Question: Hello doctor, I had asked you few questions last month about runny nose and eczema etc and was happy with your reply. I have few concerns again.

I am in the UK with my first baby daughter who is today 10 WEEKS old. She was born at 38 weeks with c-section. Her birth weight was 2.960 kg.

She could not latch on my breasts properly from two weeks of age so I had to express breast milk and give her by bottle. She sometimes latches on breast for only 1-2 minutes then starts crying or goes to sleep. Midwife here advised me to express breast milk (by electric pump) and give her by bottle which I have been doing since she was two weeks old. It is tiring but I want to keep her on breast milk as much as possible. So far I have given her formula milk only three times due to taking her out of house for appointments.

Now the concerns are:

1> She had her first vaccinations at 8 weeks. But two days before vaccinations she had started eating less. Since then I feel she is not eating as much as she needs to. Before 8 weeks of age she was taking 6-7 times a day 80-100 ml of breast milk in bottle easily without much fuss. She was taking about 650ml in 24 hours just before 8 weeks age. Since 8 weeks of age she is refusing to finish bottle and stops at 50-60ml. Then she cries and refuses to open her mouth. We try again in one hour but some times she takes it some times not. some times she does take 80-100ml but this is not too often. Overall she takes about 580-650ml in 24 hours since 8 weeks age and as of today. She has not increased her amount of milk.
Why she is doing this? She does 2-3 poos and about 12-15 times pee. This she does everyday.

2> Her weight was gaining at steady rate until she was 7 weeks old. It was not great growth but within normal range. When we had 9 weeks weight she came down on her growth chart slightly (percentile wise). She was at 4.100kg. Health adviser said it is not uncommon to go below chart temporarily and we should not worry at this stage. They will see her again in two weeks time to check whether weight has gained at normal rate. I feel because she is not eating more she will not gain enough. What do you think? Is it something to get it checked with hospital immediately?

3> She does not cry unnecessarily or does not have fever. She plays and smiles most of the time. But eating has not improved. I offered her breast today, she took it for one minute then became fussy. I gave her formula milk after 5 minutes and to my XXXXXXX she drank 100ml without fuss. Do you think is it something with my breast milk or she has some allergy? Do you prefer I offer her formula milk more?

4> Very occasionally she coughs, sneezes and has hiccups. She does not vomit regularly. In last 10 weeks she has vomited (small amounts) only three times. Do you think she may have reflux or colic or stomach gas etc?

5> Doctors here usually do not prescribe medicines straight away unless absolute necessary. Do you think we should get multivitamin drops to improve her apatite?

6> From last two weeks she also sleeps less during the day. At night she sleeps about 7-8 hours but during day time she sleeps 5-10 minutes then wake up for long time, again sleep 5-10 minutes and wake up for long time. She does not cry more and most of the time plays well. I understood that the baby at this age should sleep about 15-18 hours a day but she hardly sleeps for 10-12 hours a day. What this could be? Is it something to worry? Will this have effect on weight or overall growth of her?

Please reply.

Thanks in advance.

Thank you doctor for your detailed reply. I had lots of help and classes from many midwives and lactation specialists about breastfeeding but none had worked and all said my option is to express and give by bottle. I had tried all the methods of direct breastfeeding but so far nothing has worked.

Regarding above queries most advisers here said the same thing as you but I was getting nervous so I consulted private doctor here and he advised me to do some blood tests for my baby. We did blood tests yesterday and today morning the consultant rang me and said baby's other readings (thyroid, liver etc) look normal but calcium level shows high. He said due to high calcium sometimes appetite is less. He wants to rule out condition called Hyperparathyroidism by doing another blood test for PTH (Parathyroid hormones). He said baby's Vitamin D level is ok so no need to give any multivitamins. Also he advised me to temporarily stop breast milk and give her formula until high calcium level's reason is found. He also advised me to stop taking any Vitamin D supplements.

I searched briefly on internet and got scared. Some sources says in cancer the calcium level goes high. Also hyperparathyroidism can cause high levels. High vitamin D can cause it. etc etc.

1> What do you think about my daughter's high calcium level? I will get exact readings (report) in 1-2 days.

2> Can high level of calcium cause loss of appetite in 10 weeks old baby? Could this be the reason for her feeding less? As I mentioned before she urinates about 15 times a day.

3> IF her PTH is comes back normal then, is high level of calcium indicates serious problem with her?

4> Is this high calcium level treatable easily?

5> Could this be related to any dietary intake I had taken?


I am very worried at the moment. Could you please give some advise?

Thanks.

Dear doctor,

I just got result of my daughter's first blood tests. Please see attached. Today we have done PTH and calcium and will get results in 1-2 days.

Please advise what we should do?

Just to update that:
After doctor's advise we had given my daughter formula milk whole day yesterday. Since yesterday as of now (26 hours) she has not done poo. Normally she does 2-3 poos a day with breast milk but since yesterday on formula milk no poo.

She had urinated today with yellowish colour and little smell. Normal urine is almost clear and smell free but today was different.

She also has little sunken front fontanelle and we are worried about dehydration.

She has done her normal number of urine from yesterday but latest two were yellowish and with little smell.

She has not improved her intake even on formula as well.

Please advise what next can be done to resolve this calcium issue, feeding problem and now urine.

Regards.

Hello doctor, Thank you for your reply.

I just had a call from doctor here that yesterday's blood results have come in. PTH is within normal range so we are relieved. Also the calcium came down to normal range. He said he is not concerned about any major issues at the moment and will plan what to do next. He said temporarily stopping Vit D and breast milk may have made the difference on calcium. He has said do not take Vit d and start half breast milk and half formula until we meet him next.

He will forward me the actual report in a day or two. I will submit the report to you again.

He will see us next week to discuss further plan on why my baby is feeding little less. He said may be silent reflux need to be looked into.

Now then, reports shows no major problem. But the original question still unsolved. Why baby is not taking as much as guidance suggest and why she has not gained as much weight as growth chart suggest and why she is fussy about eating more?

Yesterday she did poo ONCE only and it was a big one with toothpaste consistency. I think it was due to fully formula fed for almost two days. Urine continues to be frequent (10-12 times) and slight pale/yellow.

The latest pattern (last 3-4 days) about her feed intake is:
During the day 6-7 feedings but only with 50-60ml XXXXXXX at a time. Evening and night feeding 2-3 times with 80-100ml at a time. All in all about 580-600ml in 24 hours. We have to offer her most of the time as she does not demand every time. Also, half way of bottle feeding she becomes fussy and try to get off the bottle and eventually does not finish the bottle.

What should we do next according to you?

DO you think my baby has some underlying problem?

Does it look like that we should do more investigation such as x-ray, endoscopy, ultrasound etc?

Regards.