Need some advice please

[hefner]

What do you think of this advice from a GP? A bit of background (I?ll try to be brief) - DD has always been very slow gaining weight ? dropping through the centiles, but usually gaining around 100g a week. She has had diarrhoea for a fortnight and over this time she has lost 20g.

We have struggled with feeding ? she is only able to latch on with a nipple shield and has never been a very efficient feeder. At first I was having to express and top her up with EBM at every feed but she has gradually improved and can now satisfy herself from the breast. She feeds for about an hour, at intervals of 2-3 hours though the day with longer gaps at night. I?m quite happy with that and although her weight gain is slow I thought it was ok.

The GP said that I need to supplement her feeding. She advised stopping each feed after 20min and giving her a bottle of EBM or formula as ?the breast will be empty after 20 minutes and anything after that is just comfort sucking?. I disagree ? I think DD is feeding slowly for the whole hour. I really don?t want to go back to expressing and topping up at every feed, but I will do it if that?s what she needs. What do you think?

Oops, not sure what happened to my punctuation there, hope you can still read it.

(How old is your baby????)

GP clearly does not understand how bf works, so anything she says about it can be discounted....that's not to say what she says about your dd's health should be ignored, about which she may well be brilliant!

The breast does not empty - comfort sucking is important and can happen after any amount of time on the breast. There is nothing magic about 20 mins. If your baby has had both breasts and wants more she can go back to the first breast and again to the second and back again to the first :) (= switch nursing).

Weight gain per week is not revealing, really - more significant is her overall rate of weight gain on the chart, as this gives an idea which can form part of an overall assessment of her well-being. Dropping through the centiles can be normal, but anything more than 2 centile spaces warrants an assessment, and possibly more frequent feeding. 2-3 hourly and longer gaps at night gives prob 8-9 times in 24 hours which is not all that often - it could easily be increased perhaps with the switch nursing. Shields almost always mean feeding is longer and less efficient, but if this is the only way she will feed there is nothing inherently 'wrong' with them.

You'd expect a baby who has lost a bit of weight after a bug to feed more often and that's a good thing.

PS Your GP has judged your baby needs more calories. These can be given with more frequent bf and/or switch nursing and/or breast compressions.

PPS :) You should really check back with GP if you intend not to do something she suyggested....just in case!

Also - you have come a long way with your struggle and anyone could understand you not wanting to go back to expressing and topping up again - eek!

Thanks tiktok. DD is almost 16 weeks. Her general pattern of weight gain has been gradually dropping through the centiles (started on the 50th, immediately dropped to the 25th within the first few days and then gradually dropped to the 9th. The last few weeks of diarrhoea have taken her down to the 2nd).

I'm seeing the GP again in 2 weeks to review her again and I will certainly try to get more calories into DD as she suggested, but I?d love to do it without expressing if possible. At the moment she averages 7 feeds a day. It sounds like I need to increase that, but I?m not sure how to fit any more in unless I can shorten her feeds. At the moment feeds tend to be 70-80 minutes (including a nappy change because of the diarrhoea), so I can?t do much less than 2 hours start to start. We have a few 3 hour gaps each day while I try (and usually fail) to get her to nap, then a 4 hour and a 6 hour gap at night giving her about 7 hours sleep. I am reluctant to add another night feed because she really seems to need the sleep. Obviously if she wakes in the night then I feed her but this is rare.

At the moment I feed her on one side for around 40 minutes. She gradually gets slower with longer breaks, and eventually I switch her to the other side. With switch nursing would you switch her over as soon as she starts slowing down?

Yes, switch nursing happens when the baby slows down/stops - to increase milk intake you would def. switch her more quickly than you are doing.

Hope it goes well.