“The baby on the left clearly had considerable problems in the early 1-2 weeks but is now thriving, although on a centile lower than the one on which she was born.  The baby on the right has the same start and end points as the baby on the left, but is not really gaining and thriving, and is drifting down centiles.  This is a pattern which should cause much more concern, and this baby is in urgent need of good feeding support now.”

The health visiting team needs to discuss with the mum a plan to improve the effectiveness of the breastfeeding, (for example, observing a breastfeed and improving positioning and attachment if appropriate, ensuring that the baby is offered both sides at each feed and feeds at least 8x in every 24hrs, perhaps expressing 1 or 2 times per day and giving the EBM as a top-up in the evenings).  The parents need to have the chance to implement the plan, with support as needed from local breastfeeding peer support groups too, for at least 1 week before reweighing the baby.  If this plan has helped the baby gain well, the parents could carry on for another 2 weeks before reweighing.  If this plan has not been enough, and it is evident that the baby needs formula too, the formula supplement should be given in a way which least affects the effectiveness of the breastfeeding (see next page) and ongoing breastfeeding should always be supported.

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