Drop in percentile- low weight gain- doc says to supp with formula :*( - Mothering Forums
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#1 of 21 Old 07-21-2013, 03:41 AM - Thread Starter
 
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I was completely surprised today when my doctor said I must supplement with at least one bottle of formula today. DD is happy and looks healthy, meeting milestones etc. But she hasn't gained enough weight (this according to the WHO charts for breastfed infants)- she was 3.785 kg at birth and now is only 5.2 kg at 3 months. She basically dropped from the 85th percentile to the 25th! I feel so awful.

I got my period back when she was 9 weeks old because she wasn't waking so much at night to feed and then it seemed like my supply dropped a little when that happened. But I tried to feed her more, ate oatmeal, drank breastfeeding tea and it seemed like things were back to normal. I did think she seemed a bit hungrier but I just thought it was normal growth spurts, so I just tried to feed her even more often. She nurses about every 2 hours during the day then she sleeps from about 5 pm till 6 am usually waking 2 maybe three times but she will only nurse well during one of those wakings. The other times she wakes up I try to feed her but she just sucks sleepily. I try to do a dreamfeed before I get in bed but she is too sleepy!

Anyway- I went and bought some organic formula today after the appointment in a panic. I know formula isn't "bad" for babies who need it- I look at as kind of like junk food I guess. It has nutritional value but is not as good as real food. DS never had one drop of formula and I guess I feel like kind of a failure this time around- my poor girl is starving and I didn't know it. greensad.gif

Is there anything I can do to help her gain weight? Should I try to wake her fully more often at night? (I was originally happy that she was sleeping well since my son is such a crap sleeper) Can I make my milk more calorific? (is that a word?!) I know it's silly and that lots of babies grow up on it- but I feel terrible about giving her formula.

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#2 of 21 Old 07-21-2013, 06:37 AM
 
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See an LC if you can or at least find your local LLL moms to help. Offer more frequently in the daytime, if at nighttime she's sleepy but satisfied. Supplementing without using an SNS or Lact-aid may drop your supply further. Some babies are born bigger but find a lower place on the growth curve to stay. My middle son was over 8 lbs at birth but moved down to the 3rd percentile as an infant and stayed there, he's 4 years now.

 

As for more calories in the milk, make sure to empty the first breast before moving on to the next, the last milk in there is richer than the first.

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#3 of 21 Old 07-21-2013, 08:30 AM
 
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My kiddo dropped percentile a between his 2 and 6 month appointments and it really surprised and worried me. I just upped his feelings and anytime he fussed I would nurse him. I think our problem was DS2 is such a content kid he wasn't complaining loud enough when hungry and could be calmed other ways. Also, I am so busy with life and my older son I think DS2 just blended in and didn't get all the milk he would have really wanted. I felt pretty bad greensad.gif

Anyway, feed her more often during the day! Every 1-2 hours. Eat fatty foods, it really does go into your breast milk. Make feeding her your focus and priority each day. Try this for a 2-3 weeks and go in for a weight check to see how things are going. That's what got my kid back on track as a chunky baby. And if it doesn't work, contact a LC or a LLL group before you move on to formula. Good luck!

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#4 of 21 Old 07-21-2013, 08:51 AM
 
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DD2 was 9 lbs, 12 oz at birth (is that the 99 percentile?) and by her 6 month appt, she was down below 20%.... My doc said she was meeting all other milestones and some kids are going to be on the smaller side.... That mother's bodies determine the size of the baby when they are born, the babies body determines the size they are going to be when they are growing.... if that makes sense.  I am not saying that there is no need for formula, but a lack of weight gain as the only indication may not be a problem.   DD2 is now almost 3 and is in the 50 percentile for weight and 65 for height. (where DD1, 5, who was always super big is in the 60 percentile for weight and 85 for height.... she is just going to be a bigger person).

 

DS was born 9 lbs, 6 oz (I think also above the 90 percentile), and he has dropped to below the 40, again, doc is not concerned at all.  He is almost 6 months now.   I think weight is just one piece to the puzzle.  I may ask to get another opinion (someone who is super supportive of breastfeeding and know what kind of growth can be healthy with a breastfeeding baby.

 

Sorry you are dealing with this though.

 

Good luck.

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#5 of 21 Old 07-21-2013, 08:19 PM
 
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if your doctor thinks that you have a breastfeeding problem, how is the formula going to fix the problem.

if there is a breastfeeding problem, shouldn't we find it? and fix it? is giving formula going to make breastfeeding better?

usually, it makes breastfeeding problems worse.

 

is there an immediate danger for your daugher? if she is happy and meeting milestones, is there an urgency to start formula this week?

is it doing her a favor?

 

you said your periods started back, are you on birth control? if so, which one?

 

read this, see if it helps:

 

http://www.breastfeedinginc.ca/content.php?pagename=doc-SWGF

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#6 of 21 Old 07-21-2013, 08:50 PM
 
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Eat fatty foods, it really does go into your breast milk.

Uh...no.
http://kellymom.com/nutrition/milk/change-milkfat/

Bring back the old MDC
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#7 of 21 Old 07-21-2013, 09:02 PM
 
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It's very common for babies to move around the percentiles. According to the Australian Breastfeeding Association only about 12% of babies stay on the same percentile from birth.

If she is a well, settled baby who has plenty of wet nappies and who is meeting milestones I, personally, would not worry and I would not give formula. I would try to increase my supply and I would try to feed her more often. I would weigh her once a week to make sure she was gaining and I would make sure she continued to seem well, happy etc. This is what I did when my oldest child lost weight and she started gaining again within a week.

If she stops gaining or starts losing weight, if she is dehydrated, if her personality changes or her development slows, then it is time to look further and consider other options for feeding her.

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#8 of 21 Old 07-21-2013, 11:40 PM
 
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Originally Posted by blessedwithboys View Post

Quote:
Originally Posted by sere234 View Post

Eat fatty foods, it really does go into your breast milk.

Uh...no.
http://kellymom.com/nutrition/milk/change-milkfat/

Oh! I had LLL and Breastfeeding USA leaders tell me otherwise! Now I feel confused, they are close and knowledgeable friends. Sigh, oh well. So them suggesting I eat avocados and full fat yogurt was just giving my baby a different kind of fat, not necessarily more fat.

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#9 of 21 Old 07-22-2013, 06:02 AM
 
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Diets high in good fats are great for mom and pass on good content to baby, but nah it doesn't effect how much baby gets. Once they're older egg yolk and avocado are great to feed directly.

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#10 of 21 Old 07-22-2013, 06:32 AM
 
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I would guess if you have deficits it would affect the milk though...
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#11 of 21 Old 07-22-2013, 07:21 AM
 
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Chloe'sMama has the doc I wish I'd had.  Our second baby was 8 lbs 3 oz at birth and didn't maintain her percentile.  At seven months she had dropped to about 10th and our doctor wanted us to check into the hospital for all sorts of horrible tests.  However, our baby was perfectly healthy and at or ahead of all her developmental milestones, wasn't cranky or lethargic, etc.  Now, after having had five babies in all, our fourth was also small and not a big eater, but by then we didn't do WBCs anymore so I never got flack over it.  I gave in and gave my baby formula when she was only 7 months old, but looking back I wish I had trusted my gut that nothing was wrong, and pointed out to the doc that everything but her weight checked out perfectly.  Some babies (some people!) just don't gain weight like the charts say they should.   

 

I remember going through this, and to the OP, I'm sorry you're dealing with it.  Try to trust your mama gut instincts; if you feel certain your baby is ok, then do what you can to get her to nurse more and try to let it go.  My baby that we went through this with is now 9 year old, skinny and health, but she's never been a big eater - not since birth.  Baby #4 is now 3yo and she too is small and has never been fat.  I was really gratified when #5 came along and has healthy fat legs, etc - but my two skinny minis aren't less healthy, they just have a different body type.  Hugs to you!

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#12 of 21 Old 07-22-2013, 08:55 AM
 
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My DD is a string bean (my husband and I are both taller and lean) but my Ped is 100% supportive of breastfeeding even though dd is only in the 20% for weight (and 80% for height!). She told me not to worry about percentiles but she likes to see that the baby will double its birth weight by 6 months. Doing the quick math, seems like your DD is on track! Has anyone else heard this rule? My Ped is a little old school but is extremely supportive of BFing!
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#13 of 21 Old 07-22-2013, 09:28 AM
 
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I just wanted to stop in and offer my experience.  DS has always been small.  He was in the 25th percentile when he was born, dropped to 10th by 3 months, and dropped to the 3rd by 6 months.  He has continued along the 3rd since then and he is now 19 months.  He was a happy baby and met all of his milestones on time.  My pediatrician never suggested using formula, although she did express concern at his 6 month visit and I visited 2 IBCLC's after that appointment.  I started taking supplements to try to increase my supply though I had no reason to suspect it was low.  DS was always a good eater, good latch, nursed a decent length of time and fairly often.  He had good uptake.  The IBCLC's offered no real suggestions, though they did offer support of the "Some babies are small"-variety.  Neither of them thought that supplementing with formula would be the end of the world or a bad decision on my part.  I did consider using formula at that point and part of me will always wonder if I made the right decision.  In the end, now that he eats mostly solid foods (and again, eats well, a wide variety and in sometimes horrifyingly large quantities) and there has been no change in his percentile- I think he truly is one of those small kids.  So I think the decision was OK on my part.

 

But it was horrifyingly stressful.  Part of me still wishes I had tried adding a bottle of formula once a day for a week just to see, just for the peace of mind. 

 

So... I don't know the answer.  But I know the feeling.  And I think whatever you decide, as long as your little girl is happy, growing even a little, and meeting milestones - you are doing the best for her and for you.

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#14 of 21 Old 07-22-2013, 11:04 AM
 
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I think we have to clarify the purpose of growth charts.

they where created based on data to help health professional screen for disease.

it is a screening tool.

it is not a diagnostic tool.

it is certainly not some kind of goal human babies have to achieve. and they are not perfect. and they apply to averages. and no human being is ''average''. but every human being is ''unique''.

unfortunately, some health professionals and a lot of parents use growth charts as some kind of ''goal'' their kids have to reach.

 

how do we use growth charts as screening tools?

well, is seems that kids with health problems( food intolrance, genetic or metabolic diseases, developmental delay, chronic infectious or inflammatory diseases etc) tend to be in the lower percentiles and/or drop percentiles rapidly.of course, the vast majority of kids in lower percentile are perfectly healthy. but the sick ones, seem to gather in the lower percentiles.

 

so how are health care professionals supposed to use the growth charts?

 

if a baby is in a 5th percentile or lower or has dropped percentiles, then the screening tool is telling us to look further. usually, just by history and physical exam (is the baby otherwise healthy, breastfeeding going well, no fevers, vomiting, reflux, diarrhea, frequent infections, milestones etc). also looking at the parents, if they are 5 ft tall both, it is unlikely that the baby should be in the 95% percentile.

if everything else is normal, that means that this is a variation of normal. so no worries.

if there is anything else that is concerning, then we should investigate (example, if baby is vomiting a lot, referring to a gastro-enterologist might be an option etc.)

 

If we ignore the role growth charts have in screening disease, and use it as a ''goal'' to reach, by adding more food (with formula, butter...) , then we are doing 2 potentially bad things :

1) if baby has a health problem, then we are delaying diagnosis and treatment by trying to eliminate/hide a symptom: slow weight gain. and that is not doing  baby a favor.

2) if baby is healthy (which is the case in the majority of positive screening tools, growth charts or others), and we try to force baby to eat more and overfeed we are undermining the breastfeeding relationship, mother's self trust and babies ability to regulate her own intake now, and in the future.

 

 

our babies are unique human beings that we want to be healthy and protect them from disease, but are not a bunch of calves that need to reach a certain weight to have a better price on the market!

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#15 of 21 Old 07-22-2013, 12:27 PM
 
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I really like Lilitchka's post, but I also wanted to ask you know what your baby's lowest known weight was, because weight gain should be counted from that point, not from birth weight. This doesn't ease your mind with percentiles, I suppose, but I agree they are a screening tool as opposed to a diagnostic one. 

Percentiles do change, my second baby was 100% at birth according to the WHO chart, but 57% at a year for girls.  If she had been a boy, she'd have been 100% at birth and only 31% at a year.  She did not double her birth weight until she was over a year.  I can't remember what she was at 3 months, and I know there is more of a drop off by a year, but I do feel that the developmental milestones and her general health is what matters in this case because percentiles will rarely be in the ideal line some doctors may want to see.

However, if you do feel that she is hungry all the time, that she is not getting what she should because she is falling asleep, have you had latch evaluated? It could be a problem of milk transference which affects production, so trying to increase production without dealing with removal isn't going to help the situation.  One thing you could do if you want to supplement is to supplement with breastmilk, pumping your breast after a feeding and feeding that milk to her instead of using formula. The main issue with formula supplementation, as I see it, is that it is not going to fix production issues, but will make them worse.

I felt that my second baby was barely nursing, her suck was really weak, and she sucked her thumb a lot which did interfere with her frequency of nursing. A few times she slept through the night, and no amount of prodding would get her to latch on and nurse, so I got my period back early also.  Because she was so large at birth, her doctor never mentioned any problem with her weight gain, although her weight gain was slower than that of a lot of other babies.  What I started to do was record every single time she came to the breast, and I found she was eating more than I realized. 

So I guess my suggestions are to avoid anything that interferes with sucking at the breast, if possible, and to supplement with your own breastmilk if you feel that supplementation is necessary.

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#16 of 21 Old 07-23-2013, 04:04 AM - Thread Starter
 
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Thanks SO much for all these helpful and reassuring replies! 

I've been thinking on this ALOT in the past couple of days. I haven't given DD formula yet. I have an appointment to go back to a lactation clinic tomorrow. 

 

When DD was a few weeks old I went because she wasn't nursing from one side and had slow weight gain and a crappy latch. My son also had a bad latch that never quite got much better- I think he just got bigger and we both got used to it and I nursed him for two years. Anyway when I brought DD in that first time, the nurse was briefly concerned about tongue tie but then said that DD had a "short tongue" and we were kind of left to deal with things. 

I was told to pump the side that she wasn't nursing well on and give her that. 

 

Now, thinking back maybe DD is tongue tied? Her tongue does seem short and her latch has always been crappy (I blamed this on my floppy breasts and big flatish nipples which were the issue with my son) but it doesn't look like the picture of tongue-ties I have seen.

 

Unfortunately I have to go back to the same lactation clinic. Maybe I'll get a different nurse for a different opinion though.

In the meantime I have been trying to put DD to breast more and she does seem to be eating a bit more. She also seems to be starting the 12 wk growth spurt/fussy period. One thing that is concerning is that she won't take expressed milk in a bottle very well (she has before). I'm not sure if it's because I'm just trying to feed her too much or if there is something else going on. 

 

I wish this were easier. If I can make it to 6 months without giving formula I'll be happy. At 6 months she'll probably be eating some solids so formula wouldn't be the first thing in her "virgin gut"- I don't know if it makes a difference though.

 

Anyway- I've been agonising over every detail of this situation. greensad.gif I tend to do that. I can't think straight anymore.  But thanks for the input and advice.


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#17 of 21 Old 07-23-2013, 05:03 AM
 
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Definitely look into tongue tie more. "Short" tongues are usually a result of a posterior tongue tie, which is more difficult to detect. The vast majority of lactation professionals, peds, etc are uneducated when it comes to tongue ties. Check out the group Tongue Tie Babies Support on facebook for a ton of helpful information about ties, how to find a practitioner who knows how to help, how to identify ties, etc.

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#18 of 21 Old 07-23-2013, 11:53 AM
 
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Just wanted to reassure you about kids dropping percentages. All of my children were born in a "normal" percentile and dropped down to the 25th, then the 10th, then the 5th (by 18 months). All five of them are healthy children, just short. If your baby is vigorous, meeting milestones and pooping and peeing, I would not supplement with formula just because she changed to a lower percentile.


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#19 of 21 Old 07-23-2013, 12:37 PM
 
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i do belive in centiles, as a screening tool ...

my third baby (just when I thought i know everything about breastfeeding :) ) lost more than 10 % of her birthweight and moved from the 50 th to below the third centile. My midwife (!) told me to supplement formula, but I felt that DD2 was feeding just fine, so that the problem was not her intake but something else, that would not be fixed by supplementing. 

 

But, I went to every LLL Meeting (they told me later that if they did not have known me for a couple of years with my older two, they would have refused to take any responsibility) - and I was fully supported by our ped. I went to see him every week and I called with problems. He checked on development and to see if they were any problems that could be caused by malnutrition, and there were none. So I stayed with bf, but did take meds for milk supply (propably totally unnecessary though) and pumped to feed one extra breast milk feed at night (which only make her sleep longer, so ped advised me to stop this to get some rest). 

 

After a couple of month she started to pick up weight wise. Now she is our little tank ;) Eating like a nine-headed-caterpillar (german saying :) ) 

 

But this is just to share, there could be problems feeding wise, that might lead to the need of supplementing. I am very happy that my doc was so supportive, (but he said that he would recommend further testing if she would not start to pick up soon) 

 

he said that with certain conditions at birth you have kind of a false birthweight, as in too muchwater in the baby (I had polyhydramnion and she was hypoglycaemic after birth, so probably undiagnosed maternal diabetes :( )  - so her starting percentiles were false. 

(she was tiny though in these month, but always happy and active) 

 

Listen to your mommy intuition!

 

Hugs, 

Trin


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#20 of 21 Old 07-24-2013, 01:14 PM
 
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Although my daughter pretty much stayed right on track in her percentiles, the midwife noted at our second follow-up that she had an odd latch. Since it wasn't bothering me in nursing, and since she was gaining well, it wasn't really cause for concern, but the midwife decided to check it. She weighed her, had me feed, and then weighed again to determine how much she was getting - she took two ounces from one breast before we weighed her, took a break for the weigh-in, then hopped on to the other breast for a similar amount of time (so probably around 4 ounces, although she was only a week or two old!). Personally, I wish we'd had some correction of the latch then, because I feel like it may have caused some problems in our breastfeeding relationship later on as her teeth came in, but that's beside the point. I wonder if the doc might be open to something similar to help really look into how much breastmilk your baby is getting? 

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#21 of 21 Old 08-09-2013, 03:17 AM
 
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Quote:
Originally Posted by expat-mama View Post

 

Now, thinking back maybe DD is tongue tied? Her tongue does seem short and her latch has always been crappy (I blamed this on my floppy breasts and big flatish nipples which were the issue with my son) but it doesn't look like the picture of tongue-ties I have seen.

 

Have the LC check you for breast hypoplasia. Check out this article and see if anything fits. http://www.sonic.net/~mollyf/igt/

 

I nursed 5 babies without knowing I have mild hypoplastic breasts. Mine are kind of floppy too, with large areolas and a wide space between my breasts, all signs that I am missing glandular tissue that can affect supply.  


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