Advised to supplement by hv? Your words of wisdom please...

[winterland]

Evening all. My baby is 10 weeks old today. Exclusively breast fed. She feeds 2 hourly through the day, sometimes 3. Sleeps through from 11 to 6am.
At birth she weighed 7lb 1 . She dipped and then by 6 weeks she was 8lb 3. Had her weighed today and she has gone down to 8lb but grown 2 cm in length. So in a month she has lost 3 oz. she does look very skinny but then, so are her brother and sister.

Predictably the hv has told me to start following each bf with formula. But won't this affect my supply? I absolutely do not want to give up bf, or supplement at all really but not sure what to do. She does have a very minor tongue tie which she has been referred to the hosp for but not sure of this is relevant?

Any words of wisdom? The hv is ringing me tomorrow to find out my decision....

I would explore other options first and ask advice from a breastfeeding helpline.

Did your HV talk to you about switch feeding? Or waking in the night to feed? I think these may be other options to explore rather than going to formula if you feed you would rather not.

Hope someone with some expertise comes along soon. Congratulations on your baby.

Thanks Humphrey, I haven't heard of switch feeding, I'll google it..

Agree with waking her for a feed. I had similar issues with my own DD and so I put her on a 3 hourly schedule in the daytime, and gave her a dream feed too. She's never been a big girl but dropped from 50th percentile at birth to somewhere in between 25th and 9th. She's now on 25th and has been there since she was approx 13 weeks.

The tongue tie could well be relevant. How's her latch?

Is pumping an option for you? I've heard BFing mums say that their supply is poor in the evening. Maybe pump in the morning and give that extra milk as a top-up in the evening, if she will take a bottle?

A friend of mine had a DS who is on the 2nd centile and has always been EBF. She points out that her DH (father of her DS) is on the 9th centile for adults and so she's not too worried :)

is there any possibility that the scales could be wrongly calibrated?

If you dont want to introduce formula (I didnt as my DD dropped from over 50th centile right down almost to the 9th in her 1st 3 months (but never "lost" weight) I would add in a night feed too.

(she is now 8m and on the 75th centile.... since 4m she has gone up the chart each time)

Winter, I can understand the concern. Here are some things to discuss with your HV:

• is the weight accurate? Are the scales trustworthy? Has the weight been recorded accurately? Has metric to imperial been done accurately?
• what explanation is there for the apparent weight loss? Is there any other possible reason other than the need to feed more often? is it urgent that your baby gains/regains weight? Or can you try feeding more often (she is not feeding very often - probably no more than 6 times in 24 hours, and she could feed at* least twice as often without being thought of as feeding 'often'), and other measures to increase her intake without formula? A week's intense extra breastfeeding might be a prospect your HV would think worth trying, unless she thinks there is an immediate health issue.

I have to say this is an odd weight pattern. She gained ok between the age of 2 weeks and 6 weeks (I am assuming she reached birthweight at about 2 weeks) and then lost over a period of four weeks....not staying the same, but losing. Healthy babies of 10 weeks don't usually look 'skinny' and I don't think it matters she has grown 2 cm in length - she needs to grow widthwise as well :) and the fact is she is longer and lighter is not good news.....if the weight is accurate.

Sometimes, third (and subsequent) babies are laid back and 'easy' - they are entertained and loved and get attention from their sibs, and if they are born with a relaxed personality, they learn not to be too demanding when it comes to feeds....and you have to take the initiative and 'make' her want/take more. I have no real research evidence for this, but I have seen it with third and subsequent babies in busy households several times.

What do you think?

I agree with tiktok.

And I would not give my baby formula, I am dead against it, I would offer feeds more. My dd had reflux and barely ate solids until 10m, before it was diagnosed my hv suggested I give her cream in her meals just so she would gain weight. I did not and she is perfectly healthy. She just never did get to that podgy stage they ofter get before they get on the move.

Trust your insticts....what do they say to you just now?

bramblina, sorry, I don't think you do agree with me :)

I think there is a worry here, or a possibility of one, and the OP needs to do more than trust her instincts - she needs proper discussion and support.

Hi all, thanks for your feedback. I am quite worried.

To answer some of the questions. - the scales where correctly callibrated, in fact because of the loss she weighed on two different sets and we took the average of 6 weighs-8lb. She did suggest waking to feed which I'm happy to do. I now worry that she has been sleeping though because she is to listless to wake.

But although skinny, she is alert, active and happy. She is semi satisfied after a feed but not for long, give it an hour and shell be back on. I do think pumping might be an idea, if I get a decent electrical one and then feeding her bottle of ebf in the evening. I'll just have to find the time to pump!

I have rung the hosp and they've brought forward her tongue tie appt to tomorrow to see if that helps her get more at a feed. The latch is fine though really and I have no pain etc. although strangely I don't feel that prickly let down feeling I had with the other two.

One thing I didn't think was significant, but my midwife tells me today it might have been was that between my last baby and this one I had a breast uplift op. Now I specified with my surgeon at the the time that I would be having more children and I would be breast feeding, and she said that to do so would be perfectly fine. I would not have gone through with the operation if I thought it might jeapordise feeding a subsequent baby. I have contacted the surgeon and she doesn't think the op that she performed would have any impact on bf.

Now of course I am consumed with guilt that my selfishness and vanity has ruined my feeding my little baby

I don't know what to do but I need to get her on the right track, I.e. gaining weight. I would hate to be the cause of her failing to thrive, so do I give in and formula feed or persevere with pumping to increase supply?

If, after increasing feeds, extra pumping and tongue tie cut, she stops losing weight, then I would assume things are improving, carry on with extra feeds and pumping and keep a check on weight gain. If she is still losing weight however, you may have to ask for your breasts to be assessed, I don't know much on the subject, but I assume a scan of some sort would show whether the ducts have been severed or not.
This might not be able to be rectified and you may have to top up with formula, but I would hold off on this for now, as your surgeon says your op won't have affected milk supply, and the increase of feeds/ getting tounge tie sorted may solve the problem.
Hope it gets sorted, and if you do end up topping up, you should be proud that you tried your best to EBF xx

BTW there is a section on breast augmentation and breastfeeding in 'the food of love: your formula for successful breastfeeding' which might prove to be helpful xx

winter, in your recent post you say "She is semi satisfied after a feed but not for long, give it an hour and shell be back on"....but in your OP you have her feeding 2-3 hourly in the day (and not at all at night). Could it be that her laid-back personality (see my previous post) has allowed her to tolerate not being fed after an hour, when you say now she would take it? It's good she wants to feed again after an hour.....this is the way to go to increase her intake. Was the HV ok about you doing this, and then reassessing later, rather than just using formula?

If she feeds often enough, your milk-making and storing capacity is irrelevant (have no idea if your breast op could have affected that, but if it has, it doesn't mean you cannot fully bf, it just means she feeds more often :) ).

I think you need to try feeding her a lot more often?

Must have got my words mixed up, say she feeds at 6am, for about 30 mins. Then again at at 7.30 for 15 mins. Then school run then feed at 9.10 for 30 mins or so. Then again at 11, 1, 2.30, a top up at 3, then 6, 8, 10, 11 and bed!

Sorry should have added the hv has given me 3 days and then we weigh again. If no gain she will 'strongly advise me to stop bf'

So no feed between 11 and 7? Thats an awfully long time. When my DD was refusing to gain weight I was told an absolute max of 2 hours between feeds even if that meant waking her. I also had to try and keep her feeding for at least 20 mins i may have let her go three hours at night time though

OK - three days of intense extra feeding, inc feeding at night, making sure each time both breasts are used at least once and possibly twice, plus breast compression should give you a result of at a minimum a cessation of weight loss.

Even if it does not, you don't need to stop bf, whatever the HV says. Formula does not have to be total, or permanent.

Keep us posted.

i'd go for the tongue-tie snip.

So wake to feed, tongue tie snip and hourly feeds through the day. Thanks all.helps a lot, particularly with the hv. I'll be sure to report back...

I just wanted to give you some reassurance about top-ups not having to be forever.

My ds was very very slow to gain weight during the first 10 weeks and in the end I followed advice and topped up after every feed (with 2oz after each feed). I also hired a hospital grade pump for a month and pumped like crazy to boost supply and to enable some of the top-ups to be with breast milk.

He rapidly put on weight (over 2lbs in 2 weeks!) and quickly started to not want all of the top-ups offered. It was almost as if he just needed a boost to gain some strength to feed properly and sleep (he wasn't sleeping at all, probably due to hunger). He is now 7 1/2 months and I've slowly weaned off all top-ups and breastfeeding is going really well (there is info on Kellymom on how to due this gradually, providing the baby continues to gain weight).

I think my main realisation (with thanks to Tiktok and others) was that top-ups are sometimes necessary and shouldn't be seen as 'the enemy'. If a baby isn't thriving, they just need food regardless of where it comes from.

Hopefully you'll quickly turn a corner and see the benefits. Good luck!

Thanks Pixie, I know you are right and I've nothing against formula, I just assumed it would never be an issue for me! I'm going ting not in the morning to hire a pump and get started...

Deffo get the tongue-tie sorted.

something i've thought from the scales thing - just because they weighed the last weight several times on different scales - the weight before that might have been wrong.
(and quite probably was)
because the baby had gained, noone thought about checking the accuracy of those scales.

I think the HV is a bit unrealistic about weight gain in 3days.
He might gain a little bit, but it's probably not going to be enough to satisfy your HV.

(my friend had a similar problem - the baby gained a couple of oz in so many days, and the MW said "that's not good enough" )

I also want to say - if no weight gain, but no weight loss then you should tell your HV you're happy with it.
It can take a while for the baby to get back on track.
In fact, I would ask your HV to wait a week rather than 3 days. to be realistic about it.

and just keep feeding.

oooh, is he falling asleep during a feed?
if so, gently wake him up to continue- sometimes you think they're done, but if they're asleep, they've probably just forgotten about it.
With DD, I used to stroke her behind the ear, or blow on her face, or rub her hand. It would wake her up with a start and then she'd start greedily guzzling again.