Not gaining weight, help! Barb??

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Senior paed came and saw us and basically said feeding 2-3 hourly at this age is too often and therefore is not getting enough from me and I should top her up after every breastfeed and give her solids 3 times a day as solids have more nutrients than milk(!) and referred me to another paed outside the hospital.

So, is feeding 2 hourly at 5.5 months too often? At the end of the day she would be taking in the same total volume of milk?

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My DS fed 2-3 hrly 24 hrs a day for the first 12 mnths and more often then not it was 2 hrly. Breastfeeding works on supply and demand the more she feeds the more you fill up (even if you don't feel it especially by 5 mnths as your bb's are use to the cycle) I think I would question his credentials in regards to his breastfeeding knowledge if he is telling you this.
I think I would be starting solids before trying to top her up with formulae (although no judgement from me if you do), I started DS on solids about the same age from memory.

Can you go to another GP to get a script for the motulim - who is he to decide it won't work for you shouldn't that be your choice!! and didn't you say it did help last time?! grrr so cranky at your GP for you.

Unfortunately reading other ladies experience it seems that it is hard to find many professionals who take breastfeeding and it's capabilities seriously anymore :wall:

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Why does this have to be so difficult?

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:hug: I wish I had the answer for you but you are TRULY INSPIRATIONAL (and sorry to other readers but yes I meant to yell that :p ) for being so passionate about what you want for you and your DD and to do this with a toddler :clap: I take my hat of to you.

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There was no UTI after all although there were some white cells but on it's own nothing to be worried about. They also took bloods (DD was even smiling at the nurse as she was poking a needle in her arm!) which came back clear. Paed did say a couple of them were slightly abnormal but on their own don't really mean anything.

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As I have said before I am not a medical expert and I don't mean to worry you but if the white cells (I'm assuming in her urine) and some of her bloods were slightly abnormal wouldn't they look at that together not on it's own as such? I don't know what it does or doesn't mean but it just had me thinking hrmmmmm IYKWIM?

I do think your DD is amazing to smiling at the nurse while getting blood - what a brave little girl she is. Does she have a high threshold to pain?

Oh sweetheart, I have been thinking of you :hug: I'm so glad your little girl is okay, but I'm sorry that you have been made to feel this way :hug:

You are doing all of the right things. 2-3 hourly is very normal. I don't have time (I'm sorry) to expand on all the other things, but I wanted you to know that you're doing so well.

Hang in there, things will get better xoxo

:hug: hun, sorry there were no answers there. At her age, breastmilk contains more nutrients than solids, so that's a furphy. If you want to increase your supply, then feeding more often will probably do it, but it sounds like she's otherwise healthy and happy (except for the white cell count).

I might change your thread title to catch Barb's attention - hopefully she can help you out. Have you considered seeing a LC (JIC this is a feeding issue - although I suspect you are doing everything absolutely right!)?

Thanks Janie. Kelebek, yeah I would have thought the results would mean something but apparently not. The white cells in the urine could still grow something and they said they would call me but since DD was not febrile they weren't concerned.

I've started offering solids and she has been great with tasting but not swallowing all that much but I expect that's quite normal?

Jen, thanks for changing title. I've spoken to ABA who said it all sounds right and so now I'm thinking of calling an LC. My MCHN has seen me feed and said everything looks correct.

I'm not sure what else I can do. I wasn't worried about my supply before but now I am. I don't know what's changed to drop it off. I'm not pregnant, no AF yet. I've increased feeding, expressing (only get around 30-40mls at a time though), drinking lots of water, taking fenugreek. My boobs feel lighter after feeds and feel full before feeds, although softer in the evenings. So yeah don't really know....

Did you ask to see that Paed's lactation credentials? Sadly so many health professionals are very misinformed. I'm cross that your GP said that too (and really don't understand his rationale for denying you motilium). You've fed your beautiful, healthy daughter for 5.5 months so far - there's nothing wrong with your milk! and feeding 2-hourly is totally normal.

Find an LC and have a chat with someone who actually understands how lactation works - it can only help from here. As for three meals a day - errrr, right. Do they want you to force feed her? I'd be a bit concerned about replacing so much milk with solids at this age too.

It is hard, I'm sorry. :hug:

I haven't got much time, just wanted to say that I am feeding Aidan 2 hourly over night. It's killing me (I look like i'm 90 years old) but it's just his version of normal. I think he is so distracted and busy during the day that he catches up at night.
Keep drinking water - that's a good reminder for all of us.
Good on you for seeking further advice. Solids are fine and all that, but they aren't necessarily going to help DD put on weight.
:hug: You are awesome Eluned for all the work you are putting in. I hope things pick up soon.

marcellus, I know, there's no way she will have 3 meals a day. I've only just started offering last week and to go from that to 3 times a day is just mad at her age.

Thanks Lenny.

Will the ABA have contact details of LC's in my area?

They might. If you google LC & perth you'll find some pages.
You know who you should contact - Rebecca Glover. She's like the Aus breastfeeding guru and in Perth. Just google her.

And I agree about your awesomeness :)

Yes, if you can speak to Rebecca Glover, please do! Otherwise call the ABA helpline and ask for details of LCs near you.

It's great that you're checking all avenues, but it may not be a feeding issue, so keep an eye on her :hug:

Pediatric Advisor 2008.3: Making High-Calorie Formula or Breast Milk
Maybe try something like this with an ebm bottle each day?
I also would try for 3 meals a day - in the sense that she tastes things more often and gets more used to them rather than the force feeding sense.
Huge hugs
Kate

Kate - I wouldn't think those instructions were as per the recommendations on most formula tins. I also wouldn't be adding formula to ebm unless specifically under medical advice. If there is an underlying issue, then you'd be best off speaking to a health professional about an alternative course of action.

Too many meals of other food (not bm) will actually reduce calorie intake, as babies of this age absorb far more calories from bm than solids.

Sorry I'm coming in late to this. I hope your little one is continuing to do well. If she is developing normally, is settled between feeds, and is putting out plenty of urine, I wouldn't be too concerned. Some babies are slow to gain weight to start with and catch up pretty quickly once they start solids. DD1 and DD3 are both like that.

As far as adding formula to human milk - that is really not appropriate. I know that site comes from a paediatrician, but it's still bad advice! If you really need to fortify human milk, you need to use human milk fortifier, which adds calories to human milk while preserving all of the other contents and without adding anything unnecessary.

Mick - thanks for clearing that up!
Eluned - let me explain why I suggested the "fortification" option; I'm no expert - feel free to poke holes in the following.
I don't think this is a supply issue - I think you are doing OK on the "dairy cow" front! Amelia is often not finishing side 2, which suggests that there is more milk there for her to take if she was so inclined. Also, supplementing with EBM didn't produce weight gain - implying that whatever liquid she takes in from a bottle she simply doesn't take from her next boob feed - i.e. EBM is just "displacing" BM.
This makes me think that formula top-ups would be a really bad idea - you find expressing difficult, and you know from your experience with DS that your supply is rather "sucking-sensitive", so if the top-up in anyway displaces what she takes from your boob then you are risking creating a supply issue where there wasn't one before. It also makes me think that motilium won't help - since there's already milk there that A isn't finishing.
This is a really long winded way of saying that I think you need to try and add as much extra energy to her diet whilst adding as little additional bulk as you can - and hence minimizing the risk of displacing the BM that she currently drinks. And the fortification seemed the logical way to do that. The other way is high-energy-density solids - but that requires her to get the hang of them first!
hope this makes some sort of sense - and hope you do find an answer that works
Kate

Hi,

Just back from a very illuminating breastfeeding conference. One thing from today that really resonated with me was - babies DRIVE supply. Babies that are designed by genetics to grow slowly take less milk and therefore mothers make less milk. (boys grow faster than girls - thus the 2 charts - therefore they take more milk, therefore mothers of boys make more milk)

Feeding 2 hrly at 6mnths and beyond is boringly normal! You don't need to be a jersey cow - you are not feeding the neighbourhood. Just one small baby. That baby seems healthy and happy. Your breasts are doing their thing - you are doing great! Just to keep everyone happy, the intro of solids is a reasonable idea. Food is available in several orms (breast and food) You are a great, switched on mum- you attend to her needs.
PS - Kate, sorry I don't think fortification is warranted in this situation - breastmilk plus food is fine

Warm regards
Barb

Thank you everyone for your replies. I have eased off today on trying to push her to have top ups and today we've had none. I haven't even attempted pumping. Have just put her on the breast instead. She has a slightly raised temp today (DH & DS both have colds) so has been doing a lot of "comfort" nursing. We've spent alot of time in bed feeding as much as possible the last few days. As for solids, I'm just going with the flow and offering tastes from my own plate. Today she had pumpkin risotto. She's tasting well but not too fussed about taking much of it in yet.

We have an appointment with a paed on Friday and I had to get a wee sample from her today as they are testing for metabolism disorders. All in all, she's breastfeeding well yet not gaining weight. Her head circumference has slowed very slightly (dropped from 25 %ile to just under) and her length has remained on the 50th percentile. Her weight has flatlined from the 25 %ile and is off the bottom of the chart. She has been 4.8kg for over a month now at least.

I'm glad they're being thorough with testing. It must be worrying for you to see her weight gains drop off like that, I'm sure you are keen to know why. It sounds as though you are doing all the right things though, keep it up, you're a fantastic mummy :hug: Will be thinking of you guys xoxo

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I haven't been on since you got home hun, but wanted to let you know I have been thinking of you.

There has been some great advice above and I can't really add more.

It is good to hear that they are doing all the checks to make sure there isn't something underlying, but the testing phase can be very difficult along with the waiting and wondering, will be keeping you both in my thoughts as you go through the next few weeks.

We had positive results with the urine analysis for DD when she was in hospital in January, and it was because with the girls the little bag covers such a large area, that the urine can wash against the skin, picking up any bacteria or anything residual, and give inconclusive of skewed resutls. In then end we ended up having a catheter inserted to get a true result and it came back clear.

You are doing a fabulous job, through a stressful and worrying time, and having followed such a difficult road with your DS. I am glad that you have BB where you can come to to seek the advice of many, to give you a mountain of ideas and support and different perspectives.

Take care and will be here for you xxoo

You're doing a great job Eluned. I'm sure you'll be able to nut this one out - here's hoping it's not too much longer for you.

Just another update.

We had appt with paed today. She has gained 50g in a week - better than nothing I guess!

Paed wants us to see a dietician next week. So in the next few days I need to keep a record of her feeds and solids intake. He wants to get an idea of the calories she's taking in.

One thing I'm a bit wary about is that on one morning feed, he wants me to give her a bottle and express that feed off. He reckons that will give him an idea of how much milk she's taking in a feed therefore potentially having to add in some high calorie supplement.

Also, her head circumference has dropped off and he said he wants to get it ultrasounded. He thinks potentially there *may* be something wrong that just doesn't make her hungry. I also think he will go down the allergy path too.

Argh, so I'm not sure what to think. I don't know how to get more calories in her and sometimes I think it might just be easier to switch to formula so I can count the calories and see what she's getting.

How do I get more into her if she won't take anymore than what she does? I know my supply is good this time around (even if I have my moments of doubt) so what if there is some underlying issue? Gah! I was hoping this was going to be a much smoother breastfeeding relationship than I had with DS. :(

Well, first up :hooray: for the weight gain!

expressing off to see how much is going in doesn't make much sense - it's going to be less than she has.
I don't know how you can get her to have any more. Can you give it a couple more weeks and see - maybe she's on the upswing now? :hug:

Great that she has gained some weight this week :) It must be incredibly upsetting and frustrating to be in this position though. It sounds as though they are doing all the right things, and probably all you can do is be patient, and wait for test results. I'm sorry, I can't remember....do you have a good LC who can help guide you through all of this? Having someone really explain things to you can be very helpful.

As for the expressing in the morning idea, just a word of warning.........I was asked to do this with DS1. DISASTER. It really stuffed with my supply, and my confidence. I very quickly went back to the way we'd been doing things. There is every chance that this is nothing to do with your supply, the last thing you want to do is risk stuffing up your breastfeeding relationship. I guess it's something that might work for some people, but knowing what a fragile position you are in right now, it mightn't be the best idea.

Big hugs :hug:

Hopefully she is picking up marcellus.

Janie, that's exactly what I'm worried about. I suck at expressing. I can get about 20 mls and that's all, my boob still feels full after 20 minutes of expressing. Doesn't matter if it's in the morning, middle of the day or evening, I just can get it out with the pump, especially on my right side. But if I put DD on she'll drain one breast in about 10-15 minutes.

I agree :leap: yay for the gain.

Hopefuly Barb will pop back to confirm that but I thought a better way to determine how much they are getting in a feed is to weigh them before a feed and then straight after a feed, obviously it is a grams measurement but definitely gives you a better idea then expressing. :dunno:
I can also see how switching to formula is attractive cause you know exactly how much she is getting but I just wonder if that is all it will do that she won't actually get any more calories/mls in cause she just won't drink it ITMS?

Massive :hug:

Thanks kelebek. Yeah, I have chatted to Barb (thanks Barb! :) ). That does make sense about her still only drinking what she actually wants. It's all just so frustrating and I just have to remind myself that she's happy with what she's getting. Will see what the dietician thinks on Friday.

I've also been wondering if it would make a difference if I cut out dairy and/or wheat from my diet. Would that have any sort of impact on my milk quality and volume and her absorption of calories and nutrients?

Hi,

At this age 50g is a very respectable weekly weightgain. You are getting there! Keep doing whatever it is that you are doing - it's working. I have PM'd you.
I know it's hard and frustrating - but what if you sacrifice breastfeeding and it's not that at all? she must be as close as heck to 6 mnths - you can get her stuck into real food, with calories! (forget stewed apples and baby rice) You are doing great. You could give the expressing a *go* (if it doesn't work out you don't need to tell anyone, but if you feel fuller in the morning it might work OK. Basically, the amount of milk expressed usually tells me how proficient a mum is at expressing, how stressed she is, how good her pump is and nothing at all about how much milk she can provide. I wonder how much the paed is *expecting* you to produce? I hope he knows that normally BF babies take 70mls per feed!

How are you going hun? I've been thinking of you :hug:

Me too :hug:

Thanks ladies :) Was just laying low a bit focussing on feeding (and trying not to stress!). We are actually going quite well now and back on track. We saw the dietician on Friday who basically gave me some supplements to give her at each feed - polyjoule and calogen. She also wanted me to increase solids to 3 times a day and include meat (for protein) and butter/oils/fats basically to up the calorie content of her meals. I did add the supplements to her meals over the weekend but it was just too fiddly to try and syringe it in her mouth and she wouldn't have a bar of it.

After that we saw the paed again who weighed her and she had put on 80grams in the week (woot!). The amount is questionable as he used digital scales the previous week and old school scales last week, but a gain is a gain so I wasn't complaining. He was happy with that and we don't have to go back unless she stops gaining weight.

On Monday, I went to my local CHN clinic and did the weigh, feed, weigh and it seems she is drinking around 90mls of milk from me. That really put my mind at ease about my supply. Plus she had gained 50 grams since Friday which was really good. On Tuesday, we saw the dietician again and let her know all the numbers and she was really happy with that. She said she would like to see a gain of 15grams a day roughly 100grams a week thereabouts just to keep her growing on a nice curve (damn those graphs!). She wants to follow up next month. If the weight is still not going on or stops then they will start looking into things like growth hormone deficiency, intolerances, etc, etc.

So we'll just keep an eye on things and keep doing what we're doing. The only thing that has changed now is since she's been having meat this week, her poops have become more formed, almost firm as in they can fall off the nappy into the toilet and just leave a stain on the nappy, they aren't as soft and wet as they used to be. She's keeping the same number of breastfeeds (around 10 per 24 hours) so is getting lots of fluids.

All in all I am feeling much better about the way things are going and more confident about my supply. Have to say thanks again to Barb whom I had a good chat with! And thanks to you all for helping me over this hurdle :hug:

Sounds like things are picking up! That's great news.

My little one has also been monitored for slow weight gains but is also doing well now. I found out that massage and sleep can both help bub gain weight. I'm not sure if either have been the cause of miss daisy increasing her weight, but massage is fun to do anyway, and when i can get her to sleep more, she is also happier. so its' kinda win win.

That's great news! :hooray: Well done to the both of you.

Interesting you say that Kate, my DS was a slow gainer in the first 3 months, but gained quicker between 3-6 months - I suspect because he finally started to get some sleep.

Fabulous news, Eluned, sounds like you are well and truly tuned into your LO's needs. :clap:

That's great news Eluned. Wow, you have been running all over the place these last weeks. I hope you can just take a break now and settle back into normal life.
The upside for all of the BB community is that you are know a fountain of knowledge and you can help the rest of us when/if we need it ! ;)

Thanks for letting us know, and I am really pleased that things are looking up.

That is fantastic news hun. Well done!! You have done a great job and I am so glad that you can relax more now :hug:

Thanks again everyone. I don't know how I would have persevered without your support. :hug:

Kate, interesting you say that about the sleep because apparently babies release growth hormones when they're sleeping.

Lenny, hopefully I can use my experience to help others. DH actually said to me last week that I probably have a wider knowledge to be better able to support breastfeeding mums because I've been through the worst and come through it all.

Just wanted to update again today that Amelia had her long awaited growth spurt this week and put on 340grams. She's now broken the 5kg and is 5.24kg :) I'm very pleased with that! :dance:

Wow! :o

Sounds like she would have averaged exactly what the professionals wanted her to over the last month or so anyway. You've managed this really well, hun. :hug: Well done!

That is a serious weight gain! Jen's probably right about the monthly average - well done both of you!
Absolutely agree with Lenny too!

Oh that's so cool Eluned.

And i love that your DH said such a nice thing!!

That's fantastic news hun. Well done!! After all that stress and hard work it must feel so good to have had such a great gain.

PS Will you be looking into becoming a breastfeeding counsellor then?? ;)

Wooo Hooo Eluned what a fabulous weight gain!!!

You are so inspirational hun, so so proud of you, for persevering and getting the results :hug:
Take care xxoo