Underweight mix-fed 8wk baby?

[mrsbean78]

Hi
My ds is 8wks. I had early bfing difficulties and he didn't regain his birthweight until 5 weeks.

He is currently 25th centile for his age, but his weight/length is 0.1 of a centile. He wees appropriately but from early on, only poos once a day and often skips. I was concerned to read that centiles under 5 were indicative of recent malnutrition. Why it surprises me given his slow weight gain is anyone's guess but it's a scary word to read.

GP says he is 'skinny' but handles well and he is reaching all developmental milestones as appropriate: very active/alert. Dh was long and lean and was (horrifyingly enough) put on cows milk at 7 weeks because he 'couldn't get enough' [hmmm].

He is steadily gaining 5.3 oz a week and feeds 8-10 times a day - roughly, 6.30, 9, 11.30, 2, 5, 7. 9, 11 and often at 1. He feeds on demand but just demands in a very regular way, you could set a clock by him. He has two formula supplementations and I rotate these round the clock - a total of 8oz a day - and he always feeds for 30-40 mins before each of these (never offered a bottle without a full bf before it). From very early on, I was pumping after every feed
but I just don't produce a lot - max 1-2 oz. I can't manage pumping in the day and ccaring for him so I have reduced this to 1-2 feeds a day. I was on Motilium for supply but had to give up as I broke out in hives all over my body. I am taking fenugreek, eating porridge and drinking non-alcoholic beer.

I am a bit bothered that his weight gain isn't really accelerating - he is sleeping well though. He has a great latch and feeds very well.

No one seems very bothered about it.. although everytime a new HV at baby clinic sees he was 91st centile for weight at birth and is now 75th they freak a bit.

Should I be doing anything differently? Should I look for a referral to a Paediatrician? Or is this just because of the slow weight gain at the start and he'll catch up eventually? I have no idea about these things.

mrsbean - "I was concerned to read that centiles under 5 were indicative of recent malnutrition. " This is not correct - where have you read this?

4 per cent of infants are on centiles under 5. That's all it means The line on the chart is not a diagnosis.

I don't understand this: "He is currently 25th centile for his age, but his weight/length is 0.1 of a centile."

Your GP says he's fine and everything in you description of him sounds fine. Is the issue your memory of those difficult early weeks?

Don't know where tiktok but found it again here, though see this says it's being revised:
www.cps.ca/English/statements/N/NutritionNoteGrowth.htm

It says:
Underweight or wasting: may be indicative of recent malnutrition, dehydration or a genetic disorder. Traditional measures of underweight (weight for length/stature and % IBW*) continue to be recommended until validity of using BMI-for-age to assess underweight is established.

I don't really trust GPs. I work in a position where GPs refer to us a lot and they just aren't specialists in everything so in my own line of work they frequently misunderstand more subtle developmental delay and don't refer at an early stage to Paediatricians.. Also, where anything under a centile would be considered indicative of a severe difficulty.. so hard to ignore it for me.

My bigger concern is that his head is over the 98th centile. GP says that he thinks will 'grow' into his head and that he reckons his weight 'should' be 50th centile. I work with developmental disorders and, well, a head over the 98th centile is macrocephalic and associated with all sorts of nastiness. I know it could be benign but I'd feel happier if it was checked out.

And yes, the memory of the early weeks haunts me. Mostly, I've been managing my anxiety well.. but the discussion about macrocephaly at my 6 week check is playing on my mind. I am hoping that it's just that the early starving (wince) skews the fact he's just going to be a very big boy. But it's hard not to worry.

Sorry, should say that under third centile on weight/length measures means underweight or wasting..

He is going to be reviewed at the GPs next week.

Oh, and he was 25th centile at 7 weeks because he was 4.535kg and that's 25th centile for 7 weeks gestation, but he was 91st centile at birth. The other figure (weight/length) compares his weight to his length (like BMI for babies). He is 60cm, so 99.9% of infants would weigh more than 4.535 at 60cms (so not very typical, whatever the reason).

mrsbean - that is not a UK site. It is Canadian. They may have different standards and use different charts. It's deffo not the case that centiles under 4 , 3 or whatever are a diagnosis of anything.

I can't follow your figures and calculations, sorry

A baby born on the 91st centile and now on the 75th at 8 weeks is perfectly within normal - especially if they are healthy and happy and continuing to grow.

Honestly, I think you may be over-analysing it all and spending a lot of time Googling these figures....yes, I agree a referral to a paed might help you gain more confidence in assessments that your baby is fine.

No, he's on the 25th.

I'm giving up on the figures, sorry - you say in your post 91 at birth and now 75...was that a typo?

Anyway - a baby who took 5 weeks to regain birthweight is bound to be on a lower centile 3 weeks later. It's not really possible for catch up to happen in just three weeks after that.

His weekly weight gain is well within normal, and his milestones and development are normal, and he is healthy and happy. You are feeding often and he appears to be feeding well, and the GP has no concerns about him. Do you think you will be less anxious when you have had your worries about his head addressed? I'm not an expert in this at all, but my understanding of large heads is that the vast majority of babies with large heads are normal, and that any underlying disorders associated with a large head would have emerged by now...is that not the case?

It's horrible to have continuing worries - I hope a paed manages to help you dispel them.

Tiktok, thanks for your time but I want to be direct and say that I would rather you didn't comment on my anxiety as you are doing. I wasn't always anxious and part of the reason I carry this anxiety relates to this forum. You may remember a pretty unpleasant thread when I was very new to breastfeeding where we had a misunderstanding and you felt very aggrieved by what I said. I apologised for that. I felt upset by what you said. You didn't feel what you said was unreasonable, I felt it was. Of everything that happened in my life at that time, the loneliness I felt when faced with some of the comments made on this forum is one of the most painful memories.

I came back to this forum as I had specific questions I wanted addressed. If you don't know what I am asking, maybe it would be better not to respond. I say this in the nicest possible way. My son is also below the third centile on the World Health Organisation growth charts for weight/length.

I in no way wish to upset you here tiktok, I appreciate others find you an amazing resource and you have helped many, many women.

OK, mrsbean....sorry

I remember that previous thread - had forgotten it was you - really sad if you think your anxiety is to do with me

It's true - I don't know what you are asking, was trying to clarify!

I agree, it's best for me not to comment. Hope others come and I hope it gets sorted.

Thanks tiktok

It wasn't really you, just a bad memory for me as much of that time is.. not your fault, my ishoo as they say but I can be a bit sensitive about it. Totally unreasonable but true nonetheless.

Regards.

It is just as normal to be on the bottom centile of a growth chart, as it is to be at the top, assuming the baby is meeting his milestones.

In your case your baby is meeting his milestones and your GP and HV are not concerned, I am unsure what you are asking about ?

Of course you can ask for a referral to a paediatrician if you want one. Maybe talking to a real life person with your red book chart in hand, will make it easier to see where your concerns are.

The best person on Mumsnet (by a mile) for these matters is Tiktok but if you are sure you don't wish her to respond to you, I really hope you get the support you need soon.

hi mrsbean - I'm not sure the figures in your OP make total sense, but think you're saying your DS was 91st centile at birth, is now either 75th or 25th or 0.1st centile (sorry, can't work out which).

Any one of them will be fine though - some babies are very slim, others total chubs - the birth weight only means that's how big your body can grow the baby. It bears no relevance to his ultimate size! My wee brother was 75th centile at birth and went up to 91st after a few weeks, whereas my sister was born on the 75th and went down to the 25th. both perfectly healthy, but obviously 75th centile is how big my mum could grow us all!

If your baby is feeding well, wetting nappies, dirtying nappies, meeting milestones, then what actually concerns you?
have a read of this article called look at the baby, not the scales. hopefully it will answer your questions - if not, speak to your GP about referral to a paediatrician to put your mind at ease. hope that helps, and enjoy your wee boy!

I'd agree with Babieseverywhere but I'd like to ask a little more about his length being measured. It's pretty rare for this to be done as a routine and even more unusual for it to be done accurately in such a small baby.

Can I ask who measured his length and how he did it?

I'd also comment that unless his head circumference is drastically above 98th centile or accelerating away from it then it is very unlikely that there is a problem that needs investigating now. I appreciate what you say about macrocephaly being associated with developmental issues but I cannot see that any further investigations etc now could be of help in preventing/diagnosing such an issue.

Will come back to this thread later.

MrsBean, I understand how horribly worrying it is to have a slow gaining baby. My dd plunged down the centiles and dropped right off the bottom of the charts. I'd have been thrilled if she had gained as much as 5oz a week, but she slowed from 3 to 2 to 1 a week. I did choose to have her checked out by a paed in case she had an underlying condition. She didn't.
My instinct told me all along that she was just dainty but healthy. I felt I had to check things out though. However, getting out of the medical conveyer belt system was quite hard, since the hcps then wanted to blame bf for the slow gain, & I had to battle hard to continue doing what I wanted.
I'm due my second baby any day now, & if he grows the same as his sister I'll just get on with things without involving medics this time.
If you have reason to worry about your baby's health or development then check things out, obviously. But if your only concern is the numbers you've mentioned, then I'd respectfully suggest that they alone do not justify the anguish you are experiencing. Please try to reassure yourself in that at least.

He just looks really, really skinny. Not quite as emaciated as before but still.. you can see the outline of his skull quite clearly. It's kind of hard to ignore as a mum.

The 75 was just a typo. He was 91st and is now 25th for weight with reference to the population (taking all babies of his age into account). The HV at baby clinic was freaking about this despite me patiently pointing out all the interventions we'd had and how he had improved and repeatedly saying: 'look in the red book'.

Weight for length is a different measure - it looks at average weights for babies of a particular length. For this measure, admittedly based on Canadian norms, he is 0.1 centile. The WHO growth charts give a similar profile. There are no UK norms.

I think my concerns are that he looks far too thin and his head looks far too big.I am trying to reassure myself that he is hydrated and alert and smiling but there is a nagging worry at the back of my mind..

If he were just thin, I could discount it. But the macrocephaly concerns me. I don't worry about autism because he is a social baby.. but I'm scared at the review that maybe I will find his head is accelerating away...

or that his weight isn't accelerating enough and then I will be pressured to give up bfing when I don't need to...

I'm not entirely sure everyone dealing with me is not worried about it.. they haven't mentioned specific concerns but are measuring his length and head circumference which is not usually done and reviewing me regularly which suggests to me there are some concerns.

You don't tend to be booked at the GP for review round here ever.. so it's a bit disingenuous to say that I am the only one worrying. The professionals aren't hugely communicative.. the GP literally did some measurements (after the HV had done them) and wrote in the book and said he was 'skinny' but he suspected he would be a 'big boy' and his fontanelle appeared normal and his head control was okay (but none of this was explained and neither I or dh were very good at asking).

I just want to know - what do I ask? Am I feeding him enough? If they do start telling me that he is too skinny or not gaining enough should I just ff? Or is this all normal?

I feel a bit lost because I feel I get tiny bits of information from the professionals I'm dealing with and next time, I need to be ready to ask questions instead of sitting there like a dumb fool and putting myself in a position that I HAVE to google because I don't have a clue what they've been looking at or what the concerns are.

By the way, I didn't tell tiktok not to post, I just didn't want tiktok to put it all down to anxiety, for the reasons I mentioned and that I know are not entirely reasonable.

And sorry tiktok, just saw your post at 9.52 now, we cross posted. Thanks for the reassurance!

My dd fell from 98th to off the bottom by 12 weeks, she did have a major problem (I'm not saying your ds does). But I do know how difficult it is when you don't feel reassured by the HCPs taking care of you.

You sound worried mrsbean. And I think based on that alone, and that you admit to being (over?)anxious you should ask for a paed referral. The only way you're going to have your mind put at rest is for him to suddenly gain a lot of weight or for someone to say he's OK, just a skinny chap. Sometimes you have to bite the bullet and say 'look, do you have concerns? What are they?' Is it worse to hear the answer or to worry about what the answer might be?

It is perfectly reasonable to ring up the GP and/or health visitor and ask them to explain their comments at a previous appointment and/or to ask questions which didn't occur to you at the time.

As for what to ask, why not start with the points you have raised on here. Here are the questions you seem to be raising from your posts, feel free to correct or ignore ones I got wrong.

1. My bigger concern is that his head is over the 98th centile. Can this be checked out.
2. Am I feeding my baby enough ?
3. Is my baby too skinny ?
4. Is my baby weight gains normal ?
5. What are the concerns (if any) with my baby ?
6. I am concern with the height weight ratio of my baby.
7. I was expecting his weight to accelerate by now, is this an problem ?
8. Would a referral to a Paediatrician help ?

What about writing the questions down and take them to the next appointment and why not write the answers down as well. If they have not made themselves clear, ask them to rephrase the answer. It is their responsibility to make things understandable, you shouldn't have to Google stuff when you get hone

"By the way, I didn't tell tiktok not to post, I just didn't want tiktok to put it all down to anxiety"
That is good to know.

HTH

It sounds to me as if things are going fine, 5.3 oz a week is a respectable weight gain.
Both my babies were very slim,dropped off the charts, my HV with my first really tried hard to push me into giving solids early. I resisted.
When I have my second baby she was just the same, very slim, I stopped going to have her weighed as I could see the familiar pattern.
I could also see that my baby was healthy, alert and bursting with energy.
My HV used to visit, I would see her marching up the garden path with her portable scales, I would hide quietly in the house and not answer the door!

These charts serve only as a guide, babies differ in their growth patterns,I would say trust your instincts, if you feel your baby is thriving, then that's fine.
Enjoy your LO!

Msmiggins - maybe I will just hide!

babieseverywhere - thanks so much for that. I do need to write these down and take them with me - and probably write the answers down too. Honestly, I think if I got some straight communication instead of this round the houses stuff, I would be much happier. It has taught me a lot about being a HCP, this experience.. I know they are probably trying not to worry me as the risks of whatever they are concerned about are probably tiny, but straightforward communication of the risk level would be better in my case.

Thanks for all your help and reassurance!
I didn't know if 5oz was enough so that's good to know.

5oz a week weight gain sounds great (aren't they meant to gain 4-8?) My son didn't gain anything week after week and fell off the chart entirely but the HV kept telling me he was fine (he was 3.4kg at 8 weeks).

Not sure if it's any comfort but when my son did get back on the weight chart he stayed just below the 50 centile while he was off the top of the height chart (not sure what that would make him on your weight/length chart).

Go with your gut and don't worry about seeming overanxious - a good GP/paediatrician would rather see you and reassure you.

Ds weighed again - has dropped to 0.4centile. I guess my post here was based on my instinct..
Any other advice - going to GP tomorrow now..

Just for a final bit of clarity - he is 8 weeks and weighs what again?

He was on the 25th centile in your OP on Saturday, but is now on the 0.4th? Is that correct? I just thought it was worth checking against the charts once more.

OK, I hope I won't get flamed for this - but my DS was down to a 1oz a week gain by week 8 and had gone into free-fall below the bottom of the charts (including the WHO ones for BF babies) - but the thing that worried me most was that he just didn't look well (one of my friends later said, when he'd filled out a bit, "he looked like a wizened old man"). I decided to use formula and there was no doubt in my mind from the first bottle onwards that it was the right thing for him - though I still cried for a week over my failure to BF. His weight shot up over the course of the next 3 weeks till he got back onto his birth centile, then he just eased back on the amount he drank (I fed him on demand as if breast-feeding and just let him set the amount), and stayed on that centile. In retrospect it turns out I had just about every risk factor going for under-supply (history of thyroid problems, polycystic ovaries, male baby with unexplained low birthweight, ancient for someone having a first baby...) One thing I would have done differently would have been to try mixed feeding as I've now met enough women who've done this successfully to know that although there is a risk of supply drying up, some women manage to do it.

Apologies if you're determined to keep BF exclusively, but I get the impression from some of your posts that you are really worried that your DS's build may go beyond skinny into malnourished (not the stuff on the website, but your description of his physical appearance, which just rang bells with me), so I thought I'd float the idea that FF might not be the end of the world (though if my experience is anything to go by, it will feel like it). Of course, as other posters have suggested, maybe the route to go down is to ask for a paed referral. And remember that though BF is a brilliant thing to do for your child, it's not the be-all-and-end-all of being a good mother (despite the occasional poster here who says things like "it's the most important thing I can do").

Good luck whatever you decide to do - I know how terribly worrying it is to feel your child is not thriving. But I have a lovely robust nearly-2-year old now, and it's great when you come out the other end, as I'm sure you will.

Lurcio, there is a huge difference between gaining 1oz and gaining 5 ozs. OP has said she is not BF exclusively.
Mrsbean, I do hope you can get better communication from your doctors. It's so frustrating to have a concern, air it to the appropriate and then to be fobbed off. I think a paed referral may be the way to go, and hopefully he will get thorough examination and full bloods workup. If there is no cause found then you can relax and say he just takes after his dad. If there is a problem, then you will know what you are dealing with. It's the not knowing that eats away at one.
Stay strong, and I hope you can get an appointment soon.