Why are top-ups bad? (And wwyd with baby not gaining?)

[WildhoodChunder]

Debating introducing formula top-ups to DS tonight, or possibly hanging on for another 24 hours til after GP trip... But I can't remember why top-ups are seen as bad?

Background - DS was 3960g born, dropped to 3700g on day 5, 3820g day 14, is now 3800g day 26. He had a cold/flu bug all last week which did interfere with feeding a bit. He feeds either hourly or every 2-3 hours, with clustering in the evening - he fed as frequently but for shorter periods when poorly but generally a feed is 20-30 mins. Nappies are regularly wet, about 6-8 poos a day, yesterday two were green which makes me think maybe it's a fore/hindmilk issue. He's alert when awake, well-hydrated, but HV has asked me to take him to GP to get checked over, she also thinks he may have thrush as he has whiteness on his tongue (although feeding isn't painful and I don't have/haven't had any symptoms so not sure on that count).

I'm breastfeeding out of duty rather than being emotionally wedded to it but would like to say I gave it a fair go, so wondering what my options are?

Top ups are bad because they reduce your supply. Any milk he takes from a bottle is milk he's not taking from you.

Most of what you're saying sounds good, tbh. Wait - he went down (a tiny bit) between day 14 and day 26? Were both those weighings done naked on the same electronic scale? That's a bit odd, but I guess not totally weird.

One detail you're not giving - how are your nipples? Are they sore, tender? What shape are they at the end of a feed, compared to the shape they were at the start?

The whiteness on his tongue may just be milk residue - thrush is more like white patches all over the inside of the mouth.

It's strange because everything you mention sounds great except the weight gain.

Yes, he's gone down in last week and a half. I think the scale was the same, it was a different HV but the scales are practice ones I think, she weighed him twice to be sure and he was naked. Nipples seem fine, rounded not lipstick shaped so I think the latch works.

If I expressed while DH tops up with FF would that cancel out the supply issue? I don't get more than 1.5oz combined when I express though (based on when I expressed 3/4 times last week when DS was struggling with his cold).

Moonunit - that's what I thought re thrush! It's only on his tongue, and only at the back. I'll see what GP says but I don't think that's the problem.

I would wait to see your GP and see what he says.

As you say it could be to do with being ill, and some babies just do lose weight or fail to gain when they are very small without it affecting later growth. He is still very young, so I wouldn't necessarily be worried about it.

If you are worried though, and want to introduce bottles I think the problem is seen in that they might start to prefer bottle and refuse boob/not take as much breast milk because it is harder to suck from breast etc, and you might end up stopping breastfeeding when you didn't intend too. It is a 'might' as this is certainly not true for everybody who tops up or mix-feeds.

If you're not besotted with breastfeeding this might not be a big risk for you anyway.

For example, my DD had one whole bottle feed a day from 10days old (separately not a top-up) but I didn't stop breastfeeding her until 11 1/2 months.

Your baby is not gaining weight and is not up to birthweight, and this is why the HV is concerned - it's a good idea to get the GP to take a look.

However, the usual reason for slow weight gain is simply because the baby is not getting in sufficient calories - formula can address that, obviously, but it can also be at the expense of getting bf going (as NQC says).

Sometimes, babies conserve energy by not feeding enough and then they take in even less.

Not possible to say what is happening in your case and I think you would be helped by talking to a breastfeeding counsellor.

She would talk to you about ensuring your baby feeds more often, using at least both breasts each time, and the option of topping up with your own expressed breastmilk, which would not affect your breastmilk supply.

The bfc would also talk about making sure your baby is well-positioned, and she might be able to observe a feed.

I think it is very, very unlikely your baby has thrush.

Hope this helps.

Thanks, the next BF clinic is Friday so I will take us off to that, and see what GP says tomorrow before panic-feeding DS some formula. Having got through the initial discomfort of getting BF going, it does seem a shame not to at least get to the bottom of why the weight's not going on.