Problems with breastfeeding at the beginning - could they be causing my very thin 19-week-old to be missing out?

[Moomma]

Background first: breastfeeding was a disaster initially, as my DS (who was born 3 weeks before his due date) had bad jaundice and slept all the time, rarely feeding. He's my first and I really struggled with sleep deprivation and lack of preparation so I didn't pester him to feed as much as I should. He lost 11% of his body weight (from 6 lbs 5 down to 5 11) in the first week and as the midwives were too overworked to check him out properly and actually HELP us, I ended up taking him to A&E where they recommended ffing to get his weight back up. Both he and I HATED it and I was determined to get him back to breastfeeding. It took about two weeks to get him back to his birth weight, when he was getting about 5 ffs a day, then his weight crept up slowly but steadily. Until he was six weeks, he was getting 1 or 2 bottles of formula a day, breastfeeding otherwise. Then we went back to just breastfeeding, probably too quickly as I've read since you should taper it off gradually, and we just stopped.

However, now that he's 19 weeks, he's just 11 pounds. I've had him checked by the GP who is happy with him and he's in great spirits - very little crying, lots of fun, lots of laughing, developmentally great. GP described him as 'slender but well'. I don't know what to do. I try to feed him a lot, but he is being a bit fey about it now during the day, easily distracted and impatient if he doesn't get letdowns straightaway. He still feeds a bit at night, so I suppose he makes up for it. But I worry that he's not getting enough, and never has, because the initial feeding was so poor and my supply has always been low. He doesn't complain, but then he wouldn't know that it's low, would he? To me, that's the only explanation for the fact that he is so little. He's right at the bottom of the centiles, and having had a tummy bug for three weeks over Christmas and the start of January, he hasn't been making up ground. He's just bobbing along, putting on 4 or 5 oz a week. And he's long enough - I haven't ever been able to get a HV to measure him, but he fits in 3-6 month clothes perfectly if you don't count the flapping fabric around the middle. He's just thin.

Basically, this has been a total nightmare from the start and I can't help but worry that I have been selfish in insisting on breastfeeding, and that now he is paying the price for it. I love him so much (goes without saying, obv) and I just worry that I should be supplementing him now. Thoughts, anyone? Am I right in thinking my supply is hopelessly compromised?

my thoughts are that your GP is right!

some babies are thin., some are fat, some are long, some are short.

someone has to be at the bottom of the charts (just as some have to be at the top)

I can see why you're worried, that maybe he is just used to a low supply? But i don't think that is the case. I think that bearing in mind he was being supplemented for quite a while that he was used to getting plenty of milk then wasn't he? so if you weren't making enough now he would let you know

if he is happy, healthy, meeting milestones, weeing and pooing ok, then you really have nothing to worry about

do you have any local breastfeding groups you could go to for some moral support? I found my la leche league group here invaluable

Does he have plenty of wet nappies? Is he alert? You mention that he is gaining 4-5oz a week, which is something, and the GP seemed happy.

I am sorry I am not an expert and don't know whether poor feeding at the start would affect supply like this later, but my gut feeling is that if you were not making enough milk for him, he would tell you about it.

I will wait for an expert to come along though and just offer moral support as I had a slow gaining baby too (though not as severe)

Hi there Moomma,

It seems to me that you have absolutely nothing to reproach yourself with. You've had him checked by the GP and the HV and they are not worried about his health. This should reassure you, as they know all the danger signs and would be telling you in no uncertain terms if they thought there was a problem. You've pulled out all the stops to breastfeed him, which is as you know the healthiest option, and well done you for persevering!

If he was hungry, you would not be seeing a happy little baby. Hungry babies who are as well as your GP describes will complain very loudly indeed (yes, they do know if your supply is not meeting their needs). Formula feeding is no more nutritious than breastfeeding, so if you made the switch, I can't honestly see how it would make any difference.

If he's had a tummy bug then its not surprising his weight gain has slowed down. Again, if the GP is relaxed about this, then you should be too. He will catch up. Remember, the centiles describe the range of normal weights. Just because your DS is on a low centile, that in itself is not a problem.

Sounds to me like you have given him the best possible start in life, despite a difficult beginning, and perhaps now it's time to sit back and just enjoy your LO. Distraction is normal at this age, it's a sign that he is getting all that he needs and is keen to explore the outside world.

I think his nappies are OK and he's super-alert - to the extent that people come over to me in cafes to say how alert he is! He's very happy and secure, and generally good-tempered, though he cries now when the milk runs out on one side (or isn't flowing fast enough for him) and I've taken to swapping sides for as long as it takes for him to lose interest). He used to feed for an hour at least, and now only does about forty minutes maximum, sometimes just fifteen minutes, so that freaks me out too though I know it's normal for other babies... From when he was a week old (after the meconium era) he only pooed once a week, until he was about five or six weeks old. No medical professional has ever been able to explain that one to me, but they just said it was unusual. Everything is unusual when it's your first child...

It breaks my heart to see him with the other babies from our NCT group. They were all born after him and are all much fatter than him. I feel like a failure, to be honest.

Cross posted with you, messofthedurbervilles - thanks for the cheering-up. I'll try to calm down about it. But I do wonder, especially since my sister has just had a baby and she's feeding dementedly - had already gained back any weight she'd lost by the end of her first week and is on course to be a giant. So different from my poor little shrimp.

Oh please don't beat yourself up, he was born early and has had a tummy bug, of course he will be small - you sound like a lovely caring mum and I am sure you are doing fantastically.

The pooing once a week is really common in breastfed babies, not sure why they said that was unusual.

Also if it hasn't happened yet, in the next few weeks you will probably stop feeling engorged between feeds and your breasts will feel floppy most of the time - this is normal and is just your supply settling down. Around the same time is when they start wanting 2 or more "sides" per feed - which sounds like it is already happening, and feeding can become more efficient so feeds are shorter. All normal and not cause to worry.

Also, the tiniest baby from our NCT group is now a gigantic bruiser, I have no idea how that happened!

If DS seems happy, alert and having dirty and wet nappies try not to worry. My DD is 18+3 Weeks and only 11lb 13oz, she was 6lb 5oz at birth and only lost 5% of her birth weight but has always been petite. She she is still in 0-3 month clothes and some of these are too big.
Don't worry, just go with your instincts.

Hey mooma I started a thread on baby rice but I guess it is really about my ds being a shrimp too! He is scraping along on the bottom of the growth charts (although he is v long - and v alert!)

Lots of nice reassurance from people here and just thought u might like to know that after the meconium phase ds went 11 days without a poo and was none the worse for it. Worried midwives made us take him to a&e but everyone said he was fine!

mooma - you've done the right thing, seeking medical opinion. This hasn't reassured you - worth exploring why not? Your concern seems very deep and self-blaming - the worries you had about him in those difficult early weeks are staying with you - outstaying their welcome, I would say Is this something you could talk about with someone who can help you offload your feelings and get to the bottom of why you don't believe all the medical reassurance you have?

Nothing in your post suggests anything other than a healthy, happy, thriving baby who's just smaller than the other babies you happen to see in your social circle. He is not suffering in any way at all - nothing in your post indicates you need to feel as terrible as you do.

There's something going on in your head that needs an airing, I think Sometimes, when babies have had a difficult start, the shock and anxiety lingers....there's no obvious reason why you should be anxious about him, so you explain it by referring to the fact he is smaller than other babies. This is not worth the anxiety - which is why I am wondering if it is anxiety hanging over from before?

What do you think?

You're so right, Tiktok - I am anxious by nature and spent such a long time worrying about him in the first few weeks that I've sort of got into the habit of it. I literally feel sick every time we take him to be weighed (my husband comes with me for moral support) and the number on the scale is always a disappointment to me no matter how low I've told myself my expectations should be. I think I am convinced that there is something more to worry about than there is.

I hadn't spent any time with babies before having him, and neither had my husband, and we live far away from our parents, not particularly close to our friends who have babies. So I felt completely alone for the first few weeks, and like I hadn't prepared properly (because I was still working when he arrived unexpectedly, and hadn't even packed a bag for the hospital, bought nappies, bought a pram or a moses basket or a car seat... I was incredibly busy and stressed at work, trying to finish up, and it was all waiting for when I was on leave). So I feel as if I have been missing something, or have got something wrong, and because he is so different from the other babies I see now, I can't help feeling worried and sure that it must be something I'm doing wrong.

God, when I think about it, I am getting myself in a tizz over this instead of looking at how he is. He is so brilliant and full of fun and energy. I just don't think I was able to give him the best start in life and if I'd known more about jaundice and breastfeeding maybe I would have been able to do better. First-time mother's guilt, I guess.

Moomma it sounds like you've done a great job to keep BFing your son despite all the challenges you had at the beginning.

I could have written your post about weight gain... I went through a very similar experience with DD (jaundice etc), and managed to get BFing going but it was hard work, she was always a distracted feeder and was also quite sicky...

Cue lots of comments from people with nice fat babies like "It's a wonder she ever puts on any weight..." that just made me want to sink into the ground.

Like you I doubted myself, but persevered with BFing and looking back I'm very glad I did. Even at 13 months DD is still on the slender side, but she is fit, happy, developing well and absolutely full of beans. More than I can handle really!

tiktok what you say about lingering anxiety after a shaky start with a newborn is absolutely true. I certainly have felt like this after DD took 18 minutes to breathe independently after she was born and then was badly jaundiced and wouldn't feed. The anxiety was crushing. Don't underestimate the impact of those first days moomma. Most mums who've had an easier time just can't relate to it, and end up making you feel like a neurotic...

You are not doing anything wrong, you are doing a fabulous job. Repeat after me 'I am doing a fabulous job' ...

mooma - can you get help for your anxiety? It's sad you cannot enjoy these first months fully. Speak to your HV or doctor? Stop trying to seek reassurance that your baby is ok. He is ok - the issue is with your ability to believe it, I think.

It is nice to hear that other people had doubts, Crazycatlady - everyone looks as if they are in control and don't have the issues that we have had. But I do know that they will have had their own things to deal with.

What sort of thing can the GP do for anxiety, tiktok? It's not the first time that I've had a very tough time dealing with a new challenge, but I honestly hadn't thought that the problem might be not with the boy but with how anxious I was feeling. I'm not depressed - I really enjoy him and spending time with him. It's more when I'm not with him, like when he's in bed that I start getting worried about how he is and doubting whether I am doing a good job. And the numbers on the scale feed into that (no pun intended) because he is undeniably small, and it's practically the only concrete way of measuring their health at this stage, aside from how they are behaving. Everyone always asks how much he weighs, when they aren't exclaiming about how small he is. (or, to be fair, how cute...).

mooma - first step is to share how anxious you are with the HV. We all worry about our babies, and about ourselves as mothers, but I honestly think the way you describe your anxiety is rather more than most women experience. For instance, it's not usual to feel the need for someone to be with us when the baby's weighed, and to feel sick with anxiety about it....talk to the HV, and she will, if she is any good, know if there is some help for you.