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?

Good news, lmn.

Hope things get better, comix - keep up the whole range of things.

Well, I think I'm doing the right things to increase intake - putting him to both breasts minimum, preferably back to the third or fourth one too; making sure the latch is good; if need be, hand-expressing a bit of the foremilk if it looks like there's too much to start with; waiting for him to come off the breast himself but generally making sure to keep him on the breast for enough time to be sure he's onto the hindmilk in the first place; monitoring his sucking / gulping patterns and how fretful or relaxed he is as the feed progresses. My latch has been checked at a couple of breastfeeding cafes and a couple of whole feeding sessions have been monitored; view is that overall the latch is fine but possibly I have been moving him off the first breast a bit too quickly so that he hasn't been having enough hindmilk overall.

To be fair, the MW today did confirm that she didn't feel worried about him herself, weight gain aside: she confirmed he isn't dehydrated, he is alert, etc etc - all things that I knew too but at least having someone external confirm it is good. If the next weighing on Monday does not yield better results then again it will be a case of going to the pediatrician to rule out any underlying cause; today's MW doesn't believe there will be any underlying cause (though personally I don't see how she can be so confident without the tests being done - something like an infection such as lmn mentions wouldn't necessarily be visible, surely?). However she did rule out tongue tie after I asked her to check.

Today's MW suggests increasing the amount of top-up ff that we're giving at the end of the evening but then she also assumed that the problem was with my breastfeeding in terms of supply: she suggested I should express in order to increase my supply, but I really don't think lack of milk is my issue (and indeed at some points I might have had a touch of oversupply and hence too much foremilk going into DS...).

Sorry for the marathon post!

Just a quick update - as with littlemiss, the latest weighing has gone much better: he's gained 100 gms and the MW is much happier. Next weighing on Friday to check it's all still going well...

fantastic news.... hope the good progress continues