Topping up: am I on a slippery slope?

[Choccers]

I've been topping up my dd, aged 19 weeks, since 16 weeks. I want to continue the bf but she stopped putting on weight and got very fussy feeding - stopping just after she'd triggered the let down reflex, fussing for 10 minutes, then going back to the breast and getting nothing. Then she gets frustrated and refuses it altogether so I get the bottle out. It's worse in the evening when my supply is low. She was becoming very unsettled every evening but the top-up of formula seems to settle her. However, I don't want my milk to dry up!

Would love to exclusively bf until weaning so any tips for coping with the situation? She has 'hidden' reflux which I treat with Infant Gaviscon. Don't know if that is part of the problem.

Hi.

I'm not an expert but if she pulls off after let-down, you may have a strong let down reflex, which can upset some babies. I would recommend a call to your local Association of Breastfeeding Mothers bf counsellor, or the NCT helpline (both have websites).

Certainly, your milk supply will adjust to accomodate the formula top-up, but if you are not feeding less, then it shouldn't dry up. If you want to kick the bottle altogether, you need to do it soon as yopu you are ready to, and drop one yop up feed at a time. Expect just a few fussy days as she re-stimulates your milk supply.

Are you on a slippery slope? Only if you choose to think that way. You might consider only bf for most feeds and adding one bottle in the evening, that works for quite a few people. Many babies fuss in the evening, as oxytocin levels and therefore milk production is at its lowest then. It's perfectly normal, and a shame more mothers aren't warned early on.

Please remember that formula feeding isn't a BAD thing- it may not be many peoples ideal option, but once you're past the colustrum stage, it should always be remembered that there are others ways to 'compensate'- I had to give up feeding my first son after his weight plummeted below 5lbs, so I made sure his early diet was full of oily fish and veg, and all feeds involved cuddles, regardless of how delivered.

And yes, I did breast feed the next child.

It sounds like you are doing a wonderful job of trying to care for your little one in the best way you can. Be guided by her weight, and what works for YOU not other people; take skilled advice if necessary and I am sure you will continue to be such a caring parent. You have a very luvky baby, that you are so concerned.

ps sorry about spelling- bf my ds as well as typing! good luck

Sounds like your supply is not a problem but could you express a bit off once she's finished, that way you keep stimulating your supply but she can still have her top up bottle if you want. Offer her a bfeed before the bottle and see if she will start to feed for longer in which case you can eliminate the bottle. Freeze any excess and you can use it for weaning in a few weeks time.

hth

Choccers, the odd small bottle will not make your supply dwindle as long as you are feeding often enough day and night apart from this....but to avoid formula altogether, you might want to go with the flow, do whatever cuddling and frequent feeding ('cluster feeds' you need to keep her happy, even if she will not settle outside your arms. A call to the breastfeeding telephone lines will help you with discussion of various options.

Punnet - I have never heard of oxytocin levels being low in the evenings, or indeed of oxytocin having a timetable like this. Can you say where you heard this?

Babies have a tendency to be fussier in the evenings - breastfeds and bottle feds.

I have some problems with some of the other information in your post but we'll let it go

Thanks everyone for your helpful advice! I think you may have hit the nail on the head Punnet about the strong let-down reflex. I am very squirty and we both tend to get soaked in milk, especially as she often pulls away. I think she copes with it when she's really hungry but when it comes to the second breast she cries as if it's going to bite her on the nose. Then she's hungry again shortly after.

In all honesty I'm not prepared to express every feed to avoid this and not sure I'd have enough milk even if I did. Perhaps formula would be kinder for her. Sounds like you know about good nutrition in weaning - any tips?

Tiktok - interested in hearing your opinions, especially if about reflux / Gaviscon.

Do you feed from one breast only per feed by any chance - that can help an over vigourous let down. Once you have fed on one side, wind her then offer her the same side again. Means she doesn't have to cope with the let down again. She might only take one breast at a time - doesn't need two. I personally would avoid giving top-ups because it is hard to know which baby is going to end up more on bottles. Sounds as though you have plenty of milk so if you felt the need to top her up you could use EBM.

I agree with mears about offering one side at a time only....it has to be worth a try.

Reflux and gaviscon - I have no opinion on, sorry.

Thanks again - things have got better in the last 24 hours, mainly because I spoke to a lovely Association of Breastfeeding Mothers counsellor and realised I was getting my knickers in a bit of a twist. I did top her up with EBM last night and fed her on one side at at a time - which is all she seems to want at the moment - and she slept all evening then all night after her last feed.

Great advice - I'll be back I'm sure!

My ds1 was very fussy in the evenings and I thought it was 'not enough milk' etc - in the end he was just tired and needed to sleep - which after training he did very happily. Had all the panics about topping up too - totally unnecessary in the end.

Glad you feel better choccers

It's me again - I've now had two evenings of her feeding much more often, but obviously being hungry straight after sucking me dry. She cries and grabs my hand and pulls it to her mouth to suck my fingers. It's pathetic. So I'm topping her up with formula again, plus letting her feed more often to build up the supply, but I honestly don't think my milk is enough

Choccers, God knows I am no expert, but i am SURE your milk is enough
Someone with much more knowledge than me will be along to advise v soon, I am sure
Keep your chin up

Choccers, your milk will not dry up and you will not be 'sucked dry' unless you have been giving formula often. When she cries and sucks your fingers, just put her back on the breast....yes, back on side one, even if you have given her side two, and then back to side two after that.

I don't know if this has any relevance but...both of mine went very fussy at about 18-20 weeks, fed forever and really got me down as they wouldn't come off at all in the evening and then they both got their first tooth shortly afterwatds, I think the sucking was relief for tooth pain rather than feeding.

Like I said, it might not be the answer but I thought I'd mention it just in case.

DS is now 24 weeks and has come out of that phase with 2 new teeth. I know it's awful when they want to feed all evening but having done it before I'm finding it easier to stick with it this time round. Good luck.

Choccers, babies putting fingers in their mouth at this age is not necessarily hunger. They feel with their mouths and like sucking fingers. Agree with Tiktok - put her back on if you think she is hungry - do not be fooled by her drinking formula - she will do it whether she is hungry or not. The breasts are NEVER empty. You just need an injection of confidence. You do have enough milk. put the formula away

Mears, I wish I could believe you! But it seems clear to me on several occasions that there has been nothing left to come out and she's still very hungry - unless she just can't be bothered to suck out the hindmilk because she knows about bottles (she's had medicine from a bottle since 4 weeks). I have got more milk today after all her sucking yesterday so we'll see. Sorry to whinge!!

choccers - my dd is the same age as yours and also puts her fingers in her mouth a lot. i have no doubts about my milk supply though.

p.s. and thanks all for your encouragement...

Dear All, My baby is now 9 weeks old. At about 4 weeks, he started to be very difficult to breastfeed as he wanted to suck on my breast forever and still seemed hungry all the time. I really did not want to stop breastfeeding and start to go down the 'slippery sloap' of formula, and was very upset that I might have to do it but my baby was not putting on enough weight, was upset a lot, hardly slept and my husband and I were getting worried. So after talking to the Health Visitor, I started to top him up with formula. I now breastfeed him on one breast (two in the morning) and then top him up. By now he is settled into a routine, gaining weight as he should, sleeps well and last night we even slept through the night for the first time. I would only recommend that you do not insist on sticking to what is good for you but what is good for your baby and do not let yourself pressured in any other way by anybody.

Judit, it's great you have found something that works for you....but what you are doing is likely to end up hastening the end of bf. This may not be an issue for you, but it may be something that matters to other people. Most women are not able to maintain breastfeeding for many weeks on frequent top ups. I say this not to comment on what you have done in anyway, but to clarify the situation for other mums. Hope you understand.