3 week old not gaining weight

[LivviPanda]

Baby Ava will be three weeks old tomorrow and is still not really gaining weight. After meconium aspiration at birth she was put on a ventilator and only had IV fluids for the first 5 days. She was in NICU for 2 weeks and it was suggested she might need a couple of extra days to start gaining. Midwife came out two days ago when she was 18 days and she'd finally put on some weight, 40g. But as of today she has lost 50g so she's now at her lowest weight. She's fully breastfed and midwives are suggesting we give her a top up of expressed milk after every feed even if she seems content/asleep. They've said we may need to strip her down to her nappy to wake her up for this top up.

I'm so overwhelmed by all of this I just feel like giving up. It's not sustainable for me to be breastfeeding and bottle feeding her as well as pumping and all the cleaning/sterilising that comes with it especially on the days I have my 3 year old so home. Not to mention that when I've tried to give her bottle top ups before she's ended up projectile vomiting after every feed. I'm at a loss and feel like such a failure. I've even suggested to midwives that I just move her over to formula but they want me to get through the milk I have in the freezer first.

I don't know why I'm posting really. Just need to get it all off my chest. I love her to bits but starting to feel like I'm just not good enough to look after her and the thought of having to do these top ups just feels too much for me.

They all naturally lose weight at the beginning and you will probably find she will start gaining again soon. Funny enough out Ava twin 1 had a rough time of it and I chose not to force feed extra because she hated it. Anyway after 6 weeks the weight started piling on and now she's a chubby toddler like her siblings. My theory was we wouldn't want to be force fed so why would baby same as the supposed to wake in the night and feed well ours woke when they were hungry and all fine with it

I am a midwife and health visitor. Sounds like you've both had a tricky start.
You just need to do what works for you and your family. Breastfeeding isn't the be all and end all, but if it's important to you then you'll need to hunker down and get through this tough beginning part. You won't be giving her expressed milk forever.
Your other option is formula and combi feeding. You can buy the starter packs that come with sterile teats so you don't have to sterilise anything.
Best of luck op.

Just be mindful of posts like the one above. She really does need to be gaining weight at this point and it's not normal for her to be at her lowest weight this far in. She needs top ups of some kind, where the top up comes from is totally up to you.

All breast fed babies do NOT loose weight at the beginning.. where on earth did that information come from? I'm an ex La Leche consultant.

We're trying to persevere with the expressed top ups. She just doesn't seem interested. Even after stripping her down, blowing on her, putting a cold hand on her she still didn't really wake up and would only take 15ml from the bottle this evening. It's weigh day again tomorrow so we'll see how we go but so far she's only taken an extra 75 ml in over 24 hours so it just doesn't seem worthwhile.
I have a feeling we'll be taking another trip to the hospital tomorrow as I can't imagine she'll have gained anything. The whole situation is just so frustrating and disheartening.

My daughter was stripped down to her nappy for every feed for the first 3 weeks. She would never wake up for a feed. She's now 3 and a half and this was probably the only time in her life she has actually slept. It was so stressful at the time and we didn't have the worry for bottle feeding.

My sister was under the 0.4th percentile until she was 1 and on the line until she was 2 when she quickly moved to the 50th percentile. 40 years later the memories still make my mum stressed so do look after your own wellbeing too.

What is her nappy output? How many wees and poos in 24 hours?

I had the exact same thing with my 3rd and I was told to top up with expressed milk which I gave up with in the end as it was too much of a faff. Think he had gained all back by 3-4 weeks after and he has gained consistently since. 15 weeks and nearly out of his of his 3-6 months baby grows! I think as long as there's plenty of wet and dirty nappies and the baby is generally content then I wouldn't worry too much. They all gain at their own rate. I understand why they have to do the weigh ins but I do think they can cause unnecessary stress half of the time.

This must be so stressful for you. Can I ask how long shes going between feeds in the day and at night?

Has anyone talked to you about getting a good latch or about trying Breast Compressions?

Have you spoken to a Lactation Consultant yet or called one of the Breastfeeding Helplines? If not I'd definitely recommend giving one of the BFing Helplines a call this morning and tell them it's urgent

Also have a look at Is My Baby Getting Enough Milk?

And How Might I Improve My Baby's Weight Gain?

She doesn't seem to poo every day. Usually once every 48 hours. She does have plenty of wet nappies though around 6, sometimes more.

I'm so sorry you're going through this. I've been there and understand just how stressful it is.

I was in two minds whether to post as I don't want to cause any alarm, but has she had her heart checked at hospital recently?

I only ask as we went through exactly the same and around 4 weeks our midwife sent us to hospital to get checked over and they found a heart murmur. (She had surgery and is fine now!) The hole in her heart meant her heart was working extra hard and burning more calories so she couldn't gain weight. I was breastfeeding and topping up too.

Sleepiness and only feeding small amounts were our first symptoms.

There's 99.9% chance it's nothing serious like this, but it's definitely worth checking.

I really hope I haven't caused any further panic 💗

@LivviPanda please call the National Breastfeeding Helpline on 0300 100 0212 and have a chat to a volunteer. As she's not pooing at least twice a day it suggests that she isn't getting enough milk. Is breastfeeding going well? Pain-free? 10 to 12 feeds in 24 hours? It would also be good to get her checked for a tongue tie (by someone who is properly trained so not a hv, gp or average mw).

@LivviPanda do you have a partner that could take some time off work for the days that your three year old is at home with you? Just so that you can concentrate on rest and feeding only at the moment.

Both of my babies were in SCBU and tube fed initially, it is hard hard work to get breastfeeding going after that kind of start.

The midwife came this morning and Ava has put on 90g in the last 48 hours. She's suggested that Ava might have a posterior tongue tie and shall recommended breast compressions which is not something I'd heard of before so thanks for the link.
Originally neonatal said no more than 4.5 hours between night feeds but I'm now waking her at 3 hours day or night if she's not woke by herself before then.
I'm now waiting for the infant feeding midwives to get in touch to assess her tongue tie.

Thank you so much for this. I'd not thought about it but Ava does have a heart murmur they picked up on while on neonatal. She has a scan at 6 months to look into it. Maybe that's another reason for her weight issues.

I would speak to your midwife/Dr about further tests sooner rather than later.
I had to be really pushy about it (they dismissed me as being a neurotic mum) but I knew something wasn't right.
If you find out it is heart related they can prescribe high calorie formula which really helped us (I did 50/50 BM and infatrini).

I'm sure it won't be anything serious (heart murmurs are apparently really common in newborns) but definitely worth investigating just to rule it out.

Hope you’re doing ok my baby aspirated on Meconium and was in the NICU. Born in feb x