In hospital for weight gain investigations.

(45 Posts)
belindarose Sat 01-Dec-12 08:19:07

DS, 21 weeks, was admitted last weekend with dehydration following d&v. Only stayed in for the day and rehydrated with diarolyte. Sickness continued all week and, after seeing GP yesterday, we were sent to paediatrics via A&E.

His vomiting is much better and he's hydrated and happy. They're going to investigate the poor weight gain/ failure to thrive (91st to 0.2nd centile). In the first instance, I've been asked to express so they can see the volume he's getting. The amount expressed looks pitiful and he won't drink it anyway!

I had three hours sleep. But that's quite normal! He's charming everyone with his cuteness.

LoisLame Sat 01-Dec-12 08:57:25

I've been there - it's awful :-( Does the hospital have an infant feeding co ordinator / lactation specialist you could request to have accompany you? It would really help to have a bf expert there on your side.

I think at 21 weeks, unless you have real concerns about the weight gain, just try to hold them back for the next few weeks until you start weaning. Solid food usually really helps with weight gain.

And asking you to express to see how much milk you produce is a load of old tosh! Some women happily feed their babies onto the top centile but are unable to express a drop. It really is no indication of what your supply is like.

If you do have concerns about how much milk Ds is getting from you, have a look at Kellymom.com.

belindarose Sat 01-Dec-12 09:05:22

Thanks. There is an infant feeding coordinator, but not at the weekend! I think they're going to feed him expressed milk (if i can give them 'enough') via NG tube to see if he gains weight. At least, that's what the registrar suggested but consultant coming this morning. Hope that doesn't upset my gorgeous contented little boy too much sad.

No vomit so far today.

CMOTDibbler Sat 01-Dec-12 09:10:56

The trouble is that the amount that you can express is not at all reflective of how much milk your ds can access.

Have there been concerns about his weight before, or is this drop across the percentiles recent ?

VivaLeBeaver Sat 01-Dec-12 09:17:25

How would you feel about him having ebm via a bottle rather than an NG tube? At 21 weeks nipple confusion shouldn't be a concern. Or try a cup feed?

Both less invasive than an NG feed. I just don't see the point of tube feeding which is normally used for ill babies who can't suck. Obviously I might be missing a reason why they want a tube, but its worth asking them what they think about these methods.

belindarose Sat 01-Dec-12 09:19:18

He won't take a bottle or cup. So lots gets wasted. Sounds like they want to measure exactly how much is going in.

The drop through centiles has been happening since birth.

piprabbit Sat 01-Dec-12 09:24:06

I never managed to express more than a few ml. But I managed the BF both DCs for months, so I'm a bit hmm at using expressing as a way to measure the amount of milk your DS is getting.

I would have thought the way to measure would be to look at what is coming out of the other end and weighing his nappies.

I hope you get some answers soon, and that your DS is soon feeling much better.

Indith Sat 01-Dec-12 09:31:18

Personsally since it has been happening since birth and therefore is not an immediate concern I would refuse, make arrangements to see the infant feeding coordinator next week and go home.

You need to talk through things with the expert and a weekend of expressing and trying to get him to take it is just going to be stressful for everyone. Why put an otherwise healthy baby through that?

Rikalaily Sat 01-Dec-12 09:34:19

Instead of getting you to express which is no indication of how much milk you have, they should weigh him before and after a feed, the amount he has will show on the scales if it's done immediately after feeding and the scales show oz's, this is what they did years ago because they knew expressing gets out alot less than a baby can get out.

Hope your ds is better soon

tiktok Sat 01-Dec-12 12:57:50

belindarose, glad you are hanging on in there!

It does sound as if you need much better and more informed bf help and support, though. How confident are you that you are getting the people who understand infant feeding?

Expressing is an almost useless way of assessing a baby's intake. All it shows is how much the pump can get out - it might be less or more than the baby actually takes.

Test weighing - that Rikalaily suggests - is no longer done because it is also a potentially misleading way of assessing a baby's intake. All you can guage is an approximation of what the baby has had at that particular session - it gives you no indication of what the baby might have over a day or so, and again, you could estimate less or more than the reality. Test weighing has been more or less discredited as an investigative tool. Add to that that scales may not be super accurate, yet you are asking them to measure really quite small amounts.

Hope you get to the bottom of it. He may be - as we have discussed a few times - a baby who is physiologically slow to gain.

belindarose Sat 01-Dec-12 16:31:25

Hi. Talk of measuring how much I express seems to have stopped with changeover of staff, so that's an improvement.

The consultant paediatrician is concerned about his weight though and is keeping us in until he gains 'a bit'. He's still BF on demand and topped up with an NG feed of expressed milk. All other methods of topping up were tried this morning and he wouldn't take any of them.

He's just had his third NG feed. Vomited after the second one so they've reduced the volume. The aim of this, as far as I can understand, is to check that giving him more milk results in greater weight gain. If it doesn't, then it may indicate a problem. If he does gain more, then they say he can just have more (via solids probably).

Tiktok, I still agree that maybe he's just supposed to be slow to gain. He's very lively and communicative. But the gastric bug hit him hard and he's looking very scrawny now!

I went out with DD for a few hours, leaving him with DH. I feel a bit better for that but seriously need some sleep. And a shower! Going to try that now.

Loislane78 Sat 01-Dec-12 19:38:58

Soooo stressful, can only imagine sad

As a first time mum I'm just glad I found MN as a resource and haven't had any real problems as I think I would have completely lost my confidence feeding otherwise when I read about things like this. I have a lot of respect for the docs and nurses but makes me a bit hmm when I hear some of the 'advice' and frankly sometimes often I'm inclined to believe tiktok and other experienced BFeeders on here.

GL hope you get it all sorted smile

belindarose Sun 02-Dec-12 11:01:50

He's now on 3 hourly tube feeds and I'm to breastfeed on demand in between. But he's not demanding, or accepting.

Any ideas on the best way to fit in pumping? He won't/ can't feed straight after pumping. Straight after a tube feed he likes a little breastfeed to fall asleep. I suppose I can only try to do it when I can. Not tolerating formula down the tube, it seems, so need to be expressing as much as I can.

He's so happy - I think it's because he's got me all to himself!

AnAirOfHopeForSnow Sun 02-Dec-12 11:34:13

Hi Same happened with my first. Norn on 75 cintile down to 2nd centile now at nearly four years old he is on the 98th centile.

Feeding plan that i used was pump every three hours for an hour 30 minutes on each side. Pump an hour before feeding baby then give ebm ff top up and then offer boob to get the weight up. Onec two centiles have increased offer boob after pumping then give ebm and then ff top up. you can reduce pumping to 10 minutes on each side and offer the rest by baby breastfeeding.

Its really hard try to get lots of sleep and four meals and two snakes per day and 10 glasses of water per day and take a pg/bf vitamin tablet to prove quality of milk.

Fennal tea is good to increase supply and can be got from holland and barettes.

Does it hurt when he latches on?

Have you asked the doctors to do an allargy test? Could he be latocse intolarant?

When bf the baby it could take upto an hour or more. Normally mine will feed and then go to sleep and only come off boob when they are fully asleep. For the first year i spend most of my time on sofa feeding and watching tv lol

Good luck

AnAirOfHopeForSnow Sun 02-Dec-12 11:41:57

Ff top ups will get fluids in him and you need to pump every time you give ff to keep your supply up.

Do not be afraid to mix feed as you can restart bf if you have pumped.

Its a cycle: The baby is hungry dosent get enough gets sleepy/weak doesnt have strenght to feed and feels sleepy so dosent feed. You need to break the cycle and ff is used for that. To get the baby to a good place to reintroduce breastfeeding.

tiktok Sun 02-Dec-12 12:08:50

Snow, your plan was sooooooo demanding - pumping for 1 hr 30 mins at a time would not normally be thought worth it, and the eating and drinking and vitamin regime they put you on is not helpful either (won't harm but wont help). What worked for you, I think, was the fact you kept things going.

belindarose, you are doing what you can. Tube feeds will reduce his appetite for bf, but it is good he still enjoys a settling bf. Expressing needs to be done 8 x in 24 hours - less if the baby is feeding somehow. Hope it gets easier for you.

smk84 Sun 02-Dec-12 13:33:21

Hi belinda, thinking of you, will pm as soon as I can xx

belindarose Sun 02-Dec-12 17:43:58

I think he's getting worse. Has vomited after all feeds today, sometimes straight after, sometimes two hours after. Has pulled his tube out three times today. I'm finding it hard to keep calm and to calm him during feeds. And I don't think they're achieving anything. No tube in at the moment but will have another overnight.

Any tips on keeping it in would be helpful. I guess the rest is just a case of getting on with it.

I do feel that if I'd managed to feed him better then he wouldn't be here having tubes stuck down his nose. Poor baby.

AnAirOfHopeForSnow Sun 02-Dec-12 20:17:51

With the vomiting could he have Bronchiolitus or RSV?

Have the doctors seen him?

The feeding plan was horrible on day three at 5am i was going to get the pump and felt like a zombie. I have never been so tired before in my life sad

My dd had RSV at 5 weeks old and i had 48 hours of feeding her every 5 minutes for a few minutes each time and still not as tired as with my ds at 8 days old.

AnAirOfHopeForSnow Sun 02-Dec-12 20:19:12

Keeping tube in - have you tried swaddleing?

VivaLeBeaver Sun 02-Dec-12 21:07:30

Socks on hands, not mittens, they stay on better and should stop him grabbing the tube.

belindarose Sun 02-Dec-12 21:34:50

Thanks. He's tube free at the moment, having got yet another out. Makes me sound totally useless, but he just gets it out. The last time he had built in scratch mitts on. But I had to change his clothes as his nappy had leaked. I just moved the mitt bit from his hand and he'd yanked it out before I even noticed. Other times, he's rubbed his face on the bed to get it out.

We're trying bottles again...

piprabbit Sun 02-Dec-12 22:07:38

He sounds like a very determined little boy grin.

I hope you have a better night and that the new week brings you some answers.

VivaLeBeaver Sun 02-Dec-12 22:08:14

Try getting your dp or one of the nurses to feed him. He's more likely to accept a little from someone other than you, just because he associates you with breastfeeding.

GeorginaWorsley Sun 02-Dec-12 22:13:41

As paediatric nurse agree re test weighing no longer done.Also babies do not need the same volume of breast milk as they do bottle,as constituents so different.
No need fornaso gastric feeding if he is well enough to suck either.
Bottle EBM fine,or even top up formula,although I would suggest attempting to increase your own supply or even (shock horror) earlier weaning.
Does he seem hungry?

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