Baby not putting on weight

[Flaya]

My baby girl is not putting on weight. She is quite petite, 8 lbs at 6 weeks and we’ve just been put on a feeding plan by health visitor (top ups with expressed milk). I’m quite upset as I feel that all I’m doing now anyway it’s breastfeeding her (feeds every hour) which means that my whole day from now on will be BF, expressing, sterilising and bottlefeeding her with no time to even make myself a meal. Of course I will be fine with that as I want her to put on weight but I’m just concerned that the health visitor it’s not trying to find the cause of a problem, just a solution. Baby has got a tongue tie that has been assessed by Dr and left as it is as it’s not significant and doesn’t affect her latch, my nipples are also fine but I do deep down think that she’s just not getting enough milk because of it. I really don’t want to put her on a formula but I will need to according to HV if I’m not able to express enough to top her up.
I booked an appointment with a lactation/tongue tie consultant, she’s expensive (£200) and my partner think it’s not needed and we can get her tongue tie cut for free at children’s hospital but I feel like I need some guidance.
Has anyone got similar experience with not putting on weight versus tongue tie? I guess I’m just looking for some reassurance, I really hope that tongue tie is the reason why she’s not putting on weight otherwise I have no idea what to do! 

Is she not putting on any weight? Or just gaining slowly? What was her birth weight and is she content?
DD was very slow to gain weight and HV did have a few concerns. She was just destined to be tiny though and I stuck with BF (exclusively). She was a content baby who slept all night (10-6) by 14 weeks and I knew she was satisfied or else she'd have been screaming day and night for food!
Although born at term weighing 7lb12oz, she barely weighed 18lb on her first birthday and wore 3-6m size clothes.

In my experience, yes, it was the tongue tie. I got put on a bfeeding, expressing, topping up routine that honestly sent me loopy, especially since my boobs hardly responded to the pump at all. I also got terrified by all the tales about bottle preference and alternative ways to feed. Honestly I wish I had been able to let go of the panic a little bit. Getting the tongue tie cut didn't make an immediate difference for us but over the course of a couple of weeks I think her latch improved quite a bit. What really helped the most was dumping that bloody pump, giving her a tiny bit of formula (the paediatrician gave us a plan for 4x70ml top ups a day to get us back up to birth weight) then as soon as she was back as birth weight I began to cut the formula back down by 30ml total per day. By the time of her 8 week review she was only having one 60ml bottle of formula across a 24hr period and I decided just to leave cutting it down there for my own sanity and be happy she was mostly breastfed. I also made a promise to stop bloody weighing her and judge by how she was in herself. She dropped that last little bottle herself when I started weaning then we carried on breastfeeding until she was 17 months.

Yes stick with the tongue tie. That's the most likely. Otherwise look for symptoms of allergy.

I put off getting a lactation consultant with DS1, we muddled through for 8 months and it was always difficult. I really wish I’d just paid for the consultant.

With DS2 I swore not to make the same mistake. As soon as we struggled again, I got a lactation consultant in on Day 7. Best £200 spent on the baby. Tongue tie identified and snipped, loads of follow up support and here we are, 8 months later, and still going strong.

People will spent £200+ on baby equipment like designer brand buggies, overpriced sleep solutions like Sleepyheads etc, or even if you add up the cost of formula for the first year. Honestly, if you want to breastfeed and need support, money on a lactation consultant is money well spent. Just make sure they are properly qualified and registered with IBCLC. If they can offer private tongue tie division with no wait, even better. You’ll wait weeks to get it done on the NHS. I promise that you won’t regret getting it sorted privately once it’s actually done.

Two other things worth a try

1. My lactation consultant also offered cranial osteopathy. Some people believe in it, some don’t. After seeing the obvious immediate improvements in DS2, I am very much converted. And at worse, it’ll do no harm and might just be a waste of money.

1. Look into a Hakaa (or I have an Elvie Curve. It’s more expensive but can’t get kicked off). That way you can express while feeding the baby. It’s quicker than expressing separately, should help your supply and easier to wash and sterilise. I managed to top up DS2 entirely on Hakaa expressed milk for the first two weeks until we were able to drop bottle top ups.

OP, what many professionals, doctors included, don't realise about tongue tie, is that it is not all about the latch. Your GP said the latch is fine, so no need to do anything about it. In your case, with baby not gaining weight, this is nonsense. Babies with TT, even those whose latch is OK, often tire themselves out feeding. It is harder work for them than usual, trying to extract the milk or drain the breast and thus they often fall asleep before the end of a feed. And yes, then will wake shortly after the feed, wanting to start again. They may have a good latch, but their tongue is not able to work as effectively as it should and they get exhausted. It makes me so cross that many GPs still do not understand the significance of a tongue tie for breastfed babies.

So, yes, please do see someone privately. It will be well worth the cost. Once the TT is snipped, don't expect instant results (although that is possible). Usually it improves little by little. With feeding becoming properly effective between 2 and 4 weeks after the snip. Or quicker in some cases, especially when, like yours, the baby hasn't stopped breastfeeding because of it. Good luck and trust your instincts!