Feeding 9mo on demand

[BuffyFairy]

Hi,

Dd had her 8-12m check with HV yesterday who seemed aghast that she was getting 6-9 bfs a day. The HV told me that dd is dropping down a percentile because she is having so much breast milk and that I really ought to start dropping day feeds especially as I'm going back to work in 2 months.

We've been doing blw with dd and admittedly I don't think she eats a lot but it is hard to tell. She tastes everything and seems to enjoy it so I'm not worried. I thought that was ok and that any shortfall would be made up by bf?

She hasn't lost any weight just slowed the weight gain. Dropped from 91st to 75th percentile so not exactly wasting away! She's now in proportion with length and head circumference. I put that down to being more active rather than having too much breast milk.

In general she has

Bf on waking
An hr later breakfast
Bf after clean up

Nap

Lunch
Bf
Snack
Bf
Nap

Dinner
Bf before bed

Some days she might have a bf before dinner especially if it takes a while to cook. Or she might have one with a snack or whenever she asks.

Do you think it's ok to offer these feeds?

I really wouldn't worry. In my experience BLW is regarded with quite a lot of suspicion by a vast range of people and it takes a while for them to accept that the baby is getting everything they need and the food/milk proportions will tip as the baby gets used to solids.

I did BLW with DS and continued to breastfeed on demand until he was 16 months. He started nursery at 8 months and I had several meetings with the manager to discuss BLW as they were so worried that he hasn't getting enough to eat and drinking too much milk. A year on and the nursery had turned into a big advocate of BLW and recommends it to anyone who asks, just based on how they've seen DS develop and his relationship to food :)

What you are doing sounds fine. Your HV is wrong and obviously needs some re-training if she's giving out info like this. At 9 months your DD should still be getting the majority of her calories from breastmilk. You are doing a great job :) and you can certainly carry on BF once you return to work if you want to.

Breast milk is much higher calorie than most solids anyways isn't it? Which is another reason the HV is talking nonsense.

Buffy, I think this is a simple matter of the HV thinking breastfeeding and formula feeding are the same, and interchangable.

6-9 full formula bottles over 24 hours for a baby of 9 mths would be considered too much.

It's perfectly normal for a breastfed baby however, and her weight and growth should not giving cause for concern (because the fall of one centile is normally within normal limits in a healthy baby)....ask the HV if you can have a better explanation of why you should change things.

yes, of course it's ok! My HV asked me over and over again how much formula my ds was having at his 8 month check, because he should be having 500mls a day, or something. every time I said 'none, because he's breastfed', and a bit later she would say something like 'well, as long as he's not having much more than 500 mls of formula every day'. I think they just don't see it that often.

My DS ate barely anything and drank loads of breastmilk until he was about 11 months. I went back to work frantic with worry that he'd be starving and miss me all the time, but he'd nibble a bit of food and just wait for me to get home then bf all night. He seems alright, 3 years later.

I think up to 1 they should be breastfed and supplemented with some food, gradually building up so that from about 1 year old they are getting lots of their calories from a varied solid diet but with breastmilk as part of that diet. Does that make sense?

I think bf on demand is fine but if you are planning in going back to work and are not planning on expressing it's a good time to start thinking about dropping sone of those daytime feeds.

I'm back to work in a few weeks and we have dropped 2 BFs so far. Another one to go. I plan on bf morning and night once I'm back at work.

DD was bf 6:00, 9:30, 1:00, 4:00, 7:00 (bed) and 10:30 (dream feed)

We dropped the mid morning first, then the lunchtime feed. I substituted the mid morning feed with a little yoghurt and sone formula. At lunch DD has water with her food.

Dropping feeds was surprisingly easy for us. I am not ready to stop completely yet though...

Thanks for all the replies. I feel reassured now

I'm planning on expressing when I go back to work. From experience dd will take a little milk and then make it up when I'm home. It's hard to work out feeds to drop iyswim as dd changes her wants every day. What I posted is more or less what I offer. Some days she'll refuse some of those, some days she'll ask for more feeds. Find it harder to look for cues as she's busy playing so I tend to offer rather than strictly on demand.

I wasn't prepared for the HV to say these things as I spoke to her when dd was 7mo and she was very enthusiastic about blw 'keep offering lots of different foods and she'll get there in her own time' and breast feeding 'night feeds are par for the course' so it was a bit of a shock that she seemed to have changed her tune. Wish I could remember Truthsweet's posts about calories from milk and calories from alternative food to quote back to her.

She kept using losing weight and dropping down the percentile graph interchangeably (sp) too. It's not the same thing! Dd has gained weight, just a bit more slowly. It does worry you when they says things like 'your dd will continue to lose weight if you carry on breast feeding so much'.

The conundrum (sort of....) is that breastmilk is more calorie-dense than many foods, but not all. But if a baby has (say) 1 oz of breastmilk and 3 oz of pureed carrot then he's taken in the same amount of calories. No one knows how many ounces a bf takes in and this can perturb under-confident HVs.

It is easy for a bf to have an ounce of breastmilk. It is unlikely that a nine-mth-old would eat 3 oz of carrot.

The info that we have about breastfeeding amounts shows that healthy, thriving babies can take in anything from 0 (yes, zero) to 240 g (about 9 oz) www.pediatrics.org/cgi/content/full/117/3/e387 at any individual feed. If a baby is being offered breastfeeds on cue, then we can trust he is getting what he needs, alongside an increasing repertoire of solid foods after about 6 mths.

Breastfeeding on cue is a good thing for a baby still getting used to solids and their variety of tastes and textures, as they can use bf to make up any gaps in calorie intake.

The risk with restricting breastfeeds in a baby of this age is that you're taking away something good, nourishing and calorie-dense in the hope (not certainty) that they will make up the gaps in calorie intake with solid foods....and they may not do this.

It is well within normal for a baby on a very high centile to drop a centile or two - unless there is some other reason to worry, then it's not normally a cause for concern, and your HV should be challenged on why she is raising it with you.

You're saying that the HV mixed up 'losing weight' with 'dropping down the chart' and talked about them as if they were the same thing?

That's actually pretty poor professional practice. The clinical profile is quite different.

I think she should be challenged on that, too. Be brave!

You rang BuffyFairy?

This is my usual spiel on calories from complementary foods & BM :-

6-8m need 130 kcals of complementary foods and 485 kcals from milk (approx 650ml of bm at 75kcals per 100ml) total 615 kcals a day

9-11m need 310 kcals of complementary foods and 376 kcals from milk (approx 500ml of bm at 75kcals per 100ml) total 686 kcals a day.

12-23m need 580 kcals of complementary foods and 314 kcals from milk (approx 420ml of bm at 75kcals per 100ml) total 894 kcals a day.

Full details here on page 18. Pleae note that there is different values for industrialised/developed countries and developing countries. I have listed the industrialised/developed countries figures.

If your HV says something along the lines of 'Well the WHO is not really for the UK it's for poor countries so we don't follow WHO guidance in the UK', this guidance is specifically split between developed (i.e. the UK) and developing (i.e. 'poor' countries) in the recommendations for calories coming from BM & complementary foods. She may find it interesting read (hopefully!) but don't be too hung up on the ml amounts as it's just really a guidance not absolutes (i.e. if a 10m baby is only on 1 bf a day and isn't taking any formula then there is pretty much a guarantee they aren't getting enough BM as it would be difficult to have 1 bf and drink 500mls!).

Also agree with tiktok, 'losing weight' and 'dropping a centile' are very different things and it's worrying a HV doesn't understand the difference between them.

Losing weight is well actually physically losing mass (and is generally a sign that baby isn't/wasn't well or something is wrong with baby in some way or the baby is consuming insufficient calories to continue growing for what ever reason).

Dropping a centile just means the baby hasn't gain as much weight as is needed to maintain the centile line they were previously plotted on which is no big deal as babies growth isn't always linear and it may just be too frequent weighing or baby may just be 'catching down' to the centile they should be on.

Yay TruthSweet! thanks for posting that again. Can you tell I'm a lurker

Thanks tiktok for the information and the link. It made interesting reading. I'll bring it up with my HV. I think some of them aren't quite sure what to make of older babies still breast feeding. Not that 9m is old.

She did say dropping a percentile followed with 'continue losing weight' so definitely mixing it up. I was expecting dd to drop a percentile at some point. She's always been one of those gloriously plump babies

It's great that forums like this exist. If it wasn't for lurking on these threads and kellymom I might have given up breast feeding in the difficult early stages. Thanks to all the informative posters I found help on here and could ignore my GP's useless advice of 'just put her on formula'.

Buffy - glad to help. Lurking is good and so is posting Congrats on getting to 9m