Failure to thrive

[worriedaboutskinnybaby]

Hi all
Hoping for some help, a friend told me this was a good place to get it!

My baby is nearly 6 months old and is dropping through the centiles for weight. He was at the 50th centile for weight when born but lost 15% very quickly. We had a lot of trouble with getting breastfeeding going in the early days. I was told to supplement with formula and then he started to gain. He got back to his birthweight at about six weeks old. He was 25th centile then but GP said he thought he would 'end up' at 50th.

He was 9th centile six weeks ago and has just been weighed again, he is now 2nd centile. He is 75th for length and head circumference. The HV says he is 'wasted but not stunted'. Wasted...

She asked me a lot about his intake. He feeds on demand and it works out as a feed at (roughly) 6, 9, 11.30, 3.30, formula at 6, breast again at 10, 12/1, 3/4. Somedays there's more. Sometimes in the afternoon he can fuss/talk at the boob for a while but he seems happy and contented at the end of a feed and I can see milk in his mouth and hear him drinking. He's not on solids yet but the HV said he should start now.

I am confused about failure to thrive. He seems healthy and is doing what he's supposed to do in all the books - rolling, just about sitting without support etc - and he looks healthy and well and has chubby little cheeks, just small chubby little cheeks! His belly is very scrawny though but I don't get where all the milk is going? And he is following the centile for length and head circ so I guess he must be getting something? I have to cut his nails every other day.. so why is he so scrawny?

Can totally understand your concern, and the HV's. This sounds like a healthy, normally-developing baby, though, which is reassuring. There are babies like this - destined to be slender, with no underlying metabolic issues, just like that because that's the way they are - and it might help you to see a paediatrician to hear this 'officially'.

The risk with solids at this stage is that they would replace milk, and end up making his net intake of calories less, so you might need some support and advice on what to give him, to make sure they are a genuine addition to his diet.

He's clearly growing, just slowly. If they think he needs more calories, as well as solids, could you think about offering a couple more bf in the afternoon/evening, I wonder? OTOH, he's maybe fine as he is, and just on the small side. Maybe a referral might help everyone sort this out?

Hi
Thanks for getting back to me. Who would the referral be to? (I am clueless).

I forgot to say that he had a tongue tie and a lactation consultant said he seemed to have a 'bubble palate'. We did all this work on repositioning and it worked for a while but he pulls backwards off my nipples and won't keep his chin against the breast. Could this be causing problems?

I am worried that this bubble palate will cause probs with solids as I read they can store food up there.

Thanks

Referral would be to a paediatician.

Can't comment on the bubble palate, sorry.

Hope you get some good support soon.

The Health Visitor came and he has gained 11 oz in three weeks or about 3 and a half a week so is this good? He had gained only 7oz the whole of the previous month so I thought this was better but HV said it is still a worry but didn't think a referral to Paed is necessary - but then said 'yet'. He will be reviewed at home in one month after he has started solids.. I feel a bit sick with worry even though she said he is developing well and wish I'd pushed for the referral now.

Is there ANYTHING I can do? Desperately want to wean now even though I know the cals are lower. He is 24 weeks on Thurs.

If you want to see a paed, then go ahead - make a call to your GP or the HV and ask for a referral.

This weight gain is within normal - I take it he has remained on the 2nd centile and not gone below it, which is also reassuring.

I don't understand about wanting to wean - although there's no big deal if you do go ahead. Is it because you worry that somehow having food sort of 'dilutes' the responsibility of breastmilk to help him grow? It's not an answer to slow growth, though, usually....you might end up even more worried!

Here's my (rather directive) suggestion: See the paed. Hear him/her say 'this is a healthy baby, no need to worry, start solids if he wants them, continue with bf as much as he wants, and enjoy him!'

I guess that I want to wean because the HV kind of told me to go for it from 24 weeks. I have good girlitis and assume that if I do what I'm told all will be well

I guess too that if he does have any problems, say, feeding with solids that it gets caught and dealt with ASAP rather than delaying and finding out later.. I want to get this show on the road, for better or for worse..

Will ask about Paed thanks.

Hey, from the sounds of it, your baby just sounds like he's putting weight on at his own rate as he's hitting all the developmental milestones and is happy and contented.

Could you squeeze an extra bf in in the afternoon? It might cause him to knock one of the night feeds out as well.

My LO talks and fusses at the boob in the afternoon, so I have to go upstairs and feed in our bedroom with no distractions etc. He's 24 weeks to and he's just interested by everything.

I started weaning at 17 weeks, and he loves his solid food. You could try a bit of baby rice for lunch or something - not cutting down on any of his bf's, but just in addition?

I think seeing a paed would be a good idea - not because it sounds like anything is wrong but because if you're anything like me, you'll get in a flap and stress about it...

Baby rice has no nutritional value but will fill baby's tummy - the opposite of what the OP wants if she's trying to help baby gain weight.

At nearly 6 months you wouldn't need to use baby rice, though, would you? You could wean onto more nutritious foods.

Though there doesn't really seem much reason to be doing that if baby is fine. Breastmilk is the best stuff there is.

The only scenario I can imagine where early weaning helps with nutrition is if a baby is like my dd and too weak to breastfeed efficiently: for her, adding solids did give her that extra little boost of energy that meant she could then also drink more efficiently at the breast. But imagine this is quite a rare situation.

worriedaboutskinnybaby, I just wanted to say I can completely understand about your "good girlitis" (great phrase!) and think I suffer from it too. I followed the HV advice with my first (which went against that of the paediatrician) because I saw her more often and didn't want to put her offside. This time I've realised that sometimes my instincts are right.

Trust your instincts. If you feel your baby is just a slender but happy and growing baby then don't worry. If a referral to a paediatrician to tell you that (as Tiktok said) would make you more confident then do that. And try not to worry about offending anyone when you ask for that referral!!

Good luck!

Thanks. Wanted to let you all know about the amazing ultrasound I had with Dr. Mike Woolridge at the University of Leeds today.

They scanned under ds's chin while I fed and weighed before and after each feed.

Dr. Woolridge was among those who managed to change the recommendation of being on one breast for x amount of time and then putting baby on second breast for y amount of time on account of oversupply/reduced access to hindmilk etc... but he said to me that in certain cases this doesn't apply and mine is one!

My ds has a perfectly normal suck/swallow but he doesn't get a huge amount of breast tissue into his mouth.. he pulls at it until the letdown, gets loads out and then tries all sorts of different things with his tongue, hanging out for the next letdown. He said that the best thing for my ds would be to switch feed until I felt him 'messing' with my nipple, take him off and play/chat with him for a minute and then put him on the other breast.. and to double nurse.

He did some maths by tallying my current velocity of gain/the figures he got from weighing/before and after the feed and, while qualifying it heavily by saying he doesn't know about the fat content of my milk or how representative that feed was, b he reckons I'm probably feeding ds about 24-30oz of bm a day. As I've had the formula since he was so young, he said it would be v difficult to increase the supply sufficiently to allow for the formula to be dropped but says that as long as I continue to offer the breast frequently (10-12 times over 24 hours) that I will maintain my current supply until the caloric content of the solids reduces ds's needs e.g. because of the way my ds feeds, he is unlikely to 'drop' a feed because of solids. He said in non-Western countries women rarely drop feeds when solids are introduced with the supply reducing only when solids are replacing the caloric value ot the milk. So he advised me to start solids 'sooner rather than later' to counteract the weight loss.

Just thought it might be of interest! Thanks for all your replies. I feel much better now.. I understand why he has been losing really as I think I was (not consciously) restricting him from feeding as freely as before when he went on the breast for very short periods because I thought he was just using me as a dummy sometimes.. but actually the pulling/messing is his way of trying to trigger the letdown and not a sign that he is not feeding.

So I am going back to frequent feeding and will introduce some avocado for him to play about with next week.. as it will be only spoons anyway!

BTW it was just soooo amazing to see the letdown on ultrasound!

Gosh that sounds great to actually see the action in so much detail. Was this part of the regular referral, or a research project?

Brilliant!! :-) Pleased to hear that all is well. I'd love to see the let-down on ultrasound - I bet its amazing to watch.

Jemjabella - babyrice does have nutritional value if you express after a playful LO only has half a feed, and then you mix it with the rice and feed it to them that way (all the time Mummy muttering under her breath "you WILL have the booby milk, you WILL have the booby milk"). I used to have a brain and a good sense of humour. Sad what it's come to really.

Wow, that's really interesting and makes me want to see what my baby is doing! I hope you're feeling v positive and glad you went - I know I would.

Starlight, Cleanandclothed it was a pure fluke that I found out about him.. I mentioned my concerns about his weight to some people I'd met at baby massage on Tuesday and one of them was involved in a research project with this team. She gave me a contact for him and I emailed with my details, pretty much as posted above, and he contacted straight away! They had never done the procedure on a baby over 16 weeks so didn't know if it would work etc but ds tolerated it really well.. (once he'd pulled off a few times to check what was going on!).
They are doing research but this wasn't for anything ongoing, although I did sign a consent form to say the dvd could be used in training others if applicable. So it was 100% independent of the HV etc!

Sounds amazing - good for you.

I did not drop my feeds when my baby reached 6 months - oh and my baby suffered weight loss so I had to feed 10-12 times a day - it really was the only way to get the weight up.

Starlight I swear 100% that this has nothing to do with plugging anything. If truth be told, I am a regular who actually namechanged so I could post in breast and bottlefeeding again because when my ds was little I got in a bit of a tizz on here. And now I have outed myself.. but actually, I've had concerns about ds's weight since he was first born.

My feeding specialist friend is a Speech and Language Therapist in a different trust who is dysphagia trained.

The lady at baby massage is, well, a mum with a 14 week old baby. End of.

I think, somehow, he wouldn't be getting a load of dollop to reassure me. I'm fairly sure that he gets the cash to do Big Interesting Things with data and reassuring me about frequent feeding along the way is just a byline. I didn't know this but apparently there is a big old academic war going on about the mechanisms of sucking/swallowing - whether it's the action of the tongue squishing the milk out of the nipple or a vaccum in the oral cavity - and he's on one side and some Australians are on the other. I think from looking online that he wrote some book about 25 years ago about how it worked and these people have challenged it... he explained all this today. I don't know how much of a difference it would have made to what he told me and I didn't ask.. but as I have outed myself anyway, I should say that I'm a (non-feeding specialist) Speech and Language therapist and so technically have some info buried deep in my brain about how a swallow works so it was v interesting to me to see it in action (and helped me 'read' the ultrasound which was fun too, antenatally I just took the sonographers word for everything!)

Excellent stuff, and in my book it does matter that he reassured you.

Me too, willowflower, and the speed at which he responded to me and the time he gave me today was great. Just wanted to say that because the above might sound sarky and I am actually very grateful for it, because I have really struggled with fears about this weight gain since he was born and huge feelings of inadequacy about the formula supplementation. It's probably all a bit 'postnatal' of me, but I was on a high today.. I think since we first gave formula I have somehow convinced myself that all my bfing is just pointless and he's probably getting nothing from me and it was really nice to have my concerns treated seriously and gently by someone. I know they may seem like minor concerns to people who have had bigger fish to fry but they have been a 'thing' to me since he was born.. so feeling very positive tonight!

Are there any statisticians on here? If these curves are for healthy babies, then isn't there always going to be some babies who fall below the 2nd centile who are healthy?

Maybe my stats are wonky, but I think maybe the HV's are more wonky? Maybe you could ask the good doctor from Leeds?