9 weeks of BF, time to add in formula?

[Glimmerberry]

Really hoping for a bit of clarity here after 9 weeks of ebf and constant worry about my baby son's weight. Feeling like it might be time, for his sake, to admit defeat and add in formula rather than risk his health and development.

I'll try to give all the details since I don't really know what might be important!

He was born at 3.7kg and took to bfing easily in the first 24 hours so got some colostrum. Next day or two barely fed at all, he was so sleepy I just couldn't keep him going. He lost just over 10% of his weight. After that though, things picked up and seemed to be working out. The bf-ing has been straightforward. I seem to be able to latch him on well, have had no problems with my nipples/ boobs other than a painful let down in the first few weeks. I have fed him on demand which has been something like 12 feeds a day, gradually decreasing down to around 6, usually for 30-45 minutes. I tend to offer, for e.g. Right breast until he comes off then left (very short feed on 2nd), next time start with left offering right after, and so on.

In some ways things have gone well, like escaping many of the nipple/pain/latch problems many people seem to have, the fact that he always has plenty of wet and dirty nappies (probably 4-5 of each daily).

The problem however is that despite looking healthy and hydrated he has been really slow to gain weight. Reached birthweight around 5 weeks and just really slow ongoing gain such that he has gradually dropped down to the 2nd centile, and may even be dropping from there.

HV is reasonably relaxed about it, agreeing with us that the large amount of fluid I received in labour may have exaggarated his birth weight -he never really looked like an 8lb 2lb baby except in his first, very bloated 24 hours. But that isn't enough to explain his ongoing slow weight gain.

My own thoughts are that i am producing huge amounts of foremilk and this is the problem. I think this because i get very engorged rapidly, i often spurt (!) very thin watery milk, he gets very windy and distressed frequently, and often even after a very long feed (when i can feel him suck and swallow well) i notice that i can still express very watery milk and he is hungry agan after 20mins or so. I think this problem is getting worse and worse. I notice he seems hungrier and fussier at the breast, latching on and off. He is windier and we've now had some green nappies (for the first time, this weekend). It's quite rare now that i'll see the thicker, creamier looking milk beading on my nipple or spilling from his mouth at the end of a feed.

I'm just not sure what to do now. I keep reading conflicting things on whether or not the foremilk/hindmilk ratio matters. I had wanted to ebf until 6 months but feel like i might be doing this at his cost.

Does it sound like a fm/hm problem? Can I do anything about that? Any other thoughts?

If you are right about the foremilk, you could try expressing a bit before he feeds, so that it doesn't take him so long to get to the hindmilk. As long as he is healthy I think there is no need to panic about the percentiles. I have read that you should track a baby's weight gain from their lowest weight rather than BW and make sure you are consulting the growth charts for EBF babies.

FWIW, my son weighed 2949g at birth and was only 3.7 kg the last time we weighed him at 3 months. I would prefer him to be small but healthy rather than fat and FF.

Have you tried calling one of the breastfeeding helplines or seeing a BF counsellor for advice?

If you are worried about weight gain you could try feeding more often - 6 feeds a day isn't that frequent. There is more "foremilk" in a full breast, so more frequent feeds will give your breasts less chance to get full and engorged?

Yes I definitely second trying one of the helplines or a breastfeeding counsellor.

As I understand it, current thinking is that older ideas about trying to control how much FM/HM they are getting are now outdated. If you are following the baby's cues then foremilk/hindmilk should balance out naturally. It only tends to be a problem if you've been given (and are following) outdated advice which is centred on how to increase the baby's intake of one or the other.

Some babies have to be on the lower centiles :)

Thanks. Which breast feeding counselling phone lines do people recommend (i'm tired of conflicting advice)?

The bf-ing on demand has increased in the past couple of days. Today has been continuous since i got up today at 8am. He has been quite windy, and seems to be very hungry.

Could definitely express off some foremilk, but a bit worried that this will exacerbate the problem by creating more demand.

Bertiebotts i think i probably agree that just going with my and my son's instincts would have been better, it's just been hard to ignore all the advice given while his weight has been dropping :(

La Leche League seem to be the best IMO.

Don't worry! Even if something you've been advised to do has messed things up (unlikely but possible) it won't be impossible to get back.

NCT - 0300 330 0771

National Breastfeeding Helpline - 0300 100 0212

La Leche League - 0845 120 2918

My phone crashed as I was typing and Rita has said pretty much exactly what I was going to say.

Oh although NCT are good too and their phone line is free. Agree probably best to stick to one!

Don't worry about changes in pattern to the bf, they do tend to take more frequent feeds when having agrowth spurt (often with mine this resulted in greeish nappies aswell) .

So long as he is weeing and pooing and settling between feeds and he is continuing to gain weight and follow a centile (not necessarily the one he started on!) you are on the right track.

Thank you all for the reassurance, will phone LLL.

OP, in your second post you refer to his weight dropping, but I assume that he is only dropping down the percentiles, not actually losing weight?

My 3 babies were all big at birth and all dropped down the percentiles. I'm not sure if it's something to do with my milk or just something my babies do!Like you, I had no problems bf after the very early days when DS1 wasn't v keen to feed. He was windy too - In fact I could practically have written your post! (Except the fm/hm bit - I wasn't v clued up about this, and as Bertie says I think current advice is that this doesn't matter).

DS1 dropped from the 75th percentile at birth to the 25th percentile at 3 months. I was so worried about it, but he seemed healthy in every other way so I carried on ebf until I weaned him (at around 20 weeks) and bf until he was a year.

I would say - try to trust your body to provide what your baby needs.

My DH would say - tear up those bloody charts!!

The vast majority of babies who appear slow to gain weight and who 'fall' down the centiles are fine. Weight is only one part of any assessment of well-being.

You say you don't know what explains his on-going slow weight gain - well, the most obvious reason is that he is gaining the way his physiology dictates or, in other words, he's meant to be that way :)

If it's thought he could do with more calories, then you have them - in your breasts :) All this stuff about foremilk/hindmilk is a red herring - mothers don't make more foremilk and not enough hindmilk, I promise you. The milk made is all the same - a fuller breast has more foremilk (proportionately) than a less full breast, because when milk is removed the first parts to be removed are the more watery components. As the breastmilk is removed it becomes progressively less watery and more creamy, because there is less there - that's all it is.

My guess is because your baby is only feeding 6 times in 24 hours you are going a long time between feeds and this means your breasts are rather full - and that means proportionately, the milk is more watery. In a thriving baby, this does not matter a bit - it is volume of milk that puts on weight, not the precise calorie count of each feed.

If you think your baby needs to gain more quickly (and there is nothing in your post to say you're right :) ), then the easiest way is to feed more often, using more breasts each time.

Most 9 week olds are feeding more often than 6 x, anyway....so there are bound to be opportunities for extra offerings :)

If he's not interested when you offer more, then you can almost certainly trust him to know what he needs :)

PS my DS1 is now nearly 6, is a great eater and still tall and skinny like his Dad, wish I had those genes!

mumofthree yes, dropping centiles rather than losing weight. He lost weight in the first week, stayed the same until week 2 and has been slowly gaining since along the 2nd centile roughly.

It seems wrong to me because i understand his centile ought to be determined by heritance...his Dad and me are both well above average height and are not slim!

tiktok i haven't been feeding to schedule or anything, all on demand and it's just gradually reduced over the weeks. Most recently this has been 30-60 min feeds around 7am, 10am, 12noon, 4pm, then a spell of cluster feeding between 6-9pm. I put him down when he dozes off after this cluster, then attempt a dream feed when i go to bed around 11/12. He doesn't take much. He then tends to sleep through until 6/7am. I have wanted to wake him to squeeze in another feed thru the night but HV thinks this is daft. Thanks for the reassurance on the hindmilk issue.

I'll try to be a bit more conscious of the duration and number of meaningful feeds this week, trying to get in 8 good feeds at least, and see how things go. I don't want to use formula but also dont want to let him down if he needs more.

Think best advice I was given is to trust your instincts.
I was also told to eat cake, most enjoyable piece of advice I've been given, not sure quite how it works, but assume makes your milk more calorific and you a happier lady(well it did for me!)
I've been told by health visitor not to try to do too much, a couple/few duvet days were suggested where you spend the day at home, feed baby lots and only venture to kitchen for food and lounge for some tv whilst baby feeding! I find my baby feeds better if I watch tv, think very little to do with him liking grand designs or location etc, but related to me chilling out and him just Drinking away all relaxed? Think yours health visitor sounds very supportive, enjoy, I've met nursery nurse at our local clinic who seems to be totally unsupportive of BF, which seems a shame,especially when people with queries geniuinely want to feed their babies this way?
Just a final thought, does your baby end a feed by falling off the breast and for the last bit doing little fluttery feeds with big gaps between? Apparently this is when they are on desert, having the hind milk, I made mistake initially of thinking poor baby was just messing about, when apparently not getting his 'afters', I'd have been feeling miffed if in his knitted booties?

Sorry for giving poor advice re: hind/foremilk. I was just passing on what I had been told. What I had read was that the foremilk was more watery because while it 'sits' in the breast, the fat sticks to the ducts creating a 'skimmed milk' effect. The milk that follows once this has been emptied has a higher fat content. It would seem logical to me that this milk would have a higher calorie content. However, whether this is true or not, expressing the foremilk before feeds is additional faff that no breastfeeding mother needs.

Could it be that your son is getting too tired to feed enough? This happened to DS and it can turn into a vicious circle. I ended up having to supplement his feeds with expressed milk, which is a pain, but worked for us. However, his weight situation was pretty extreme, so maybe this is not relevant to you.

I honestly think you are worrying over nothing and you would be mad to give formula. It sounds like you have plenty of milk and your baby is a good, efficient feeder.

We are desperate for babies to gain weight and be fat and then once they get past the age of 12 months or so, desperate for them to be slim toddlers. The beauty of breastfeeding is that your baby knows what he needs and unless he is fed to a schedule, he will take exactly what he needs and no more or less.

It sounds as if he is doing really, really well. If it would set your mind at rest, see a bfc, definitely.

"It seems wrong to me because i understand his centile ought to be determined by heritance...his Dad and me are both well above average height and are not slim!"

Of course your genes are important here, but it's not quite as simple as that. My friend and her DH are both of average height and weight but have had one v small baby and one v large one! And a small baby can turn into a larger than average child or vice versa.

If your DS has been gaining along the 2nd centile for the past 7 weeks then I think the chances are this is where he is meant to be at the moment. But of course you should seek help if it will put your mind at rest.

I expressed milk for about three months due to latch issues so got quite familiar with the consistency of BM! Have to say I never noticed much of a difference between FM and HM after the first few weeks of thick creamy yellow "gold top". From then onwards, if I leaked or first few spurts it was very very watery but then it just sort of looked like semi-skimmed milk all the way through (I was expressing about 5/6oz per boob at the time so going from totally engorged to empty)

You may be worrying unneccessarily, I suspect like many aspects of pregnancy, birth and breastfeeding the ratio of FM/ HM differs from mother to mother and not everyone follows the same pattern.

I agree with mumof3kids on that - dp & I are both taller than average & slim, but dd1 spent her first year around 25th for height & 98th for weight. Dd2 seems to be doing the same. Dd1 has ended up tall & slim, but seems like my babies start out short & fat! My friend is doing her Phd on the role genetics play in determining stature & failure to thrive.

mrsred i think that might be the best thing for him at the moment, to just relax and feed for a few days and give up on trying to do anything else or trying to feed according to any particular rules. It might not change anything other than giving me a bit of reassurance about responding to his needs.

RingEir don't worry, there's so much conflicting stuff out there about BF, and so much advice given on "authority" it all gets very confusing!

Thanks for the reassurance everyone else. I might well be worrying unecessarily. I suppose I'm one of life's pessimists and think that kids have enough to contend with without starting out undernourished! I'm also the first person in my family to have tried bf-ing so little support/advice from that quarter, amd have become used to seeing big chubby FF babies.

If he's been following the same centile line since 2 weeks then that sounds absolutely normal to me. Babies are often born bigger (Especially if overdue! Or in fact the fluid issue as your HV said.) and they then "catch down" - that's why the centile lines themselves don't actually start until 2 weeks, because there are so many different growth patterns they can have, and almost all sort themselves out.

Breastmilk is thinner in consistency than cow's milk, or formula. So don't be comparing it to those or you will worry :)

Are you very busy during the day? The early weeks a complete blur to me now (DD is 32 weeks). But she definitely demands more if we are at home, and a lot less when we are out and about. I think the longest she can go between feeds is 5-6 hours when out. But she's usually 2-3 hours when at home.

Maybe if you are out a lot, then she's feeling a lot less? Also I do agree 6 times is very infrequent for a 9wk. I think I'm doing 7-8 times a day and I'm feeding a 7mo who has 3 meals a day on top.

If he's sleeping through 7 hours a night, asking for feeds in the day, gaining weight and is happy and alert then it sounds like you are doing a brilliant job and have a text book baby to me!