Sleepy baby needs top ups

[kissitbetter]

I am BFing but at 5 weeks baby is not putting on weigh fast enough according to paed, who has asked me to top up. This I am doing with expressed milk, which I am able to do because there is plenty left between feeds because she basically falls asleep after a few minutes - which is what seems to be causing the weigh gain issue.

Does anyone have experience of this - will I be able to go back to BFing solely perhaps when she is bigger/stronger and it's not such an effort for her?

But also, when I have topped up I have found her a completely different baby. She is alert and we have spent some time together with her awake. While I realise she is constantly developing and this could be coincidence, it's different when I try to solely BF as it's then a constant round of feed, sleep, feed, sleep as she is just falling asleep on me. So actually I wonder whether expressing and giving a bottle is better for her, i.e. her weight and perhaps even for her development?

hi probably already doing this but are you changing nappy to wake up between breasts? flicking feet to keep awake? my ds was like this ...good news is he loves his sleep still! dd however is screaming and at 5 weeks is a very different baby indeed! I guess they've sent urine sample off and generally ruled out infection if paeds involved.

does normally all settle down. well done with bf...it does get easier!

We had to top up DS for a while but were eventually able to stop.

Dd is probably in a vicious circle right now of being a bit tired and weak and needing food to help her thrive but being a bit too tired and weak to eat enough!

As mentioned above I used to strip DS off before a feed - usually to vest then down to nappy only of necessary, did a nappy change between boobs, blew on him, tickled his chin and feet etc to keep him awake. I figured the more he could get direct from me the better.

Eventually we seemed to turn a corner where he was suddenly just more alert and brighter and was more interested in eating from me than before. One wore of warning - we cup fed all the top ups of ebm to avoid nipple confusion and don't know what would have happened if we'd have used a bottle...

I had to give my baby small top ups of expressed milk from a cup after every feed until she was about 2.5 weeks as she was a bit jaundiced and sleepy and very slow to gain weight. As she got less sleepy, she stopped falling asleep at the breast so much and I reduced the top ups over a few days. She is 6 weeks now and her weight gain is good. I still do nappy changes mid feed to keep her going and she feeds a lot but she is alert and growing. If your baby is getting more alert then she will hopefully start taking more quite quickly.

My Dd was like this when she was younger and we were also advised to start a top up from 10days old. While feeding I used the strategies already mentioned to keep her awake but also blowing in her face whenever she started to drift off worked really well.

We chose to give her the top up bottle last thing before bed. I cried so much the first night we gave it and felt like I'd let her down. I hated the idea of something other than my milk being given to Dd and it made me feel so guilty. I was initially frantic to avoid giving formula if possible so was trying desperately to pump off ebm, this became quite a hectic routine for me because I couldn't get much off so was constantly pumping and sterilising through the day. My husband gave the evening bottle to our Dd and began to really enjoy having that time with her. It helped him to feel useful and to develop his bond with her.

She is now 20weeks and we are still giving the top up bottle but it works brilliantly. The amount we are giving has obviously increased as she has grown. She has had no problems switching between breast and bottle (using TT closer to nature) and is putting on weight brilliantly.

I totally understand your feelings about wanting to only give breast milk but at the end of the day, the important thing is that your baby is getting enough food and hydration into her by whatever means necessary. If you have noticed she perks up with extra feeds then it does suggest that she's not getting enough without them.

Thanks everyone. Barefoot I feel like I am getting on a weird feeding treadmill because if I'm not feeding her directly I seem to be expressing or sterilising! But as I have plenty of milk I feel like it would be a shame not to use it.

Can I ask - how much weight is baby putting on that you've been asked to top up?

Given you're talking about a paed, I'm guessing you're us or Canada based, and I believe they can be a bit twitchy re weight gain ...

Good question Bunty- it would be good to know the average weekly weight gain.

Kissit- how are you feeding at the breast? Roughly how often are you feeding, are you using both breasts at each feed, are you using a dummy to pacify? Has anyone been able to check the latch for you? It may be that it is not as efficient as it could be and she is struggling to remove the milk from the breast, hence the sleepiness.

Just some thoughts...

I'm in the uk. Can't remember weight gain but know she went from 25th to 9th centile at 5 weeks having already regained lost weight. It was explained to me as you suggest, badger, that feeding is too tiring for her, but only remedy proposed was topping up. MW previously said her chin was nicely down, which I took to mean a good latch but perhaps there are other indications? No dummy. When feeding solely at breast it seemed like permanently; with top up bottles following a feed its about 2-3 hours. Swap breast after an hour at least, but it's not an hours feedjng it's five mins on, sleep five to ten. Five mins back on again etc, even with tickling to keep going. She went six hours through the night last night, not taking a dream feed as it was suggested I try. Some might think six hours is blissful but I didn't think so at this early stage and I spent all night awake and willing her to wake up! Do acknowledge I may need to relax a bit though... Thanks again for your support.

Why is your Dd being seen by a paed? Are there other health issues? Are you in the private healthcare system?

Oh yes sorry there was a suspected urine infection but turned out to be nothing. Not private, no, but returning next week.

Hi kissit. Had the same issue. Had to use formula with my first, but expressed enough to do the top ups/feeds with DD2. Had to move to almost exclusively expressing and bottle feeding it to her at 2 weeks to 6 weeks.
I BF for no more than 15 mins on one breast, then gave her a poke using all of the tricks listed above and topped up with a bottle of EBM. As soon as she was big and strong enough, she started to feed much more effectively and stay awake. Like yours, she was much more alert and with it once I got the food into her. The paediatrician that we saw was very dismissive of "nipple confusion" as a concept and while I got very stressed about it when she was very lazy/sleepy/disinterested at the boob but happily sank a full feed, she was v happy to BF once she was bigger and hungrier.
I think I stopped expressing entirely around 8 weeks. She is now 5 months and refusing a bottle...

Is she back to birth weight yet? Is she gaining weight now or still losing weight?

Chin being tucked in is one sign of a good latch. Other things to check for are:
cheeks puffed out
a nice big mouthful of breast
audible swallowing (for most babies you can hear this)
coming off the breast by herself
generally seems happy after a feed

You may get some more expert help if you can contact an infant feeding specialist through your hospital. They can also check for tongue tie.

Regarding the feeding- you can do switch feeding to increase milk intake. You can swap breasts much more frequently than every hour and swap back and forth many times. You can also try breast compressions to keep her interested. See Jack Newman's site here.

kissit definitely get her checked for a tongue tie by a specialist. I was told by 3 different midwives in hospital post-birth that my DD didn't have one and she dropped from the 25th percentile to the 9th by day 3 as we had lots of trouble feeding.

She was very sleepy and in the beginning few weeks wouldn't take the boob much so I was offering the breast, then after she wouldn't feed I would give her an expressed bottle then I'd express for the next feed, every 3 hours. It was like groundhog day! As she got bigger she would take the breast for 25% of feeds offered, then 50% etc and I started to drop off the expressed bottles. We got to a point where I just give her a bottle every other day or so just to keep her taking one so I don't have refusal problems later.

I paid for a private consultant at 8 weeks as I thought there was a still a problem even though she was feeding and following the 9th percentile curve as I felt that the latch was shallow. A tongue tie was diagnosed 9and cut there and then. At our 13 week weigh in yesterday she's made it back up to the 25th percentile curve so I think it's made a difference.

Thanks again for your thoughts. My tired old brain got confused; we actually went back today for a weigh in. She has gained sufficient in a week of top ups for them to be happy but request I continue with top ups.

I was surprised that the doc suggested I supplement with formula rather than EBM for my own convenience, not just because I thought he would be keener on BM than that but also because I worry about decreasing supply. But anyway, I shan't be following that advice.

He also confused me by taking an average of the weight gain overall, which he said was low, rather than looking at the pattern which was dip after birth then good gain, then poor gain, then good again this week which suggests a blip to me rather than consistent issue. But perhaps 6 weeks is too short to think that way.

Crikey - I was staying on one breast for the fore milk hind milk thing, is that a concern with quick switching?

Badger - MW did check for tongue tie but interesting to hear a second opinion might be needed.

Tongue tie sounds v likely to me TBH. Not all paeds get the whole infant feeding thing, amazing but true.... a qualified lactation consultant would be your best bet and I think would likely give you some more useful tips than 'top up with formula' .

re foremilk/ hindmilk thing, no, I don't think this is an issue. Maybe your baby is one who needs two or more breasts in rapid succession, IYSWIM.