Baby not gaining weight on mixed feeding

[Secondsop]

Hello, I'd be incredibly grateful for any help on this. When my baby boy was born 5 weeks ago, his blood sugar was low (I had gestational diabetes) so the hospital said I had to formula feed him at the start to get his blood sugar up to the right level. I did try to give him colostrum too by hand-expressing it and tried to keep my breasts going , and I also put him on the boob at every feed to see if I could get him to latch on (I couldn't at first) but the first 5 days were almost completely formula.

I was rehospitalised at 5days for reasons to do with me not the baby, and decided to nail the feeding while I was there, and succeeded in getting him to latch on. I then exclusively breastfed on demand for a couple of weeks before reintroducing a night bottle for our sanity.

However, he didn't gain weight. He in fact continued to lose weight every week until week 3 when he gained a tiny bit. We saw the GP after the first health visitor clinic of loss and the Gp checked him over and everything looked fine. The community midwife suggested supplementing with a bit more formula as I was still having various health problems and this might be affecting the quality of my milk. So we moved to 3 bottles of 90ml formula per 24 hours plus unlimited breast milk and it seemed to work as he put on 180g in a week and we thought we 'd turned it around.

But this week he has only put on 60g and we are being referred to the paediatrician. He currently weighs 6lb4 and weighed 6lb10 at birth although 2 people have independently queried whether that weight was correctly recorded.

Feeding wise he is still getting the 3 bottles and is feeding for 7-8 hours a day, each feed lasting 20-60 minutes. Sometimes he feeds for hours on end and is still ravenous and takes down a whole bottle immediately after all the breastfeeding. At least 3 people have looked at my latch and say its fine. Im feeding frequently and doing breast compression during the feed. I can feel the breasts as lumpy before a feed and flaccid afterwards. I really, really don't know what I'm doing wrong and why he isn't putting on weight.

Has anyone had a similar experience who can tell me what else I could try, feeding-wise?

One more thing to add that might be pertinent - I've got my period already (so it started within 5 weeks of the birth) ; not sure if that means anything relevant in terms of hormone levels and breastfeeding. Many thanks again in advance for any help you're able to give.

Secondsop you have had a difficult start....it's great you are hanging on in there :)

However, I think it makes a lot of sense for you to see the paed. Your ds's weight is well below the normal expected level, and you do need to get a medical opinion on this.

For some women, those early days are crucial - they are the time when the basic physiology of breastfeedng is laid down (google prolactin receptor theory for the details - it's not 'theory' = 'idea without any proof' but 'theory' = 'coherent explanation'). Some women can deffo get away with a difficult start, others are dogged by it for a long time.

The amount of formula he had and is having is large - yes, it was justified to supplement him when you did, but the downside of this large amount is that it leaves less 'room' for him to have breastmilk and reduces the stimulation of your production, and yet it is not sufficient for him to grow well on formula alone. Ask the paed to do the calculations - he'll prob confirm that your baby's intake of formula is about half of his overall needs, and to build up and maintain a breastmilk supply you'd need to be breastfeeding more effectively, and for this to have started weeks ago.

Hopefully, the paed will find there is nothing 'wrong' but your baby does need more calories....so you would then have to think about your options, and one of these would be to work on your milk supply by expressing frequently and perhaps using a nursing supplementer at the breast (gives formula at the same time as the baby sucks at the breast) as well as judicious amounts of formula bottles.

Sucking for many hours is not necessarily a good thing for a little baby - the risk is he uses up energy and his net calorie gain is affected . Not a problem with a 10 pound bruiser and a mother with a huge milk supply, of course, but it can be in a situation like yours.....but these things can be turned round, with the right info and persistence.

Hope this helps.

Hello tiktok. Thank you, what you have said is more helpful than anything I've had from any medical professional to date. I completely see what you mean about the formula being about half what he needs and the breastmilk simply not keeping up with providing the other half because I didn't establish a good enough supply soon enough. It's depressing to be stuck in this sort of halfway house but it does make perfect sense that that is what has happened.

I'll see what the paediatrician says about my options. To date, I haven't gone for more than a few hours without giving some breastmilk even when I'm giving formula so I haven't quite been missing a full breastfeed for every bottle, but it may be that my milk production isn't good enough to feed him in this way. Which would explain why he is often really hungry even after a long feed.

I really want to continue some breastfeeding. If I'm beyond the point of being able to get my supply up, could I still give him a full complement of bottles with a bit of breast as an extra?

Secondsop, you can continue to breastfeed for as long as you want/as long as your baby is happy to come to the breast :) Whether there is enough/any milk there, is not the point - the closeness and connection you and your baby experience is clearly important to you, and why wouldn't it be?:)

But you won't manage to maintain a supply without frequent, effective removal of milk from the breast.

A call to any of the breastfeeding helplines will help you explore your options and your feelings, and the paed's visit will help you have more information for the discussion.

Thank you tiktok . We saw the GP today who is referring us to the paediatrician - we will see where we get to after that.

Have you checked for lip and/ or Tongue tie? This has caused similar problems for me- sorry to hear you are struggling too

bearhugs he hasn't been checked for tongue tie. I will ask the paediatrician about this - thank you.

Excellent idea to ask paed to check - any competent paed who understands about infant feeding should be checking this out as a matter of course, but in fact not all of them do :(

Hello, just an update: I went to see my NCT breastfeeding specialist who has been supporting me throughout and she checked my latch (it's generally fine) BUT: she agrees that there is a degree of tongue tie on my poor little man. Which explains an awful lot! In particular ive noticed that since i've been hardcore expressing (by hand) in the last week to compensate for the increased bottles, my breasts are MUCH more engorged, which does suggest he hasnt been able to empty them before.

We also went to the health visitor clinic (who confirmed that there seemed to be tongue tie) and - hurrah - he's had amazing weight gain this week (which I would expect after feeding fully on formula with breast as extra). I'm going to go to the breastfeeding clinic next week to get a referral to the tongue tie clinic, which should hopefully make a difference to the breastfeeding. He's also got the referral to the paediatrician at some point.

So, THANK YOU for suggesting tongue tie. And for all your other help! I am so happy that he is now doing well and that hopefully i will be able to find a way to keep the breastfeeding up for him.

Aha! HOpe the snip makes all the difference. It's good it's been spotted. Best of luck - it sounds like you've been trying so hard.