DS losing weight & EBM solution offered by clinic nurse

[Renee_AW]

Our DS is 4 mths + 5 days and although he is 3cm longer than he was at 2.5 months he is 20 grams lighter. According to the nurse he should have put on approx. 500g in this period. He is in 50th percentile for length & now 10th percentile for weight.

DS is fully breastfed. The solution she suggested we try to increase his weight was to breastfeed & then offer a bottle with EBM immediately after the feed. Try this for a week and weigh in again. Trouble is, DS doesn't take a bottle or a sippy cup. We have tried the bottle four times now & no luck. Sippy cup only once so I will continue to try...my goodness it is stressful.

We are currently in the Sleep, Feed, Play routine & I asked if we changed to Sleep, Feed, Play, Feed, Play (rather than giving EBM) if that would work. She told me that the problem with doing that is that it takes DS energy to breastfeed and he is not likely to get enough milk to cover the energy expended for a second feed. She said drinking from a bottle takes DS much less energy so he will benefit more from giving him a top-up after his breastfeed.

I obviously need to increase my supply and will do anything for DS & anything to save breastfeeding & avoid formula but am wondering if I really need to express rather than feed to do this.

Does anyone have any experience or advice.

I am desperately sad that I have been starving our beautiful DS.

Also, DS has about 5 wet heavy nappies & at least one poo'y nappy per day. He is a 'regular' baby when it comes to poo's & has never had a period where he has gone for a day without a poo. He is also very alert & happy.

[onthefly]

What a worry for you
Is your nurse an LC? If not, I would suggest you find one to get a second opinion, and/or call the ABA and see what they say (they may also be able to recommend an LC in your area if you don't know of one).
Expressing rather than feeding doesn't really make sense to me, I must admit. Babies do much better at getting milk from the breast than a pump. I'm not entirely sure about the energy argument either - is he actually weak? Aside from the weight loss, are there any other signs that he is not getting enough? How have his nappies been? His skin tone, demeanor...? These signs are just as important for determining whether they are getting enough milk. A fuller picture could give you a better idea of just how much of a problem you have here.
I'm no expert, but my first instinct would be to feed more often also. Good luck to you

[Janie]

It sounds as though your instincts are guiding you in the right direction. Seeing an LC may be useful for you, because by the sounds of your DS's nappies, there might be something else going on, rather than lack of milk intake. In the meantime, adding in some extra feeds certainly won't hurt.

I'm sorry you're faced with this stress, I know how hard it is. Hang in there, and have faith that your body is doing exactly what it is supposed to do

[onthefly]

Just saw the nappy update.
Janie is very wise

[Alan]

Hi Renee

Your baby does use a little less energy feeding from a bottle than he would feeding from the breast however, if he will not take a bottle then there is no point in doing this. I think that you should give sleep, feed, play, feed, play a go. Trying to force your baby to take a bottle or a sippy cup will only cause him more stress and thus cause him to burn more energy.

Another thing to consider is:-
Has your baby become more active recently? If so this could explain the reason for the lack of weight gain. I would not be overly concerned at this stage. See how things go over the next month.

[Barb Glare]

Hi,

You won't hear me say this often, but the information you got from your nurse is rubbish - and alan, I have to take you to task about bottle feeding taking less energy than breastfeeding. I have NEVER seen any evidence for that - but you are welcome to send it over. Babies are physiologically designed to breastfeed. when they are breastfeeding their heartrate is lower, the mother regulates their temperature and they use less energy.
Milk supply is boringly simple. The more you feed, the more your baby takes the more you make. Except in rare cases of unusual medical conditions this works every time. I wonder, how many feeds is your little one having in 24 hours? 8-12 feeds at this age and beyond is NORMAL.
Renee, your plan - feed, play, feed sleep is a top one. More feeds = more milk intake. Your baby may never be designed to be on the top percentiles - but more frequent feeding will mean he gets more milk and he grows.
You are NOT starving your baby - this is one of the cruelest things mothers can be told, or that mothers believe of themselves. We are given so much conflicting messages in our society. Are you feeding on cue? When your baby looks like he wants it?
Get back to us and let us know how you are going

[Renee_AW]

DS is a very alert, happy and beautiful boy. People have always & still comment on how alert he is. Nappies are good. He is pale but so are DH & I.

I saw a LC last week because I have issues with blocked ducts...no solution to this one but have learned to identify earlier & clear blockage at nipple as soon as it appears

I am going to phone her tomorrow and talk to her about what the best way forward is. This is all very stressful but I am determined to continue with breastfeeding so long as DS is healthy.

[Janie]

You sound like a very on-the-ball mum Renee I feel positive for you that you and your son will breastfeed for as long as you mutually desire. It's good that you have an LC that you trust, I hope she can help you tomorrow. Let us know how things go, will you?

[Renee_AW]

I wonder, how many feeds is your little one having in 24 hours? 8-12 feeds at this age and beyond is NORMAL.
Renee, your plan - feed, play, feed sleep is a top one. More feeds = more milk intake. Your baby may never be designed to be on the top percentiles - but more frequent feeding will mean he gets more milk and he grows.
You are NOT starving your baby - this is one of the cruelest things mothers can be told, or that mothers believe of themselves. We are given so much conflicting messages in our society. Are you feeding on cue? When your baby looks like he wants it?
Get back to us and let us know how you are going

He feeds 6 times in a 24 hour period. I feed him when he is hungry....generally when he wakes up he feeds & he wakes up once during the night plus three sleeps in the day and then an additional feed before bed at night. Occassionally I feed him if he wont settle after about half an hour of trying to get him to settle but this is not often.

It may be worth noting that both DH & I are slim people & DH is tall and slim.

[Ryatha]

I think - and someone correct me if I am wrong - told me that BF babies put on weight slower than bottle fed babies. I know that DD2 who was BF had a much slower weight gain that DD1 who was bottle fed. I also worried about my supply because of this and went by the theory that every time DD2 opened her mouth to cry - I gave her the bb, or if she had the hiccups, or was tired or needed comfort.

I also did baby led solids or baby led weaning and at about 4 months let her play with food. Occasionally she got it into her mouth and tasted it, but she really enjoyed massaging it behind her ear once she started eating the solids I found her weight finally did start increasing, but that was at about 7 months.

In the meantime, believe in yourself your bb and your LO will be fine

[Alan]

Barb
When I first read your post my thoughts were “of course it does. We all know that. I remember it from when I worked in SCN”. So I decided to do a search and send you the info. And what did I find? You are right. All the recent research shows that there is no significant difference.
Thank you for correcting me

[Barb Glare]

Hi, Renee,
As my old aunty Daphne said "you won't make rats from mice" - so your baby probably won't be at that top end of the weight scale. But, you will be amazed to find that he will put on more weight if you feed him more. (weightgain is highest in the first 3 mnths - you would expect 150+ g per week - but after 3 mnths 70-100 would be the norm) 6 feeds per day is very minimal - not even I would gain weight on 6 feeds per day. Never be afraid to use the breast as your first line strategy when settling - there is a whole "cult" around not settling a baby by feeding, but breastfeeding is the natural way of baby settling. You will be surprised to find that you can find may opportunities for a feed - let him have a cluster of feeds in the evening if he won't feed. And many mums find the more they feed the more they *want* to feed - and this is a good thing. I see babies like yours at my clinic every day of the week - and it's the simplest problems to overcome. Unfortunately the info your nurse gave you will result in premature weaning if followed.
And Alan....thankyou.

[Renee_AW]

Thank you all!

I spoke to my LC this morning & she said the same as Barb & others...breastfeed! She said if over time he still wasn't gaining weight I might need to go down the expressing route but it really shouldn't be necessary. She said the only way that he would use more energy from an additional feed would be if I kept him up longer to feed him....I told her that was not my intention. She is also keen for me to keep in touch & let her know how we get on which is very kind & generous of her.

My plan is to feed when DS wakes from his sleep and then feed again about an hour later. He currently stays up for around 2 hours so I am not worried about feeding him to sleep as we still have some time after the second feed. We did it this morning and he fed hungrily both times...hooray. After the second feed we played a while & then read a book and then he self settled for his sleep.

When he gets up we will do the same again. In essence this means he will get three more feeds a day making a total of nine feeds.

He did bring up some of the milk from his second feed - I was feeling a bit stressed about that but I guess if his tummy is full it is full. He fed well & now I just have to continue and see what the scales say.

I love breastfeeding, I have had a lot of problems with it (blocked ducts & Mastitis) but I feel I am on top of them now & I love the closeness and naturalness of it. I despair over the thought of not being about to sufficiently nourish my baby & will do whatever I need to to ensure he is healthy.

I will post again on Monday after his weight check.

[onthefly]

Renee, it sounds to me like you know exactly what you're doing!
A few extra feeds and that'll probably do the trick. At any rate, your baby is most definitely not starving!

BTW, if you compare the charts in the standard baby books they hand out with teh WHO charts, you'll see that fully breastfed babies tend to put on more weight than ff ones in teh first few months. However the curves seem to level out more later on and they're often lighter at 6-12 months (this is based on my rough comparison).

[AwesomeFoursome]

Do exactly what you are doing. My DD was on the 90th percentile for weight when she was born, it dropped to around the 3rd - 10th percentile for weight by 4 months. She was put down as FTT. I was so worried I started seeing the mchn every 1 - 2 weeks. I thought she must not be getting enough milk and the mchn encouraged me to add formula. At 6 months we added formula by 7 months she was fully on formula because she refused the breast. And I didn't bother expressing cause I thought my milk must of been crap. The things that went through my head, I've been starving my baby, docs are going to come take my girl away, she is going to fade away, I felt like the worst mum in the world. I seen a pediatrician who said she was fine but it was too late. She is now 12 months and still sits around the 3rd - 10th percentile. The formula didn't put extra weight on her. When I took her to her 12 month check, she is still on the same percentile and the nurse (the same one we seen before) said her weight is great. Why it the same but great now and was terrible before. I am so angry about it. She is the size she is meant to be, its her and she is perfect. I cry when I think about it. I missed out on feeding my baby and it shouldn't have happened how it did. With my next baby I will be taking it to see the dr for its checks not the mchn cause she made me feel like crap.

You are doing a great job. Your DS sounds perfect.

[onthefly]

Wow Yowie, that's terrible!
I'm so sorry you were let down so badly by someone who was supposed to be offering support and guidance.

[Renee_AW]

Yowie, Thank you for sharing with us. I am so sorry that you were made to feel inadequate and not given the support you needed. I know how easy it is to doubt what you are doing is right & I think it is amplified by the fact that you love your baby so much & want to do everything 100% right (although I am not quite sure this is ever possible).

I took DS back to the clinic yesterday for a weight check and he has increased by 40grams since Thursday. The nurse said Ã*t wasn't as much as she would have expected but agreed it was a move in the right direction. She said she was at a real loss as DS is so lively and alert & looks healthy in every way. I have decided to take DS to the Paediatrician to make sure he is okay so I had to go to the Dr today to get a referral. She checked DS over, said he has a good covering of fat, good muscle tone, checked his heart and eyes, head/neck strength and DS had a good chatter with her...she said in her view he is a perfectly healthy baby but did agree that since he has crossed percentiles for weight that it is a good idea to go to the Paediatrician. We have an appt. in three weeks.

She also said that given his father's build (tall & slim) it is not surprising that he is thining out. And she said she didn't think I needed to continue with the additional feeds if he was alert & happy with what he was getting before I started with the additional feeds.

I have also looked at DH's baby book which has some of his weights in it and his weight shows a similar pattern with �H being born in the 75th percentile (based on my blue book charts), by the 3rd month he is between 50-75th percentile, 4th month 50th percentile, 5th month mid-way between 25-50th percentile, 7th month 25th percentile & by the eigth month 10th percentile. The pattern is much the same for DS but it is just happening earlier. I don't know if DH was breast or bottle fed & both of his parents have died so there is noone to ask.

Now...I am a bit confused. He was a happy baby on his old feeding pattern (set by him, not me) and he is regurgitating a lot of what he takes on the additional feeds as soon as the feed is finished. My thoughts are that I will continue the additional feeds until the end of this week which should give my milk supply some time to increase if it is needed...if not I guess it will decrease again according to how DS is feeding. Problem is....I've created a 'milk monster'.....DS now expects this second feed so I need to wait until DH is here to help with taking it away; I need the support.

It is a very tricky situation and I am still not entirely convinced of how I will handle it but I think what I have written is what I will do...not to say I wont change my mind between now & then. I will also be calling the LC tonight just to let her know and see what she thinks.

[onthefly]

Renee, that's great news that your boy has put weight on. It sounds like he is just following his own growth pattern.
If he's happy to have the feeds, then perhaps just follow his lead for the time being? Talking to the LC is a good idea.
All the best