Low weight baby - bf to schedule

[TeacupTempest]

DD has dropped below bottom centile. She is 7 weeks. We had been bf on demand.

After being checked out at hospital they could find nothing wrong with her or my milk supply.

We have been sent home with instructions to stop feeding on demand and to start feeding every 3 hours for a max of 20 mins...

They say on one hand she isn't getting enough calories as they say she falls asleep on the breast ( she does as she also comfort suckers but this is at the end of a feed or an additional visit to the breast) on the other hand they say she is expending too much energy sucking for so long.

Seems very contradictory as an explanation.

The advice seems counter to how I want to parent. I feel sick having to take my tiny baby away from the boob and for so long.

I have been to a local group and they said my latch and her feeding were good.

Lost.

Have sent you a PM

I would speak to a breastfeeding support group. If baby wants to feed all the time then she should. No way makin her wait for 3 hours is going to help! Sounds like u had it everything right before hand. If she's gaining at each weigh in then that's fine those charts are only averages and some babies are at the bottom and some at the top! Of she's feeding well, happy and alert and lots of wet nappies - sounds like a happy baby!

Also 7 weeks is too young to be worrying about routines an making her wait for feeds etc. sounds like u got some bad advice and everyone on here seems to think u were doing great in the first place

3hrs between feeds for a BF 7wk old seems an awful long time. I do question how much some health professionals know about BF, even a paedatrician.

Kellymom and LLL are great sources of advice, you can email LLL and one of their advisors will reply back very quickly. I found them much more knowledgeable and sympathetic with my problems with tongue-tie and mastitis than most of the health professionals I dealt with.

Has your baby been checked for tongue-tie? It can make them less efficient at getting milk from the breast? My baby was really inefficient (poor little man) until his tongue tie was snipped.

Also, do you think she's getting the fatty milk which is at the end of a feed? If she falls asleep before getting this, she could be getting too much foremilk. You don't have to wake them up entirely, just rouse them slightly and they tend to dream feed with little fluttery sucks which will extract the thicker, fattier milk.

I would carry on demand feeding if it were me, I just think 3hrs is too long and could make things worse, however please consult Kellymom and LLL. My DS is 8 months and BM is still his primary source of nutrition (with small amounts of food) and I feed him on demand, night and day, I couldn't tell you how long he goes between feeds as it varies but I doubt its ever been 3hrs! I suppose I am a bit of an ecological BFer, my HV would say he's using me as a dummy and I suppose he does but its worked out well for us. Hang on in there!

Also, I've heard, maybe from MN (!), that you shouldn't interrupt the fluttery sucks at the end of the feed, they can go on for a while like this so some people might think the baby is asleep and this sucking could just be an automatic reflex so they may delatch... but this is when they're getting all the fatty milk so do not disturb! I've just heard this so don't take it as gospel.

To confuse you more! Fatty milk tends to recede to the end of a BF the longer you go between feeds because its thicker I think. So the more you feed, the more 'mixed up' your BM will be, ie. a better distribution of foremilk and hindmilk. So your baby will get a higher content of fat compared to if she's always waiting for long periods in between feeds. A better argument for demand feeding?

I'm sure someone will come along and explain this better!

Read this article - it is written by a breastfeeding counsellor (unless she is an IBCLC, I can't remember off the top of my head - if you need clarification on the terms see here.)

She's both Bertie but I think she wasn't a qualified IBCLC when she wrote the article (although I do stand to be corrected)

Hi, I'm the husband of TeacupTempest. Have read through this thread.

I have a theory about this feeding routine we're currently on, which is a modified version of what we were told to do.

We (we lol, they!) are switch feeding like this 10mins-10mins 5mins-5mins 5mins-5mins every 3 hours. If she's still actively feeding then doing further 5-5s. At the moment this is usually lasting circa 45 mins total.

She then comes off the breast relatively calmly and seems content with the world and I've actually had some of my best interactions with her during these times.

Then she drifts off to sleep.

Then before the next feed time (which is in fact ~2 hours 15 mins after the end of the last one, not 3 hours as I think some people above had suggested it was) she wakes and sometimes cries a little leading up to the start of the next feed.

Then the cycle repeats.

--

Now I'm wondering if this is actually resulting in the following things (this is just a personal theory):

1. At the point of feed starting, mum's boobs are very full and ready to release a lot of milk very quickly, and easily.

1. DD is very hungry and awake and ready to eat a lot, very quickly, and does so. Getting in a really good feed in the ~45 mins. This takes less effort to extract this amount of milk - it's a doddle for her to get it.

1. DD's digestive system is kicked into action for this load of milk, it processes what it has received, and then becomes ready for the next lot. It does not, need to be constantly ticking over and is therefore acting more efficiently.

Before we were doing this DD did seem to be drifting off to sleep on the boob a lot and I wonder if she actually wasn't in fact getting as much milk as she is now with this regime, and she's perhaps now getting it more efficiently and also getting more, better sleep. If that's true then more milk coming out in total over 24 hours should also have a positive effect on mum's milk supply, not a negative one as suggested by some of you in this thread.

Any thoughts on this theory? It seems to make a lot of sense to me.

(ps. I have a maths/science background - not a total numpty even if i may sound it;)

(pps. just read this to DW and she does not entirely agree with my account of all things exactly.)

Teacup's DH - do you know how breastmilk supply works? If not I strongly suggest you read this which is a comprehensive but concise overview.

Also remember that, in the early days especially, breastfeeding is about so much more than food. It is comfort, it is reassuring, it is familiarity (amniotic fluid tastes similar to breastmilk), it is calming, it is a pain reliever, it helps regulate body temperature. It also induces sleep, which you've probably noticed. Also remember that your baby's tummy is very very tiny. They are meant to have frequent feeds at this age, not just for food, but for all of the other reasons mentioned above. So their digestive systems are well able to cope with being used near-constantly.

Breastfeeding is not logical in the way you would expect, which is mainly because we all unconsciously absorb messages about baby = bottle. Bottles are familiar to us, we understand that they need to be filled and that they empty at a certain rate, it makes sense. When we apply this logic to breastfeeding, though, it does not make sense. Once we understand how breastfeeding really works, (which involves starting from scratch and forgetting everything we think we know!) it is once again logical. But don't make the mistake of going for what you think is the logical solution, if you don't fully understand the process. I hope that as a scientist you will understand the importance of that :)

BertieBotts - I take your point, but remember that this thread was started because the "on demand" way or doing things, for 6+ weeks, has resulted in DD being "of extreme concern" to our GP because her weight is well below the bottom of the WHO weight norm 0.4 centile. My feeling is that we really need to get her weight rising quicker as soon as possible. It's a compromise that has to be made because her health may be badly damaged if we don't do something about it.

I don't know Teacup's DH
How long is she active for before she drifts off to sleep?

My DD is about to be 8weeks (tomorrow) and her pattern seems to go:
feeding for bloody ages (scientific description ), then going off to sleep, or being active and awake.
We can usually get about an hour out of her being awake before she either wants to eat again or fall asleep.

Sorry, my point, not being very well made, is that she is normally fallling asleep as a result of a feed and/or as a result of activity.

I do not think that letting her do the active sucking only is a good plan - if she's sucking like mad at the beginning and then you're switching, it's interrupting the flow for one, and for another, she's getting the easy (more liquidy) milk each time. That feels to me like she's then not actually getting the fatty stuff.

Eg my DD will do fast and furious sucking for a while when she starts, then she will stop for a while, (that's basically just taking a breather and making sure she's swallowing it), then she'll do some deep slow sucking for a while, then she'll go into the pause for a bit, then butterfly sucking, then pausing.
If I think she's drifting off, I tickle her hand, or just pick it up, and she starts eating again - she normally drifts off in the butterfly stage - I like to thinmk of this as the big meaty part of a massive meal - she's eaten all the veg, and now she's onto the main part, but it's harder to eat that, so it takes a while longer, and it seems to be more of a problem.
After she's done all that, she'll drift off.
I have found that she's actually asleep and not resting between sucks if when I tickle her hand I get no response.
Then i let her drop off.

oh, interestingly, you might want to get Teacup to try this too - if you let her drop back a little bit (ie let gravity take her) when she's pausing inbetween the butterfly deep sucks, if she's still feeding, she'll grab back on by doing more butterfly sucks. If she's not resting, she'll just pop off.

please please please please don't ration her feed at this stage
I don't care what the HV said - you will ruin Teacup's supply, and you will make your baby hungry.
She might not show it for a while, but she won't gain as much weight.
All I can say, is the experts say she should drain each breast fully before finshing or starting the nex tbreast (it doesn't mean she has to have both breasts in one session, mine doesn't, because she's still so small, but it does mean that you shouldn't stop the feed on that breast until it's empty. (of, you can tell - after the buttefly sucks, she'll get really arsey and start pulling miserable faces and pulling the nipple like mad!)

Teacup, sorry you're having problems. I had similar problems with dd1 who is 7 now, HV started talking about topping ner up with formula etc, I was so stressed but persevered with bf turns out she is really quite a petite child but has a huge appetite. I have 7 week-old dd now who has only been weighed once the HV this time told me not to bother so long as I was happy and she was happy. when she is awake she is happy, she sleeps well she does have a bizarre feeding routine in the day but does like to have a comfort suck here and there.

We don't weigh children weekly throughout their lives and adjust their diet accordingly so I'm not entirely sure we do it with babies. My advice would be trust your instinct, she is your baby, you know her best, the centiles are based on ff babies. Feed her if you think that's what she needs, like you said surely crying is burning more calories than sucking.

The trouble is TeacupDH is that in the early days, some babies don't 'demand' to be fed- they can be a bit sleepy in the early days or sometimes a less than perfect latch can result in poor milk transfer.

Also- if you read about Feedback Inhibitor of Lactation- you will see that 'full' breasts are not good for milk supply.

I wonder too, was DW doing switch nursing previously? This is the way that is known to increase milk intake.

I don't know how it fits with limiting feeds, but as I understand switch nursing is considered a valid technique for both increasing supply and getting more milk into a sleepy baby. Also, have you come across breast compressions?

Hi there TeacupDH it is so nice to see such a sop puerile partner, and you have obviously been thinking about this a lot.

Unfortunately, our HVs and GPs (and unfortunately the Paediatricians too) have very, very limited knowledge about breastfeeding and how it works. Your description of your DD's feeding pattern sounds entirely normal. I know Teacup is switch nursing in an attempt to increase her milk supply and increase weight-gain This is a recognised technique, as well as using breast compressions. It is normal for such a small baby to feed for about 40 minute per feed and to request a feed every 2-3hrs toned from the start of the previous feed. So the fact that your DD is requesting a feed 2hrs and 15 minutes after the start of the previous feed is absolutely normal and desirable. Limiting her feeds does risk a decrease of milk supply based in the demand-supply nature of milk making.

All of this does not mean that the GP should not be concerned (after all he/she is the medical professional) just that they do not understand how breastfeeding works

Their regime, I fear is only resulting in an unhappy mum and baby, and will do little to increase weight gain.

So far we know we have an alert, happy (when not hungry ), baby who is weeping and pooing well, requests feeding about every 2 hours in the day and has a good, comfortable latch with a active drinking at the breast and a mum that is actively aware of positioning and attachment, is switch feedi g and doing breast compressions.

Baby had an initial loss of just over 10% (which wasn't flagged at the time) but has been gaining consistently every week since then (about 3 oz IIRC?).

So far, there is nothing that screams alarm bells to me.

Other than the slow weight gain did the doctors have any other concerns?

Please excuse what seems to be a terrible insult I really do need to check before posting. My typing is atrocious and autocorrect vicious.

I did not mean puerile I meant 'so supportive'

Hi TheRealMBJ, thank you for the reply.

Sorry, I didn't explain very well. What I described is the routine we've settled on as a compromise between what we were doing and what the doc told us to do. We are now, after doc advice of 20 mins max every 3 hour, in fact, doing about 45 mins switch/compression feeding, followed by 2 hours 15 mins of enforced NON feeding. Then repeating. Which is a 3 hour cycle as advised, but with much longer feeding sessions.

We're going to talk to the lady you recommended we call tomorrow and take it from there.

"peurile" - Belonging to childhood; juvenile. 2. Immature; childish.

Yep, that's me :D

Cannot add anything to TheRealBMJ's advice, but can I just say

Haxby
Mondays 12.30 - 1.30pm Oaken Grove Community Centre, Haxby, York YO32 3QZ

from the Treasure Chest website

Hope things have gone better today, teacup family.

I agree that it's important to understand how bf works. The only thing that drives production is frequent, effective removal of milk from the breasts.

So-called 'demand' feeding (better termed 'responsive' feeding, IMO) only works if the removal is both frequent and effective. Sometimes, babies don't gain weight well despite frequent bf because the baby has not been actively transferring milk and this has not been spotted. The baby just 'hangs out' at the breast, looking as if there is a whole lot more active feeding going on than is actually the case. Once this starts happening a lot, the baby actually conserves calories by expending very little energy asking for feeding, and may sleep a lot and when at the breast, feed even less well.

Restricting the feeding in any way does not address this issue. Instead, the mum needs to get help with positioning and attachment ; she needs to learn the signs of effective milk transfer so she can recognise when it's not happening; she needs to 'switch nurse' and do breast compressions - both of which keep the baby actively sucking and actively transferring milk and therefore maintaining intake and production.

Breastmilk production is dynamic, and will increase and decrease readily.

MrTeacup - your point 3 about the digestive process is just not what happens.

It would help if someone observed a feed - as has been said - and included in this a check for tongue tie. Feeding needs to be effective - that is crucial.

tiktok what would you suggest if the mum is already paining attention to positioning and attachment, aware of the signs of active milk transfer, switch nursing, doing breast compressions, feeding on demand, getting lots of skin to skin, expressing between feeds and waking baby at night for feeds?

Thanks for the replies. Yep, to echo what TheRealMBJ has said. Teacup IS doing all of those things and has been for some time. She has been observed and others have confirmed she is doing everything correctly. But DD has still been low in weight, and gaining slowly.

--

Against recommendations of some I actually did do a home weigh pre and post feed. No clothes. No nappies. DD increased by 70 grams in 40 minutes.

MBJ- if all underlying conditions have been ruled out (including tt as tiktok suggests)then maybe it is just the case that the baby is just a slow grower?

crikey yy, I was just wondering if there is anything else that can be done, that I'm missing here. I know that the limiting feeds routine suggested by the hospital is not it.

TT would be worth exploring, but teacup will need to travel for that as no one in our area is properly qualified. Or look at this and contact Charlie of Milk Matters.

Thanks for the link TheRealBMJ - reading through now and have emailed them.

Crikeybadger - that's what I am hoping. DH and I are not giants and all DH's family are on the small side.

The compromise your husband has described actually sounds fine! feeding every 2 hrs 15 minutes and then having a really long feed. Importantly you are also doing the switch feeding at the feeding times to hyperstimulate your supply and to also ensure she gets relatively fast flowing milk, so she doesn't have to work for it. You have also been right not to limit her on the breast at feed time if she still wanted more - so in effect you have 'topped-up' with more breast milk, which is great as many women are told to top-up with formula and then do limit the time at the breast.

My rule of thumb if latch/positioning correct was either frequent, but relatively short feeds every 1.5-2 hourly or 2-3 hourly feeds that lasted 30mins to half an hour.

Although growth/developmental spurts can throw it all out.

Hopefully in a couple of weeks she will have got the hang of it and the anxiety will fade away in all corners.

I take it she is a pretty teeny baby?