will be absolutely fine but patting you on the head and saying yes, yes all will be well when tiktok doesn't necessarily know this to be the case, would be truly irresponsible.

Anyway, this is all hypothetical. Your baby hasn't been weighed and found to have lost weight yet, he's probably gained so just do what you're doing and enjoy your beautiful ds .

The early days can be tough, you'll get through this.

Clique clique clique

You are all in love with Tiktok, I get it..
But it was fair for tiktok to post a sceptical face because I totally panicked about the 'very real concern', said I would ask MY health professionals about what that meant (panicking, panicking) and then she suggested IN ORDER
metabolic disorder
something affecing my baby's chance of survival {angry]
and then, maybe, just maybe, a gastric bug.

You may all love Tiktok but if you think it was acceptable to suggest that level of serious concern in response to a panicking first time mother, and you think that it is rude for me to have the response I had, you are all being highly unreasonable. I will remind you I have a 12 day old infant that someone on line suggested might have a metabolic disorder or something compromising their survival.

Good grief, indeed.

I didn't know the answers when I posted. I was terrified. I have spent all day researching it. I know more now.. enough to know that Tiktok's response was egocentric and cruel.

You may think otherwise but you are sorely lacking in perspective if you think that it was a balanced or fair response to my post.

Noooooooooooo we are not a clique!

Its just that we know Tiktok is a mine of good advice - you were rude to her, so we defended her

Shame on you

I am going to report your most recent post

I think (hope) the OP will rather regret that response when her current situation has passed...!

Anyway just wanted to say to the OP I was in a similar situation with DD although she was a much lower birth weight. Our GP was much less sensible and was equally as scaremongering/formula pushing as the HVs.

What worked for us in the end was a combination of:

• expert bf advice from the BFN and the hospital lactation consultant
• great MN support (including tiktok )
• a REALLY good private paed (cost a bloody fortune though) who assessed dd and wrote a stinking letter to GP and HVs to tell them to leave us alone!

The paed's assessment was based mainly on the criteria you have listed in your OP. He walso showed us the "thrive lines" growth chart as an overlay on the standard growth chart, which reassured us that dds slow weight gain and (tiny) loss was NOWHERE near "failure to thrive".

I knew all of this in my gut but was much happier once a medical professional had ruled out anything more serious.

But you asked

Ok mrsbean78.

Usually, when someone posts a query on an open forum, its because they want an answer.

You posed what appeared to be a direct question to tiktok - "It would be a real concern if he had lost weight.. a real concern in what way?"

Giving the answer to your question can hardly be construed as rude, cruel, or egocentric.

OH i am such a slow typist and also bought some online gifts mid-posting, so have missed the most recent posts...

Heavens.

Ds was prem and lost so much weight when he came home that he dropped off the centiles (having started on the 50th). He had gastro enteritis twice within two weeks of being discharged and then he got reflux which lasted several months.

I wasn't concerned as he had wet nappies, opening his bowels and not in distress once the gastro enteritis bouts were finished.

My HV was completely and utterly freaked by him (he also had apnoea attacks which were infrequent once he was home but still happened, particularly when feeding and scary to witness).

You have said that you aren't happy with the MW and don't know whether to believe her or your GP. I have offered you an easy solution but instead you rant at anyone offering you advice. I don't know tiktok either in RL or on here and I can only speak from my own experience (actually I would have loved to have ds at home at 13 days - I had to wait four weeks for that having been told at one point he was unlikely to survive).

If there is a serious concern the GP will refer you to immediately and you will be seen the same day. Or you can go privately. My (extensive) experience of the NHS paediatric service has been nothing but excellent (excluding a HV that was way out of her depth).

oh dear

You are upset and I am sorry, I hope you get some advice that you feel is helpful.

But I saw no rudeness at all, only a helpful and informative response. Tiktok's face was due to the fact you said she was irritating.

Mrsbean I am taking from your most recent post that the MW has been again and weighed your baby again? i remember all too clearly sitting in stressed out tearful exhaustion while our HV trotted out her duff old scales again, paid no attention to clothes/nappies etc making a difference and then started her teeth sucking and sighing...I know there are some amazing health professionals out there but there are also some really bloody awful ones, so please remember this MW is not the person who holds the key to your baby's health, she is most likely not all that well informed TBH. Calm down, eat chocolate, feed baby, see proper GP or paed next week.

I was scared.

You have no feeling or compassion, any of you. I don't understand it. I have a 12 day old baby I am worried sick about.. I have learned since I originally posted that the weight loss/ failure to gain weight will most probably be related to breastfeeding and latch. Tiktok has suggested that my child might have something that might mean he can't grow because he is just using calories on surviving..

Honestly, no one thinks that is a bit OTT? It is not AT ALL the most likely thing.. NOT AT ALL.. so why post it, if not in anger (associated with the sceptical face?)

My comment was related to MY health professionals and was a bit panicked. I am sorry if this is so HARD on some posters ego that you all rush to defend her.

I really hope none of you ever have someone suggest your child might have a serious lifelong condition or be on death's door because they were annoyed at your tone in an online forum.

I didn't ASK in all seriousness, I said (ill-advisedly - oooh, sorry for not being totally with it in my fear and panic!) that I wish I knew what the risks were. The risks, as presented with Tiktok, went from very rare to more likely and left out all the more obvious and benign reasons. That seems cruel to me.. I don't know why anyone would write it to flag up the worst case scenario and use that silly sceptical face..

But anyway.. I'll just sit here in floods of tears while you all talk about how I should be reported for my anger. Fair enough. I am appalled by your lack of compassion.. appalled.

mrsbean I'm quite sure you don't mean to be so rude but I'm afraid you are. Allowances are made for a stressful situations but you need to calm down or you won't get any help at all.

Thankfully there is an option to change your posting name so you may want to use that once you have a little perspective and you can see how silly you are being by ranting at people on the internet.

Do you have any real-life support you could call on? Have you tried the NCT breastfeeding support line? Or could you join an early days or bumps & babies class?

It sounds like you could do with a sympathetic ear in RL where all the nuances and tone can be conveyed effectively.

Good luck

I understand you're upset, but you're being so, so rude to someone trying to help you!

You wanted more concrete answers on what "concerns" about weight loss could mean - you got that.

Tiktok's face was due to the fact you said she was irritating.

I never did.. I said it was irritating that professionals in the NHS wouldn't tell me what was going on.. Does Tiktok work in the NHS? If she does, how would I know? I really wasn't talking about Tiktok, I was just having a moment of total panic.

My post might have been unclear but I think it was a bit unfair to come straight back at me with the hard and heavy - your baby might have something that will kill him - when that is extremely unlikely (thank God I know that now.. although of course as a new mum I'll be worrying about it now at the back of my mind, hence1 my floods of tears here).

None of you think that it was bad form to go to this 'worst case scenario' situation.. Tiktok said if my baby had lost weight that then this would be a real cause for concern and that healthy babies would not lose weight. This is the opposite of what my GP said.. and yet Tiktok said that she had not assessed my child. Then Tiktok outlined that her understanding of the concern would be that it was something that could kill my baby. Sorry if I overreacted to that

As a matter of fact I have lots of feeling and compassion. I am sympathetic to your problem and I hope you get it sorted. I hope your baby will be ok

I am also sympathetic to towards Tiktok who you were unjustifiably rude to

I do tend to report posts when people are rude - sorry for that!

Perhaps you could apologise to tiktok?