Can I top up without affecting supply?

[Secondsop]

Hello, I have a 9-day-old baby who I have been exclusively breastfeeding on demand apart from top ups on his first day when his blood sugar was too low at birth. Since then he has, I think, been feeding well - latching on without problem and enthusiastically swallowing, feeding about every 1-2 hours with the longest gap between feeds being a bit over 2 hours and that's about once a day. But his weight gain has been slow - he weighed 3260g at birth and lost 13% of birth weight at day 5 but the midwives thought he was perhaps just turning a corner so let me carry on as I was doing and the next day he'd put on 30g, but 3 days after that (ie today) he'd only gained another 10.

The midwives were happy enough that there was a gain, and he is otherwise well, lots of wet and dirty nappies a day, periods of alertness, but suggested I offer a top up of about 20g twice a day after he's fed on the breast.

I just want to do what's best for him and have nothing against formula - it sustained my first baby (who I now realise was a poor feeder) - but I really don't want to find that my supply is affected so that I end up giving more and more formula and then giving up breastfeeding, as this is what happened with my first baby. The few times he did have a formula top up at the start he was sick. The midwife said that my supply shouldn't be affected if I offer after the breastfeed and that it might stretch his stomach a bit so he takes more breastmilk. But wouldn't it also lead to him possibly feeding less frequently and my supply being affected in that way?

Does anyone have any tips as to how I could introduce the top ups without them affecting my supply, so that I can revert back to exclusively breastfeeding once the baby has gained more weight? I've tried expressing and pumping but I get hardly anything out,

[tiktok]

You're right to be cautious about this, OP, but there are times when a top up is helpful and even needed.

Usually, if a baby needs more calories to grow there are several options before topping up with formula.

The easiest are

• simply feeding more often day and night
  
• switch nursing ie going from side to side a number of times each feeding session
  
• breast compressions
  
• topping up with expressed breast milk ( you might find hand expressing or a different pump would give better results)
  
  What do you think?

[DinoSnores]

I did all the things that tiktok suggested when DC1 needed top-ups for about 3-4 weeks before he had his tongue tie snipped. We then got back to EBF and he was fed until he was 16/17mo, and then the only reason I stopped was that I was expecting DC2 and doing lots of vomiting and just not coping with anything other than the minimum!

[Tomkat79]

I could've written your post OP! DD is 15 days old today and we've been ebf. She initially lost 7% of birth weight and I thought all was going really well until day 12 weigh in and she'd lost again. I felt awful.
3 days later and she's gained 2oz thanks to a few expressed top up (takes ages but we get 2-3oz), breast compressions and a load of skin on skin!
I was anemic after birth as had section and they think my milk took a bit longer to come in than usual.
An old school midwife told me that my DD was perfect, lots of wet/dirty nappies, generally content etc so to try and not get fixated on weight, accepting that she might be a slow gainer.
I'm just continuing to feed on demand and follow her lead. I thought about a formula top up but decided against it. Whatever you decide your baby will be just fine xx

[Secondsop]

Thanks all - tiktok thanks for your suggestions, you were also really helpful last time when I posted about the difficulties I was having with feeding my first baby. I'll try hand expressing again as last time I had more luck with that than the pump. I might try in the mornings as that's when I seem to have the most milk.

I've been switching between both sides but not every feed - I'll do it every time now. (I tended to let him finish one and then move him to the other. I've also started trying breast compressions and they're definitely doing something as he picks up his swallowing in response.

In terms of how often to feed, at the moment he is feeding at least every 1-2 hours. Sometimes he cluster-feeds for a period. I'm not sure how to really get more feeds in - at the moment the longest he goes is perhaps 2 and a quarter hours and that's generally only once a day.

I just gave him a formula top up to see how he took it, and he took 30ml after having been back and forth between both breasts.

In terms of types of pump, I've got the Medela swing but it didn't seem any better than hand expressing. Does anyone have any suggestions for something else I could try?

[Monikita]

I had lots of weight gain problems with my DD due to undiagnosed tongue-tie but once I got it divided properly, I did all the stuff recommended above. She did gain weight but I found her weight really shot up once I started doing two extra things (I was already feeding her every 1-2 hours during the day and finding it hard to get extra feeds in):

1. An extension of lots of skin to skin but I kept her on me pretty much all day. You already have another child so I understand that would be quite hard but you could try a sling. I found it was all the little extra snack feeds that helped build my supply and and get her weight up - she didn't really show signs unless she could smell my milk.
   
   
2. I bed-shared (safely!) with her. I appreciate this isn't for everyone and a bit controversial but this made a big difference for us. At night she would get 5-6 feeds in (when she was in the cot, again she didn't really signal she was hungry and I would get two feeds in), and bizarrely, both of us got more sleep.
   
   She is a bit like me in that she's a grazer and has a small stomach so needs to eat frequently and I think that coupled with me having a small capacity meant that these things really helped. I breastfed her to 14 months when she self-weaned (I'm pregnant) and I went back to work when she was 8 months. She's now 16 months and has a ridiculous metabolism - she eats the same as a four-year-old over the course of a day and just about maintains her line on the weight charts!
   
   Just remember to do what's right for the two of you - your baby's got a great mum. Good luck x

[NickyEds]

I'd try the pp advice too. My DS had weight gain issues at birth and still hadn't started to gain at 11 days. I was told to top up with formula by the mw and just did as I was told really. DS has been mix fed and I'm ok with that but I do sometimes wish I'd been better informed and a bit more....forthright with the mw- I found topping up affected my supply. Using bottles and formula also got DS "used" to a faster, easier flow which really didn't help.

[Secondsop]

Hello all, thanks again for posting. Today I gave him 2 top ups after feeds - offered formula for the first and he only took about 12ml but then slept soundly for over 2 full hours so even that little bit seemed to keep him satisfied for longer. While he slept I then tried really hard at expressing and got out 40ml which is a lot for me in a session and he took 30ml of it after his early evening feed. The expressing is going a lot better this time round - I can find the letdown much easier than I could with my first baby. I'm going to do this for the next couple of days - expressed milk for 1 top up and formula for the other - and see how he is on Thursday when weighed. tiktok on another thread you posted about how some babies just don't ask for as much milk as they need to actually thrive as opposed to ticking along - I do wonder if I've got one of those babies.

[Secondsop]

Oh monikita I kept him on me for almost all the day to make sure he got all the snacky feeds (my mum helped with my toddler). This is something I definitely didn't do last time as it would have involved wrestling the precious first grandchild out of everybody's arms but I'm much more assertive about it this time. We also co-slept last night but more by accident than design - I was feeding him and then we suddenly woke up nearly 3 hours later having both had a lovely sleep.

[Secondsop]

Hi, just an update: he was weighed today and he's put on 90g since Sunday! Am v happy, this is on 2 x 30ml top ups a day (at least one of which is expressed breast milk) and loads of skin to skin, cuddles, time spent on me.

[Secondsop]

Hello, me again. Just when I thought it was going well... He's been weighed today and has put on precisely zero weight since last Wednesday. He's 17 days old and still 10% below birth weight. I've been told to top up for every feed. I reckon I can continue to express a couple of ounces a day in the time that he's not on the breast so the rest will be formula. Which is fine as the most important thing is for the baby to be fed. But, I feel so upset as this is surely the end of the road for hoping for exclusive breastfeeding at any point, isn't it? I feel we're back where we were with my first baby. I'm already putting him to the breast loads - at least 12-15 times a day - and he never goes more than 2.5 hours between feeds and that's only a couple of times a day - and he spends 90% of the day on me so I think I'm picking up every hunger cue and then some. He does seem satisfied after his feeds and we have plenty of wet and dirty nappies a day. If he's not gaining weight now, he's never going to get on the breast enough to keep my supply going to ever exclusively breastfeed him again if he gets more and more formula, is he? I am so upset that he's not thriving - I feel like I've failed him but I don't know what more I could have been doing.

[tiktok]

Sorry to hear that, secondsop :(

What sort of real life help have you got? Are you confident in it? Are you confident in the scales, in the weigher and in the maths (ounces/grams, percentage loss)?

[tiktok]

90g gain in 3-4 days last week and then nothing.....it makes me ask those questions about maths etc :)

[Secondsop]

Hi Tiktok, I really appreciate your responding. In terms of real life help it's just been the visiting community midwives thus far but they're referring me to the breastfeeding specialist who runs a clinic locally. I'm also looking up where else I can go in terms of drop ins to get another opinion on latch etc (although the v helpful midwives at the hospital said they had no concerns about it).

Re the scales: it was a different midwife today who had a different model of scales to what he's been weighed on before. How much could different scales vary? Re the maths I worked out the percentages myself as the midwife was struggling a bit so am pretty confident in them.

With my first baby, there were other signs that he wasn't getting enough food - he was never happy after a feed and he didn't have many wet or dirty nappies a day. But my new baby seems quite happy after a feed (with a bout of cluster feeding each evening except today after his formula top up grrr) and has lots of nappies, and he really looked to me to be filling out a little in terms of getting slight rolls on his arms and thighs. So I just don't understand how he can be gaining nothing.

[tiktok]

There are a few studies which show that different scales and different weighers do make a difference - of course we don't worry a bit if we have a baby who is clearly bouncing and who has had no problems with weight gain, but this does not apply to your baby.

Given there is no obvious reason why his weight gain should have stalled (you think he's filled out; his nappies are normal; you are doing what you were doing last week; you are doing all the things you need to do to ensure a good intake), would the HCPs involved consider you continuing with the top ups you were doing up to now, and then weighing again on, say, Friday?

You do need to ask them about this - dont just ignore what their advice was.

What do you think?

[Secondsop]

The community midwives are coming again on Thursday to weigh again on the basis of him having the increased top ups between then and now so I'll follow their advice (I definitely wouldn't ignore it as I just don't feel qualified to do anything apart from take the advice I'm given) and see how we are on Thursday and then take it from there. I was so shocked at the lack of weight gain today that I didn't think to ask her about the fact that he had been gaining before.