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 meant she - i don't know where I got he from

Also consider the weight of her before and after a feed and before and after a wee - a full nappy could weigh about 3oz. My sister went through this with her DS and questioned the weighing naked thing with her HV and she agreed that yes, its probably more accurate to weigh babies with their nappies ON, as long as it is always done that way.

Good point pippinella - the normal variation in baby's weight before/after wees/poos and indeed possetting, is one of the reasons why frequent weighing does not give clinically useful information. You need to get a trend and so good practice is not to weigh more often than once a month, at the most, with a baby under six months. It's no better to say 'always weigh with a nappy' as nappies themselves differ in weight between brands and sizes.

If a baby is thought to need weighing more frequently than once a month, then the fact that this might not be accurate has to be taken on board, and the whole baby assessed. That's why I noticed the OP said her baby was 'skinny' - that's not usual in a baby of 10 weeks old. A baby whose weight was static per the scales but who looked plumpcious and whose mother reported needing to use bigger clothes is a different kettle of fish from a baby whose weight appears to be less per the scales and who looks thin.

not wanting to soil the debate, but DD looked skinny at that age.
she didn't start getting the cankles and armwrists until about 13-14 weeks.

Hi all, do I woke her twice through the night, fed at 2 and 4 then again at 6. She did keep dropping off though. I'm picking up a double electric pump shortly and I rang the gp to expedite the tongue tie snip. I am worried about her though. I've had to wake her every time for a feed today. She's had hardly any wakeful periods today. I reckon if I hadn't woken her to feed she would have slept all day so far? Having said that she's feeding now and has been for about 20 mins. Tiktok, what I mean by skinny is that her elbows and knees are far wider than her limbs, if you know what I mean, you can see her ribs and her neck is tiny. Absolutely no 'flesh' anywhere.

To clarify: most skinny-but-healthy babies of this age are indeed ok :) But it's unusual enough to warrant checking out and monitoring, and ensuring that the baby gets plenty of opportunities to take in more milk.

If she keeps falling asleep, I found moving DDs arm in a front crawl swimming motion quite effective.

TBH if she's not waking at all for feeds, and is as skinny as you say I would be seeking professional advice NOW. Don't wait for your HV.

I am not an HCP but a breastfeeding counsellor - so I would run a mile before actively differentiating in individual babies between the skinny-but-hale-and-healthy and the skinny-and-really-underfed and the skinny-and-would-certainly-benefit-from-more-milk. It's beyond my boundaries.

The research shows that most 'underweight' babies are fine, though they do tend to look skinny - but guidance is that they should be checked out, to make sure the underweight is just physiological (ie how these babies just are). The usual rule for checking out is a baby who has crossed over 2 centile lines, and/or a baby who appears to have lost weight. Both those apply to your baby, and she is being checked out, and being given the opportunity for more milk, which is sensible.

The persistent sleepiness needs to be reported if it continues, winter; a tired morning as a one-off is not worrying, I would say, but if it carries on, you can speak to the HV.

yes, definitely keep an eye on that sleepiness -that's one of things they class as failure to thrive.
If it's just today, it should be fine, but if she doesn't have any wakeful periods, you need to tell the HV.

keep a record of everything she does - how often she's awake, how many times she has a "play period" (hard to judge at 10weeks, I know! - but it's looking around, smiling, gurgling, maybe, etc), how many poos, how many wees, how many times you feed her, when she possetts, etc.

you're still expressing when you can i take it?

maybe you could offer her some of that in a bottle after you've BFed her - then you can see if she's still hungry?

The sleepiness today has got me more worried tbh. I had to wake her for every feed. However she's been perky for the last couple hours. I fed her at 8 for about an hour then I gave her 3 oz of ebf that I'd pumped later. She took the bottle really well and looked like she could have had more.

The problems me, isn't it..

winter, is there someone you can call to talk about this?

Hi tiktok, the hv is coming at 1. I pumped this morning and only got an ounce. I beginning to think I'm going to have to abandon the bf. and I NEVER thought that would be something I'd have to do. I bf the other 2 exclusively for a yr. I feel I'm ruining her little life so far by making her grumpy because she's hungry. And that's not fair because she is a happy little soul when full. I can't believe I've got through all the pain and hardship of early bf to find that physically they aren't working. My only hope is the tongue tie thing I reckon. I've no idea why the pumping isn't working either, it's just so frustrating. Time is an issue too, maybe I need to spend more time expressing but with two other children , school and nursery etc it's really hard..

you really really really need to talk to people in real life.

please find a local bf clinic/peer support group.

type into facebook "la leche league" and your local area. you should find a group you can go to.
or ring your children's centre and ask for a group.

and not everyone can pump, either.
i have a friend who bfed 4 babies and she used to get trickles when she tried to pump.

get real life help. :)

winter, so sorry you are feeling down and disappointed about all this.

I absolutely agree you need to speak and see someone knowledgeable in real life about this - prob in addition to the HV, whose previous interventions and suggestions indicate she has not much to say except 'give formula' .

It's not possible to draw any conclusions from your expressing yield - some women find the pump works better than a baby and some find it works less well and even hardly at all.

In the absence of any other symptoms, then it's likely your baby is basically healthy but yes, does need a bit more to eat.

It may be that she managed ok for the first weeks, coasting on the generous-enough supply many women have at first, but her personality was such that she did not 'insist' on sufficient feeding after that to really establish a good supply. The fact that she went through the night from a young age and was happy enough feeding 2-3 hourly only in the day are not great signs - and there are other ????? like your breast op, her tongue tie. None of this would matter if she was really gaining, but the evidence from the scales and her appearance is not great either.....but it does not mean you cannot rescue the situation.

That's why I say to speak and see someone who has the knowledge to recognise any clinical implications, and who can work with you to breastfeed. If formula is needed, then it need not be 'all or nothing'.

Well the hv came at 1 as I said. We weighed her, as I was hoping for the same or a tiny gain due to the expressing. But she's lost again, now just under 8lbs. So the plan of action is obv tongue tie snip, expressing, hv said feed two hourly plus formula after every feed. Despite my reluctance to ff, having seen that drop on the scales again I need to go for the mixed feeding, and hopefully after the snip I might get exclusive back. The hv confirmed my worries about her appearance and confirmed that she is indeed a bit thin. Her rib cage is and bone. So thank you all for your helpful comments so far and I'll keep you posted..

Best of luck getting things sorted. :) If you contact NCT or LLL then you'll be able to get someone to support you through all this and provide information.

Thanks for the update, winter - I think the continued loss is worth taking seriously, as you'd have least expected her to stay the same (though of course we have to remember that precision weighing with babies is never possible).

I think formula at every feed is probably justified to stop the downward trend, for a short time only, alongside frequent bf to maintain the bf, and yes, the snip for the tt.

Lets hope this saves the day and you can return to full bf as soon as poss :)

Thanks all for your comforting words and tiktok you've been a bloody star. Great advice as usual. Thank you to the super help full pm's too, you know who you are. She's had a 30 min feed and now guzzling a 5 oz bottle as we speak. It breaks my heart that I'm not enough but great to actually 'see' some food go into her...

:)
Sorry she's lost again.

keep expressing as much as you can.

My friend's DS that I told you about, is about 70% formula, as well as BF and expressed milk.
I think my friend BFs first, then tops up with expressed milk, then with formula.

She did say last night that he's getting more breastmilk directly now (he's now about 5/6 weeks, i think), and he's getting enough not to finish a formula feed.

oh, my friend is expressing with an electric pump while she's bfing (ie on the opposite boob) - it means she doesn't have to spend all day providing milk!

and she's able to make the most of the letdown.

Arghhh she's starting to refuse the breast completely because it's clearly easier to get milk from the bottle. I don't know what to do!

oh no

do you have RL breast feeding expert people who you can call or even see?

well done by the way... i really admire your determination

you could try a bottle with a more difficult teet - one with smaller or fewer holes.

You really do need to talk to someone IRL.

how soon after do you do your top-ups?

plus the weather is really hot now, so it might be that she feels too warm snuggling up. I find DD is more comfortable when she's not against my bear arm - put a long-sleeved teeshirt on and have a fan next to you maybe?

and ring LLL