Poor quality breast milk?

[littlemissnormal]

I have a 14 week old DS who was 9,10 born and on the 90th centile. He is EBF but has not put on a single oz in the past 4 weeks and after previously dropping to the 75th, he is now on the 9th. This caused concern with the HV and we saw a Dr today who is also concerned and is looking into primarily whether he has a urine infection causing the lack of weight gain.

She mentioned that we may have to look at a feeding plan for him to help him gain weight. Selfishly I don't want to give up BF as we are doing so well (I thought) but I will obviously do whatever is needed for DS.

So this evening as well as a normal BF I also gave him 3oz of formula which he guzzled down without a problem. I'm now concerned that it may be my milk that is not giving him enough calories to enable him to put on weight, and was wondering if this is actually a possibility?

And if I'm to supplement breast feeding with formula, can anyone advise on how much formula and which feed is best to give it to him at so my supply doesn't dry up and I can continue to BF him? Or should I just try and give him more BFs in one day and not offer any formula at all?

OP I would second advice to get the latch checked and make sure baby is feeding effectively, also lots of skin to skin and feed feed feed.

Dippy I'm sorry you were made to feel that you had poor quality milk- lots of premature babies especially those born small for dates grow slowly, and their feeds are often fortified to give them a boost. Not because there's anything wrong with your milk!

zzzz yours is a very common misunderstanding. Yes, removal of milk is important to ensure continued production, but 'complete' emptying is not possible - the baby does not ever suck on an empty breast.

The milk from a relatively empty breast - what you are calling 'hindmilk' which is the correct term - is higher in fat and yes, higher in calories, but the baby can usually be relied on to get what he needs in terms of calories if he is fed responsively and is offered the second (or third....or fourth) breast each time (may not take it).

This is what drives the production - frequent removal of milk - and if both breasts are 'used' then volume of milk made is increased. Babies don't need to be taken off the first side before they have indicated they want to stop - this is still responsive feeding.

Please don't tell the mothers who speak to you that they must completely empty the breast, or that foremilk is likely to make their babies fractious, or that foremilk = drink and hindmilk = food. You can read about this at www.kellymom.com which has some good explanationw of how it all works/.:)

yes ticktok as always comes along and explains it better then I can. A a skill I need to work on I think.

A good way of thinking about it is your breast are like rivers not ponds, they are never actually empty. But the flow does change.

Oh wow loads of advice, thank you!

I really don't want to stop BF so I'll up the feeds and make sure he feeds on both sides each time.

He normally sleeps for about 8 hours at night, so it would be worth waking him for extra half way through?

Hey OP!

My DD2 is also having issues gaining weight and I was advised by a consultant and GP to consider FF as '3 months EBF is a good enough'. I do have a thyroid problem hence the consultant but I ignored them! She was happy, alert and sleeping well.

My DD is gaining between 2-4 oz a week now and I have an amazing HV who was very supportive when even my DP was advising me to FF.

It can really knock your confidence when your baby doesnt put on weight, but you sound like youre doing a fab job

PS listen to tiktok, she is a legend!!

I think feeding formula can also give you false reassurance.

You can't see how much a BF baby is taking and it's easy to imagine that there's only a little going down. Seeing milk disappear from a bottle gives you proof that your baby has taken a good amount. Breastmilk is produced constantly straight from your bloodstream and only a small amount is stored in the breast. Your baby is healthy and well hydrated so is unlikely to be taking any less from the breast that he did from the bottle.

It's also easier to encourage a baby to take more formula from a bottle which is impossible with a BF baby. IMO that is a good thing but I can see why some worried parents find it reassuring to get a bit extra down each time.

You've had lots of good advice and you're doing a good job. Stick it out and I'm sure your baby will be fine.

zzzzz, that NHS Wales info is very, very poor indeed....it's a disgrace, in fact.

Would you agree though tiktok that if Mums do swap sides too early (ie. they don't let their baby come off on their own accord), that could lead to problems?

There's a fantastic analogy here kellymom.com/bf/got-milk/basics/foremilk-hindmilk/. Mums only produce one type of milk, but the fat content does vary. The two types of milk thing is quite inaccurate, misleading and can be worrying for mums who are new to breastfeeding (it certainly was for me!).

OP TikTok gives some very good advice here. I follow what she's saying and the info on Kellymom and successfully feed a 23 month old after a very very rocky start, he was jaundiced.

If you want to successfully BF you just need to keep giving the baby your breast, I also did what TikTok says despite friends saying I was BFing wrong! I constantly swapped him from breast to breast, my supply was great and then he just put loads of weight on whilst my friends gave up early on having stuck to a rule they heard that they just empty one breast and then you offer the other one...then that's it! Just go with it.

zzzzz not that old lol, I remember that too (quite fondly tbh, we used to fight over the top, if the birds didn't get it first!) it was quite funny when I was expressing for DD that people thought that the milk had 'gone off' because it separated out. There's a blog somewhere showing the transition in little test tubes......

Anita - is this what you are thinking of?

Lots of stuff here that is relevant to my case too I think! Hope I'm not hijacking the thread but it has raised some further queries in my head...

(my DS is only 2 weeks old and I'm tandem nursing a toddler a couple of times a day: probably about two or three times a day? No ones told me that my milk is poor quality or anything but DS is being very slow at putting on weight: 10 gr in 5 days, last time we measured him. His big sister took 4 weeks to get back to her birth weight so there's precedent there. I'd say that his latch is reasonable and certainly better than his sister's was at the same stage: I can see sucking / gulping / swallowing, he comes off by himself, there is little deformation of the nipple, there is little nipple soreness.)

• How important do you think the weighing is, in the overall scheme of things? How long has it been policy for, and what are they trying to identify / guard against? I say that because I suspect my babies just have a pattern of slow weight gain at least initially, that is, they are just on one end of a normal range.
• I've been offering both breasts most feeds but sometimes I've been concentrating on one breast in particular if it feels particularly full. Do you think this could cause any problems; should I more diligently swop breasts even if one feels pretty full and I'd like it to go down more?
• what even counts as 'one feed' anyway? If he has a good go at one breast, comes off by himself, and then is offered more after a brief rest, is that the same feed or not? How long would the gap be to make it count as a separate feed? How long is a piece of string?
• I'm tandem feeding my toddler as I said above: I figure this should protect my supply at least to the extent of allowing me to substitute one evening feed with a ff topup, allowing me a few hours sleep before the nights feeding session(s). Still foolhardy & risking my supply, or something I should get away with?

Sorry for the hijacking of the thread...

TikTok, as always, is the knowledgeable one on here. Please take her advice and don't get distracted by outdated ideas on feeding.

Thanks for the comps, people.....actually the NHS Direct Wales stuff did not get everything wrong, but an NHS site should get everything 100 per cent right! So maybe I was being a bit picky!

zzzzz I am an NCT breastfeeding counsellor.

crikey, yes, 'making' the baby come off the breast before he/she indicates she wants to could lead to problems. Sometimes, deliberately shortening a session at the breast by 'switch nursing' and putting the baby on the other breast and then again back to the first and then back to the second rather than letting the baby 'languish' for ages 'n' ages on side one, is a strategy to boost supply and baby's intake, but you wouldn't do this unless there were already concerns about it all.

comixminx, you ask some good questions, with no solid answers. Too much attention can be paid to weighing and the rate of the baby's weight gain, but then again I have been involved with situations where the weight gain was nil or slow, and everyone ignored the 'red flag' this was waving. Weight's only one part of assessing a baby's well-being, and it should be part of a range assessments and observations, including the ones you cite, and including your own feeling about how things are going.

Yes