Breast feeding supplemented with formula top ups

[MyEllaBella]

My ds was born at 36 weeks and 4 days at 5lb 7oz (25th centile)and had to be formula fed (and colustrum and EBM)via a tube for 5 days in hospital. He was weighed when we left hospital and had lost 6 ozs, then lost a further 1oz over the next 2 weeks whilst being exclusively breast fed. We had to go to the hospital for tests and it was found his jaundice and thyroid levels were high, so it was thought because he was quite sleepy he was taking enough to sustain himself but not grow (all other signs were good - passing plenty of wee and poo fine, alert etc). I was told to give 2oz formula after every feed (worked out about 9 to 10oz over 24 hours as I didn't top up at night)and he put on 1lb 9oz over the next 18 days.

Then we started to reduce the top ups as the aim was to get back to breast feeding exclusively. Over the next 9 days he only put on 1.5oz but the HV wasn't too concerned as it was after significant weight gain, plus he had had a bad cold and had gone 16 hours with only one feed at one point because he was so sleepy.

I had him weighed again yesterday after 5 days of breast feeding plus 4 x 1oz top ups each day and he had put on 3oz. This put him slightly below the 2nd centile curve he had been following so the HV rang the hospital and I was told to go back to the 2oz top ups after each feed. I was gutted as I thought we had cracked it - he had been feeding well, pretty settled, output fine etc.

I am now in a real dilemna - I really wanted to bf but it doesn't seem to be working and I feel like I'm going round in circles here. I have tried so hard and would feel really guilty giving up, but at the end of the day I just want ds to put on weight. I saw the doctor today for ds 8 week check (he is now 7lb) and doctor said whilst he couldn't tell me what to do my baby would grow and thrive on a bottle and if I were his daughter asking for advice he would say switch to the bottle.

I am pretty close to doing so as I am thinking is there any point carrying on with bf or are the benefits negated due to the ff? If I do carry on could bf and ff like this be sustained? Is there any way to get back to exclusively or even reduced top ups? Any advice/similar experience gratefully received.

I have been taking fenugreek and expressing to try to increase supply (haven't been able to express that frequently due to bf and preparing bottles for each feed). Baby's latch and sucking is fine, never had any problems there even after introducing the bottle.

Sorry for the length of this post just thought I should give as much info as possible!

I'm not an expert but i think it's usually perfectly possible to get to ebf if you want to. Even if you continue with ff top ups though there are still great benefits to bf. A bit of breast milk is much better than none.

I would ring one of the bf helplines or go to a local group where you can talk to a bf counsellor. They should be able to advise and support you in what you want to do.

From my own experience, DS had a lot of formula in his first 10 days but I managed to get to ebf after that. I built my supply up by using a pump after feeds. I would only get a few drops out but the stimulation tells your breasts to produce more milk. But I never had any concerns about weight gain so it was a much easier situation.

better advice will be along shortly than me but I think what you need to do is lots of skin to skin and feed at every possible opportunity. Yes of course baby will thrive on the bottle but you don't really sound like that's what you want. The benefits aren't nageated due to the ff he's had, every bf is great and it sounds like you've done a fab job so far with a tricky start, so well done.

:( :(

You sound so low, MyEllaBella...but the good thing is that it seems pretty clear from your post why things have gone wrong, and that's good because they can be put right again :)

2 ounce top ups at every feed is a lot for a tiny baby - easily two thirds of what he would get if he was fully ff. This did not leave much room for you to establish bf and unless you were also expressing frequently ie 8-10 times in 24 hours inc at night, when you dropped the formula (or reduced it) it would be unreasonable to expect your body to turn on to full bf immediately.It's not surprising that weight issues emerged as a problem as a result.

2 oz top ups are still a lot - probably more than half of what a fully ff baby would have. Of course these top ups can be of expressed breastmilk, and if this was the case, that would be good as it would mean you would have to express a lot - fenugreek will do no good at all unless you are doing this key thing of expressing frequently. When the baby is not feeding effectively/often enough the pump has to be a stand in and it has to stand in at least as often as the baby would feed. You say he is feeding well - that's good. he needs to feed often as well, on at least both breasts each feed, so each breast gets stimluated to produce milk many, many times day and night...12-15 times in 24 hours would not be excessive at all.

This is hard work and needs a lot of motivation and cheer leading, time and committment. But from what you say, all that has happened is you did not get the advice to express frequently enough in those early weeks, and someone did not do the maths well and told you to top up 2 oz per feed :( :( So no wonder things are as they are now....not a mystery, not magic, not bad luck, just poor advice from people who meant well but who did not know enough about how to fix a bf issue.

What do you think? To get things going again would be hard, and your heart has to be in it.

DS was on formula "top-ups" for a couple of weeks.
I pumped when he slept (one problem with formula I found was that it made him sleep rather than want to latch on to me). I didn't produce much when pumping, but that isn't unusual. It didn't mean there wasn't anything there.
When he was on the formula, we didn't give him a set amount. We just filled him up after he'd fed from me for about 45 mins (can't actually remember as was 18 mths ago).
After the first 24 hours, he didn't have formula at night; I slept with him and fed him when he woke.
It can be done.
He was born on 25th centile and remains now on about the 9th.
Good luck with getting some better advice .

Sorry, crossed posts with that better advice .

Thanks everyone for your advice, really appreciated.

Good question TikTok. I am considering giving it one last shot. As I have been told to go back to the 2oz top ups due to the weight issue I guess I need to bf, ff and then express? Could you give me advice on how long before/after each feed to express and how long for? Does it have to be regularly throughout the day or could I make it up whenever possible - just thinking if out and about easy enough to bf but not necessarily to express every time?

I am also concerned that when I reduce the top ups again it is such a fine balance as if his weight doesn't go up enough he will have to go back on them. Is it better to wait until he's on a higher centile this time and do it more gradually to make sure my supply can make up for the top up?

Sorry for so many questions, I just want to get the right advice this time so that all my efforts aren't wasted.

We had to do top up feeds with our dd, as she dropped more than 10% of her weight when she was born. We were told to do 45 mls after each feed but the mw told us not to worry too much if she didn't have all of this. When we left hospital we had to carry on with the top ups, we then gradually reduced them to every other feed until she reached her birth weight. After that I breast fed, it was a relief to stop the top ups as I remember thinking all I seem to be doing is feeding her. It was hard once dh went back to work, I don't want to set eyes on that feeding cup again .

At about 3 months dd dropped from the 25th centile to just below the 2nd. Anyone who met dd could see she was healthy and thriving, but the hv kept on questioning my feeding technique and I was told to see the gp and to go to a bf support grorreup. The doc was very supportive of bf and gave dd the all clear. She looked at the bigger pic and said dd had probs just dropped to the line she should be on. She also said genetics can be a factor, apparently I was a slim baby . The bf people were also v supportive and actually complimented me on my technique. They just said make sure she feeds until she comes off so that she gets enough hind milk (the fatty stuff). They also said if I could to go to bed for the weekend and do skin to skin with dd. I felt I didn't need to do this but have heard from other mums that it really worked for them.

Dd is now 6 months and even now I get slightly nervous getting her weighed. She's stayed around the 2nd line consistently but if she drops slightly I get 20 questions from the hv and I have to explain what's happened so far. At the next weigh in dd inevitably goes back up again.

My situation was slightly different to yours but I am so glad I stuck with the bf. I had so many people saying 'have you thought about putting her on formula', including my own mum every time we spoke on the phone. Good luck in whatever you choose to do, there are people out there who can help. I also hope you have a supportive dp too, he never suggested formula to me as he could see how healthy our dd was. My mantra was always 'someone's got to be at the bottom of the chart'.

Grorreup is obviously group, getting used to new phone!

MyEllaBella - would it be possible for you to ask the clinic if 2 oz at every feed is essential? It is a lot...and the regime you are planning (bf, top up, express - at every feed) is the hardest way to feed a baby :(

My concern would be that a 2 oz top up will really scupper your plans to get back to full breastfeeding. Your baby is likely to feed less frequently which is the opposite of what you want.

Of course there may be good reasons why they have suggested this, but you need to know that they understand your wish to breastfeed, and that you have confidence in their knowledge of how best to make this happen.

Hang in there. I was in a very similar situation but have now stopped formula and almost stopped ebm top-ups too. Baby is 4 weeks old.

Poor positioning, latch issues due to bottles & a sleepy baby used to being tube fed meant that part of our issues was LO not getting enough fatty milk. Green frothy poos are a sign of this fwiw.

One of the best bits of advice I got fron our nct counsellor when I was desperate was that as baby was already used to the bottle, it wouldn't really do any harm to exclusively bottle-feed for 1-2 days while I concentrated on getting some rest and pumping regularly to get my supply back up. That advice saved our chances of bfing imo.

Otherwise, breast feed, top-up, preferably with ebm but with formula if you dont have enough and then pump. Massage while pumping and carry on pumping until each breast is "empty". A double pump really really helps if you can get hold of one.

Your baby should stabilise on a centile line - this may be well below their birth centile. Our LO is now consistemtly about 7th centile but her weight is going up okay and HV and GP are happy. Don't try to get a temporary weight gain to a higher centile.

Hello OP,

Just to offer you some support - my DD had a very similar pattern. Our routine was to BF as much as we could (e.g. until she stopped the feed, offer both sides or even 3/4 sides), then express and give that and then offer a formula top-up of around 40ml. So 1oz. I did thsi every 3 hours. In terms of dropping the top-ups often she wouldn't tak ethem anyway - clearly full on BF. I dropped them at night quite early on - around 1.5 weeks and then during the day around 3 weeks. She then lost a little weight so we re-intorduced them and then droped again a coupel of days later and as she was basically refusing them. I also stopped pumping around this time and went EBF. So - you can get to EBf and it is 100% worth it. Personally I would pump for 10 mins a side each time - anymore is just punishing!

Bring your baby into bed, feed for as many hours as you like, cuddle, stroke, eat yummy food and drink lots of water!