Poor weight gain in 5.5 month old

[Newmumtryinghard]

I am having a feeding/weight issue with my DS and would really appreciate some support and advice from like-minded moms.

My DS is 5.5 months old. He is exclusively breastfed. When he is on the breast he is a very quick nurser - he takes about 3 minutes to drain each breast, apart from his morning feed when he takes a little longer (I assume because breasts are fuller). He is offered both breasts at each feed, and always takes both, and unlatches himself from the nipple.

He is on a rough 4 hour EASY (4 feeds a day, occasionally 5 if he has a bad nap day and I can squeeze an extra one in) and seemed to be doing very well on it. He also STTN with no df (which we never did) or nfs (this happened naturally - I always fed him when he woke in the night, he just stopped waking). He does not have a paci. He wets and dirties diapers appropriately and his poop is mustard yellow.

At our last health check, it turned out he had fallen way off his growth chart (from 60th centile to 5th centile). I hadn't had him weighed since moving to a 4 hour EASY and am very worried that I have been under feeding him.

After I found out about his weight issues, I started expressing milk and topping up two of his feeds with a 3-4 oz bottle, depending on what I have expressed over the course of the day. He always finishes the bottle.

I chose to pump because I figured it was that or topping him up before his naps and I was a bit nervous about creating a breastfeeding association with sleep (I don't see myself as a long term nurser, especially once I go back to work, and it seems a shame to introduce a bf as part of his nap routine at this stage now that his naps are in a pretty good place). To be honest, I was so worried about the weight issue that I also really wanted to see some milk going in, especially as we were introducing solids at the same time and I was worried that he might feel full on fewer calories. That said, since his weight issue came to light I have occasionally topped him up before a nap if he seemed upset because I am now always worried he is hungry if he makes so much as a whimper. Each time he has taken the feed then fallen asleep on the breast (ie sort of feeding himself to sleep), so I am really not sure if he is hungry as opposed to sleepy.

I am speaking to a doctor about this so I am getting medical advice, but I really wanted to get some advice and support from other mums who share a parenting style, especially any who may have had a similar issue. I feel really awful about it - although he is a happy little boy, so I don't feel like he is constantly hungry or anything like that, I keep thinking about the days when he was upset before his naps, which I diagnosed as overtiredness because he had been put down late or something, and then rocked him to sleep (he generally self settles but if he is upset before a nap then I PUPD him a couple of times and if that doesn't work I rock him to sleep). Now I am worried that he was actually trying to tell me he was hungry and I didn't realize. The whole thing has made me much less confident at diagnosing cries etc.

He seems to be gaining a bit of weight now but it is obviously going to take a while and it is going round and round in my mind. I am trying to work out what best to do, including whether to introduce formula or whether to top up before naps rather than express etc. Can anyone share any tips or advice to help me, or share any similar experiences. I feel quite alone and am worried that in trying to ease him into a routine I have compromised his health and development. I know i haven't left him to cry, but equally i haven't always offered the breast every time he has grizzled/cried and am really concerned that I have made some bad choices over the last 5 months.

Thank you in advance

[*Ali*]

Sorry to hear you are so worried. It's hard not knowing exactly what they have taken, isn't it?
Firstly I just wanted to say that it is unlikely he would sleep through the night without waking if he had been hungry all this time so I'd try to forget that notion.

When was he last on the 60th centile? Just wondering if that was right at the beginning and now he is settling into his true curve. Was the health visitor who weighed him concerned? If he is meeting milestones and not looking skinny then it may well be nothing to worry about.

It can be common for LOs to start needing top ups before naps as their A times increase around this age. It's all very well going 4hrs between feeds if you are asleep for the last two hours but as A times get longer, and it starts being 3hrs since the last feed before you even start settling to sleep, it can be easier to notice hunger starting to creep in. Plus of course being awake and active burns more calories

It sounds like the bottles of expressed milk are helping his weight gain so how do you feel about continuing those for now? As he takes more solids over the coming months you could phase them out perhaps?

[Newmumtryinghard]

Yes, it is hard! It is definitely the worst thing about breastfeeding for me! I was enjoying it and feeling confident with it, which is why I am struggling with his weight issue I think.

We don't have health visitors here so I saw a doctor. She isn't worried about his weight in itself, just the way it seems to have veered away from the curve. She is happy that he is meeting his milestones. He is also quite long so he is growing lengthways, but he is skinny I think. There is definitely space for lots of growing in his 3-6 month clothes.

He was on 60th centile at birthweight and then maintained thereabouts until month 3, but wasn't weighed in the intervening period so I don't know whether he steadily declined or whether he maintained and then dropped. I am quite long and lean(ish -ha ha) myself so he may just be taking after me. He got on a 3 hour EASY routine at about 10 weeks but I figured he wouldn't settle himself to naps and sleep for a couple of hours of he was hungry so I wasn't  waking him to feed every two hours or anything like that.

That's a good point re top ups as his A times lengthen. We are on about 2.5 hours now and I don't think 3 hours is far away, not least because I might need to nudge it in that direction to avoid a car crash at bedtime - I think we are nearing the 3-2 transition. He is quite active too. If I leave him on the floor to fetch something from a different room he is often at the other side of the room when I get back. He has also got two teeth now so maybe he has just been a bit off his food and burning what he does take in a bit more quickly recently.

I think sticking with pumping with now sounds good. It is a bit of a commitment as it really means I need to be at home but I feel better seeing it go in and can always offer an extra bf instead when I am out and about. The other advantage is that it keeps his routine a bit more consistent. Although it is a flexible routine, i think he likes the general structure to his day and was a bit unsettled when I kept trying to feed him all the time!

Thanks Ali. I know I am a bit of a worry wort but I have been beating myself up about this. I think I just need to plod on and keep doing my best but try not to worry so much

[clazzat]

This happened to mine, although he dropped from the 90th centile to the 8th!  I was very lucky that a) he was my third and I was pretty confident and b) I had a really good health visitor who applied good common sense rather than blindly following the official guidance and we just carried on the way we had been.  DS was very happy and contented and was meeting his milestones well and didn't look skinny or unhealthy so the health visitor said to carry on doing what we had been doing and to bring him back if I was worried about anything.  As I say, he was my third and therefore I was happy that he was eating well and his weight didn't bother me particularly.  I never did any top up feeds or expressing to increase his intake, although I do remember having to give him top up feeds before his lunchtime nap if he seemed very hungry.

I think that there are a number of babies who start off at a very high point on the curve and stay there for a couple of months before finding their 'true' curve which can be much lower.  In the absence of any other worrying factors (being very unsettled, not meeting milestones etc) I don't think that it necessarily has to be a cause for concern.  I think that you are the best judge of whether he is contented - and hungry baby will not be!  Given that you are enjoying breastfeeding and feeling confident with it, he is probably actually getting all he needs - some babies are very quick nursers, particularly as they get a bit bigger - and you should relax and enjoy it again.

My DS stayed at the bottom of the charts until he was about 16/17 months when he started climbing back up again.  He is a pretty sturdy 4 year old, on roughly the 60th centile, and I have just let him decide what he wants to eat and when.

WRT pumping, I used to pump to have some milk to freeze and I found that the best time for me was about 10pm - I got a reasonable amount and it meant that I didn't need to worry about being in specifically to do it (I really wasn't out at that time when they were little! ) so it wasn't inconvenient.

[Newmumtryinghard]

Thanks Clazzat. It is comforting to know that I am not alone! I think I am going to try to continue breastfeeding and will try to be confident with it. Solids seem to be going well so hopefully we can quickly progress to more calorific foods to help his weight gain, although I am trying to be careful not to push it and to take my concerns out on making healthy recipes for the freezer rather than force feeding him carrot! I do think some babies find their true curve. I honestly don't think you would know there was anything "wrong" with him if you met him so I am going to try to remember that!