Help, DS not gaining weight - formula top ups, wind issues. How do I keep up supply?

[Weescottie]

I was wondering if anyone could give me some advice, I'm so confused. Apologies in advance - this is a bit long but thanks for reading.

My 6 week old DS put on weight no problem for the first few weeks, however for the last 2 weeks he hasn't been putting on weight. Therefore the doc and HV have advised that I try to give formula top ups (offer 150ml after each feed) to see if the issue is him just not getting enough calories. I've only started the top ups yesterday but am worried this will cause my supply to dip. Is there any way to keep up my supply or even boost it? Also, for the reasons below it takes ages to feed him both breast and bottle. Doc advised only bf 20 min each side then give bottle. But today it took 2h due to DS falling asleep/needing changed/burped/refusing feeds! Given all this how frequently should I feed him? Pre top ups I'd bf every 3/4h.

I think a lot of the problem is that DS fusses a lot at the breast. He seems to suffer a lot from lower wind and can only do a number 2 or fart (which he does a LOT!) if he is suckling at the breast. This means he is often wriggling and squirming and coming off and in the breast in between suckling. Once he has passed wind etc he calms down to feed. Therefore it takes ages for him to get a good feed by which time he has tired himself out. Is this normal? I know babies get gas but he is always squirming or crying, needing to fart/poo, from when he wakes up!! I tried explaining this to doc but just dismissed it.
The HV thought he had a slight tongue tie - could this be causing his wind issues? Or is he just sensitive to wind pain? Again doc seemed dismissive of this. He also has silent reflux but is in meds that seem to have helped this.

Also, I seem to have plenty of milk so confused as to why he isn't putting on weight. He literally drowns in the stuff when I start feeding him, and milk squirts from my breasts if he pulls off. All I can think is he's not getting enough rich hind milk due to all the fussing/wind pain.

Has anyone got any tips or been through something similar? I know the main thing is he puts on weight but I feel so guilty he isn't getting enough from me and seems in pain a lot of the time due to needing a fart/poo. He burps no probs in feeds. If I have to formula feed so be it but I can't help thinking if I could sort gas pain he'd settle in feeds and get more.

I would perhaps go back to the HV and say that you want support with increasing weight gain by breastfeeding, not by using formula top ups. You don't have to do that I you don't want to, so get them to support you with your breastfeeding.

Have a look at the Kellymom website as there is lots of advice about the different issues you are having. Also maybe get the possible tongue tie investigated - if the HV isn't helpful you can get it done privately (have a search of this section of mumsnet, there are lots of threads about how to do this).

Can you express and use ebm instead of formula for top ups? If you have a good supply it seems really odd to suggest formula top ups.

Have you tried baby massage for his tummy pain? It can help with the trapped wind.

It sounds like you have a fast letdown, which can contribute to fussiness and gas. Kellymom has more info and suggestions to help.

Otherwise, I second the pp that formula topups are unnecessary at this stage - 2 weeks' growth pattern is not enough upon which to base a recommendation to mix-feed, especially following weeks of normal weight gain and when you don't want to take that route.

Your HV and GP may not be the best informed about bf, so get some help irl from people who do. A La Leche League meeting will help a lot if there's one near you, or get a face to face meeting with an NCT breastfeeding counsellor.

And don't panic! You've done great so far and there are lots of steps you can take to manage bfing how you want

and if you did give extra formula I wouldnt give 150mls as that is 5oz of formula which would certainly impact on your milk supply, if you gave that amount after every feed.

kellymom.com/bf/got-milk/supply-worries/fast-letdown/

Oh, and absolutely ignore the 20 mins per side instruction from your GP. It's rubbish, and combined with the advice to top up 150nl formula on EVERY feed, is like it's designed to sabotage your supply and ability to ebf.

Call the NCT or LLL helplines if you can't get face to face help straightaway. And check out breast compressions and other ways to increase weight gain here.

Hello Yes I agree with last message sent. You say your 6 week DS was breastfeeding 3/4 hourly before top ups. Most breastfed babies feed more often when they are not getting enough or are having a growth spurt. I found my babies breastfed 2 to 3 hourly most of the time and 4 hourly being a gift to get some housework done! You don't say if the health visitor actually watched you feed to check your baby was well attached at the breast? If the health visitor thought your baby had a small tongue tie this could be a reason for static weigh as baby is unable to milk the breast effectively. I am surprised that the health visitor or Gp did not suggest Breastfeeding more frequently before starting top ups as this may have helped the weight gain. Also baby fussing at the breast could be due to a very fast or very slow letdown. Sometimes lying back can help gravitywise with slowing the flow down or if its too slow kneading the breast gently can help to increase let down. You could also consider trying the services of a private lactation consultant. She would watch you feed and help you to improve your baby's position and latch at the breast. it would be money well spent. Some lactation consultants also specialise in tongue ties. If you are in Great Britain go to the Lactation Consultants of Great Britain website for more information www.lcgb.org/consultants_local.html
www.lcgb.org/images/shop/Tongue-tie-leaflet-2013-small.pdf. Another thought is it might be an idea to write down what foods you are eating just in case your babyis developing an allergy to anything you are eating as this makes babies fussy windy and not gain weight well.

I agree about the fast letdown. It can help with the wind if you take him off when you feel let down and let the milk spurt out a bit then put him back on.
Also agree with the others that you will need to breastfeed more frequently if weight gain is an issue. Every 2hrs during the day and 4 at night will help your supply. And agree that 150ml sounds more like a full feed than a top-up.

I agree, get more help with BFing. I would have the TT looked at again.

Could you afford a lactation consultant privately

TT can cause long inefficient feeds and over supply as the breast is stimulated but the milk isn't extracted properly. It can also make the latch poor, meaning the can take in air and be windy. It's also linked yo reflux.

I would also feed more frequently, every two hours in the day until his weight gain improves. That way you are topping up and increasing his intake.

What medication is he on?

Thanks so much for the replies.
Unfortunately I live in an area that doesn't seen to be covered by the lactation consultants (north scotland) but I will see if I can find someone else to come out and watch me feed. Do the nhs also have people who will come out? No one has watched me feed him, only checked the initial latch was ok. I'll also try to get tt looked at. I've asked hv previously about this but will ask again.

I think the reason they didn't suggest 2h feeding is that he would often be suckling for hours with me but not actually feeding, just sucking the nipple . But I will follow up on this to see if I can give this a go. I also thought this would be the first step. Although he's being offered 150 ml ge never finishes this amount, he usually has maybe 50-75ml.

He is on ranitidine (sp?) for his silent reflux.

I'm going to go look at kellymom and the other links now. Thanks!

Hi Weescottie, I also had a baby who fussed at the breast, seemingly fed for hours and didn't gain weight for several weeks at a time. We eventually switched to formula as I found the whole experience too stressful and I was crying a lot. I never looked back and my son is thriving and never ill (now 18 months). If you want to continue bf then get somebody to check your latch, even ask several different health visitors. I think we had poor latch and my son also ha terrible reflux and gas (also on ranitidine). Also, try expressing for your top ups if you can and want to avoid formula. But, at the end of the day, it's important for your son to gain weight, at least over a weird of several weeks (I agree that two is not a big marker). So maybe formula will help you get there. Good luck!

Period... Not weird!

Thanks Oly4 it's very reassuring there is light at the end of the tunnel! Ultimately if formula helps him and solves his issues I wouldn't look back. It's just purely selfish reasons that I want to see if I can continue with the breast feeding.

It's all such a minefield and guessing game

It is, it's so hard. If I were you I would give it a few more weeks as your baby could just turn a corner. I know every day feels like 20 days. My son had terrible reflux and wind issues and slept for 45 mins at a time day and night. I would go days with so little sleep, it was horrible. The good news is by six months of age he was SO much better. Still doesn't sleep through the night but is utterly adorable! Hang in there x