Advice on Breastfeeding/Combination Feeding

[Rachel37]

Hi, I'm really confused and would really appreciate some advice.

I have a 3 week/3 day baby who I'm currently breastfeeding. I'm concerned that he is not putting on as much weight as he should be and it has been confirmed that he has tounge tie although the Midwife has said that it's not that extreme for him to have it treated. His weight is going up but I feel I can't keep up with the expressing to replace the milk that he is not taking. At present I'm trying to breastfeed every 3 to 4 hours... but I find that he gets agitated when he can't latch on and sometimes only does a feed for 10 to 15 mins, on a good day 30 minutes... I'm concerned with all the coming on and off, tantrum screaming that he is not getting enough breast milk. The midwife suggested topping up with expressed breast milk after every feed but that is just not realistic as I can't express that much. I'm managing at the moment to definitely feed him 2 oz of expressed breast milk a day early evening sometimes x 2 oz on a good day.

The last few evenings I have started to introduce formula for his night time feed which I give him 4 oz.... if I wanted to up the amount of formula throughout the day but continue with breastfeeding what would that amount be?

Any advice would be gratefully appreciated.

Thanking you in advance.

It sounds as though you really need to speak to a specialist given that there is tongue tie involved. Do you have contact details for a La Leche League near you? I would also insist on seeing the infant feeding coordinator and not just the midwife.

Will he feed more often than 3-4 hours? That is not actually that often for a newborn. Because he has tongue tie his latch may not be as efficient as a baby without tongue tie and he may be having to work much harder for his milk which would result in short feeds (unable to keep up the effort for long) and laso frustration at the breast.

However, he is not losing weight which is brilliant. SOme babies just put weight on slowly, in is not necessarily a cause for concern. Also some babies never feed for more than 10 mins or even less so again that in itself is not cause for concern.

The best indicators of how h is doing are his nappies- plenty of wet and dirty nappies? Is the poo a nice mustardy yellow splat? That means the milk is going through which in turn indicated he is getting plenty of milk. And how he is inhimself between feeds- is he settled and happy between feeds?

What I'm trying to say is formula may not be needed. If you do continue to top up though please seek some expert advice locally.

Giving formula at night may impact on your supply. Breastmilk production is supply and demand so every oz of formula you give is stimulation to produce milk that your body is not getting. Your hormones are at their highest level at night so that is when it is most important to feed your baby.

That said if topping up gets you through this and allows you to continue to breast feed then that is great. Sometimes you have to do things to get yourself through a tough patch and you can deal with the consequences alter. In this case if you don't snip the tongue tie then he will probably get better at feeding as he gets a bit bigger and it becomes less of an issue, once he is feeding better then you would be able to gradually reduce the top ups and up your own supply by lots of feeding :)

Rachel, sorry you are having a difficult time :(

Have you thought it might help to talk to someone in real life about this? Mumsnet has the nos. of all the bf lines and you could call one or more of them.

Can you give some details about your baby's weight?

Tongue tie does not have to appear very 'extreme' to interfere with feeding, so your midwife may be mistaken in thinking it does not need treating.

However, there may be other reasons for the issues arising with your feeding.

Your baby is not feeding very often - has anyone talked to you about what you might expect? 3-4 hourly is really fairly infrequent - most babies of your little son's age would be breastfeeding much, much more often. Frequent feeding (as you prob know) is important to stimulate production as well as to get more milk into the baby.

Keeping your baby close and responding to early feeding cues helps with this - avoids the baby getting upset because he is desperate to feed, and also means you get the 'right moment' to offer as you are aware of his needs quickly.

If there is a concern about weight and intake, then you can also increase supply and intake by making sure you offer at least both breasts each feeding session - 'switch nursing' also helps, which means you go back and forth, switching sides when your baby seems to lose interest each time.

Yes, expressing can be a useful thing to do, but it should be in addition to frequent feeding, not instead of.

If you want to introduce formula alongside breastfeeding, then you need to be aware that it's quite early for your body to maintain a supply if formula becomes a regular thing....any formula undermines breastfeeding, and gaps between feeds reduce production. So if you give a bottle of formula and this means your gap of 3-4 hours between bf extends even more, you will make less milk, and production will dwindle. This is especially likely to happen if breastfeeding already seems not quite enough....an option for you would be to fix the breastfeeding so it is enough, and then see about intro'ing formula, when your supply would be less at risk.

Hope this helps. Do post again with more info.

I don't know anything about tongue tie so can't comment on how if would effect bf. But I did manage to top of with formula whilst bf and then gradually weaned her off it again. MWs made me think I didn't have enough milk or it wasn't coming in quick enough. Couldn't use expressed milk cos baby was constantly feeding (still is at 10 weeks). EVERYBODY told me my milk supply would go back and I would never be able to bf fully if I gave formula. But I wanted my baby to be happy and not be rigid about bf. Of course it is the best. But u want to enjoy ur time with baby and not be stressed about feeding/weight etc. BUT I did always bf before and after top up, I never replaced bf with formula. I think that's probably why continued to produce enough milk. BTW I'm not saying its the right think to do. It worked for me and I would do it again.

Another thought, coming on & off the breast might not be anything to do with milk and feeding. I read an article on kellymom.com about 'fussyness' that really helped. Sometimes taking her for a walk in the house, changing nappy or letting my DH have her for a few minutes is enough to calm her down.

But like I said I no nothing about tongue tie.

Also I gave her as much formula as she wanted each time, she would usually drink 90-100 mls and then breastfeed for hours straight after. But I wouldn't give hungry baby formula, would stick to number 1.