Failure to thrive

[monkeytoes]

On our GP's advice, I have made an appointment to see a Paed for my 6 month old in regards to Failure to Thrive. At 6months she's 5.6kgs (just below the 3rd percentile).

I am getting concerned now as I feel like she's not taking much milk in (BF). She hardly ever cries. Never asks to be fed and is often not interested in feeding. BF in public or when there are people around is a waste of time. She's too pre-occupied with what's going on and not interested in feeding.

I express 180mls every morning at 6:30am.
Bub wakes and has a good feed at 7am.
Another good BF at 10am.
I offer a BF at 1pm, she'll have a small drink from each side, then I'll offer her solids (apple/pear). She will eat maybe 2 Tablespoons.
I offer a BF at 4pm, again she'll have a little drink, but not very interested. If I offer a bottle she'll drink it all.
5pm I'll offer solids. Pumpkin/sweet potato. She'll eat maybe 2 Tablespoons.
6:30pm I give her the bottle of BM I expressed in the morning. She drinks it all then goes to bed.
She sleeps thru until 7am the next morning.

I'd really like to keep BF, but I feel like my supply is dropping (although I am already taking prescription and herbal tablets to increase my supply).

Does this sound normal for a 6 month old? Is there anything else I should be doing to try and get her to take more in?

What sort of tests can I expect the Paed to do?

[Lastcenturymum]

Oh hun, I had a friend whose bub had this. I also had a sleepy bub who never complained (she was 6 weeks prem) and after battling around I did wean her at 4 months when she suddenly lost a heap of weight. In hindsight I should have offered her lots more feeds more often, but I didn't know enough then. It's hard when they are sleeping so long, you don't want to wake them, but I think take on board what the paed says and you should get some experience and advice on here :hugs:

[MordecaiAliVanAllenO'Shea]

Firstly :hugs:. My bub is a little one and we are under a paediatrician too. I've been told to up his solids as quickly as possible to three meals a day and include more "fatty" foods where possible - eg yoghurt, cottage cheese etc. It's a little stressful as he isnt that interested and like your bub has never been an avid feeder and I feel like I spend a heap of time just trying to get the most into him I can either food or milk. He is not failure to thrive yet but close, also has dropped near to the 3rd percentile after starting out at 3.96kg born.

Our paediatrician has also just gotten me to do a urine test for him as they can have an ongoing very low-grade UTI which can affect weight gain but not cause a fever.

With regards to the feeds I would be seeing if you can give her a dream-feed - as much for her as for your supply. With day feeds I too was trying to feed more frequently to get more milk in but found if I left it till closer to the 4 hourly mark he was actually a little hungry and would have a much better feed. Also with the bottle you are giving her, could you try a bf first and then offer the bottle, so she's getting plenty of milk but her sucking will help your supply?

Just a few ideas, none may help but wanted you to know youire not alone. And it's hard not to take it personally when you're bf them I know!

[Chickadee]

Before you freak out too much and for any other's who have small bubs, I just want to say that someone's baby has to be on the 3% or lower line and it's not necessarily abnormal. That's the way percentiles work! So if bub is light weight but also on similar curves for length and headsize, and has always been on that curve, then bub is more than likely perfectly healthy.

That said, my DD did drop from 50% to around 10% for weight, at around 5 weeks. So I understand your concern.

My only suggestion, though I'm no expert on bf, is that you reverse your morning routine to feed bub directly first and then express after. You may express less, but I would think that you'd be assured that DD is getting a full feed and lots of let down.

[monkeytoes]

Our paediatrician has also just gotten me to do a urine test for him as they can have an ongoing very low-grade UTI which can affect weight gain but not cause a fever.

With regards to the feeds I would be seeing if you can give her a dream-feed - as much for her as for your supply. With day feeds I too was trying to feed more frequently to get more milk in but found if I left it till closer to the 4 hourly mark he was actually a little hungry and would have a much better feed. Also with the bottle you are giving her, could you try a bf first and then offer the bottle, so she's getting plenty of milk but her sucking will help your supply?

Thanks JaidevsMum. We sent off a urine sample yesterday for UTI. Still waiting for the results.

Tell me........how do I do a dream feed? I've heard people talking about it, but I can't understand how to do it unless you're co-sleeping. Bub sleeps in her cot. If I go and pick her up during the night she will wake up. :confused:

[Lillynix]

Just wanted to say that my DS, who is now 7months, weighed in at just 5.17kg at 6months old (which is well below the 3rd percentile even though his length is in the 50th) :)

He was born at 4.16kg but dropped to 3.53kg before starting to gain weight again. He is however, happy, alert, reaching milestones, gaining weight (just small gains), has normal amount of wet/dirty nappies and is ultimately healthy.

My advice to you after reading everything I can, speaking to other mothers of small babies and my GP is...do what you feel is right. If you honestly don't think there is an issue and your babe seems happy and healthy in every other way, then that should give you all the answers you need. If there is some sign happening that is causing you concern, then by all means follow it up, but if you think all is going well, it probably is :)

My GP gave me a refferal to a Paed a month ago, but the appointment isn't until the end of November at which time DS will be almost 10months, so it is obviously not all that important. The GP herself has said it's up to me if I go or not, she said DS is most likely just small, but IF we had concerns, the appointment was there...I don't think i'll bother.

If you have any questions, or just wanna chat about it, feel free to PM me :)

[monkeytoes]

Before you freak out too much and for any other's who have small bubs, I just want to say that someone's baby has to be on the 3% or lower line and it's not necessarily abnormal. That's the way percentiles work! So if bub is light weight but also on similar curves for length and headsize, and has always been on that curve, then bub is more than likely perfectly healthy.

That said, my DD did drop from 50% to around 10% for weight, at around 5 weeks. So I understand your concern.

My only suggestion, though I'm no expert on bf, is that you reverse your morning routine to feed bub directly first and then express after. You may express less, but I would think that you'd be assured that DD is getting a full feed and lots of let down.

You are right. Somebody's baby has to be on the lightest percentile. Infact I have the two extremes. My 6m/o is below the 3rd percentile and my 2y/o is way above the 97th percentile.......I can't seem to find a happy medium:rolleyes:

DD2 was 8lb 2oz born, so she was a decent size newborn, but has just kept dropping down and down. She was following the 10th percentile curve for a while, then dropped down to the 3rd percentile, not sitting just below the 3rd.

I will try swapping my expressing to after her morning feed and see if that helps. It's just that with 2 young ones 6:30am is the only time I have to sit quietly and express. During the day and at night I can only seem to express about 30-40mls no matter how hard I try.

[lukaelmo]

Hey there...

My little Luka was just a tiny baby, and he only weighed around 5 kilos at 6 months after weighing 2.8 at birth. He is still now, at 3, the smallest kid around. As Chickadee said, someone has to be the smallest, that's how it works.

He never cried to be fed either, and solids were very slow. But he was a happy baby, so I did think that he was just tiny naturally. I took him to specialists, and they all agreed, he's just small.

LCM said that in hindsight she should have offered more feeds, and in hindsight, so should have I... but he was my first, and I didn't know. I did have plenty of milk though, he just wasn't hugely enthusiastic, just like some adults are really. Some love to eat, to others it's no big deal.

The best advice that I have ever been given is to trust your instinct when it comes to your baby. You really do know if there's something wrong. By all means take bubs to specialists, but don't let worry eat away at you.

[monkeytoes]

Just wanted to say that my DS, who is now 7months, weighed in at just 5.17kg at 6months old (which is well below the 3rd percentile even though his length is in the 50th) :)

He was born at 4.16kg but dropped to 3.53kg before starting to gain weight again. He is however, happy, alert, reaching milestones, gaining weight (just small gains), has normal amount of wet/dirty nappies and is ultimately healthy.

My advice to you after reading everything I can, speaking to other mothers of small babies and my GP is...do what you feel is right. If you honestly don't think there is an issue and your babe seems happy and healthy in every other way, then that should give you all the answers you need. If there is some sign happening that is causing you concern, then by all means follow it up, but if you think all is going well, it probably is :)

My GP gave me a refferal to a Paed a month ago, but the appointment isn't until the end of November at which time DS will be almost 10months, so it is obviously not all that important. The GP herself has said it's up to me if I go or not, she said DS is most likely just small, but IF we had concerns, the appointment was there...I don't think i'll bother.

If you have any questions, or just wanna chat about it, feel free to PM me :)

Thanks Dragonfly. I guess my main concern is that I would like to BF bub, but I feel like my milk is not enough for her. I am concerned that I am neglecting her. I know she enjoys bottle feeding and I often wonder if I put her on formula fulltime will that fix out Failure to Thrive issue. I just want to do the best thing for her.

[Lillynix]

Trust me, I understand exactly where you are coming from and what you are going through, i've been dealing with the same thing since DS was born (and still am).

I'm breastfeeding DS still after many a person (the CHN and in-laws) has told me to formula feed, the bottom line is, you will KNOW if she's not getting enough milk by her hydration levels, ie wet nappies. So long as she has good wet nappies, she IS getting enough milk, there's no maybe's about that part.

I understand that you want the best for her, as I do with my DS, but formula may not even fix the issues, that's what you have to stop and think about this, because IF you swap to formula, and your milk supply drops, you may realise that formula isn't making a difference and by then it may be too late to get a good breastfeeding relationship back on track without having to work hard for it, and you don't want to go through all the "if only..." things, so here's a few things...

Generally, breastmilk is higher in calories than formula.
Your baby will only drink what she wants to, giving her formula will NOT make her drink any more than she already does.
It is not gauranteed to make her put on weight or change any of things that are currently happening.

As for breastmilk quality, if your DD is growing, whether it's slowly or not, so long as there is growth and weight gain, has good skin tone, is alert, strong (as opposed to floppy) and is reaching milestones (as opposed to lethargic) then your breastmilk sounds fine. This too was a concern of mine, that my milk wasn't "good enough" but then I look at my DS and see how well he is doing and how happy he is, despite being skinny, and KNOW that my milk is good enough.

It has taken a lot of strength, soul searching and sheer determination to get where I am now, confident and happy that my DS IS doing well despite being skinny.

[JabberJaw]

Hi,
I was reading on another post somewhere that there is some kind of percentile chart for breastfed babies and the percentiles are lower than the ones in the baby book. I am pretty sure it was from World Health Organisation, Has anyone else seen it?? i will have a look for it and if i find it i will post it here for you.
Your bub sounds happy and isnt screaming so that is a good sign.

[JabberJaw]

Found it :

http://www.who.int/childgrowth/standards/cht_wfa_girls_p_0_6.pdf

I saw it previously :

http://www.bubhub.com.au/community/forums/showthread.php?t=191005

Might be worth a look, by what you said yr bub is above the the 3rd percentile but just below the 15th percentile. My bub is pretty small to, she is under the 50th percentile but my GP has never been to worried about it. The W.H.O recommended a new chart in 2006 i think as breastfed bubs put on heaps of weight between birth-3 months and then slow down n gains till after 12months.

[monkeytoes]

Found it :

http://www.who.int/childgrowth/standards/cht_wfa_girls_p_0_6.pdf

I saw it previously :

http://www.bubhub.com.au/community/forums/showthread.php?t=191005

Might be worth a look, by what you said yr bub is above the the 3rd percentile but just below the 15th percentile. My bub is pretty small to, she is under the 50th percentile but my GP has never been to worried about it. The W.H.O recommended a new chart in 2006 i think as breastfed bubs put on heaps of weight between birth-3 months and then slow down n gains till after 12months.

Nope, she is under the 3rd percentile in the WHO chart too.:thumbsdown:

[lotti]

I don't know if this helps, but I would try to make sure she absolutely empties a breast before going to other side as the fatty stuff is at the end. That probably also really helps stimulates the breast into making more milk.

[lotti]

Oh and I just wanted to add that my last ds was in the 5th percentile at some stage...but he looked so healthy I just thought it was normal for him.
He is just perfect now at 2. :)

[JabberJaw]

Nope, she is under the 3rd percentile in the WHO chart too.:thumbsdown:


Oh damn she is to, sorry i read it wrong :confused:

Hey i just thought i made some of those lactating cookies. I found a recipe on her in a breastfeeding sticky! You could give them a try to if you think yr milk is slowing, i was a bit dubious but i have gone from not needing breast pads even overnight to using them in the day and a cloth nappy at night LOL. (they do taste yum my hubby loved them!)

[reAllytee]

Do you have issues with her losing weight or dehydrating ?

There isnt a huge cause for alarm unless this is the case but also her demeanor does factor in as to whether she sleeps too much, not enough wet nappies etc etc.

Obviously weight does count for something but as the others have said someone has to be at the bottom iykwim just like someone always has to be at the top !

Offering more feeds is definitely a good idea while a switch to formula may help but it may not either iykwim. If there are underlying issues then that may be something that needs to be looked at & then the switch can be thought about but i honestly wouldnt think about it until absolutely necessary.

I know it hurts to be told this because we went through this with DS2 & struggled for months but since getting lots of different things sorted he has come on so strong he is actually a 'normal' sized 12mth old at 10kgs !

[monkeytoes]

Oh damn she is to, sorry i read it wrong :confused:

Hey i just thought i made some of those lactating cookies. I found a recipe on her in a breastfeeding sticky! You could give them a try to if you think yr milk is slowing, i was a bit dubious but i have gone from not needing breast pads even overnight to using them in the day and a cloth nappy at night LOL. (they do taste yum my hubby loved them!)

Yep, I have a batch of cookies in my freezer. They are yummy, but I haven't noticed any change in my milk supply. I think my supply is dropping necause bubs is getting lazy and not sucking. Then I get worried cos she hasn't had much to drink so I give in and get a bottle for her.

[monkeytoes]

Do you have issues with her losing weight or dehydrating ?


No to both of these. She hasn't stopped putting on weight, just slowed down. And she is having lots of wet nappies.

I wish I had more confidence in knowing what I am doing is the right thing for her.

[JabberJaw]

No to both of these. She hasn't stopped putting on weight, just slowed down. And she is having lots of wet nappies.

I wish I had more confidence in knowing what I am doing is the right thing for her.

I am sure you are doing the right thing, you said she has just slowed down and she is having lots of wet nappies so that is a good sign, my bub was sick last wk and not feeding properly but i could notice the change in her wet nappy output. Maybe she is just a little bubby, dont get down on yr self you sound like you are doing a super job, it did say on the web site i mentioned that they slow down on there weight between 3-12 months, but go see yr pead as they are experts with bubbies and give you good advice on what to do.
But honestly dont get down on yrself, that wont be good for your milk either.
good luck

[mordygordy]

My son is 6 months old too and is in the 3rd percentile for his weight to but the midwife isn't worried and neither am I he is just small. He is happy and healthy and reaching all his milestnes a little earlier then he is ment to and has lots of wet nappies.

Like others have said there has to be someone in the bottom percentiles.

Someone I know is having the same problem as you and her pead has told her to feed feed feed her little girl. She is breastfeeding whenever she can and has gone right onto 3 solid meals a day. Since being on 3 solid meals a day she has stacked on the weight 550grams in a week. SO she gained heaps on this diet

Oh I just found what she is having this is cut and copied ok
breakfast: 1/4 - 1/2 cup raffertys garden banana cereal made up with formula (for the calories) with 2 tablespoon puree apple
lunch: custard - 2 teaspoon custard powder with 100ml formula
dinner: 1/2 cup vegies with ground rice (for calories)

PLUS 6-8+bf a day

This baby isn't quite 6 months old yet. Hope this helps. Good luck

[kkaz]

Lots of good advice on here already...

I just wanted to add, with regards the BF, that you might be better off offering BF at EVERY feed, rather than the bottle. You can then express a little after each feed if you want to keep stimulating the breasts (to increase future supply) and keep a stock of EBM in the freezer (for a time when you are happy and satisfied that your supply is okay). I agree with an earlier comment to not express at 6.30am and then offer a BF...there might not be much left in the breasts at the 7am feed.

My other piece of advice is this...

Contact the Australian Breastfeeding Association!! :yes:

They are great!! They have trained lactation counsellors who will help you over the phone. If anyone can give you the right advice about building up your supply (and even whether you NEED to build up your supplies) it is them. I cannot recommend them highly enough.

PS - I am not suggesting that you have dwindling supplies either. I know how you fee. It is one of those guilt trips that comes with BF territory..... we always doubt our own supplies :rolleyes:

[monkeytoes]

Someone I know is having the same problem as you and her pead has told her to feed feed feed her little girl. She is breastfeeding whenever she can and has gone right onto 3 solid meals a day. Since being on 3 solid meals a day she has stacked on the weight 550grams in a week. SO she gained heaps on this diet

Oh I just found what she is having this is cut and copied ok
breakfast: 1/4 - 1/2 cup raffertys garden banana cereal made up with formula (for the calories) with 2 tablespoon puree apple
lunch: custard - 2 teaspoon custard powder with 100ml formula
dinner: 1/2 cup vegies with ground rice (for calories)

PLUS 6-8+bf a day

This baby isn't quite 6 months old yet. Hope this helps. Good luck




I just wanted to add, with regards the BF, that you might be better off offering BF at EVERY feed, rather than the bottle. You can then express a little after each feed if you want to keep stimulating the breasts (to increase future supply) and keep a stock of EBM in the freezer (for a time when you are happy and satisfied that your supply is okay). I agree with an earlier comment to not express at 6.30am and then offer a BF...there might not be much left in the breasts at the 7am feed.



You ladies have some wonderful ideas but I'm not sure how they're going to work.

mordygordy.........I have tried to feed, feed, feed. But bub is not interested. Turns away from me or arches her back when I try to give her extra BF. And as for solids I have to fight to get a few teaspoons into her. She will keep her mouth shut. I do the 'here comes the areoplane' thing. She laughs at me so I quickly get a spoonful into her, only for it to be spat out again:rolleyes:.

kkaz.............I understand why you say not to express at 6:30am. It makes sense, but I am not able to express much else during the day or at night. I pump and pump, but not much comes out (I'd be lucky to get 30mls). Bubs ALWAYS refuses to BF the last feed of the day. She's tired and I think she can't be bothered waiting for the let-down. This is why I have been expressing a bottle every morning to give her at bed-time. And I feel like me expressing this bottle in the morning is the only thing that is keeping my supply going. I will call the ABA and see if they can suggest anything.

Thanks ladies for all your advice and positive comments.

[reAllytee]

No to both of these. She hasn't stopped putting on weight, just slowed down. And she is having lots of wet nappies.

I wish I had more confidence in knowing what I am doing is the right thing for her.

If she has only slowed then tell them to bugger off lol !

She is fine :yes:

Gosh with my little guy just keeping weight on him was all i wanted ! He couldnt hold the weight & he was always dehydrating with lots of issues so thats how i knew something was drastically wrong iykwim.

By the sounds of it your little girl is just that ! A littlie ! Thats ok !

If she is still gaining then a gain is a gain ! Dont stress yourself :hugs::hugs:

[UmmInayah]

With regard to trying to feed, feed, feed and bub refusing, if bub is a sleepy bub, offer dreamfeeds! A lot of the time bub will have a nice big feed and not even realise. LOL.

I hope this helps. I hope that you aren't stressing too much. Some bubs are just small. My bub is 8kgs and is 15 months old. My midwife had a bub who was 8kgs at 12 months and still 8kgs at 15 months but she said she wasn't worried cos she was energetic and happy.

[veve]

what about food play??? its how we get kids with sensory issues to taste bits and pieces at school ?? isntead of playdough/ fingerpaint - get messy with food .. :D try heaps of different textures/ smells - you might find she likes something you wouldn't normally offer?? and if nothing else - it would take a bit of the 'stress' away from eating times???

you could involve both your munchkins :yes: brace yourself for the mess- but have FUN .. ( i have memories of fingerpainting in yoghurt, making snowmen and animals out of pumpkin puree .. and painting letters/ numbers/ shapes in chocolate custard :laughing:)

xx
Jen

[MordecaiAliVanAllenO'Shea]

What veve said about playing with food is a good idea - I remember with DS1 he was such an avid bfeeder he wouldnt have solids. In the end I put down a plastic tablecloth, stripped him to his nappy (was warm then) and gave him some pureed pumpkin to play with. Very messy but he actually tasted some and after doing this about three times he started to actually eat instead of spitting everything out.

You asked a while back about how to do a dreamfeed. It depends on the bub. With DS1 as I said he loved bfeeding, so just pick him up out of his cot, breast in his mouth an he automatically started feeding. DS2 however (my 6mnth old) if he's sleepy isnt that interested in feeding. He always has a snuffly nose from his reflux so a couple of times a day I have to spray saline in his nose so I actually do it half way through the last feed to stir him a bit so he will take the second side so something similar could help? YOu should find if it's the time she normally sleeps she will stir briefly then be sleepy while feeding and go back down easily.

Just wanted to add, with my DS starting out a good weight and dropping from about 75th to 5th percentile, my paed said their birth weight is determined by the placenta for the most part and then after birth they settle into what their natural body type is, so my DH and DS1 are both lean so she said it is likely this bub is going to be lean so he wouldnt make big gains in the beginning being born so big. I hope that makes some sense.

Oh and one more thing, when I was in a mothers group when DS1 was a bub there was a very little bub who struggled to make gains so the mum switched to formula, still hardly any weight gain, then solids from 4months, 3 HUGE meals a day compared to what the other bubs were eating full of high calorie foods and still this now 2 yr old is the littlest of our group. Seems she was just always going to be a littlie.

Good luck! It all seems a bit of a guessing game sometimes hey?

Mel