Does all breastmilk have same nutritional value!!!!????

[lisafredsandcesca]

Hello everyone - my sister has been breastfeeding exclusively since baby born at 8lbs 8oz on dec 19 but he is still only 8lbs and has actually lost weight in last few days. Midwife says not enough milk - but she can express really easily - 4oz in 10 mins. Also, baby filling nappies and has milk in mouth after feeding. But he is feeding for up to 90 mins at a time and still hungry. Sister exhausted and midwife threatening formula next visit. But what if doesn't gain with formula - then have given up breastfeeding for nothing. Is all breastmilk same in calorie/nutrient terms? Am struggling to help her as my two girls have both doubled birthweight before 10 weeks with exclusive breastfeeding. Any advice/thoughts/experience much appreciated. xxxx

The midwife is threatening formula?! What's she going to do? Forcefeed the baby against your sister's wishes?!

Can your sister ring one of the bfeeding helplines? Just on way out so can't get the numbers, but someone will for you or search the archives.

I would say don't bother with expressing - it's no measure of how much the baby's getting.

Feeding on demand and skin-to-skin contact will all help. If he's weeing and pooing and alert when awake, I'd say he's fine. How is your sister finding breastfeeding? If she's got sore nipples, etc, it might be that her latch needs adjusting a bit? But she needs someone who knows about bfeeding to sort this, not a midwife who "threatens" formula

Yes, breastmilk is always very similar in terms of nutritional content and certainly in calorie content. And it has slightly more calories than formula, so I cannot see why formula would help at all. It is normal for babies to lose weight though most will regain their birthweight in two weeks. If this baby is still really losing significant amounts of weight (ie with a proper weighing, naked, same scales as last time) despite very frequent feeds (including overnight) then the midwife should be referring your nephew to a paediatrician, not bringing out the formula. It sounds as if the latch is right, but it is worth checking with a breastfeeding counsellor. Does her hospital offer a breastfeeding support service?

I think in this case, expressing clearly is a sign that there is plenty of milk

is the baby feeding regularly - at least every three hours? Is he feeding at night?

Is the baby being weighed on the same scales each time? And are they proper scales, not cloth sling ones?

Aloha, yes, agree it does sound as though expressing is a good measure that the mum's producing enough - but I didn't want her to get hung up on it or feel she needs to express and feed EBM in bottles instead of breastfeeding.

Shouldn't she be under a HV now, not a midwife? Midwife sounds horrible.

D'you know what - I just think if the baby is fine in all other regards, i wouldn't worry and I'd just carry on breastfeeding.

Ds1 was born at 8lb 4oz and although he put weight on all the time, it was very little and over time he dropped, dropped, dropped till he was on the 9th centile (he's 4.5 now and has somehow worked his way up to the 20th!). He was breastfed to start with, then formula and it didn't make a difference - I think babies just find their own natural weight and size. Some are born small but pile on weight and become big for their age, while others do the reverse. Ds1 is perfectly healthy and bright but he was soon smaller than babies born at the same time at under 7lb.

I just don't think the birth weight really bears any resemblence to their ultimate size iyswim.

Message withdrawn

Exactly what i was trying to say Pruni!

thanks everyone. will try to answer you all at once here - first, baby is fine apart from not feeding and birth jaundice which still persists. Sorry, word 'threaten' is my terminology - not meant to reflect attitude of midwife! She has not been signed off by midwife yet because of weight issue - HV due today.
Baby is ertainlyh feeding regularly and at night - for very long stretches. He wasn't at first but that was days ago now. I think it is same scales but not sure what type. HV may have other ones. Difficult for Gina to get out because of c-section (elective - breech - like both of mine)but will try nct and hospital. huge thanks for all your input. lx

Would strongly agree that:

• switching to formula often doesn't fix this "problem"
• if the baby has a real feeding problem, first stop is a Paediatrician, not changing feeding method.

I had a baby who genuinely was "failure to thrive". Signs:

• some dehydration problems: not enough wet nappies, constipation, dry mouth
• height and weight getting out of synch: went from 50th for height and 75th weight to 50th height and 2nd weight over 4 weeks. So was growing but not putting on weight. This is a different thing to not putting on weight because having a bit of a rest from growing.
• very skinny: no body fat under the skin. If you pick up a FTT baby their skin wrinkles under your hands; their fingers are very skinny like an old woman's; you can see the backbone.

It's a bit early for that sort of problem, but if any of this rings bells, your sister should get a GP to refer her to a Paed just in case - a lot of these cases aren't really a problem and self-resolve, but some can be caused by metabolic disorders or persistent viruses in which case there might be something the Docs can do to help.

Ah, so the baby was sleepy with jaundice and not feeding? That would easily explain the lack of weight gain (though as I said, recovery of birth weight by TWO WEEKS is the ideal and your sis isn't far off that I think). What that baby needed was more BREASTMILK, not formula, and it sounds as if he is now getting it and if he's having long feeds, lots of wet nappies and your sister isn't having pain or cracked nipples (indicating bad latch) then I'm sure he will now begin to gain and you can all relax and never see an HV again. Hooray!

my ds was born 7lb 12oz and took three and a half weeks to regain his birth weight. looking back it seems like he fed almost all the time - certainly 90 minutes was not unusual.

i got in a terrible state but fortunately had a very supportive midwife who actively encouraged me to stick with excl bfing.

ds also had jaundice and the midwife suggested that might have been the reason for the slow weight gain - that he was using the milk to get over the jaundice.

ds is now 7 months and 24lbs, so am confident that excl bfing was right for us.

good luck to your sis - i can vividly remember the stress and distress of having ds weighed and finding there had been no gain.

I am ging to sound a different note here - I think there may well be a problem here, and just carrying on doing nothing different is not an option.

This is a baby who appears to be actively losing weight. That is a sign the baby is not being well-nourished. This has nothing to do with the quality of her breastmilk (which will be fine) and nothing to do with how much she can express....and everything to do with the amount of milk getting into the baby.

Firstly, the weights need to be confirmed as accurate. If they are and this baby is still way off birth weight and losing more weight on top of this, then he needs to be seen by someone who knows what they are looking for. This means a bf friendly paediatrician or GP, or a very experienced and knowledgeable bf support person who can recognise when the mother and baby need more help than she can offer.

If it was me, I would watch a feed, take a careful history or what has happened so far, and I would probably be looking for ineffective feeding....I would ask if he is pooing several times a day and more than just a skid mark? If I could spot ineffective feeding, I'd try to help her adjust positioning and attachment, and encourage her to feed more often....but I would still get him checked out by a doc, because this is the sort of profile that fits babies who are actually either ill or who have some undiagnosed congenital problem (eg a heart defect) where all the calories are being used up in keeping the baby well, with none left over the grow.

I don't think this baby should be left for even one more day without a professional's view.

I don't want to panic anyone, but on the facts you have given here, Lisa, this is not something that should be left alone.

the grow = to grow.

I should add - this baby may be fine, but he needs checking out.

And of course, the feeding needs attention.
It's the loss of weight that is the crucial worrier - slow weight gain can be fine, but babies should not lose weight at all.

But Tiktok, the poster said the baby was NOT feeding frequently until recently - presumably because of the jaundice - but is now feeding frequently and for long periods. It seems very likely to me that the baby being sleepy with jaundice and not feeding is the obvious reason why this baby did not gain weight. And the baby IS being seen today.

And it is normal for babies to lose weight after birth. I agree the losing weight in the last few days is worrying - but not sure from the original post when that applies to. And I did say that if the weight loss continues then the baby should see a paediatrician, not an HV.

Sorry, Aloha, lisa says the HV is seeing the baby today, not a doc. Maybe the HV will refer, and if the baby has stopped losing weight and seems to be on the up, then maybe she will not need to.

Aloha, the baby has lost weight in the last few days.

Of course it is normal for babies to lose weight after birth. But weight loss should have reached its lowest point by 5 days.

Weight gain from then on is a sign all is well. The weight gain can be slow, and even in healthy, thriving babies it sometimes is...but the direction should be consistently upwards.

I stress again, I am not diagnosing anything! I am not even saying there is certainly a problem that's not being addressed in the right way. But weight loss like this should always be a red flag - especially with a baby who seems to be feeding without showing signs of contentment.

i think fear of possible/potential problem is why midwife still visiting. MW did call registrar yesterday who not overly worried as baby filling nappies (properly), alert when awake and no problems with feeding apart from baby not gaining weight (!)and appears hungry even after long feed. No latching on probs or sore nipples etc - I'm still feeding my 9month old so I should be able to tell - he looks fine to me. Bottle of expressed after a feed seems to satisfy more for some reason. How long does it take for breasts to replenish after a feed ready for next one?!

Lisa - the shorter the gap between the feeds, the more quickly milk is made. Milk supply is driven by milk removal.

The breasts are never totally empty, either, though there are times when they are fuller.

I am glad your sis's midwife is taking it seriously enough to speak to a doc and to stay in touch with the situation.

Bumping this to ask the OP if there are any updates....hope your sister's baby is ok?

Sorry for not replying tiktok and thanks for enquiring - going back to work soon so lots to do and haven't been online. g started expressing in quantity 3 times a day and supplementing breastfeed. As result, baby finally put on 2oz in 4 days and it seemed like the heat was off, albeit that G increasingly exhausted. baby still jaundiced so paeds checked everything at hosp this week and nothing wrong. Then, this week, he loses half an ounce. I know that's nothing - possibly the difference between a full and empty bowel. But it's not putting any on is it? So, baby still just over 8lbs (birthweight 8.8)and will be four weeks on mon. Midwife now recommends topping up each feed with 2oz formula - she's right in that he does need to start putting on weight now.

I'm sure if paeds are happy then it's all OK. BUT, I would be watching that weight closely... it doesn't sound to me like topping up with formula is the answer as she is already topping up with expressed milk? Not sure what the answer is though .

Assuming that the loss was due to empty tummy/bowel, the next week should see a marked gain. If baby hasn't gained then I would be wanting to see someone again! Good luck

I'm also not sure why everyone is dismissing the persistent jaundice. It isn't really normal to have jaundice persisting almost 4 weeks after birth. It can be a sign of a slow metabolism and therefore an underlying metabolic disorder, for example.

I assume his guthrie is back and looking fine? Has anyone checked? Although if he had a thyroid problem he would be unlkely to be pooing well and the jaundice would be quite likely to be severe... but I agree completely with Tiktok that perhaps a paed should be looking over this child very carefully and trying to make all this add up. It doesn't, to me, at the moment.

oh sorry, missed the bit where you said the paeds had checked him.

will you double check for me that his thyroid results were back /redone at hospital? guthrie is done at 7 days and takes up to 3 weeks to come back so it is possible that it has been missed.
If he has a thyroid problem (as my son did - no thyroid at all, and picked up because of persistant jaundice, not through the guthrie) then it is VERY easy to treat. If it is not picked up it very very badly affects brain development (IQ), growth and metabolism. The sooner treatment starts the better, and certainly in the first month/6 weeks to avoid damage. Please just double check that this has been looked at?