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DS not satisfied by BF, not back to birthweight at 4 wks

(21 Posts)
WildhoodChunder Tue 30-Nov-10 16:51:45

I posted previously but to recap - DS is nearly 5wks old and I'm taking him to be weighed tomorrow: he was 3960g at birth, last week he was weighed (4wk old) and his weight had dropped from 3820g at 14 days to 3800g. He had a cold virus for about a week around the 14 day weigh-in which affected his feeding slightly but not dramatically.

So, since the weigh-in last week I have been encouraging DS to take the breast as often as possible, grandparents and DH helping out so I've basically been feeding and nothing else since Wednesday last week. The doctor checked him over and said he looked fine and just keep encouraging him to feed and keep an eye on his weight.

However for days DS has been cluster feeding all day and 1-2 hourly at night (I've been very sleep-deprived). As an example of the cluster feeding, on Saturday he'd been on the breast for three hours solid (having had a 20 min sleep after the last feeding session) and throughout the feed he was coming off but then screaming shortly after and wanting to go back on.

I was alternating breasts each time he did this, but fed up at this point with DS still screaming inconsolably I gave him a bottle of formula, which he guzzled, about 60ml. He then slept for 3 hours. I expressed and DH bottlefed that for next feed so I could get some sleep. DS has since had another bottle of formula last night to settle him after a four-hour breast session, and again this morning when after 2 hours on the breast he was still screamingly hungry - he took 80ml. The other breastfeeds seem to have been sufficient to satisfy him.

The latch has been checked by midwife, I'm swapping breasts and waking him up if he drops off so he spends 10 mins each side minimum. I don't have much faith in the local breastfeeding clinic as they gave me duff advice with DD previously.

With DD we had a feeding nightmare at the start, we ended up mixed feeding for 3 months before moving onto FF solely. With DD I tried pretty much everything before going the mixed route - so I realise I should probably be breastfeeding, then expressing, then bottlefeeding expressed milk, then offering formula, to try and get supply to catch up but a) breastfeeds are taking so much time and I have a 2 yr old who needs attention so I can't devote the time to expressing etc this time around and b) with clusterfeeding like DS has been doing, after 4 days I would expect supply to have caught up if it was going to? DD would spend 12 hours a day on breast and weight was still dropping off, failure to thrive situation, and the feed/express/etc cycle didn't work last time so I have deja vu to an extent, although DD had to be topped up at day 10 as she wouldn't wake to feed and weight was plummeting more dramatically than it has with DS. DS remains alert and hydrated, poos and wees as he should.

I really went through the wringer with DD so looking for a solution that ideally means DS keeps getting some breastmilk to at least 3 months but that also means I can still function as a mummy to DD and get enough sleep to stay sane. So I guess I'm looking for any general advice, or tips on keeping some breastfeeding going alongside formula?

tiktok Tue 30-Nov-10 16:59:32

Has he been weighed in the last 3 weeks, Wildhood?

I don't think anything can be suggested until you get the full picture with the weighing tomorrow, sorry.

tiktok Tue 30-Nov-10 17:00:09

Sorry - misread your post.

I'll have a think

tiktok Tue 30-Nov-10 17:01:40

OK - I still think you need tomorrow's weight to complete the picture.

Sounds like you are anticipating being told he is not heavy enough, is that it?

WildhoodChunder Tue 30-Nov-10 17:25:08

Hi Tiktok, thanks for wading through my epic post! I am expecting to be told he's not put on enough weight, I've totally lost confidence after the last weigh-ins as I thought he was doing fine on the feeding front. I'm possibly jumping the gun, but if they tell me he's not put on/not put on enough I know I'll be so dis-spirited (if that's a word) it will all feel pointless and I'll be feeling like giving up BF completely, so I'd like a plan in advance, if that makes sense?

TruthSweet Tue 30-Nov-10 17:59:38

Not to poach on TikTok's land (so to speak) but I was wondering if you could answer these Qs? You certainly don't have to post the answer to me/on the board but they might help you to determine if there is a problem with you/supply or baby/ability to suckle or if baby is just destined to be a little one. I'm not trying to diagnose anything (God only knows I'm not qualified to do thatgrin) but something may have been over looked or not noticed even by the most able of MWs. Apolos it they are obvious and you have already covered these with your HCP.

Do your breasts look anything like these on the left hand side at bottom? Or does anything on that page ring true re Hypoplastic tubular breasts? Have you had a reduction/enlargement/serious injury to either of your breasts

Do you have PCOS/Poland syndrome? Or any other medical condition?

Do you take any medications? Some can effect milk supply or weight gain in baby. Please don't stop taking anything with out Drs say so (obviously!).

Does baby have tongue/frenulum tie (to any degree)?

When baby feeds can you see a 'suck, suck, suck, swallow' pattern or 'suck x4, swallow' or 'suck x 5, swallow' etc?

Do you ever see milk in/around baby's mouth or feel a left down? (not feeling a let down is not indicative or no let down happening, just the reverse is true. BTW I have only felt one let down in 7y nursing and that was with a pump!)

Again these are just for you, for thought provocation purposes not because I think there is XX wrong with you or baby. The more you can rule out the better smile Good luck with the weigh in tomorrow.

corblimeymadam Tue 30-Nov-10 18:05:43

Message withdrawn at poster's request.

WildhoodChunder Tue 30-Nov-10 18:24:15

Hi Truthsweet, thanks for the suggestions - I can rule out hypoplastic tubular breasts, reduction/enlargement/serious injury, PCOS/Poland syndrome etc, and I'm not on any medication, no tongue tie's been spotted, he sticks his tongue out quite far so I think that's okay.

DS did put on 100g between day 5 and 14 so something was working, although that wasn't a huge weight gain (and he has lost weight since then). The suck pattern seems fine (got good at checking that with DD), although he flutter-sucks a lot after 5-7 mins of energetic sucking. Let-down is fine I think, it happens within a couple of sucks, same when I express. I usually notice it at the start, and sometimes I can feel a second let-down mid-feed. DS has spit-up milk occasionally and he dribbles sometimes out of the corner of his mouth if my breasts are particularly full. I can feel the breasts getting emptier when he feeds (if they've had chance for a break and gone a couple of hours without him feeding) but I don't seem to get as engorged or leak like I did with DD, I don't know if that means anything.

WildhoodChunder Tue 30-Nov-10 18:25:40

Belgianbun, thanks - I'll ask about posterior TT tomorrow...

TruthSweet Tue 30-Nov-10 19:47:57

WildhoodChunder - That's great. To paraphrase someone (Sherlock Holmes??) when you have eliminated the impossible what ever left no matter how improbable is the answer. So some more impossibilities eliminated.

Leaking is no indication of supply, it's to do with the muscles controlling the milk being stronger. I have leaked less and less with each subsequent pg until with DD3 I haven't even had to use pads.

WildhoodChunder Wed 01-Dec-10 13:58:10

We've had the weigh-in and he's put on 300g! I'm ecstatic - he's now 4120g and over birthweight - but still in a bit of a dilemma about what to do when he's coming off the breast still hungry. Do I keep offering the formula? Will that send my supply into decline? (Health visitor thinks he's just a hungry boy and didn't seem to think the formula top-up is a problem.) I'd estimate DS is getting about 120ml a day formula - e.g. he fed at breast 9-11 and then still wanted 60ml top-up this morning (and had breast again 12-12.30, and he's back on breast now), and last night he fed 5-9pm and took 80ml straight after. Nights seem better with the top-up, he fed at midnight, 3am and 6am, but I noticed I could still hand-express some after he'd come off at midnight and 3am, but he wasn't interested in taking any more despite being very awake at 3. I'm thinking perhaps express via pump at those times and bank the expressed milk to bottle-feed in the morning? Will the breastfeeding calm down soon? I am getting better at wandering around with him attached to me, doing things one-handed, but a bit of a break would be nice!

RufflesKerfluffles Wed 01-Dec-10 15:23:03

Hi, sorry can't help on the topups - sure someone more knowledgeable will be along soon - but wanted to send you a massive grin for the impressive weight gain.

TruthSweet Wed 01-Dec-10 15:51:38

Congrats on the weight gain 300g is vv impressive smile

Do you do breast compressions when DS stops actively suckling? This can be very effective at encouraging a reluctant feeder - works quite well if you start doing it on the 3rd side (i.e. Baby finishes L side, finishes R side but is still hungry so offer L again) as soon as baby starts feeding as it can trick baby into thinking it's a new full boobwink

Also, have you thought about swapping the bottle for a open cup? It can be very easy for a baby to take more milk than they need from a bottle. So if you offer a top up with a cup if they don't really want to drink it they won't and if they still want to suckle they can have another bf.

tiktok Wed 01-Dec-10 16:49:36

Wildhood, that's excellent news

So he has gained 300g in a week?

Why do you think you need to continue to top him up??? If he looks as if he needs more when he comes off the breast, stick him on the other side....not sure why you would not do that? It's easier, quicker and you clearly have the milk to do it

WildhoodChunder Wed 01-Dec-10 17:49:23

Technically, it's 300g in 8 days, but yes.

He stays on feeding (with me alternating breasts) for hours, and still seems hungry in the morning and early evenings, which is why the top-ups. He's still screaming when he comes off and the formula seems to settle him which is why I thought he must be hungry...?

mears Wed 01-Dec-10 17:56:36

A breastfed baby will often take formula if offerred because it is something different. It's like when you have a big main meal and you are full - you suddenly have room when the dessert arrives smile

Are you letting him feed as long as he wants and spitting the nipple out before offerring the other breast? Your not stiwching breasts after a set time are you?

When you are busy with other children sometimes you need to dictate feeds a bit. I used a dummy in those circumstances. As long as the latch is good then a dummy can help. It should start to get better. Just make sure he is on as well as he can be.

WildhoodChunder Wed 01-Dec-10 18:08:38

I've been leaving him on til he spits the nipple out, but he tends to either spit it out and then try and get straight back on, or he drifts off to sleep and comes off and then wakes after 5 mins wanting it back again, so I'm switching then, we just tend to go back and forth between breasts for hours. Sometimes I tickle him awake if he drifts off on the same breast and I don't think he's fed properly. He's not very impressed by dummies, I can't get him to take it!

Truthsweet Hello again - I've been doing the breast compressions to keep him interested/get more milk in him, but I might give the cup a go...

TruthSweet Wed 01-Dec-10 18:23:31

Wildwood - If you scroll down about 2/3rds of the way down on this page there is a video on cup feeding which might be helpful to watch.

Cup feeding is to get the baby to 'lap' the milk like a cat not drink like we as adults do, so a shallow cup like bottle lid or medicine cup (like from cough mixture) is ideal to give the milk in. You can get specialist cup feeders but unless you plan on doing it full time I wouldn't bother <tight fisted old me>.

WildhoodChunder Thu 02-Dec-10 19:51:35

Thanks, think I would have drowned DS without that video!!

TruthSweet Thu 02-Dec-10 19:58:40

Glad to be of help. Do you feel things going any better today?

WildhoodChunder Thu 02-Dec-10 20:38:38

On the plus side, we got through the morning without him getting hysterical for a top-up, but he has clusterfed again from 9-1 this morning (after feeding 7-8), then fed from 2.30-4.30 and then 5.30-7.30. He took a bit from a cup around 7 but has been back on the breast since 8... could really do with him feeding faster/less frequently!

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