Breastfed baby not gaining enough weight

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My 11 week old DS is ebf. He was born on the 75th percentile and steadily gained until 8 weeks but now he is on the 50th.
Before his 8 week jabs he’d feed for at least 30 minutes every 2 hours and have 2/3 dirty nappies a day.
Since the jabs he has cluster fed for 5-15 minutes every 1-2 hours and his dirty nappies are now once every 2-4 days. The nurse said this would happen but I don’t think it should still be the case 3 weeks later?
When I had him weighed the HV said I need to see a doctor or go to a&e which I thought was extreme, but it has made me panic and feel like the worst mum in the world that he has gained just over 1lb in 4 weeks.
I felt really proud of myself ebf when my milk dried up after 2 weeks with my older children. I felt like I’d achieved something with DS but now I know he isn’t gaining enough weight I feel terrible and contemplating switching to formula.
I had an awful case of mastitis when he was 3 weeks old but I pushed through it. I can’t use a breast pump as I only seem to get around 4oz out and it takes over an hour.
Could I be having a supply issue? He is offered the breast constantly but rejects it outside of the feed schedule as above. He never cries or acts hungry.
He is sometimes sicky after a feed so could potential reflux be a factor?
Can anyone please share their stories and advise what you would do/did do?
Giving up bf would be a last resort but I’m scared he will continue to lose weigh and become unwell so formula seems the easiest solution, particularly now the HV is watching me like an abuser and telling me I have to come back weekly for weigh ins until he is on the 75th again.

Are you or your parent of a stature that suggests 75th percentile is the right line for him to trend on?

Have you tried to give him the breastmilk from a bottle? Would he take it from it? You said you can't express much, but it might be worth the try.
You don't have to stop breastfeeding: you can keep doing it and maybe top it up with formula (I did half expressed breastmilk half formula for the nights).

We’re both around 5.5 foot and slim, ds was big at birth and gained his birth weight back quickly despite some early latch issues where I needed nipple shields.

If I pump I’ll only make enough for a small feed and then there will be nothing left to pump in time for the next feed. I spent a relentless day and night constantly trying but there wasn’t any ‘spare’ to feed DS in between on demand so I gave up on the machine and stuck to breast.

What centile is baby on now? It took my LO a little while to 'find their line' and for BF to become well established. I combi fed at the start and think that contributed in part to the delay. My LO also had a tongue tie which I got snipped at 8 weeks.

It would be worth asking the HV to refer you to your local infant feeding specialist, in my city these are all trained lbclc lactation consultants. You could also go private. They should do a full assessment and be able to advise if top ups (either breast milk or formula) are needed, see if there's any changes which could help with milk transfer etc. I'd also see if there are any BF peer support groups locally.

Little things which can help are offering both breasts at all feeds and breast compressions when feeding, particularly when baby is doing sleepy suckling. Don't spend an hour trying to express! You could try expressing after a feed just for 10 mins to see if that helps increase supply

Any breastfeeding groups near you?

There are some types of slight tongue tie that don't impede feeding to begin with, but start to cause issues around 8 weeks. DD had hers snipped after that. Might be worth asking about. Something about mouth getting bigger or drinking more or something.

We had the same issue with my DS. He was putting all his effort into growing and not putting the weight on. We did end up seeing a paediatrician who said to start weaning at 4m. I kept breastfeeding until he was 2yrs

You are doing a great job!

Does your baby look happy (alert when awake, content after feeding) or is he constantly fuzzing?
Does he have several wet (not necessarily with poo) nappies per day?
Does he grow in lengte and weight?
Personally, I wouldn’t worry if it you answer all with yes. Look at your baby, those lines are just an indication.

When mine lost weight I was advised to not let feed go on for more than 25-30 mins (though that doesn't sound like it is for you anymore) and to pump after the feed and use that to top up after each feed so I think it helps increase your supply and gets them a bit more. I also hated pumping as got so little out - weirdly massaging breast while pumping helped and I think different breast pumps can be more effective. If you have a BF support clinic try there for advice and our one lent out pumps so you could try different ones to see if any work better for you. They can also prescribe something to help supply if they think that is the cause. Mine stayed along 2nd centile for ages and has gradually gone back up towards birth weight percentile. Hope it gets better for you

With the poos have you considered cmpa?

Are you

• Drinking absolutely loads of water
• Eating lots, including fatty things like cheese and milk plus milk-supply foods like oats?
• Getting gim as much skin-to-skin / sucking time as you can?

If you aren’t then try that and your supply should improve

I don’t know anything about pumping but I do know someone who was badly advised to increase time between feeds and that made things much worse for her as her supply dropped.

Gently- Are you absolutely sure you're producing enough milk if you're trying to pump and not getting much?

I had supply issues with my son. He lost weight and the HV told me to go to hospital and it turned out he was really dehydrated. Believe me when I say I spoke to every breastfeeding support person, nurse, midwife and God knows who else. I tried herbs, special food, the most ridiculous pumping and breastfeeding schedule known to humankind and I just didn't make more than a few mls of milk even after weeks and weeks of trying this.
(I say this to say that unfortunately, speaking to helpers and getting advice sometimes isn't enough and sometimes you just need to use formula, even on a short term basis).

Best of luck.

My baby's 15 weeks and hasn't been weighed since 8 weeks. No one has offered to. I'd have no idea if she'd fallen down the centiles, but she's grown into the next size of clothes, has plenty of wet and dirty nappies and seems happy and well in herself. Surely these are the most important indicators by this point? What does your baby seem like in himself?

Some people don't get much at all when they pump.

Also I'm very confused why you've been advised to shorten feeds. Feed as much as baby wants. The more you feed the more your supply will increase. The advice you've received sounds odd.

Pumping is never an indication of what you produce so don't worry about not getting enough when pumping.
I would just keep offering feeds. Babies become better at getting milk out of the breast so the length of feeds often shortens.
DD was a "snacker" and fed every 1-2 hours for about 5/10 minutes on one side, DS can go longer between feeds but he'll often feed from both sides or just longer from one side.
Their dirty nappies changed aswell and both ended up going a week or two between, they didn't seem in pain so I just trusted my instincts and went with it. DD is 2y3 and absolutely fine and DS is 10 months (was 5 weeks premature) and he's doing really well. Both ebf!

Does he seem happy and settled after a feed?
Is he moving up in clothes or nappies? (Hard to tell at that age but keep an eye on it).

I wouldn't say you need to top up with formula, it's often advice given when it's actually not needed.

There's some great IBCLC's out there (Lucy Webber Feeding Support on Instagram is a great IBCLC I follow) or maybe a local breastfeeding peer support group could help if you're really worried.

Some HV's aren't that knowledgeable around breastfeeding so be wary of taking just their advice, A&E seems a slight overreaction for a baby that might just be settling on their own centile line with no other major issues.

Absolutely nothing wrong dropping 100 to 75 centile!! It's if they drop more than 2 centiles there COULD (not necessarily) be cause for concern. Does she look happy, healthy, is nappy output good

My baby dropped 50th to 25th then 9th. Was being weighed fortnightly by health visitor. She didn't go below 9th. When started solids went up to 25th again. Currently sitting nicely on 25th. When she dropped to 9th, hv did get me to make doc appointment just to check no reason for the weight loss

You don't have to have any weigh-ins and weekly is too much. Fortnightly is better. Your hv sounds awful. Your baby certainly doesn't need to get back to 75th!! I would not see her again, she sounds awful.

We had similar issues. Born on the 50th centile, dropped to the 9th at 6 weeks and then didn't gain any weight at all between 7 and 9 weeks.

Mine was supply issues caused by a tongue tie (so he couldn't get the milk out easily), so had that cut.

I triple fed for a week with full top ups of formula after breastfeeding, and then we combi fed until 9 months old, so it absolutely doesn't mean you have to stop breastfeeding (even if you do need to give some formula).

Triple feeding is very intense though, I couldn't have done it any longer (although I know people do). I was able to get more pumping as my supply increased, but some people just don't get very much no matter what they do.

Make sure you've got lots of support - I felt a really upset and guilty initially, which I definitely shouldn't have.

re nappies it’s common for breastfed babies to not have many dirty nappies. My children had about one per week, but plenty of wet nappies and were not experiencing any pain or discomfort.My dd was on the small side and my gp was pushing formula top ups and weekly weighing and I was getting very worked up about dd’s health and progress. I changed doctors and new gp was very supportive, said that dd was petite and nothing to worry about. Dd is now 17 and a size 4/6, has never had any health issue and is petite.

No you don't sound like you have a supply issue at all. Pumping is never an indicator of supply, the process is different and babies are much more efficient at removing milk then a pump. (I fed 2 babies but could never pump)

No pooing for several days is also totally normal for a breastfed baby. My eldest once went almost 2 weeks. Watch out though as when they do go it's often a lot.

4oz is often the right volume for brestmilk feeds anyway. The volume of milk doesn't change much as baby gets bigger, it's the composition that changes.

If you feel you need some more support seek out a breastfeeding group or support line.

Your baby certainly doesn't need to get back on the 75th centile, these are average lines. Most babies will move around on the chart ro some extent.

The best thing to do is look at the baby, is your baby alert, happy, having plenty of wet nappies. If yes then everything should be fine. Go for a GP checkup if you feel you need to.

I'm sorry you've had this news from the Health Visitor. I feel taking him to A&E is quite dramatic - and as the Health professional she should know if he needs to go immediately for dehydration or not, so that's not helpful advice.

Has he been weighed regularly or just birth, 8 weeks and now? With just those measurements I would want a few more to see if he has just settled on a new centile. There is nothing at all to be concerned about being on the 50th centile. Also if scales are calibrated differently, one was on carpet, one in the GP surgery, then a pound or so can be quite a bit of a difference.

However there are a couple of things you could do - breast compressions when baby is actively sucking to get a bit more milk in them, pump or hand express after each feed to up supply (even if he doesn't drink it), take fenugreek supplements or eat lots of oats to boost supply, get him checked for a tongue tie. In my area the Infant feeding team only see babies under 12 weeks so I would do this ASAP.

Not being able to express much is not an indicator of low supply. If you are desperate to pump then make sure you use the right flange size to start with. Lots of lovely baby snuggles before/during, some breast massage before to get the milk flowing.

And probably the first thing I would do is speak to someone like a La Leche League leader or the National Breastfeeding Helpline to get some support. For me these have been way more helpful that the Health Visitor run groups.

DD was not gaining weight when she was first born. She had jaundice and was always falling asleep while trying to eat. I remember that Christmas my family kept telling me I was being silly for waking her to eat and we'd have to blow on her face to keep her awake.

Anyway, the midwife suggested we supplement with formula. I tried pumping but it wasn't doing anything and just meant I was tied to a baby or machine for literally over half the day. I was worried it would mean we stopped bf, but actually it was fantastic. She'd bf, then have a top up of formula. It meant that she got all the bf benefits from me, calories from the formula, and she got much better. I almost exclusively bf, but having the option for DH or a grandparent to feed her a bottle if they were out without me was brilliant too.

All that to say that if you need to, don't worry about topping up with formula. It doesn't mean you have to stop bf and we had no problem dropping it when it was no longer needed.

Wishing you the best x

thank you all so much for your kind comments and reassuring advice, I feel a lot better after reading these.
he has constant wet nappies which is good, I’ve seen mixed opinions about the poo quantity but as so many say their bf baby went days/weeks between I don’t feel so concerned. He’s a very happy baby in general I don’t have any concerns outside of the feeding. He has been weighed during the first weeks of his life, his 6 week check, 8 weeks at his jabs and then today. MIL has told me DH was always below 10th percentile and he’s turned out fine, skinny and short but healthy none the less lol.
The HV comments have hurt I must admit, as if she was accusing me of not feeding my baby. She seems to think infant gaviscon for the sickness will cure it and he’ll gain the weight back.
I may try a top up of formula before bed this weekend as my nipples are so painful today where I am constantly offering and he’s using them as a dummy!
I am quite relaxed on how much water I drink, I know dehydration can play a part so I will make sure I am drinking at least 2L from tomorrow and avoid anything fizzy with meals.
I hope I’ve answered all the questions, sorry if not, I’ll check back in the morning. Thanks again ladies you’ve given me that push to not give up bf.

I find health professionals change their mind all the time.
She's a 9th percentile baby she's fine, it's not like she has dropped a percentile
Cut out dairy she's now a 25th-50th percentile ah maybe she wasn't gaining enough weight she is now
Drops a percentile due to minimal weight gain over 5months. Ah yes she's dropped a percentile but it's not like she has actively lost weight or dropped multiple percentiles
She dropped 3 percentiles for length/height. Ah maybe she was never a 25th percentile length at least she's following a new line.

I have spoke to other and they either get a "you don't need to worry" narrative if they raise concerns or a "what are you doing" if they don't

The standard weight centiles are based on bottle fed babies who gain more weight than breastfed babies. HVs are trained on what bottle fed babies are like, they usually have fuck all idea about breastfed babies. If you’ve been advised to shorten feeds that tells you she’s talking bollocks! You should be feeding as much as the baby will take, not cutting feeds short! Have a look at weight centiles specifically for breastfed babies, before you decide that your baby is underweight.

Your baby sounds absolutely fine.

Ignore anyone who says pumping reflects supply - I ebf two babies and could never get more than the tiniest dribble out with a pump.

Both of mine were born big (one on 75th and one on 95th centiles) and both dropped one centile fairly quickly after birth (75th to 50th, 95th to 75th) and then maintained that to this day (now 5 and 3!).

Sounds like you are doing great - keep it up and ignore the HV!