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

[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?

[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]

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]

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.

[Jennifer13]

Renee, possetting is just a sign that the valve at the top of his tummy isn't as strong as it will be soon enough. My DD possetted until around 7mths. It's like the valve lets out a bit of the stomach contents with a change in position, when he's full, rolls over, etc. The amount he brings up will always look like more than it actually is. It isn't anything to be concerned about. It's what's known as 'happy chucking'. Just keep a cloth handy to wipe up! Possetting is not an indication of anything serious. It doesn't mean he hasn't kept a feed down and you need to be concerned about how much he's had. He will take what he needs, what comes back up is much, much less than it looks like. If he is still hungry he'll let you know.

At DS's age weight gain does start to slow down. What are you and your DH like build-wise? Anyone tall and skinny in the family? DS's weight will be correcting somewhat to what he's genetically designed to be, his birth weight is not necessarily the same. What about his health generally? If he's happy, healthy and meeting other milestones then I'd discount the slower weight gain (and a gain is still a gain, btw). If he's grown length wise, then he's obviously still growing. Is he being weighed on the same scales every time?

Please don't panic, if you weren't worried before that magical number on the scales came up, then it's more than likely you have nothing to worry about. MHCNs can be notorious for unnecessarily making mothers worry about their milk supply by tsk-tsking over the scales. If everything else with him is good, then you're doing a wonderful job. Add in a few extra feeds and go with your instincts.

PS FWIW, and I know every baby is different, but my DD was always well ahead on the height charts compared to weight. I rarely had her weighed, mostly just at vax with the GP, because I felt she was doing fine (seriously, what did mothers do before we gave them scales and clinics to go to every other week??). Since her birth weight was also low there was never any %age drop, but the difference you talk about was certainly there - over 50% for height, under 10% for weight. Still is, she's a pre-schooler now and weighs less than children who are inches shorter. It's just her build, and she's just the same as her Dad (and a bit like me, I'm quite light). She eats like a horse and is never sick. Trust your instincts.

[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.

[Jennifer13]

Regurgitating or possetting is not something to worry about in itself. Small babies sometimes have a weaker valve at the top of their tummies and it lets a little bit out. It could be from being full, but it could just be from the way he moves, lies, you hold him, etc. My DD possetted until about 7-8 mths. If he is taking the extra feed, by all means keep offering. If he isn't interested, then don't bother. Sometimes a bf is a great way to help him wind down, as well. He probably won't bf if he isn't hungry, but he'll only take what he needs. It might help him settle and he likes it. Who can blame him?!

Sounds like you've done a great job with him. I actually didn't bother taking my DD as a baby to MHCN check-ups after the first couple of months. We saw the GP for all regular vax and I was happy she was thriving. The weight on the scales is only one indicator of a healthy baby and it's notorious for being used to stress mothers out!