Best practice for starting formula top-ups for low weight gain baby?

[Inukshuk]

Morning all

My baby was born at term at 7lb 9oz, lost just over 10% the first ten days but back up to birth weight after two weeks. At 4 wks though he was only 7 lb 11oz and the midwife mentioned she'd hope he would gain a bit more than that. I didn't think of it again, as he's v happy and lively in himself, until going for his six week check this week and he's only 7 lb 13 oz now, so now I'm worried - he's gone from 25th percentile to below the bottom of the chart. He's exclusively breastfed, but now the doctor has recommended topping up with formula (in a fairly cursory way - she didn't seem very concerned about his low weight gain, so maybe actually I could give it another week and see his weight gain then?).

But - if I am going to top him up with formula, any thoughts please on the best way to do it with minimal compromise to my breast milk supply? Looking around the threads here I thought either (i) one feed a day I would give him formula, but express at that time so I still have that lot of milk for top-ups at other times of day (I've started expressing a little after every feed anyway to increase milk supply). - or (ii) I could just give him a little bit of formula at the end of every feed.

Would be v grateful for your thoughts! This is my first child and I had no clue that breastfeeding was going to be so confusing / worry-inducing.

Right I'm now going to give you two pieces of advice.

1. Relax and stop worrying
2. Do not be tempted to feed 24/7, even if it means leaving grumpy baby with DO or granny for an hour or too. Get out, go shopping, swimming anything and let your body have time to make milk.

I let DD2, who did the falling off the graph and frightening HV thing too, feed far too long. It was easy DD2 feed, I read to DD1 or admired her Duplo creations or we put the TV on. In the mornings DD1 was at preschool so simply cuddling up on the sofa was even easier.

Don't do it!

As for top ups, DD2 refused point blank to take a bottle, of anyone, including the pediatric nurse after we got sent to paediatric out patients.

In the end she was just weaned in to yoghurt at 5.5 months and yoghurt and juice remained my way of getting an evening out for years. She never did drink milk and BF forever.

As soon as she started on real food she climbed back on the graph reaching the 50% line at 12 months and there she has stayed.

Aged 12, she still only drinks milk shake and hot chocolate and that's very recent.

Sorry I must proof, DD1 came in waffling and I pressed send too soon

Thanks Star! I was inclined not to worry just as he's so happy and smiley in himself, but just on the verge of tipping into panic I think - will try and pull back!

is there a reason why they suggested topping up with formula rather than giving more
breastmilk?

it can be a slippery slope, and almost certainly will do no favours for your milk supply, so i would be very wary unless it's absolutely necessary.

i'm going to disagree with star here and say that you don't need to let your body have time to make milk. your breasts produce milk constantly and the emptier the are the quicker milk is made. the more you feed the more you will make, so I would be increasing feeds as much as possible

2oz weight gain in 2 weeks is potentially concerning, so i wouldn't just be ignoring it and hoping it all ends up ok.

it might also be worth contacting a qualified breastfeeding counsellor and asking for advice.

what is his feeding pattern at the moment? are you feeding on demand?

Inukshuk are you Canadian?

Anyway, I'm not an expert but if ds is lively, producing poo and wee and your doctor wasn't panicking then you're probably alright. If you are worried maybe call the NCT bf line or find a local group and have a chat about your worries.

And I thought if you're trying to up your milk supply then having a period where you do just feed all the time for a couple of days is a REALLY good idea as it can boost supply? But I'd have to go check that.

bundaberg- that's what I thought. And yes to getting expert help. Good luck op.

there is some good information here regarding weight gain

and also slow weight gain

Panic is tempting, but not helpful.

I was stressing about my stupid car breaking down in stupid places at the same time and that wasn't helpful either.

Active relaxation is what's needed. I'm certain achieving things and feeling positive improves milk production.

Too much integration with HV's scales does not!

Thanks both.

Bundaberge yes I'm feeding on demand - although he's poss not demanding enough! I feed him c every 3hrs and he's rarely interested more quickly than that - have tried feeding him e.g. every 2hrs but he just sucks and doesn't feed when I do, I assume he just doesn't feel hungry yet. It is the slippery slope thing that I'm worried about so yes think I'll wait and see what he weighs at clinic next week and then try and talk to the doc about it more - she didn't seem worried, but I asked her about it again at the end of the apptmt so she said 'oh well you could top him up with some formula if you like' - so was just for my benefit I think, not that she felt it necessary.

Rednelle - Not Canadian! I just love the concept of an inukshuk (and v helpfully with teeny baby to keep reminding myself how many people have been here before!)

If I don't get better answers at the doc next week will push for some expert help I think like you say - tbh the doctor's cursory response kind of made me think that would probably be a good idea anyway.

I know the advice is feed more often and for longer, but if you have a baby who will happily half heartedly feed and snooze and feed and snooze, it doesn't actually work.

You sort of settle into a just keeping the system ticking over mode.

I don't think my body ever sensed DD2 was really hungry, because she never fed as if she was. She just fed in her gentle chilled way, taking what came her way.

That's why I wish I'd taken a break and let her get properly hungry and seen if we could have broken the cycle.

My DS1 went from over the 25th at birth down to below the 2nd within a similar timeframe. I'll be honest, I just ignored the suggestion to top up and ploughed on, and after six months he suddenly leapt up to the 90th+ centile.

I really think though that you should get some expert advice on this one. I would put a shout out from tiktok on this board and give the LLL/NCT helpline a ring (or go along to a meeting if there's a group locally).

I mix feed because of early weight loss and have to say getting back to ebf is an uphill battle (4 months on and still trying) as it's affected my supply.

Main thing I learnt for me is I really need to relax to lactate. Deep breathing and visualisations.

If you do top up I'd recommend a supplementary nursing system. You can buy kits or do your own by buying a 5fr infant feeding tube (5fr is the size - don't know what a fr is).
Put one end in the bottle with the teat off and the other in their mouth along side the nipple (takes practise). Hold the bottle at head height or lower (I use a little bag round my neck) and as they suckle they take in formula too. So they're getting the top up plus the bf. hth