Breastfeeding. Worried about underweight 6 week old breastfed baby by anorexic mum.

[DH2R]

Doc has just decided we need to "top up" with forumula because for the first time our baby has dropped down below the bottom centile on the weight chart (in the red book).

She's been doing OK, a little low, but OK, but today's weighing unexpectedly was very similar to the one she had about a week ago. (6 weeks old, she's now almost exactly 3kg).

We're super keen not to use formula at all - for the usual reasons.

The complexity with this is that DW has anorexia (well, she's 'recovering'). She claims she's eating 1600 calories a day, so I'd guess it may be a little less than that. She looks well - not drawn like she did a couple of years ago - but it seems to me that at her weight and height 1600 would be her baseline for normal life - and breastfeeding (I read) adds another 500 daily to that.

But also everything I read suggests that DW's food intake has little or nothing to do with breastmilk quality and quantity.

We're doing all the right things and milk seems plentiful. We're co-sleeping, getting lots of skin to skin, feeding on demand. Baby seems fine in herself.

I'm suggesting to her that she massively increases her own calorie intake for a few days to see if it has any effect - but she's not keen because of the current thinking saying it's pointless:

www.kellymom.com/nutrition/milk/change-milkfat.html

But equally is super anti formula topups.

Sorry about the essay. Stressed.

Upshot is... do we do as instructed and top-up, or for a trial period try bumping up mums calorie intake?

The latter seems harsh to baby, why risk it when research says it won't work and she may be going hungry in the meantime.

Dilemma!

Any alternatives? What about topping up with pumped "hindmilk" in a bottle rather than formula?

Help!

Thank you!!!

I just saw this but don't have time to answer properly. However, I think you need to get good advice from trained staff on a helpline. See here.

They will be happy to help you.

:(

Diet and intake don't have an effect on breastfeeding and breastmilk, but this is not the case with genuine starvation. Sometimes, women with anorexia are in starvation mode - only you, your dw and your doc could make that judgement.

It's also not possible to say whether your baby needs extra calories but clearly your doc thinks so - and the easiest and most efficient way of supplying these would be to breastfeed more often using at least both and possibly three or four breasts each time (switch nursing) along with breast compression (google it). You don't say how often your baby is bf at the moment - maybe she needs to be offered more than she is 'demanding', which can be the case with very small babies, who need encouragement to feed more.

Yes you can top up with expressed milk, but this is in addition to the extra feeding etc.

Do you have a knowledgeable health visitor you can discuss this with?

If your baby's need for extra calories is urgent and affecting her health, then temp supplementing with formula might be a sensible option - but it's worth discussing first. Helplines are good, but this is bordering on medical and they cannot really help with that. They will outline your choices and signpost you for further help, though.

It is worth remembering that temporary top ups don't have to mean the end of breastfeeding. I did it for a couple of weeks when DS was new, went back to ebf still bf now he's a whopper 17mo.

You need to speak to someone medical who knows about breastmilk.
Your GP isn't always the best answer.

I would probably say that making your DW eat more calorific food (not necessarily more food in quantity, but more with calories in - so butter instead of low fat, full fat milk, etc), and do the switch feeding that tiktok suggests.
When baby's finished on one boob, switch it, and then do that again. - that will tell your DW's breasts that they need to produce more milk, and they should do.