I don't think I'm making enough milk...

[Chulita]

Bear with me and humour me in my paranoia please.
I bf'd DD for 11mths and am currently bfing DS who's 10 weeks old. DS has reflux so is quite unsettled and rarely feeds comfortably. He's putting on about an oz a week and has skied down from 75th to 25th centile. I'm not horrendously worried cos he is gaining albeit slowly, he's got plenty of wet nappies and has a couple of poos a day, he's alert and responsive.
Right, so the problem is that my boobs constantly feel empty. If DS goes longer than normal between feeds I don't get massively engorged. He often seems to be struggling to latch cos my boobs are so saggy and empty feeling and he very, very rarely feeds for longer than 5-6 mins. He feeds about every 2 - 2.5 hours during the day and night apart from one 4 hour stint in the evening. I just feel like he's not getting enough from me and it's a constant struggle to feed (hopping on/off, fussing, wanting to suck constantly but not always on me), any ideas?

The wet nappies suggest he is getting plenty of something. You make milk as he feeds so feeling empty isn't necessarily an indicator (in fact you make the hindmilk on empty so thats good). He is gaining a bit, is your HV concerned?

it's normal for your breasts to stop getting engorged after a little while. that just means your supply is regulating and isn't anything to worry about

is he being treated for the reflux? have you tried keeping a food diary to see if anythign you are eating is making it worse?

Chulita - it's really difficult to have a view on this, as much of what you say is (sort of) normal. Breasts may well feel empty all the time after the first weeks, and little engorgement after a longer than usual gap can be normal, too, after a while. The length of time of feeds is within normal for a beyond-newborn baby, and the feeding frequency is, too. Even the fall on the centile chart is within normal.

What isn't normal is the fussing and the struggle. Reflux is not really a diagnosis, IMO, but a name for a collection of symptoms - some of which can be explained by something other than 'milk coming up again and causing pain' which undoubtedly happens with some babies, of course. If he is being treated for these symptoms with no improvement, then may be it's not reflux or not solely reflux.

Coupled with the slow weight gain (which could be normal, of course), I think you have grounds for looking to improve the breastfeeding - someone experienced and knowledgable should listen to you, see you feed and watch his behaviour, and get the whole visual picture and the whole story. Do you have anyone locally you could get this sort of one to one, face to face, support from?

Thank you for answering so quickly, I suppose one reason I was wondering about supply is that with DD I got engorged all the time, had blocked ducts at least twice a week and she was gaining around 9oz a week at this age.

tiktok I agree with the reflux 'diagnosis', he was given gaviscon but it made no difference except that he got constipated and was in pain from that. I was a peer support volunteer at our local breastfeeding group and asked the counsellor there - she said the latch was fine and apart from that didn't have any ideas. We've just moved so I don't know anyone in the area yet and I've yet to find the HV. I spoke to one last Wednesday and she said that any gain is a good gain so she would only worry if he stopped gaining.

He also doesn't seem too bothered with feeding a lot of the time but is really sucky if that makes sense. He wants to suck my finger (won't take a dummy) but isn't interested in comfort sucking me which I find frustrating cos I'd like him to suck to stimulate a bit more. I don't know, I'm probably just worrying for nothing but he is a very unsettled/crying little boy unless he's sucking.

Sucking creates saliva which soothes his poor throat. The fussing sounds pure reflux :(

We had the same constipation problems with the gaviscon and stopped it. For me, dropping dairy from my diet worked really well and this is apparently a really common cause of reflux.

There are others, and most can be improved - and there are other reflux meds, too, if the weight loss continues. There's a support thread here and loads of info on the net.