topping up with formula?

[emilie89]

Hi,

I have just come back from a stressful visit with my HV and am quite upset. My son is 9 weeks old and was quite small at birth 5lbs 10ozs, he now weighs 7lbs 14ozs. Apparently he is severely underweight and looks it (!), I knew he looked small but I presumed that was because he was small when he was born. He has always had good nappies, lots of yellow poos and he wees loads (mainly on me!). He is very alert and happy most of the time, he is smiling and is developing normally (confirmed by Dr today).

We did have some problems with feeding at 1st and he was slow to gain weight so I was told to express (to keep milk supply up) and give that to him after feeds, which I did and he got to 6lbs 3ozs by the time he was 3 weeks old which my midwife seemed happy with at the time. I have had my latch checked at a BFing support group which was confirmed as good and I have never had any pain in my nipples or boobs. However my baby doesn't feed for very long and still at 9 weeks wants feeding every couple of hours. I presumed this was because he had a smaller tummy.

Anyway, my HV seemed to thinking he was half dead from starvation and that I hadn't been paying enough attention to his weight gain. I was only visited at home once by her (didn't check his weight) and then told to go to baby clinic at 8 weeks for a check up. I have never noticed any signs that he is dehydrated and he is content so didn't feel the need to have any extra checks. I now feel awful about this obviously and feel as if I have neglected my son.

She has told me to top up 3 to 4 ounces after every BF and they will check his weight again next week. If he has not gained enough he will be referred to the hospital. I am going to top up even though I didn't want to give him formula at this age and I feel like an awful failure but feel like I have to listen to her.

Does anyone have any experience of this? Ideally I would like to go back to EBF, will this be possible? Going to try and express as much as possible as well to try and keep my supply up, although know I am going to end up feeling like a big massive milking machine :(!

This is my first baby and I feel awful and that I haven't been observant enough of my babies needs.

Sorry forgot to mention at the beginning that he has been EBF since birth.

I couldn't let this go unanswered..... I was also under pressure to top up my 4w old as she took ages to regain birth weight. I have to admit I ignored her advice, kept breast feeding and she put on weight eventually. Like your DS, my DD was alert and producing dirty and wet nappies so I went with my gut feeling and ebf for 6 months in the end.

I know it's different for everybody but sometimes I think hv have their weight charts to stick to and get worried if babies diverge from them in any way.

Good luck with whatever you do.

Reading your post the main thing that strikes me is that you don't feel very confident about your HVs advice but you feel you have to follow it. If you don't feel convinced by it why not try talking to your GP, or even asking for a referral to a paediatrician now to find out if topping up with formula is necessary.

Feeding every 2 hrs is totally normal and not a sign that anything is wrong. It is great that he doesn't seem dehydrated and is content. The likeliest explanation for his slowish weight gain is that he is just small but it is worth keeping an eye on because slow weight gain can indicate other health problems.

If you don't feel like topping up until you've had a second opinion I would hang on until you've had a chance to talk to your GP or a paediatrician. Provided he isn't dehydrated he isn't going to expire if you don't start topping up for another week or so.

If your DS needs topping up (and it's an if depending on lots of things - is the weight today correct, is he deviating from centile line etc) then surely he can have top ups of your expressed breast milk like before.

That protects your milk supply & gives him extra rations whilst the 'true' picture is confirmed. This is a one off weight. It could be wrong.

HVs advice sounds abit panicked - did she really give no thought to your baby being happy & content with lots of poos or how her advice may have a negative effect on your milk supply?

Agree with Finally - your HV sounds panicked. Did the Dr. have concerns about his weight when you saw him today?

I would certainly try and top-up with breast milk if you can (or even easier, just attempt to pop him on whenever he opens his eyes - that's what worked for us when our little one dropped weight 3 days of stuffing my nipple in his mouth whenever he opened it) - breast milk is easier to digest, so he can get through it and eat more, more quickly than formula (I assume she just said formula, not some extra-special high calorie formula)

emilie, a lot of posters including myself have been in similar situations and it's awful when you think you've been starving your baby.

The problem is that if you top up with 3-4 oz of formula after each bf, that's 3-4 oz that your breasts will ultimately not produce. Even if you continue to express, you may find your milk supply dwindling. It is possible, but difficult, to go back to EBF. You need to bear this in mind if you do choose to top up.

If you feel that you don't want to top up, and it sounds like you don't, please go back and get a second opinion as soon as possible. Whilst it sounds from your post that your baby is not unwell, dehydration can be very serious - however, if the HV were that concerned she should have referred you immediately.

When a similar thing happened to me I got a second opinion from the GP and ultimately had to report the HV because they are not meant to recommend formula top-ups as a first line treatment for low weight gain.

Has he dropped any centiles or is he following his curve? And if the dr is happy, then what grounds does the HV have for saying he is so underweight? Feeding every couple of hours at 9 weeks is completely normal, it was months before DS went any longer (I think 5 months ish?), so that?s not something to worry about in the slightest.

3-4oz as a top up after every feed sounds like an awful lot to me and I would have though would interfere with your supply a lot. I would have thought ebm top ups would be a better idea, if top ups really are required, but feeding at every possibly opportunity, offering 2 or 3 breasts at each feed etc would be even better?

Thanks for the replies.

Finally-I will start expressing again and give him that but last time I was doing it, I was only getting between 3 and 6 ounces a day and the HV said that wasn't enough for efficient topping up at this stage. Obviously I will give him whatever I can express though.

HV did not even ask whether he was content and I had to tell her that his nappies were fine. She didn't mention anything to do with milk supply, I knew about that from researching mixed feeding before. I actually found that I was encouraging myself in relation to the breastfeeding while she barely mentioned it. I find it strange because I was really encouraged to BF (although I always knew that I would) while I was pregnant and in hospital after the birth but no-one seems interested in it now...

Chunky- Dr didn't mention his weight just that he was developing fine and seemed a happy baby. Feeding him at every opportunity is a good idea, do you think waking him to feed if he sleeps for more than 3/4 hours would be a good idea too?

Janitor- I don't quite know how to work centile charts out . Where she plotted his weights on the chart I can see that his weight now is slightly lower that it was at birth, if that makes sense. But I can't work out by how much....

I've just had a look at the charts and by my estimates he was on the 2nd centile at birth but is now off the bottom of the charts. So I can understand why your HV is concerned, but she should put this into context, the vast majority of babies who are slow to gain weight are fine, just small.

The problem with your HVs advice is that she is assuming that there is something going wrong with your feeding relationship and topping up with formula should sort it out. It doesn't sound like there is anything obvious wrong from your post, so I'd be wanting to explore and rule out other possible explanations. I really think you need more medical advice.

In the meantime keep your little one close, feed as often as possible, switch breasts during a feed as often as he seems to want (don't worry about keeping him on for a fixed amount of time to get to the hindmilk - so long as you are following his cues which may mean swapping frequently, you'll be fine). Maybe try giving one of the breastfeeding helplines a call for more ideas about increasing his intake of breastmilk.

And try not to feel guilty - which is a ludicrous piece of advice to give but honestly the first few months of motherhood can be a perfect storm of guilt trips. I agonised over the fact that my DD was slow to gain weight (I too had an unhelpful HV) and only came to my senses when having coffee with a friend who also had a 4m old who was agonising over the fact that she must be overfeeding because her DS was on the 98th centile. If you weren't feeling anxious about this it would be something else...

It may also be worthwhile seeing a bf counsellor who can observe you both and make sure that your son is feeding efficiently. The Breastfeeding Network/La Leche League/NCT can advise you on this: the helplines I don't have to hand but give them a google.

I hope it goes OK: let us know what happens?

There is a 'breastfeeding cafe' at the library behind my house every thursday so I will take him there then and ask their advice, get them to observe my latch and feed to see if there are any obvious problems that I am missing.

Veronica- That is really good advice about swapping the breasts, as he often only feeds from 1 then a little on the second but I will keep swapping him over when he seems like he's finished. I am also glad you mentioned the hind milk as I have had it hammered into me that I must feed him until 1 breast is completely empty so he gets to the hind milk.

This website has some good tips on increasing the amount of milk your baby consumes including switch nursing. It is true that the longer you feed for the fattier the milk your baby gets will be(or the emptier the breast the fattier the milk), but that does not mean forcing your baby to stay feeding on one side for a fixed amount of time if he is showing signs of wanting to swap.

3 or 4 oz of formula after every breastfeed is a HUGE amount! A 100% formula fed 8lb baby would only be having 20oz in a day.

I second the advice to try one of the helplines - I got some really helpful suggestions when my DS was struggling with weight gain.

One thing which the BFC I spoke to suggested, which I thought really helped us, was breast compressions .

Thanks again for all the advice, am feeling a lot more positive now about forgetting the formula. I know it sounds pathetic but I am just worried about continuing to EBF then him not gaining tonnes of weight by next week and the HV thinking I am being neglectful. I am not very good at sticking up for myself if these situations.

Can definitely hear him gulping when he feeds. The breast compressions sound good and will give that a go.

He had a good feed off of both boobs just now then took him for a walk to a local bookshop to buy him a treat as on top of everything else he had his 1st round of jabs today so it's been a stressful day all round. Going to try and do some expressing now as well while he has a nap.

You are definitely not neglecting him! You are doing what a good mother should: worrying about your baby and feeling guilty :-/

Whereabouts are you located?

We're in South East London. Have spent most of the day in bed with baby today, just eating and sleeping and he seems pretty content.

Was looking at formula feeding guidelines earlier and can't believe HV suggested feeding up to 4oz after EVERY feed. That could mean that he was getting up to 28oz a day!! Surely that's just ridiculous, doubt he'd be keeping half of it down as his tummy must be tiny.

It is a ridiculous amount - formula fed babies take about 2.5 times their weight in lbs in oz a day. 28oz is way more than your average 8lb baby would consume in total.

Agree with RitaMorgan- it's a ridiculous amount and one that would probably knock your breastfeeding on the head.

It just proves that she really knows nothing about how breastfeeding works.

You've had good advice already-
breast compressions
switch nursing
baby mooning
getting advice on latch from baby cafe
ringing the bfing helplines

Is there another HV you could see? Or bypass her and see your GP that confirmed he was developing normally.

Havent read all the replies but wanted to respond as I was advised to do this when DD was about 3 weeks old and had been feeding constantly every hour for 5 days, I was knackered, but thought it would all be worth it when she got weighed. However, when she did get weighed, she hadnt put on sufficient weight and the HV expressed concern and suggested topping up. I felt terrible that my DD hadnt put on enough weight and even worse that I felt a bit relieved that formula had been suggested because I was so exhausted.

However, for me, topping up has been fantastic and has meant that I persevered with breastfeeding. DD has been mixed fed ever since then and is happy and thriving, and I am happy about it too. She's now 13 weeks old and has 2 bottles of formula a day (one at lunch and one before bed) and breast the rest of the time. There are no supply issues as I can very easily forgo the formula feeds if I need or want to and no confused baby - she takes breast or bottle perfectly happily, even if a bottle is offered at a usual "breast" time or vice versa.

I also imagine that I could reasonably easily go back to exclusive breast feeding if I wanted to, but I do like the flexibility of mixed feeding and am going back to work full time soon so it isnt really terribly practical.

If I hadnt gone to topping up and then mixed feeding, I would have given up breastfeeding a long time ago. So guess my point is, if you have to do it, dont beat yourself up, it isnt the end of breastfeeding and may even help, either short or long term. Good luck!

Don't think there is a another HV I could see as I think they have one that deals with the baby clinic and one that does home visits, I guess I could request a home visit from the alternative HV but don't know if they would agree. The clinic seemed very chaotic and badly managed, packed full and with waiting times of up to 2 hours :-/! Guess that is probably pretty normal though. Have got an appointment with GP next wednesday, the day after seeing the HV again.

Took him to the BF cafe today and the councillors there again confirmed a good latch however did witness baby's fussing at the breast which has been going on for a couple of weeks. They said to check with GP about thrush but don't think he could have that as whenever he has had bottles of BM he has fed very well. I presume if he had a sore mouth from thrush he would fuss at a bottle aswell? He does have quite a white tongue most of the time, but I assumed that was milk/puke and I have had no pains in my breast.

I did give in and give him 3oz of formula from a carton that we had for emergencies, last night as he was fussing a lot and getting very upset.

Stabiliser- It's nice to hear that you have had a good experience with topping up and that it has enabled you to carry on BFing without upset. While I still want to persevere with EBF, it is reassuring to know that some people have managed to combine feed happily, if for whatever reason I decide that I need to do this too.

Did your DD start gaining weight quickly once you started?

Thanks again for all the advice.

emilie89 - yes she did immediately gain the "appropriate" amount of weight. She was born on 50th centile and dropped to 25th when we were given the advice. After starting topping up she had maintained 25th at a check 2 weeks later and has crept back towards the 50th more recently.

I'd also add that DD is my first and I felt truly awful about apparently not doing so well with bfeeding and I cried when I first gave her formula. However, she demolished the first formula she was given which suggested she was hungry, and then continued to demolish any top ups offered and her sleep improved almost immediately (although could also have been an age thing). This made me feel MUCH better about it.

How did your DS take to the formula?