Struggling with a 5 week old - feeding issues /weight loss

[Zelda100]

Hi

A desperate first time mum here.

Our baby is just over 5 weeks old and we’ve had big feeding issues - which we think we’re linked to tongue tie (frenulum cut last week), the issues were shown in a poor latch/unproductive feeding and then slight weight loss in a two week period.

We have since been advised to top up with expressed milk and formula which we’ve been doing and she’s gained around 45g past two days. Current weight around 3.225g.

However, it feels unmanageable atm as she rarely seems to settle after a feed, crying, hands in mouth, this is after improved feeding on the breast (swallowing sounds observed, average session between 5-10 mins) and we’ve been averaging just under 400ml in expressed milk per day (pumping after every feed) and some formula. Around 5 top ups a day which was advised

We have constant paranoia about feeding her enough now due to the weight loss so are worried about over feeding and are finding it impossible to distinguish between hunger cues, overtired or colic. No
idea if fingers in the mouth is for soothing as she nurses quite a bit or still hungry. She also spits up a fair bit after the bottle. Poos mainly yellow colour occasionally still greenish.

Sorry for the long post but losing my mind as just don’t know what to do !

If she is bringing up a fair bit after a feed, how long after before she has another?
I bottle fed but with ds i used to offer another after about half an hour-an hour. Sometimes he would take more sometimes not( he was a gannet so 9/10 he would take more lol) on the not times he was just wanting soothed i used to put him to my chest and just lie and rub and pat his back

Will she breastfeed for longer? Usually advice for slow weight gain is breastfeed and observe swallowing, once swallowing is less than 1/2 sucks per swallow use breast compressions and once they no longer work to get good swallowing, switch breasts

repeat on other breast then switch back and repeat. Keep repeating until it’s all no longer working.

Top up after feed as much as she wants (use paced bottle feeding) burp and then she may need to use the breast to comfort off to sleep (or a dummy but this should be used with caution with slow weight gain)

If she settles and sleeps on you, that usually will mean she’s eaten enough just then, she may cry if put down, many babies do but if she’s happy to nap on you or in the sling, she has lots of good nappies and is gaining consistently then all is working.

If she remains very unsettled but has good weight gain then it might be worth exploring other causes like reflux.

Dors your tongue tie practitioner or the infant feeding team offer support with feeding?

Also you’re at the peak age for grassiness, crying and being unsettled. Hits the peak at six weeks and most babies at this age are still manically cluster feeding at nights so I wouldn’t worry overly if she’s unsettled for several hours such as 9pm to 2am etc, that tends to resolve itself around six weeks.

All three of mine have been a bit like this due to jaundice which then causes sleepiness and poor feeding and then weight loss etc.

How much are you topping up each feed? 5-10mins BF for a small baby is very little. However it’s possible she’s over full after the top up as their tummies are tiny at this age especially if she’s still around 7-8lbs. She shouldn’t really be having more than 3oz total. The hospital should have told you a minimum amount per feed eg 60ml.

what I do to ensure mine are getting enough is switch the feeds round. Instead of doing BF then top up, I give the bottle first so I can ensure they have had the necessary Xmls required. Then I give them free rein at the boob to have as much extra as they want. Only once they’ve reached birthweight again so I switch this back round.

I wouldn’t say she is bringing up a big amount, just spits some small bits a few times after a feed, more so bottle, never projectile, once through the nose

I wouldn’t say she is bringing up a big amount, just spits some small bits a few times after a feed, more so bottle, never projectile, once through the nose

10 minutes is probably about the average for BF sessions (swallowing), but if we wait a bit then she starts again and does another few mins, so it can be over 10 mins but not all in one go. Sticking to between 2-3 feeds an hour. Pumping after each feed

The tongue tie practitioner advised 5 top ups per day of between 50-70ml which we’ve definitely done, probably more tbh looking at the figures

The finger in mouth confuses me a lot cause it can be soothing right , she nurses on me sometimes.

Have you had someone from the infant feeding team watch you breastfeed? Or gone to something like a la leche league meeting?

DS2 was a very very poor feeder because of muscle tone issues, and things that helped were:

• rugby ball position. It got a much, much better latch for him.
• chest compressions (basically squeezing milk into his mouth)
• switching breasts frequently

Generally the main thing recommended was lots and lots of skin to skin - if you have the opportunity to just both be in bed then go for it. Trying out different positions was another thing, apparently the "koala hold" can help, but I never got the hang of it.

He never managed more than a 5-10 session though. He was on the cusp of needing top ups, but there were other heath issues going on so they decided that in the round his weight gain was fine.

I do really understand how stressful it is thinking that your baby isn't getting fed, but 5-6 weeks is also just prime baby moodiness territory. DS1 was powering up the centile charts and, it felt like at the time, desperately unhappy at 5-6 weeks, which definitely made me less concerned for DS2 going through the same pattern.

I’d say around 70ml 5 times a day, so not with every feed. Mixture of expressed milk and formula.

Yeah we’ve attended a breast feeding support session and that was where the tongue tie was noticed. They gave some tips on positions which helped, like doing the rugby ball position.

I do compression to help as well but sometimes she does by herself

Good to know about the peak moodiness stage.

Need to do more skin to skin

The nice thing about skin to skin is that it's never the wrong thing to do! Have you got a stretchy wrap? I also found that really helpful for the moodiness stage, and generally just a nice thing to do.

I spent the first, oh, 8 weeks I'd say of DS2 being home from hospital in a state of health paranoia. He'd had a 3 month stay in NICU, so it was understandable, but I remember just not enjoying him the way I did with DS1, which was an added sense of guilt. I hope your worries about the feeding aren't feeling too all consuming.

Go back to the BF support group.

I am a long time BF peer supporter and had 2 TT'd babies. One of the things I see, over and over again, is this myth that T division is a magic bullet that will fix everything immediately.

It's very, very rarely the case. It takes AT LEAST 2 weeks for the baby to regain full tongue movement, and that's if it was done very early. It also takes a lot of positioning and attachment work - it took my son and I a month to get it right, and his was done in just a few days. It's so hard to correct your p&a with a wriggly baby and sleep deprivation and trying to remember all the tips. Keep going back for face to face support as often as you can.

This really will improve but it will take time and work! Good luck x

Another BF peer supporter here. You are being amazing and very conscientious here, in circumstances full of doubt and exhaustion.

As pp have said lots of skin to skin, not necessarily feeding, can really really help. Long slow feeds can be really helpful for baby to regain weight, but not always easy to adjust to- in 2nd and subsequent babies bf is almost the only excuse to sit down so feeds are often slightly extended so this problem is less prevalent. All of which is to say I wonder if it would make any positive difference to have those feeds as quiet moments where you can try and enjoy the squishy softness, and let that linger if you can. As far as I remember, if baby is still swallowing, albeit infrequently and with that fluttery tongue thing in between, they are getting the hind milk which is less sugary but more fat-rich. The pattern might go something like glug-glug-glug-pause... flutter flutter-pause... flutter-flutter-glug-glug-glug-pause....
but most importantly, please remember you are doing a great job and you're both learning together.