Top ups - am I doing something wrong?

[TabithaTwitchet]

DD2 is 2 weeks old. Midwife is a bit concerned about slow weight gain, and has advised pumping at the end of a feed and giving DD about 20 ml of expressed milk in a bottle when she has finished with the breast.

Managing Ok with the pumping side of things, and DD will take a bottle - alhtough often not interested just after a feed, she often wants to sleep, or else she is busy looking around and doesn't want the bottle and just spits it out or won't open her mouth. So generally we put it in the fridge and give it a bit later - maybe we should be persevering immediately after the breastfeed??

But main problem is that she seems to spill/ dribble out so much, and also often throws up after the bottle. I have the right size teat (0-6) months, but it seems too fast for her. DD1 never had a bottle, and I don't know if I am holding it/her right - is there any way of slowing down the flow? Is it normal to vomit up loads of milk after?

i suggest you get a slower flow teet.

perhaps change the bottle if necessary. AVENT do a slow flow teet as does closer to nature.

sounds like you are doing really really well

when holding the bottle make sure the milk fills the teet (so she doesnt swallow lots of air)

Has she been checked for tongue tie? I belive that can lead to a lot of dribbling milk out.

How slow is the weight gain? Is it possible she's just full after a breastfeed and can't take any more milk?

Hi Tabitha 2 weeks is still very young and 20mls is quite a lot of formula for such a little baby.

Can you tell us a little bit more about your baby's birthweight, how much she lost and what the gains have been? How is your breastfeeding experience generally, do you have any discomfort or pain? How are your DD's nappies? How many wet and dirty nappies is she having in a day and what was the colour of her poo before you started the formula top-ups?

We had to top-up and found that the Nuk teats which the hospital gave us were very fast (our baby was being sick and dribbling) so we now use the Breastflow teats which are slower and supposed to be more similar to breastfeeding so we can go between the two. We are now at 4 months and have only just moved onto the faster teat (Breastflow again).

Thanks all for replying, sorry i am so slow to get back it is hard to find the time.

To answer some questions - I am topping up with expressed breast milk, about 20 ml after a breast feed, not using any formula.

Birthweight was 7lb, she has not regained it yet, currently at 6lb 11 at 2 and a half weeks old (DD1 took 3 weeks to regain birth weight so maybe it is genetic??)

I am a bit sore sometimes, but I think latch is OK - have v big flat nipples so it is sometimes a bit hard for DD to open mouth wide enough. Midwife checked latch and thinks it is OK, as do I, BUT she weighed her before and after feeding today and said that she hadn't eaten enough in the time I thought she had been sucking and swallowing really well...

Midwife also said that health wise DD seems perfect (bright, alert, strong, lots of wet and dirty nappies). But she also said that if DD doesn't drink enough each feed it will start to affect my supply! Feeling a bit at wits end now. Midwife also looked for tongue tie today, and doesn't think she has one, was hoping it was that as would explain things!

Will look out for slower flowing teats - will try the breastflow one, although shop nearby is quite small selection avaiable, and the bottles which fit onto breast pump seem narrower than lots of the teats.

On my phone so just a quick post, sorry .

Do you have a breastfeeding support group in your area you could go to? Or a breastfeeding counsellor you could see?

Amazing how advice differs.

My DD took 3 1/2 weeks to regain and never once was it suggested that I top up. She was weighed weekly until 4 weeks and I have had her weighed twice since then (now 17 weeks and averaging 200g a week).

I presume she is gaining something, this together with being alert and wet/dirty nappies was enough for my midwife.

There is a La Leche League group meets monthly, could try and go along to that, although next one is not for a couple of weeks.

Loopymumsy didn't know that about the weighing. Will try to wake DD more often - thing is sometimes she feeds for ages and then sleeps deeply for a long time, other times she is on and off, on and off the breast and awake in between or just dozing, doesn't seem to fit in with every 2-3 hours. But I suppose if she sleeps a long time I should wake her?

I had similar problems with DD1, and really struggled with BF in the first few months. Hoped this time would be different, not least because I am more experienced - but it is so different feeding a newborn and I never knew what I was doing with DD1 at this stage either :(

I would not let her go more than 2-3 hours, but if she feeds more often that's great.

'other times she is on and off, on and off the breast and awake in between or just dozing'

This sounds like cluster feeding which is great and perfectly normal it'll help build your supply and hopefully get a longer streach of sleep afterwards.

If the LLL group isn't for a couple of week's I'd give one of the help line no's a ring and have a chat with them. There are lot's of things that can be done with BF before topping up with a bottle which is a last resort really.

National Breastfeeding Helpline
0300 100 0212

The Breastfeeding Network Supporterline
0300 100 0210

NCT Breastfeeding Helpline
0300 330 0771

La Leche League Helpline
0845 120 2918

Association of Breastfeeding Mothers
08444 122 949

Plus agree with Rita, I'd not let her go more then 2hours during the day actualy. Feed both side's at each feed as well. The weighing before and after a feed is a bit useless with BF really as babies take different amounts at each feed and the compesition of a feed varries during 24hours to so is no real indiation of what baby is getting. So don't worry about that one, get some good BF advice from one of the above no's and good luck.

Thanks for taking the trouble to write out all those numbers. I'm not in the UK - am I still allowed to call them? I can't call one based here as I don't speak the language.

I woke her up every 2 hours yesterday and today, so she fed a lot from the breast, but made it harder to find time to pump as she was awake demanding more milk and it seems quicker and less stressful to just stick her back on the breast, rather than making her scream for 10 minutes while I pump it instead. But that is going against what midwife said to do .

Definitely go to your la leche league group even if it is in 2 weeks. I imagine you can still call them although I don't know how 0845 numbers work internationally and it might be very expensive.

I would stick her back on the breast if she's screaming while you are pumping. I understand not wanting to contradict the midwife's advice, but there is no way this can do any harm, at best she'll be getting more milk and stimulating your supply, at worst she'll be getting no milk (this is extremely unlikely) but at least she'll be happy. There's a great article somewhere as well - I'll try to find it - which explains how to bottlefeed in a way which enables the baby to really control their own intake like they do while breastfeeding.

The one I was thinking of was better as it had pictures and more explanation, but this is the best I could find: www.kellymom.com/bf/pumping/bottle-feeding.html

Thanks for the bottlefeeding article, really helpful :)

Turns out DD probably does have tongue tie, which would explain all the problems we've been having.

Have emailed La Leche League coordinator, all set for the meeting- fingers crossed tongue tie might even have been snipped by then...