What might the Paediatrician say?

[St0pTryingT0MakeFetchHappen]

DS2 (15 weeks) has always been rather small (7lbs 1 at birth). In the last month he's dropped from growing nicely along the 9th centile to below the 0.4th. He's v happy, meeting milestones, many wet and dirty nappies. He is ebf, and refuses bottles including expressed breast milk. Both the HV and the GP have said that he seems absolutely fine, but he needs to see Paeds just in case. MiL wants me to give him baby rice but I really don't want to (would not be my choice of food for weaning whenever I did it). Has anyone been in a similar situation? What did the paediatrician recommend? Thanks!

Hi OP,
I was in a similar position but less dramatic. DS was born tiny (5lb) and was on the 3rd centile, then dropped below the 0.4 centile line.

He was referred to a paediatrician and honestly she was hugely unhelpful. She told me to stick him on formula, to force it down him in anyway I can and that clearly me breastfeeding wasn't enough. Thing is, DS was always satisfied by my milk, refused bottles outright and there was no forcing it in him, nor did I want to. When it clearly wasn't working I chose to try feeding DS every two hours, night and day. That didn't really work either as he wasn't always hungry and we were both exhausted.

Then I saw the paediatrician again and again instead of trying to support breastfeeding in anyway she basically said I had to stop and he'd have formula if he was hungry enough. 28 hours later DS was in A&E with dehydration and I was hugely engorged, and he still wouldn't touch a bottle. The A&E staff were horrified.

Back to the paediatrician a week later and she recommended early weaning (at 4 months). This was awful and DS wasn't ready at all, I really wish I'd waited as he still has food issues now at 1.

I then finally was referred to a dietician who just said that I was doing everything right, and some babies are just small, it's perfectly normal. DS is still tiny and below the 0.4 line but he's doing great and eats plenty and I'm still breastfeeding, and so glad I listened to DS and my body and didn't quit.

Remember, if your baby seems satisfied and happy after breastfeeding, your milk IS enough. No baby NEEDS formula more than breastmilk and your body knows how much milk your baby needs. Trust it.

Also 15 weeks is too little for weaning! Please wait!!

I have allergy babies so my first thought for weight loss would be whether there is an underlying allergy.

He hasn't lost weight so much as isn't gaining - only 5oz in 4 weeks. However, while he' awake he spends the entire time kicking his legs, waving his arms, wriggling on his tummy and trying to stand on people's knees! I feed him on demand which is around every 1 to 1.5hrs in the day. We get about 4hrs/2hrs/thw hourly wake ups at night, but I co-sleep so it's manageable. No signs of allergies - no rashes, normal poos, not uncomfortable after feeds.

He is maybe just a slim baby! breast fed babies tend to be leaner than formula fed and you can’t really compare the two!

Still too young for baby rice

It's is possible they will ask you to do top ups with special milk which is higher in calories if they are concerned with the drop in centiles

This happened to my cousins baby

They won't suggest weaning.

@PrayingandHoping it'll be a syringe job then if they ask me to do that!

My daughter went to 0.4 percentile. She has been on high calorie milk since October

My daughter is on the 0.4 centile (born at 4lb9) and formula fed from birth but just standard. Has been under paeds but because she had stayed on her curve they are happy for her to stay as it

They may leave her be if she stays on that curve as she is now

Have you had some good bf support from a Breastfeeding Counsellor or preferably an IBCLC Lactation Consultant? That lack of weight gain really isn't good and could be an indicator that there are feeding issues or an underlying health issue. You may well be asked to top him up with extra milk (that can be expressed or formula) to get extra calories in but that doesn't need to be with a bottle. A Supplementary Nursing System (SNS) will allow you to give those top ups at the breast.

@Gammarays You are completely wrong ! There are thousands of children out there who need formula to exist and survive. Without tubefeeding my DS would have died as we could not get enough calories into him. We had to use a high calories formula with easily digestible ammino acids.
Please dont talk about formula when you have no experience. Both my other DC were breastfed until they were 16 months.... my disabled failure to thrive DS could not survive without formula !

I second what Bert2e said. It could be that you could increase the amount of milk he gets from you by using for example breast compressions. A lactation consultant should be able to check if his feeding is optimal or if there are little tweaks you could make.

Also, totally horrified about the pediatrician someone was describing above, that's just awful.

Hi, thanks for the replies. We go to boob group most weeks and I do breast compressions. Feeding is painless and there's never been any indication of tongue tie. I see his jaw working and there is plenty of "slurp slurp swallow". He gets a fair amount of non-nutritive sucking too.

TBH, I'm not particularly worried, I'm more curious about paediatric practice in these cases

I would assess for tongue tie anyway just to cross is off the list as it could be it's not painful but is causing issues transferring milk. Get a proper lactation consultant to do it. Someone at your group should be able to suggest how to get that done locally. Could just be a small baby though, are you and your DH on the petite side?

My friend's baby was like this. The paed explained that what they had to figure out was whether her ds was small because something was wrong, or whether he was just one of the one in 250 babies who was naturally that small.
They did various tests and concluded he was naturally small, wiry and energetic. 10 years on he's still small, wiry, and constantly moving. Apart from topping him up with extra fat content once he was a preschooler and never switching to half fat milk, no intervention has been needed.

@jackparlabane I hope that's the case!

@Bellesavage I'm a smidge over 5ft 2, DH is 5ft 9. DS1 (aged 4.5) is the model for an average child in that he's just over 1metre tall and weighs 17kg - so bang on 50th centile. He also had faltering growth but was really unwell with it (had an ultrasound showing inflammed gut), never settling between feeds, 4 hours of constant screaming, green sticky mucus poo. I thought I was doing quite well with DS2 so I was really surprised at his lack of weight gain.

Re: the tongue tie - I wouldn't have a tie snipped and the infant feeding midwife doesn't think there is one.

For the percentile thing to work, there has to be babies who are smallest and babies who are biggest.

Im where you are (ish), DD was born 6lb 13oz, on the 25 line, and is now on the 2 line. Dropped in steps when she got bronchiolitis and colds, still gaining but slower than the curve. GP and HV are keeping an eye but no one seems too worried. She's healthy and happy and DH and i are both 5ft 4, so she was never going to be huge!