Poor weight gain

[TaffyandTeenyTaffy]

DS was born 6 weeks prem due to cholestatis and GD after a very difficult pregnancy. He was 6lb 14oz born but dropped quickly to 6lb 1oz. He is now 5 weeks old and 6lb 5.5oz - a long way off his bith weight and dropped from way over 99th to the 9th centile.

He was in NICU for almost 3 weeks and has now been home for 2 and a half. He was initially tube fed with EBM and formula top up in NICU - then exclusively breastfed for a while.

During the 1st week home he lost weight so we were advised to give 1x3-4oz formula top up a day. As he had still only gained 1.5oz in a week I was advised to increase this to 2 top-ups. He had not gained anything over the next few days so paediatricians have now advised a 1-2oz formula top up after every breast feed.

He is really contented, is feeding well at the breast about 7 times a day for 20-30mins, my supply seems ok - and he is always zonked at the end of a breastfeed.
He will however happily take whatever formula he is given - but he seems to be sleeping longer between feeds so I am having to wake him, particularly at night.

I have also been expressing at the end of a feed and giving him this (1oz or so) by bottle to keep up my supply and make sure hes getting hind milk.

I have adjusted my diet (guinness, mars bar whole milk, veggies and lots of water) to try and improve quality of milk.

I have had a chest infection so know this may have some impact but dont think it can all be down to this.

HV and midwife are supportive and I have been referred to lactation consultant but she has been on holiday and has not yet returned my calls. Not sure what else I can do?

I have always been of the view that I wanted to BF if possible but would not get stressed about it if I couldnt - but now I have got this far I do want to persevere as long as its not to the detriment of DS health/growth.

Any ideas?

7 times in 24 hours is not a lot for a baby this age. Can you put him to the breast more often? Are you offering both breasts at each feed? I have a son who was born 5 weeks prem and once he was bf directly used to feed him from one breast til he lost interest then swap sides, and repeat til he didn't want anymore.

Even if he isn't 'asking' to be fed you can still offer.

You can also try breast compressions- google this term To find out how to do them. It's a technique to stimulate letdown and keep a baby interested in feeding.

Lactation consultant is a good idea- someone who knows what to look for should watch you feed.

Good luck, you've come far. Hth

What a difficult situation, Taffy

I think you will be helped by speaking to a specialist bf person....if the one you have been trying to contact is away, get someone else asap.

Your diet will not improve the quality of your milk - not in any way, shape or form (anyone who has suggested it will is giving you a Big Clue that there knowledge of infant feeding is poor!).

When you speak to someone about all this, you might want to include a discussion on the frequency of feeding - 7 times in 24 hours is way below the normal frequency of bf, esp in a small baby, esp in a young baby. Many women will not be able to build up and maintain a milk supply on this, and most small babies simply will not grow well on this.

He's being supplemented with formula and ebm, which I think from what you say is probably essential at this stage, but it seems he is still not getting the calories to grow. Sleeping longer, and not gaining, and having to be woken for feeds, are all signs he needs specialist help.

It may well be that his difficult start really compromised establishing breastfeeding and a good supply, and you will need to talk to the specialist about ways of protecting breastfeeding and ensuring it continues....might be hard work, in the short term, needing lots of expressing, skin to skin 24/7 with your baby, and careful monitoring.

Good news is there is no need to panic as he seems healthy, but sorting out the right help is nevertheless priority for you, as you obviously know.

Hope this helps a bit.

Thanks both. I have been trying to increase the number of feeds but he can be difficult to rouse and then is slow to start feeding but will persevere!
Have been doing lots of skin to skin to make up for missed cuddles in week one- and
been doing breast compressions.
I have left another message for lactation consultant who is in clinic today so hopefully she will call!

Just to update - I saw the lovely lactation consultant yesterday afternoon. We have a plan ... and one that I am happier with.

Give DS2 full breast feeds per day
Express 6 x per day and feed as much EBM as I can produce by bottle, followed by forumla top ups at 6 feeds per day.
She has also suggested feeding lying down will be easier for DS.
Going to try Domperidone to increase supply, which I think has diminished since offering formula.

Rather fiddly and time consuming - but at least we are monitoring about 3/4 of what he is eating. Fingers crossed that this does the trick.

The biggest problem is getting DS awake for his 8 feeds a day - he feeds v. slowly when woken. Tried the nappy changing/stripping him off - any other suggestions welcome!

Have you tried Biological nurturing? I saw Dr Suzanne Colson speak on Tuesday and it was a revelation!

Quite a lot of the behaviour (breast boxing/bobbing on & off, shaking of head) in my babies I (or HCPs!) had put down to baby not being 'interested' or refusing the breast was behaviour designed to facilitate breastfeeding.

It was actually down to me trying to force feeding to only happen in a particular prescribed way (sitting bolt upright in chair with my arm along the back holding baby in place) that was actually STOPPING them from wanting to nurse .

It may help you make the most of each feeding opportunity which in turn could help you to drop the top-ups and pumping.

Hi Taffy just wanted to say that me and my daughter were in a similar position, especially if you have been poorly don't beat yourself up about not exclusively bfing (having been there, I KNOW this is easier to say than to feel).

My little girl's having 2 course feeds - me then formula and has put on load now, she was 8lb 6oz at 8 weeks on Thursday (born at 6lb 5oz and she dropped to 5lb 9oz while I put myself through hell trying to exclusively breastfeed her having had "breast is best" rammed down my throat throughout pregnancy!).

My health visitor explained that sometimes babies need the fattier milk in formula to put on the weight... I like to think of it as their "dessert"!

Good luck and I hope TeenyTaffy's weight starts to tick up for you.

Thanks for all your replies - just wanted to share the good news that Teeny Taffy gained 8 ounces at this weeks weigh in - so we will keep going with the mixed feeding for the time being. I like the idea of dessert blondie!