Formula 'top up' for skinny bf baby

[TartanKitty]

My son is 11 weeks old ebf. Dropped from 91st centile at birth to 9th. I thought he was latching and feeding well, producing plenty of wet & dirty nappies etc. But if he had kept on 91st centile he'd be 3lbs heavier than he is now! So, health visitor has got me keeping a diary of times and duration of feeds as well as nappy changes/contents. I feel like I'm failing by not giving him all he needs and that HV is checking up on me.

She mentioned having to give him a formula 'top up'. Does anyone have any experience of this? Any advice?

I don't know much about this, but when did the drop happen? I suppose what I mean is, some babies seem to start out big, but then comfortably track a lower centile quite quickly. It might be useful for people who know more than me to know a bit more about the details.

Also, did the HV suggest offering more feeds before going to formula top ups. I wouldn't want to second guess what the professionals might say, but I'd have thought the first step (along with possibly a feeding diary) is to offer the breast at every available opportunity?

Oh, also, have you been able to have a trained breastfeeding counsellor or someone observe a full feed? Wouldn't that give you a better idea of whether there is any issue with latch/milk transfer, etc? It seems to me that there could be lots of reasons for this - ranging from it being your son's natural pattern to there being a problem, and I'm not sure a feeding diary is going to tell you a great deal - a baby could be on the breast for 20 minutes 10 times a day and getting plenty, or not getting enough based on whether they are correctly attached and all is well, surely?

Hopefully someone who knows more will be along soon.

bf babies quite often don't keep to the same centile although that is a few to go through. im not an expert and hopefully someone with more knowledge will come along soon but if he's having lots of wet and dirty nappies and seems alert when awake then maybe he is getting enough.
How many feeds does he have over a 24hr period?
a top up may or may not be good, generally with top ups its a slippery slope and you end up using more and more formula and less and less bm, which if thats what you want to do(ie switch to ff) then thats fine but if you want to carry on with bf it might not be best. HOWEVER as this is all online we are not there in rl and so we cannot tell exactly whether top ips would be the right cousre of action.
Are you acle to get to a bf support group to get someone to check latch and watsh a feed as this might put your mind ast rest about this.
Also nresstmilk has LOADS of calories in it so depending on how many feeds he has it might be worth offering more.

Has he actually lost weight? or just not gained quickly? anyway, I'd suggest offering the breast at every possible opportunity. Speaking only from experience I've been through this very recently and in hindsight the tops ups should have only been given as a last resort, not first. If he's not losing weight I'd tell her to do one.. ( I have actually, kinda, I asked her for some research based evidence to support her position and haven't really seen her since...). You could definitely do with some qualified support here, there's a lot can be done to make sure the feeding is going as well as can be. It'll do no harm to ask eh?

You'll often read on MN of big babies that subsequently crash through the centimes and settle.

Is your baby alert and happy? No suggestion of reflux?

See a BF counsellor ASAP. Your HV has a concern so you are obliged to see her, but I would lay off the weighing if it's obvious your baby has settled on the 9th centile. The scales are the only thing HVs understand.

I would really recommend getting someone to observe a feed as my LO was a slow gainer and my HV said similar to me in regards to "top ups", I kept a feed diary but all that showed was that DD spent about 22 hours per day attached to my breast although in reality most of this was comfort sucking. I didn't offer top ups (although I am not saying this is a bad thing) as as soon as our latch was looked at and changed slightly DD's weight gain improved dramatically, I also offered the breast at every opportunity. Good luck x

My DD (now 9 weeks) was born 7.5 weeks prematurely and was fed EBM by tube during week 1, EBM by bottle with formula top up in week 2 and came home at 2.5 weeks, breast-feeding but with formula topups. I've been told my milk supply is not great due to lack of contact / BF in first 2 weeks (no suck reflex at birth due to prematurity and she was in a Spanish SCBU - thereby hangs a tale - which was less touchy feely than a UK one I think; though she seems a very contented baby even without early skin to skin etc) Without the topups she seems starving the whole time, even if fed for a couple of hours. Her latch etc is deemed to be excellent, so if anything it's my milk / milk supply that's rubbish. Anyway, she gets on perfectly well mixing boob and bottle and seems to enjoy both. Mixing / topping up maybe doesn't have to spell the end of BF and whilst obviously the way things happened did mean I ended up in a position I might not have chosen, it has advantages (DH doing a night feed :)!) My position is she's getting lovely antibodies and some calories from me and a calorie boost from the formula, and I'm not run ragged with constant feeding. Good luck.

My DS had to have formular top ups in hospital as his blood sugar was low and he wasnt getting enough from me. He seemed to take to it really well, no stomach upsets and was content.

I may be in your position if my DS hasnt put on enough weight by next Thursday.

I should add that DS is 3 weeks old and was born at 36 weeks which is why they are keeping an eye on his weight gain.

The NICU nurse did tell me not to worry about weight gain as long as he was gaining weight and was happy and content.

Is this a sudden or a gradual drop in weight OP?

How does he seem in himself? Contented enough? Are you feeding on cue or to a schedule?

I am feeding on demand. Not sure how often that is - seems to me like I spend most of the day with my boobs out! At least 10 times a day I'd say.

He is happy (quite smiley) and content generally ,alert, developing fine, looks healthy. His weight tailed off from an initial strong couple of weeks (he hardly lost any after birth at 8lbs 13oz and was up above birth weight within a week), dropping to 50th centile at four weeks, 25th by six weeks and seems to have settled on 9th. He lost weight between 7 and 9 weeks (1oz) but generally seems to gain 2-4oz a week. I take him to clinic to get him weighed every couple of weeks and no hv mentioned him looking unwell or slow gain at all until his official 8wk check when they looked at it on the centile chart. Maybe he is just meant to be skinny - my husband is 6'6" and thin and always struggles to put on weight (wish I had that problem!)

I have not been observed by a breastfeeding support worker as such, but I go to a breastfeeding group once a week which is led by a health visitor. I have fed at the group and no one mentioned anything about how I was doing it, though I don't suppose anyone was really paying any attention. After his immunisations at 8wks he was unsettled so I put him on the breast in the waiting room and the health visitor observed and said it looked like he was on fine. I have never had any problems with nipples or pain beyond the first week. I've not had any leaking or fullness/pain in my breasts either though so maybe not producing enough?

I want to continue breast feeding and it is hard to accept that maybe my son needs more than I can give him. It feels like a failure on my part to have to give him formula. I know this is silly and there's nothing wrong with combination feeding but I can't seem to shake the feeling. Really hoping it won't come to that.

but if he is happy, gaining some weight, and producing wet and soiled nappies, it suggests that he is getting enough. I'd ask the people at your bfing group not about your latch, but about the weight gain. DD dropped to the 9th centile and then at about 4 months, she'd gotten up to the 25th centile.

HVs aren't known for their breastfeeding expertise afaik.

All the other breastfeeding mums I know have said not to worry as he looks fine and happy - the health visitor at the group even said to me that if there wasn't a chart to look at no one would have mentioned anything as he looks healthy and happy. Their babies all seemed to gain more than him though and there are already younger babies who were lighter than him at birth who are now heavier. I guess this worrying is just part and parcel of motherhood and there will be many, many more things to concern me over the years!

Sounds like he's doing really well. I'd really recommend going to a BFing clinic run by the LLL or NCT.

As a fellow healthcare professional, I was really disappointed in little midwives/HVs knew about BFing.

You said you never felt full or leak & are worried you didn't make enough milk. We did have a few weeks of formula/EBM top ups before a tongue tie was snipped, but otherwise I EBF my (once the tongue tie was snipped) 50th centile baby for 6 months and am still feeding at one year.

I have never felt my breasts as full or swollen and didn't leak.

From all you say, it sounds like the HV is chasing numbers rather than looking at your baby.

Ah, cross posted. If the baby is happy, weeing, pooing, and putting on (some unspecified amount of) weight, she is just chasing a chart.

Well done, you've done really well to get this far.