Is my child underfed? . Baby not gaining enough weight

[VioIetMoon]

I've attached kendamil feeding guide.
My baby will be 3 months next week. He's 11 weeks currently weighing 8lbs11.
I'm giving him 120ml 6x daily. he's getting more feeds than what is stated on the tin as they state 5 feeds in day. I know its just a guide. At 3 months they suggest 150ml 5 x a day of formula plus I put him on my breast for a while a few times daily , In between feeds although he's not getting much. Probably 10 or 20ml as I can't produce much BM due to medical condition.
My health visitor has told me he's dropped off the charts and I need to feed him more 6oz and he needs weighing again in 2 days time. I feel this is unrealistic target giving him 2 days to gain weight? She said if he doesn't gain weight shell have to refer him. 6oz seems to be what kendamil is advising for a 4-5 month baby . Is this correct ? Although a guide, seems significantly more. He has alot of gas issues, and I worry feeding him more than what kendamil are advising, would this be too much for his tiny stomach? Giving him the same feed as a 4-5 month old baby. He was only 6lbs when born and was always measuring small and scan showed he hadn't grown in the 2 weeks prior to birth. Could he be a slow grower or am I just not feeding him enough. Would like some advice from other mums . Health Visitor said I'm not feeding him enough milk. She made me feed him more in front of her , despite the fact he was fed 1 and half hours before . How much did you feed your little one ? I want him to gain weight but I also don't want to upset his tummy as he has alot of issues with gas . Should I be giving him this 6oz 180ml in one feed or should i break it down into smaller feeds? for his tummy and gas issues as this seems alot of milk per kendamil guide.
I feel rather upset with myself to be told im essentially underfeeding him as I was following the feeding guide on tin.
Any advice appreciated

Just let her refer you. It's not a punishment is it? It's to investigate why he isn't gaining more weight. Well probably turn out to be something like 'he's just naturally small ' bit rather than put yourself through the stress of over feeding him just take the next step in the process and then you won't have to talk to her about it any more either.

I've had lots of trouble with two babies that haven't fed well. Firstly, it can be a good thing if the HV refers you so please don't worry. My DD2 was referred and checked over by a paediatrician before being passed to speech and language feeding team. They've given me brilliant advice about changing teat shape and size to maximise the amount she drinks. So it really isn't a bad thing!

The calculation that i was told is 150ml x kg per day. So if 8lb 11oz is around 4kg, then sounds like baby needs around 600ml a day. If you are doing 120ml x 5 feeds then that sounds perfect to me. In which case, its important they are checked to see why they are not gaining weight to make sure there isnt an underlying health issue. If you are worried about overfeeding, you could always try offering a dream feed whilst they are sleeping and see if they take it?

The other thing is whether your DS has other things going on that might be impacting feeding. Maybe a tongue tie? It's often ignored in formula fed babies but it can make their feeding very inefficient. DD2 had a very bad one and her feeding slowly improved after it was cut. Other things that a referral can help to look at is reflux / silent reflux etc. So if milk is coming back out a lot, they may not be getting the full amount you expect.

I've heard lots of babies suffer from bad gas on kendamil because it is very rich. You could try a different formula to see if that makes a difference? Again, if you are referred to a feeding team, they will be able to advise on this.

Does your baby finish his feeds? If so, I'd increase them. You can either give more in each bottle or feed more often. You should be guided by your baby’s appetite not what the side of the tin says.

If he's finishing his bottles, increase the amount.

Definitely get the referral too!

That’s really quite small for 11weeks OP.
As someone said, if he’s finishing the bottles you’re giving him, try giving slightly more and see if he takes it.
And don’t worry if you do get referred, they’ll just check nothing else is going on.
Slightly random thought but could he be a bit cold sometimes? Babies use up more calories when it’s cooler and they are wearing fewer clothes.

My baby is 5 months old and weighs 8lb 10oz. A referral is nothing to worry about. They will check that there isnt medical reason for slow weight as there has been for my little one. Its not a parenting criticism. The feeding guide is for babies gaining weight with no issues. They do suggest more milk when gain is slow too.

Oh, OP, I was you. My son literally dropped off the percentiles for weight (0.4th percentile!!!) It was so horribly stressful and the doctors seemed to be insinuating that we were starving him. Nope - I spent every second of his awake windows trying to feed him. We saw every specialist under the sun, gave fortified formula, formula designed for children with heart problems and he never gained any faster (note: he always gained, just v slowly after dropping loads in hospital while we tried and failed to get him to breastfeed). His weight only ever picked up when he was about 12ish months and fully on solids. Our ped eventually surmised that he was an unusually active baby, with a fast metabolism like me and my husband and that he is just genetically predisposed to be lean.

TL:DR - take the referral to rule out anything sinister but in my experience it can be totally normal if baby is gaining some weight (even if not as much as they want to see) and is happy and active and settled between feeds and meeting milestones etc. Try not to panic and I promise you are doing nothing wrong. It’s so horribly stressful so pls ask away if you have any questions. He’s now a super skinny but thriving 2 year old. His baby sister by contrast is a great little eater and happily on the 25th percentile for weight and the only difference was that she didn’t drop so much as birth and was mix fed from the get go. Hope this helps!

Thanks for the advice ladies.
Yes he finishes all his feeds of what I was giving him previously and that would settle him for around 2-3 hours . Id top him up sometimes with 60ml in between feeds if he was unsettled . however didn't finish his last feed which is the increased amount hv wants him to take. He could only manage around 130ml . She wants 180ml per feed.
I'd be happy to be referred to ensure there's nothing underlying as we had a few complications in pregnancy, he spent 3 weeks in nicu when born due to low blood sugars and he's 11 weeks now and still doesn't follow with his eyes. thinks this could be due to him not getting enough milk .
She questioned why I was giving him kendamil and not sma.
He's actually been on different formulas in nicu and they didn't agree with him. Cow and gate made him sick after every feed and aptimil gave him gas so severe he was curled in a ball in pain. It's improved greatly since switching him to kendmil. He was also on nutrimigen from gp but that didn't seem to fill him, he was very unsettled on it.

HVs provide a useful service because they can refer, and I've heard that many of them can be very good, but I'll be honest the ones I've met have given me across the board terrible advice (eg telling me to only let my newborn have ten mins on each nipple). Don't ignore the putting weight on worry - get him checked out - but otherwise just nod and smile at what she says. The developmental things you're worried about may be connected to the reason he's not putting on weight but I don't think she can say one is causing the other.

● Feed more frequently. Instead of 3h between feeds, do 2h between feeds. Instead of 4h between feeds, do 3h etc.

● If baby finishes the bottle, it means future feeds should be bigger. The aim is that there's always a surpluses of milk in the bottle when baby naturally finishes the bottle.

● Ignore recommended amounts. Especially when your baby is underweight. Feed Feed Feed as much as you can

● Given baby is underweight, if baby is crying and not settled by a dummy, Feed every time, regardless of time since last Feed. Not with top-up amounts. With full feeds.

● Use a dummy. Good for digestion and sleep.

Just saw your update about NICU, OP. My DD1 was below the 0.4th centile as she had sepsis at birth and spent 2 weeks in NICU. We were followed up by neonatal outpatients at various points for a couple of years. Is your DS having something similar? Maybe a check up at the hospital? I thought it was routine for babies who had been in NICU. You can talk to them about these issues as well.

@Slowfeedingbaby they did mention a 3 month check up when discharged from nicu but I haven't received any appointment yet. I might give them a ring this week to find out

Oh yes, definitely do! If it's like DD1's, they will weigh and measure baby, then the doctor will give baby a thorough check and ask you lots of questions about how they are getting on / their development etc. Do tell the doctor about the feeding and the eye tracking. They might refer him to another team for a follow up appointment, but then at least you can tell the HV that he is in the system.

Thanks all. I think I'm just going to ask hv to refer us to pediatrician for advice and investigation.
I thought every baby was different and hence that's why it's a 'guide' some will take more, some less. I don't feel right trying to stuff him with such an increase in milk if he's not finishing feeds and suffering from terrible gas and as a result and hes curling up again crying in pain. I'm going to ignore hvs expectations of 180ml per feed as its too much for him. I've increased him to 150ml per feed now which is 30ml more than what we were feeding him but even his last feed he couldn't finish that. The volume is hit or miss with him. Most of the time he will definitely take it (150ml) but some feeds he won't so how the hell can I force a baby to take the feed to match these expectations of 180ml
My personal opinion is that I don't feel I'm feeding him too little. I'm feeding him when he cues signals but hv insists I'm not giving him enough milk and I left appointment feeling like I'm to blame for his development delays.
Don't know if it's true, but I did read a few articles suggesting ivf babies tend to be smaller. I don't know if that's anything to do with it as he's always measured small. He didnt grow in last 2 weeks of pregnancy, although they did way the cord or placenta was in bad shape so that could have been why

You’re aiming to get him to drink as much as he will take - so you don’t want him to finish the bottle. You want there to be a little bit left at the end that he’s not interested in. It sounds like 150mL is the right amount to be making for him at the moment. You can also try feeding him a little bit more often.

If he was unsettled on nutramigen did they not suggest trying a completely dairy free formula?
My daughter was on the 9th percentile and didn't feed much until I went dairy and soya free. She then moved to the 25-35th percentile. She's 4 now and she still stops eating if she has food she reacts too.

My sister had slow weight gain. At 10 weeks she was less than 1lb over birth weight and had issues with sickness. She didn't reach the 0.4th percentile until 1 and was on it until 2 when she moved quickly up to the 50th percentile. She always had random bouts of sickness that went away when she turned vegan at 40. We suspect she had a dairy allergy as a baby. The timeframe for her weight gain matched when most babies with cmpa start to improve how they tolerate dairy. My mum can't tolerate high levels of dairy. She is fine with cheese but yoghurt, milk and ice-cream cause her issues.

It might be worth chasing that post NICU check up. They can make a more holistic view as they have broader knowledge. The role of the HV is spotting potential problems and sign posting to more qualified professionals. Weight /height/lengths are crude measures which may or may not be due to other causes.
Paeds will measure length as well as weight to see whether they are proportional too. A 0.4th percentile baby that is say 90th percentile for length is more concerning than one on the 9th percentile. Length and weight ideally should be within 2-3 percentiles. Paeds can also put you on a different chart that has lines below 0.4th which can make it easier to plot if they are following a line just one below the 0.4th or continuing to drop.

Any signs of cmpa?

Is the teat hole large enough?

If he was on nutrimegan why is he back on a dairy based formula. Surely they should have tried him on neocate which is totally dairy free. How are his nappies? Are they usually full of runny poo? Because if they are the milk is simply passing straight through. Happened to my youngest who was bf, I suggested CMPA as the medics couldn’t explain it.

I would make up feeds such that he always has some left over every feed. I’d say if he’s finishing every bottle, you aren’t offering him enough. More is always better unless there are concerns a baby is significantly overweight. I’ve never paid attention to what it said on the packaging with my bottle fed one, just fed as much as they would take.

I really don’t mean this to sound mean or snarky but I don’t understand why you wouldn't offer bigger feeds - your dc needs more food to put on weight and you need to give them to them

I would look into your own diet if you are offering BM too, if he has gastro issues on different milks already.

He may have some sort of intolerance that comes through your milk, coeliac etc can cause a lack of growth so would cut wheat from your diet if you are wanting to continue offering BM.

Focus on more feeds per day.

At 4 months my DD was having 7 or 8 full feeds in 24h

(Around every 2h during the day)

Same. And surely you feed on demand, not from the back of a tin! As pp said you want a little left over so you know he's had all he wants and needs. Not finishing each bottle as that's obviously not enough for him.

The recommended amount is 150-200ml per kg body weight per day. Then divided up into however many feeds he wants. Ignore the package, many babies want more feeds - mine had 6-8 a day until 7 months old.

They're not meant to 'finish' the bottle, the idea is they leave a little once they've had as much as they want. So if he's draining the bottle add another oz and make up the next one with an oz more than you think he'll want.