Author Topic: Tiny appetite and progressively slowing weight-gain  (Read 3108 times)

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Offline zoeselina

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Tiny appetite and progressively slowing weight-gain
« on: October 20, 2010, 12:20:55 pm »
My five month old baby girl has never been a great feeder, but since 3 months has been progressively slipping down the growth chart for weight, and now her height is slipping too. Her whole life she's never fed for more than about 6 minutes at a time, and she most often will only take one side. Originally I had a lot of milk, but it is slowly dwindling, and now some evenings I can only manage to pump 50mL from both side (we bottle feed breast milk for the DF).

We are currently on a milk-free diet to test for protein allergies, but after a week there is no improvement. She takes one bottle of formula a day (I was advised to supplement, a decision which I mostly regret now) and it now has to be prescription formula. She hates the prescription formula, so as a result she's eating even less.

I was also advised to start her on non-allergenic rice cereal, which we have, but she eats almost none of that as well.

She seemed to take more from a bottle, so for a while I was pumping for every feed, but eventually it started to negatively affect my milk supply and was just too exhausting to keep up.

I'm so scared my baby is slowly starving. She never cries for food, and so it's almost impossible to tell when she's truly hungry. Does anyone have any advice or similar experiences? I'm desperate!
Zoë


Offline ~ Vik ~

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Re: Tiny appetite and progressively slowing weight-gain
« Reply #1 on: October 21, 2010, 01:22:42 am »
First, big (((hugs))) mama :-*  Let's see what we can do.

Have you discussed your concerns with her doctor?  How does her doctor feel about her weight gain?  Has she actually lost weight, or is it that she is dropping percentiles?  Do you know what growth chart your doctor is using?  (Many doctors still use growth charts based on formula fed babies, where ebf babies tend to follow a different curve.  Try http://babywhispererforums.com/index.php?topic=63598.0 and see how her growth charts)  How is her wet/dirty diaper output?  Are there any other health issues?  How is she sleeping?  Do you do night feeds?  Have you read the http://babywhispererforums.com/index.php?topic=94121.0 FAQ?

We are currently on a milk-free diet to test for protein allergies, but after a week there is no improvement.
It can take longer than a week to show any improvement - it takes up to 2 weeks for all milk proteins to get out of your system and breastmilk, and then it can take another 2 weeks for your baby to eliminate them too.  Some babies show improvement right away, but when I eliminated dairy I was advised to do it for a month.  Are you eliminating all dairy (even hidden and trace) or just obvious?  Some babies are so sensitive that even trace amounts can cause severe reactions.

She takes one bottle of formula a day (I was advised to supplement, a decision which I mostly regret now) and it now has to be prescription formula.
If you want to eliminate the formula supplements you can, but it's important to do it gradually.  There's more information here:  http://babywhispererforums.com/index.php?topic=178517.0

Sorry that I've asked so many questions without too many answers.  I will try to get some more eyes on this for you too :-* :-*
D ~ dairy, egg, peanut/nut and mustard allergies
Proud to have breastfed for over 24 months!


Offline ~inbalance~

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Re: Tiny appetite and progressively slowing weight-gain
« Reply #2 on: October 21, 2010, 01:45:05 am »
(((hugs))) zoeselina

I think Vikki has asked all the right questions to hopefully point you in the right direction.

How often is your LO BFding at the moment?  I personally would scrap the cereal for now, she's not eating it anyway and milk will be far more beneficial for her than cereal will at this point.  I might even be inclined to stop pumping for the DF as well and just do it by BFding.  Just in my experience the pumping really messes up my supply.

It's tricky because I want to say put her on the breast more often to help increase your supply, but it won't work if she's not hungry in which case you'd want to stretch her feeds a bit so she takes proper ones.  I guess it depends on how often you are currently feeding, and if you are feeding at night as well.  A few weeks ago I felt my supply was dwindling so I went back to feeding DS2 more often, and putting him on both sides even if he wasn't as hungry.  Even if he sucked for a few minutes it helped stimulate more milk production.  It worked like a charm and after a few days my milk was back up.

In the meantime, try not to worry yet.  My DS1's weight gain slowed around the 3/4 month mark and he dropped percentiles and gained very slowly from that point on, but he was always healthy and doing well, so don't assume the worst just yet.

Hopefully we can help you get it sorted.  There is nothing more worrying than thinking your baby is not eating enough.   :-*
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Offline Jenn©

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Re: Tiny appetite and progressively slowing weight-gain
« Reply #3 on: October 21, 2010, 02:15:19 am »
Dropping in with a big hug!!!!!!!!!
 When you're soaring through the air, I'll be your solid ground.  Take every chance you dare.  I'll still be there when you come back down.

Offline Vicku

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Re: Tiny appetite and progressively slowing weight-gain
« Reply #4 on: October 21, 2010, 10:27:58 am »
Hi there!

Big hugs to you {{{{}}}} I know how stressful it is when you are worrying about your LO's weight gain. My DD2 has also slipped down the growth chart (the WHO one) from 15th percentile weight to 3rd where she then stabilised. She is itty bitti tiny compared to other babies her age but doing really well and is still BFing. After ruling out other reasons we just think she's meant to be this small. I know the stress and worry of wondering if anything is wrong though...

How often is your LO BFding at the moment?  I personally would scrap the cereal for now, she's not eating it anyway and milk will be far more beneficial for her than cereal will at this point.  I might even be inclined to stop pumping for the DF as well and just do it by BFding.  Just in my experience the pumping really messes up my supply.
Agree with Martina on this. Often health professionals don't seem to know that the cereal will usually take the place of the milk at this stage rather than add to it, and breast milk is far more nutritious and has more calories than almost ALL solids, so the rice would mainly just fill her up and seems counterproductive to me :-\ As her appetite isn't great I'd feel it would be better for her to fill up on milk alone.

Also how is her poo? Does she feed better with lots of skin-on-skin contact? That would help your milk production too.

Will look out for your answers on all the questions from me and the other ladies, and I would recommend printing out the WHO weight and height charts, charting her on them and then we all know what we're looking at to see if we can help. :-* Vick

PS. We are really close (in BW distance terms talking ;)) as I'm in Gothenburg Sweden. We aren't that many BWs in this part of the world... Hello neighbour! :)
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Offline Tay

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Re: Tiny appetite and progressively slowing weight-gain
« Reply #5 on: October 21, 2010, 11:18:18 am »
Hiya,
Just dropping some hugs and sharing my experience with DD1. Around 5 months she also started dropping down percentiles - weight, height and head size. She wasn't feeding great (as I thought) and had started waking up once at night for a feed (she had been sttn). But like your LO she seemed content, wasn't crying or complaining.

We ended up getting referred to the Paed (when her head size dropped outside of the chart and her weight was closely following) and he said that she looked alert and interested in things, reaching her milestones etc. Also that because it was a drop in all measures it was more likely to be just because she was a small child anyway.

Then he went on to ask me what height I was and DH and said we shouldn't expect to have a big enormous child if the two of us were so small, unless she was the milkman's... ;)

Like Vikki said, the Pead asked me to look at:
- nappies
- milestones, being alert
- putting weight on (even if slowly)

And only to worry if she started losing weight.
She did have a MPI that we found out at a later stage (once we introduced formula).

xxx


Offline zoeselina

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Re: Tiny appetite and progressively slowing weight-gain
« Reply #6 on: October 21, 2010, 14:41:38 pm »
Hi!

Thanks so much for all your replies. What a lovely group of people it is here on the BW forums! :)

Lots of questions to answer, so here goes:

Have you discussed your concerns with her doctor?  How does her doctor feel about her weight gain?  Has she actually lost weight, or is it that she is dropping percentiles?  Do you know what growth chart your doctor is using?  (Many doctors still use growth charts based on formula fed babies, where ebf babies tend to follow a different curve.  Try http://babywhispererforums.com/index.php?topic=63598.0 and see how her growth charts) How is her wet/dirty diaper output?  Are there any other health issues?  How is she sleeping?  Do you do night feeds? 

Her doctor(s) are telling me not to worry overly much, but say it's something to keep an eye on, just in case there's anything sinister going on. It's mostly the ped-nurse that got me panicky in the first place because she told me that it would be fine if Ella was just small, but because she started off average and has slipped down the curve, then we should be concerned. She's given me quite a lot of conflicting advice, so I'm not all that happy with her.

The growth chart is the Norwegian one, but one of her doctors told me that her progress will look different depending on which chart you use.

She hasn't lost weight, she's just slipped on the percentiles.

Her nappy output is fine. I spent two weeks tracking absolutely everything (nappies, sleep, feeding etc) and the only thing that stood out was that she's just not eating very much. 3-6 minutes breastfeeding per feed usually, and often won't take the second side.

No other health issues that we're aware of, aside from the eczema. But I had/have that, and her dad has pretty bad pollen allergies, so it's not a big shock that she has it.

Sleeping has been pretty terrible, but I think we're getting on top of that now with some good advice on the Night Wakings board, as well as having just weaned the swaddle and moved her into her own room for all sleeps.

It can take longer than a week to show any improvement - it takes up to 2 weeks for all milk proteins to get out of your system and breastmilk, and then it can take another 2 weeks for your baby to eliminate them too.  Some babies show improvement right away, but when I eliminated dairy I was advised to do it for a month.  Are you eliminating all dairy (even hidden and trace) or just obvious?  Some babies are so sensitive that even trace amounts can cause severe reactions.

I'm eliminating all milk and soy proteins from my diet, and making pretty much all my food from scratch just to make sure. Honestly though, I'd be surprised if it turned out to be a milk intolerance, because when we first started her on milk-based formula she had no negative reactions at all (not obvious ones at least) and her weight did stabilize a bit at that time.

Quote from: Martina Rae
How often is your LO BFding at the moment?

I feed her pretty much every three hours with DFs at 11pm and 3am (ish). The ped-nurse advised me to try feeding her every two hours instead, but that made things worse, because she'd eat just enough to take the edge off and never really got hungry at all.

I did mention to the doctors and the nurse about her getting less calories from solids, but they all kind of poo-pooed me. The nurse wants me to try vegetables with added oil as soon as we've finished the milk testing. I personally don't think it makes a difference either way, since she eats less than a teaspoon of any solid food I give her anyway. And I give her a milk feed first before offering any solids, otherwise she gets frustrated.

But on the positive side, the first thing the doctors and nurses say when they look at her is how alert, active and healthy she looks, and how she doesn't look skinny or scrawny. Both her parents were small as children (in fact my mother was told I would probably be brain damaged because of my small head - the good old 70s eh? Heh).

So I'll just push ahead with the breastfeeding and try not to worry (bahaha yeah right). Thank you all so much for your advice and support. It really means a lot to me.

And Vick: Hi! I didn't think there was anyone from our part of the world on here! Nice to "meet" you! I hope the Swedish system isn't as annoying as the Norwegian one can be! :P We got so frustrated with the red tape at one point that we went to one of the rare private hospitals to get some answers... and then the next day I got a call from the public hospital offering us an appointment.  ::)
Zoë


Offline ~inbalance~

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Re: Tiny appetite and progressively slowing weight-gain
« Reply #7 on: October 21, 2010, 16:07:44 pm »
A couple of things come to mind when I read your post.  One is the eczema, so I wouldn't rule out any intolerances or allergies.  I know Vikki has some extensive knowledge on allergies and eczema I think, and Vicku knows a lot about multiple food intolerances, so hopefully something might ring a bell with them.

Secondly, what do you think about starting to stretch her feeds out longer than 3hrs?  At 5mos old I would think she'd be well on her way towards a 4hr EASY.  I suspect she just isn't hungry enough after 3hrs.  This happened with my DS2, he wouldn't nurse for very long and even when he did he was easily distracted.  Once I started stretching his feeds out he started eating more efficiently.  Now he won't even take a proper feed unless about 4hrs have passed.  Just a thought.

But if she is happy and thriving, then I wouldn't jump to conclusions.  Like I mentioned my DS1 dropped percentiles and his gain slowed from 3mos onward, and there was never anything wrong with him.  I am very petite and my DH was not a large baby by any means, so I wouldn't expect my children to be huge either.  I think you are doing all the right things by keeping logs and watching what's going on with her.  Definitely something to keep an eye on, but also try not to worry too much.  :)
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Offline zoeselina

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Re: Tiny appetite and progressively slowing weight-gain
« Reply #8 on: October 21, 2010, 17:12:06 pm »
I have thought about that, but she absolutely can't manage more than 2 hours awake yet. She's always been a bit behind the average with that. At the moment she's VERY ready for bed after 2 hours, even with keeping things low-key for activity time.

So I'm not quite sure how to juggle her sleep and activity time around a four hour feeding schedule without making her exhausted. Any ideas?
Zoë


Offline Tay

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Re: Tiny appetite and progressively slowing weight-gain
« Reply #9 on: October 21, 2010, 19:46:43 pm »
You can try to stretch it out just by 5 or 10 min and see how it goes. If she handles it ok then you can stretch a bit more.
Some BF mama/babies duos only get to around 3.5hrs. Do you think that could work?
xx


Offline zoeselina

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Re: Tiny appetite and progressively slowing weight-gain
« Reply #10 on: October 21, 2010, 19:55:16 pm »
I can give it a try. We're working hard to get her routine back on track after a month with a very demanding houseguest who took over Ella's bedroom (and our lives!). Also we're going to Australia in just under four weeks, so that will turn everything on its head. Not looking forward to it, really. :P

Thanks for your suggestions. I'll keep you all posted on how we're doing. We have our follow-up at the hospital next week.
Zoë


Offline Vicku

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Re: Tiny appetite and progressively slowing weight-gain
« Reply #11 on: October 21, 2010, 20:13:57 pm »
Hej hej! :)

she absolutely can't manage more than 2 hours awake yet. She's always been a bit behind the average with that. At the moment she's VERY ready for bed after 2 hours, even with keeping things low-key for activity time.

So I'm not quite sure how to juggle her sleep and activity time around a four hour feeding schedule without making her exhausted. Any ideas?
You could always try a 3.5 hr EASY. 2 hrs A time plus a 1.5 hr nap. Works in theory at least! ;)
Saying that, my DD2 has taken forever to be ready to feed every 4 hrs, only just now are we getting there! It can really vary between babes and also womens' breasts vary. I think I have a fairly small storage capacity and need to feed often to keep a good supply and satisfy my babies, or so it seems :P (Didn't realise with DD1, pushed to 3 and 4 hr EASY too quick and supply suffered :() Some babies do need longer between feeds to take a full feed though, so it can take a little creativity to fit the feeds around the naps :P then once you've got it all figured out, it all changes again! LOL

The fact that she doesn't feed for very long doesn't necessarliy mean she's not getting enough milk or taking a full feed in that time though. They get really efficient! And some are just faster feeders than others. Have a look here: http://babywhispererforums.com/index.php?topic=65904.0  
DD2 has always been a fast feeder. Never longer than a few minutes per feed.

It sounds to me that if she's satisfied with one breast per feed still the formula supplement is unnessesary really, so if you don't want to do it (you didn't sound too keen) you could phase it out. Agree that it takes more than one week to really know if milk protein is a problem. I think at least a month to get rid of it all, then reintroduce and see if anything happens. If she didn't react to the cow's milk formula it is possible she is fine with MP but I *think* (not entirely sure) delayed reactions are also possible ???

It is great that she seems so happy and healthy :D I do think that is the main thing to look out for, her general wellbeing. And then keeping an eye on the weight but not obsessing (I know it's easier said than done not to worry!) And if you and the father aren't very big either then she's probably not meant to be huge.

Just saw the last two posts... Yes, do keep us updated!

:-* :-*
Vick
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Offline ~ Vik ~

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Re: Tiny appetite and progressively slowing weight-gain
« Reply #12 on: October 22, 2010, 01:23:32 am »
Wowzers!  I work for a day and tons happens on here! ;)

I think everyone has you covered!  Like Tay said, I do have lots of BTDT experience with eczema (Dylan was covered, cracked and bleeding at its worst, but much better now) and multiple food allergies.  Feel free to send me a pm if you have any questions!

Sounds like you have everything well in hand, and that Ella is doing great :) :-*  Definitely keep us posted about her appointment next week!

D ~ dairy, egg, peanut/nut and mustard allergies
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Offline zoeselina

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Re: Tiny appetite and progressively slowing weight-gain
« Reply #13 on: October 27, 2010, 14:04:27 pm »
Just a quick update; we had a weigh-in today, and Ella's only gained another 20g this week. The doctor has told us to go back on dairy and watch for reactions.

Her first two teeth popped a few days ago, and it seems as if her appetite has increased since then, but it's not showing up in her weight yet. I'm wondering now whether she's getting enough milk from me (I've pretty much gone back to EBF), so I'm drinking fenugreek (blech) and doing all the other usual milk increasing things. But I might have to supplement formula, at least for a little while, to make sure she's satisfied after a breastfeed.
Zoë


Offline Vicku

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Re: Tiny appetite and progressively slowing weight-gain
« Reply #14 on: October 27, 2010, 15:09:17 pm »
Hugs {{{}}} Have you tried pumping after a feed? Maybe try that now as you're doing all the milk increasing things, to stimulate the supply further. Then you can supplement with what you've pumped at the next feed. I can't remember if you've said anything about this or not, but have you had your latch and feeding technique checked by a LC? Would be worth doing to ensure she's feeding in the most efficient way from you.
20g isn't much but it's something! At least she's not loosing weight. How is her length growth now?
Good luck for the reintroduction of dairy products :-*
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