Breastfed 4 month old has developed severe wind following introduction of evening Aptamil

[Mouseketeer]

My 4 month old is exclusively breastfed, but has fallen 2 centiles since just after birth (from 50%). I have no worries about him and he is happy healthy etc. He is in a routine in which he sleeps from 7pm to 7am, but wakes up once every night for a 15 min breastfeed sometime between 1 and 4am, which is bearable.
However the Health visitors are checking his weight every 2 weeks and generally sucking their teeth at me because his growth curve is heading into the tramlines (Wimbledon reference - currently on TV).
2 weeks ago, on their advice, I started expressing all the feeds because otherwise he seemed to get wind (screaming, back rigid, posseting up most of the feed taken) and this has been a great success - I thought he was taking at least 50% more feed and should have put on weight. BUT this week he still hadn't put on enough, and the HV advised giving him the last feed of the day (6pm) as Aptamil (number 1).
We started this, and he took it fine, but it has had the disastrous effect of him waking up at 2am with a rigid back screaming in pain (exactly the same symptoms as before we starting giving expressed milk in a bottle), and being impossible to wind. Last night I spent an hour winding him and then he projectile vomited all over the bed. He then went straight to sleep. the wind has persisted today - again more rigidity and screaming - I think he can't digest this Aptamil so it gives him colic or wind. This seems odd because we had used the little cartons of made-up Aptamil from 0-8 weeks as an 11pm feed, and he had never had any problems with it.
Should I:
a) switch back to exclusive breastmilk (despite having to express all the feeds which basically keeps me housebound, bent over the steriliser or pump) and start organic baby rice (he is 4 months)?
b) switch to a different formula - if so which one?
Thank you for any suggestions offered!

[Alibabaandthe80nappies]

Well I can't see that the fact that you are giving him one feed of formula rather than breastmilk is going to help his weight gain, so that seems bizarre advice from your HV.

Is crossing 2 centile lines classed as failure to thrive? If so then I would take him to the GP to be checked out and just keep giving him breastmilk in the meantime.
It may be that he is just supposed to be small, in which case the GP can rule out any problems and you can just keep giving him BM. But if there is a problem then that can be dealt with and you can still keep giving him BM.

By the way, there is no need to sterilise bottles etc that are going to be used for breastmilk because it is a naturally sterile substance. Just a good wash in either hot soapy water or the dishwasher is needed.

[RitaMorgan]

Mine dropped 2 centiles (75th at birth to just under 25th at 4 months) and I was never told to top up with formula or express feeds. Maybe he's just not meant to be a big baby?

I think in your position I'd try to find a breastfeeding counsellor or lactation consultant who can help you get back to feeding from the breast - expressing all feeds doesn't sound sustainable. Was your baby ever checked for tongue tie? Maybe there are some adjustments to latch or positioning which could help with feeding.

[tiktok]

????? Very strange advice from the HCPs...worth a second opinion from someone who understands bf, I agree.

Expressing all feeds is hard work and rarely worth the hassle unless the baby really is unable to feed direct from the breast - it may not be as efficient at milk removal as a baby and this can affect supply.

I don't understand the logic of substituting a bf with a ff - the calorie content is about the same, and missing a bf will reduce supply.

If your baby is going short of calories (and there's no real evidence for this - his weight gain may be fine for him) then the easiest and most effective response is to breastfeed more often - using at least both breasts each time and fitting in as many extra feeds as you can. If your baby seems unhappy at bf direct then there are ways of investigating this and amending it - expressing all the feeds is about the last option on the list!

Hope you manage to find some decent help, or at least an explanation from the HVs and paed about why their suggestions are the ones to follow, despite them making your baby uncomfortable and your life more complicated :(

[Mouseketeer]

thank you very much for these messages.
he has had only breastmilk for last 48 hours and still wakes nightly at 3am screaming with wind. maybe this is Aptamil still in his system?
I agree that expressing all feeds isn't really sustainable (or efficient) but he simply refuses the breast now (after 2 weeks of bottlefeeding) and I was always planning to stop breastfeeding at 4 months to go back to work, so the next stage has to be finding a formula he can tolerate. maybe I will try Hippe or Holle or Nannycare Goats milk.
also we have GP appointment in 2 days so hopefully that will be helfpul