I don't know if I should give formula..

[ApuskiDusky]

DS2 is breastfed, is 7 weeks, and has continued to be slow to gain weight after recovering from jaundice that the blood tests showed had cleared at about 4 weeks. It took him this long to regain his birth weight (8lbs). Since then, he has gained some weight but not that much - 2oz a week on average - no indication of catching up on his slow start, and hasn't 'caught' a percentile line yet (dropped from 50th to just above the 2nd so far).

The HV I saw last week (for the first time, at clinic) hasn't panicked, and didn't suggest to do anything different - but she is assuming the continued slow weight gain is still because of the jaundice, and only glanced at the previous weights which show no weight gain acceleration since this cleared. And she thinks that because he is feeding every two hours, he's probably 'catching up', whereas that to me is completely normal frequency! So I don't entirely trust this.

Midwife had checked latch, said it was OK but could maybe be deeper - and I went to bf support group yesterday and the BFC said the same thing - improving the latch could maybe improve things a bit, but doesn't seem to 'explain' the poor weight gain. I was already doing the things they suggested to improve the latch, and it hasn't helped, I don't know what else I can do to make it better. I've had no nipple problems or discomfort.

Other things I have been doing: feeding at least every two hours in the day and at least two feeds at night (sometimes setting an alarm), switch feeding up to four sides, breast massage and compression, and spent all of last weekend in bed 'babymooning'. Nothing seems to be helping.

And now he is showing signs of a growth spurt - unsettled, hungry and dissatisfied with my supply. Normally (I bf ds1 for 13 months) I would chill, feed more often and wait for supply to catch up, but now I am really wondering if I should give formula to take advantage of his hunger. If I start giving formula, I would likely carry on doing some kind of mixed feeding - I suspect this will be the recommendation at the weigh-in next week anyway.

In every other way he seems healthy - alert, smiling - but I am genuinely worried about his weight. I don't want to carry on being this worried about it, and maybe formula would make the difference.

Hello there AD, try not to worry, easy to say that i know! - but seriously, its very easy to get distracted by these charts, my youngest child is 6 months, she is my 4th and i have breastfed them all, i think i can confidently say i have experienced most if not all breastfeeding related problems, but have to say with dd2 (the youngest) i experienced probs i hadnt done before in as much as she was soooo tiny, all my others were ranging from 10lb to 8+lbers! dd was just 6lb and she then went and lost so much we both got re-admitted as she went to almost 5lb she was incredibly slow to gain and i was so upset, and convinced maybe i wouldnt succeed this time, but despite my midwife and hv saying i should consider helping her out with some formula, i haveto admit i didnt listen, i fed dd, and when she got tired and slowed down, i used the breast compression, and i tried as hard as i could to get her to feed for at least 20 mins before i let her nod off, left her no more then 2 hours and then another 20 mins, she did pick up quicker and quicker, she soon made half hour+ feeds and then i felt happy leaving her for almost 3 hour sleeps, she did pick up, honestly she went from being a VERY scrawny VERY tiny, skinny little thing, to a very chubby 6 month old that she is now (she has so many rolls on her legs and arms lol) i know its sounds cliche, but try and believe in yourself, YOU CAN do it!, but the more you obsess and get stressed the more difficult you will find it, just put him to the breast and try to get him to feed for as long as is humanly possible, then let him rest, then again, feed as much as you can get him to take, then let him rest etc etc, IF you feel a little formula may help, what a good friend of mine did was buy a small syringe from the chemist (one they usually give you for giving them calpol) and give him a SMALL amount (2/3oz) just enough to help him out abit but make sure you have offered him breast first - as much as he will take, your milk is fantastic, it wont let you or him down, the more he feeds from you the more your body will make, i promise! My scrawny little skinny girl became a big rolly polly in a few weeks on JUST breastmilk! Im here if you need me, i will be back on here tommorow morning to check how your getting on, as for the latch, how do you feel? do you feel the latch is right? its good that its not hurting, but sometimes if he not quite on right he may not be stimulating your milk supply as he should - dont worry, this is soooo easily sorted xx

I really don't know - there will be someone along with more advice shortly. Personally, I would be tempted to just carry on, especially with the growth spurt happening, and see how things lie after that. But that's just me.

Know its stressful worrying about their weight (slightly different, DS is a bit older but has dropped some percentiles, and I am worrying myself) - but try not to. You're doing all the right things (and far more than I could face at 7 weeks!!).

Many thanks both - I've not cracked open the formula yet. It's really hard to see him hungry when I've tried everything to get milk into him.

Charlotte, the latch can be variable I'd say, he doesn't always stay consistent during a feed, eg. dropping his chin a bit, but I can always hear him swallowing and never get pain.

well done on getting this far! You are doing so well! I have nothing to offer in the way of advice but think the mner tabouleh may be able to help. Iirc she had similar issues and has ended up ff but since found out a lot about the advice she should have been given iyswim.

Keep going, you CAN do it!

apuski he is putting on weight not losing? just not following a line?? is poo and wee ok?

was the bfc you saw at bf group a properly qualified counsellor? if not can you contact one?

why not just feed more often, another babymoon? giving formula at this stage is going to affect your supply.

i know it is nerve wracking and horrid when they start weighing and judging. but if he is doing ok just not exactly following the chart then is there really a problem?

Just wanted to say that there's nothing in your OP that makes it sound as if he's 'hungry' apart from the classic growth spurt signs they all have - he's settled, alert, happy - are you getting plenty of wet and dirty nappies? I have got the T-shirt on slow weight gain but as it transpired my DD is just a small one - I had months of worry as she flirted with the bottom of the chart, but there do have to be some small babies - they are centile charts after all, it just means most babies are bigger than yours... DD was born on 25th but 'caught down' and has tracked the 0.4th ever since... as she is now a hale and hearty 4 year old starting school in January, I have got used to the fact that she is just little (am not enormous myself - short, but not as slim as her).

She gained on average 2oz per week from 0-6mths... she was also jaundiced/sleepy at birth and slow to get the hang of bf. I excl. bf until she was 5.5mths when started solids on paeds recommendation due to reflux. Actually, no one ever suggested top ups with formula, which was good because I wouldn't have done it! Sounds like you are doing all the right things trying to get more milk into him and my guess is that after growth spurt and a few more weeks he will get more efficient at feeding and you will start to feel calmer. You sound like you are feeding v. regularly, but if boobs are full in the morning you could express a bit then and top up with that maybe (I used to do similar, but mainly to have bm to mix with reflux meds).

The potential issue with mix feeding (not saying it will happen to you, but does for some women) is that if you give formula, your supply is reduced because baby is not stimulating production as much, which leads to more formula... which ends up being the end of bfing earlier than you might have hoped.

Another thing you might consider is going to fortnightly or three weekly weigh-ins (or monthly, or even less)... you don't have to go and sometimes it is just putting you under pressure when weight gain is slow again. Somehow 8oz in 4 weeks always seemed better than 2oz in one week! When I had DS 21 months later I don't think I ever took him to clinic to be weighed - he went to his scheduled check-ups/jabs and was weighed then, but I never voluntarily went to clinic.

HTH - you are doing a great job persevering with the bf, so hang in there.

Hi fishie, he is gaining weight, just very slowly, so the weight gain isn't enough to let hom follow any line. Wees and poos ok now (didn't have enough dirty nappies in the early days in retrospect).

BFC was qualified, but wasn't the help I was hoping for - she looked at the latch, then told me how to latch, which I already knew and think I am doing right. Then said my supply was at risk if he wasn't draining the breast properly. The main way to improve the latch would be to get him to open his mouth wider to take in more breast, and then stay put!

I'm torn between wanting to stick with exclusive bf (did it with ds1) and just having this sorted. No guarantees I know, but I think he's up for more food, just not able to get it from me.

Thanks SuseB. The HCPs have been OK so far - not very helpful in terms of practicalities, I got most of the info on how to feed him up from here or kellymom - but not putting on pressure; I'm anticipating this pressure rather than it starting yet! So creating it for myself I guess.

It may be that he is just a small one - head circumference was v small (ironic since I had a emcs because he was brow presentation, with his head size I could have probably pushed him out!), and he's not long either. But both DH and I are tall, as is everyone in my family, which makes it more odd!

If you want to introduce a bottle feed, why not make it EBM? Giving a bottle don't have to mean using formula. Has the added benefit of maintaining your milk supply so you don't have to worry about "formula creep".

I'm not sure how I fit in expressing, as he's fully feeding from both sides at every feed. I would if I could see how to do it.

Well, I'm probably not the best person to advise on that, as my DS is exclusively EBM fed (as he wouldn't breastfeed). AFAIK the advice is to express straight after feeding (to take whatever's left, so to speak). Then your supply will have built up again in time for the next feed. Presumably your DS doesn't completely empty both breasts at every feed?

i feed my ds and top up with ebm. I express after a feed, always in the morning for the first feed, often at lunchtime and in the evening too depending how much I can be bothered. I am always thinking about formula but the ebm is my insurance policy!

am in the 4 month growth spurt at the moment but after 4-5 days the milk has caught up and I get a little more when I express which I often use that day

feeding every two hours is actually not that frequent for a small breastfed baby. I fed dd every hour or more at that age and size and was feeding every 2 hours during the night until she was 9 months. So there is no reason why you should not offer milk more often.
Also remember that 7-14 weeks or so is the fussy/colic stage so they will be more unsettled than they are used to.

DS2 has only just in the last couple of weeks stopped feeding every hour or so. He was on more often than not at 7 weeks. If you can just let him at them as much as possible, you really do have plenty of milk for him and he just needs access to get it.

Giving him formula will fill his tummy, but it won't tell your body when it needs to increase/change the milk to suit him. I don't think I know anyone personally for whom introducing formula hasn't been the beginning of the end for BFing.

Perhaps he is just a littlun'? Not all adults are the same size so it makes sense that babies would cover all shapes and sizes as well.

just to clarify apuski when you are lactating your breasts are never "empty" they may feel that way, and the flow may slow down, but the boobs will still be making the good stuff! As someone on here described it, breasts are like a river, not a pond.

Thanks all! Feeding tends to take a good hour with all the side switching, so I'm not sure how much I can increase frequency - and the intensity of all this is hard with a toddler around!

I think I can keep going for a little while longer in the hope it settles down, but it's hard. If I try to relax about the slow weight gain I won't be able to keep up the current regime, it's my worry that is driving me.

All the help is much appreciated, I think it's getting me through at least til the next moment of doubt hits!

Come on ApuskiDusky - you're an experienced breastfeeder. You should know to trust your boobs :)

Hiya Apuski - sorry, my useless internet connection has been playing up. How are you getting on? Can i ask about the switching between breasts? Ive completed a breastfeeding support group and one of the things we discussed in some depth was how switching helps and how it doesnt help. It depends on how you are switching, a mistake i made with my second was switching before he had emptied the first breast, and so he was recieving lots of the foremilk, from both sides and not so much of the fattier hind milk, so id hear him swallowing, knew he was getting something so didnt worry too much, but didnt fully understand why he wasnt putting on weight as much as he had done previously, and why he had become so windy and fussy. Wasnt until i called LLL line and the lady explained, that i realised, so i made sure he took every tiny last bit from one side, before i switched - this did the trick! Please try and forget about the charts and centiles etc - all babies are different, if he is well and gaining no matter how slowly thats all that counts! You are already doing brilliantly! Your milk is so much better for him then any formula

Well, on to the next installment - I haven't given formula, but have given one or two small bottles of ebm in between normal feeds. I'm just back from clinic, and he has only put on 4oz in two weeks - so has now dropped to just above the 0.4 percentile line .

HV was very good, but basically said I was doing all the things they would suggest, and broached the subject of top-ups. Because I have started using ebm, she wants me to do more of that, and she asked what I thought about formula, but isn't directly suggesting it unless I can't manage with with the ebm.

I am seeing the GP tomorrow to have him checked out, though the HV doesn't have any particular concerns bar the weight.

Any suggestions on the best way to supplement with the ebm? After each feed, after every other feed, or trying to slot it in as a separate feed?

God this is feels relentless.

How about pumping after each feed to try and improve supply? You could then offer a couple of oz if you think he didn't have a good feed?

Also have you heard of a latch assist (from lansinoh) might help with the latch?

"I don't think I know anyone personally for whom introducing formula hasn't been the beginning of the end for BFing."

Thankfully, as I am in a similar position, I do know someone who had to give formula top ups for about a month but then managed to EBF until 6 months.

She basically did everything she could to increase and keep up her milk supply (lots of feeding, lots of pumping, fenugreek) and managed. I was so encouraged by her and am doing everything she did in the hope of keeping breastfeeding going and, after feeling so despondent last week, have managed to express enough for all his top ups today.

May we end up like my friend!

Should say that I am trying all this until he gets his tongue tie snipped in the next few weeks so want to make sure that there is plenty of milk for him if that makes it all better.

Could that be the problem here?

Thanks for the replies, I think I am going to start trying to express after feeds tomorrow. Today has been a write-off as he's been so unsettled after jabs.

MrsGangly, are you offering top ups after each feed? I am still not sure of the best way to offer the ebm, to minimise disruption to normal feeding but still help with the weight. I've ordered some Nuk bottles that will arrive tomorrow.

He gets a top up of EBM and/or formula of about 20ml about every 3 hours, as he is doing a lot of cluster feeding at the moment. I've not noticed any nipple confusion and have found that as he has got more energy and is more awake, his latch and sucking are generally better when he is breastfeeding.

He is getting weighed tomorrow so I'll get to see if it is working and consider if I can reduce the top-ups.

Good luck with the weigh-in!