breastfeeding at 4 months and beyond.....how do I do it?

[elliott]

ds2 is nearly 17 weeks and exclusively breastfed. He's a very easy going baby who rarely cries and is a joy to care for....At the moment he has about 5 feeds during the day and one at night (I've just stopped waking him for a late feed) He is settled between feeds, which are approx 2-3 hourly depending on his demands and his sleep pattern on any one day. The fly in the ointment is weight gain - since he was 8 weeks he's gained an average of 2.5-3oz per week. I'm trying to ignore this, as he seems fine in every other way, but it does sow seeds of doubt about the adequacy of my milk when I see him drifting inexorably down the centiles (from nearly 90th at birth to well under 25th now!)
I would really like to keep bf going for most of the first year but I really doubt whether I can.
My current worries(!) are:

1. Should I do anything at all to try to increase his weight gain - should I try feeding every 2 hours whether or not he asks for it?
2. If I do decide more input is necessary than breastmilk, should I go for solids or formula at this stage? Clearly formula is better nutritionally, but my experience with ds1 suggests taht if I try mixed feeding, my milk supply is likely to decrease rapidly and we'll end up on bottles very quickly.
3. Introducing solids - my plan is to introduce solids when he starts to demand feeding more often, if things don't settle after a few days of increased feeding. When I do start solids, what's the best way to safeguard my milk supply whilst still ensuring that I'm meeting ds2's needs for more food?
4. Length of feeds - a full feed still takes 30 minutes - I'm waiting patiently for the 10 minute feeds promised in all the books - is this length of feed usual at this stage? He'll normally graze for some time on the first breast, and I generally take him off and offer the second which he will take enthusiastically for a short period and come off himself. It would obviously be nice to have shorter feeds but I feel wary of curtailing them too much while I know he's not gaining fantastically.

Anyway any advice/experience welcome. Sorry this is a bit long and rambling, I do have a bit of trouble pinning down exactly what I'm worried about

Oh babe, it is difficult when they drift across the centiles, isn't it. My dd2 did too. I just stuck to my guns - it does sound as if your ds is just drifting towards his 'natural' weight to me, but what do I know...I did resist weaning. I couldn't see the point of filling dd2 up with pureed veg rather than high-fat breast milk. If you are worried, I'd try bunging him on the boob more frequently (if you can face it, your poor love).

I think as far as 3 is concerned, the advice is usually to breastfeed and then top up with solids.

And as far as length of feed is concerned...I think they all vary. I know when I was getting my knickers twisted about dd2 a friend said (quite innocently) that both of hers had b/fed for much longer at a session than my little snacker. you can't win...

Good luck. And he sounds a total dream in every other way, you lucky lucky thing!

My dd had poor weight gain/failure to thrive she is not even on the centiles - have you investigated any other reason for his drop in weight? Look at your build and husbands build and see if he falling into his body type after a while.
Early solids do nothing for weight gain - they eat such infinitessimal portions for it to be inconsequential.
Talk to a health professional about his weight, if there was a problem they would have flagged you up by now...
Babies who are b/f don't generally overfeed, if he has always been demand fed you will find offering him shorter frequent feeds will cut down on the hindmilk he has which will affect his weight.
Good luck

sorry that was quick was on phone to MIL while typing. Do try not to worry and not blame yourself, you have done bloody well and pat yourself on the back (if you can reach) and congrats on your happy contented baby too! You must be doing it right!
xx

I should warn you re health professionals - it was my HVs (quel surprise) who wanted me to wean.

Hi Elliot! I'm not very clued up as to "quality" of milk, but I really don't imagine that can be a problem after 17 weeks - a bf cousellor might know more about that one.

As for the centile worry, is your HV or GP worried about his weight gain? If not, then don't you worry either - they're only a guide and not set in stone.

Um, my take on solids is as late as possible - as close to 6 months or from 6 months. Your ds will be fine with that, it's more about whether you can stick out the "oh are you not weaning yet?" comments.

Milk has more calories than solids - you'd only be able to give him baby rice and fruit/veg mush anyway - you have so much more choice for interesting foods after 6 mths.

Ds had a late feed with expressed milk until he started solids at 5.5 mths. It was only once he started cutting down from about 8oz (about 2 boobsworth) to about 2 oz that I stopped waking him - that's when he didn't seem to need it.

After introducing solids I carried on expressing last thing at night before bed and kept the expressed milk in the fridge to mix with the mush. It also kept my supply up cos ds had dropped the late (11pm) feed around that time too.

Length of feeds - can't help you on that one I'm afraid! Ds was bf until last mth (he's 18 mths now) and he still took half an hour!! I waited for 10 min feeds too, to no avail!

Let him feed for as long as he wants until he starts that weird fluttery sucking - that's when he's finished and just using you as a dummy! If you cut him short then he might not have reached the hind milk which is the full cream stuff. I'm willing to be corrected on that one though.

Long post too!! hth

Elliott, I'd dearly love to know how many 90th centile babies who are exclusively b/f thereafter stay on that centile...every single one known to me has wibbled on down to 50th (at most) and more like 25th - which is where both of mine ended up.
With dd I went through a phase at almost 17 weeks when she wasn't gaining much either and was also an "easy" baby but not a manic feeder. I actually had the HVs breathing down my neck when she plateaud but like others here, I could not see how 1 x tsp of pureed carrot was going to help much. She is still bobbing along cheerfully on the 20th but found her level at around 24 weeks. She is popping out of her 9-12 month vests she is so tall and not thin, but still LIGHT by weight standards.
I'd go for 3 in due course and feed him first before offering him his puree.
He sounds like a treasure!

thanks folks! MI, is your dd2 the one you have been expressing for England for? (can't remember if you are on no2 or no3) if so then I will stop worrying right now
HV is not giving me grief particularly (well I won't let her, I can be quite intimidating I think!) She did say that if they go through two solid centiles they should be referred (to which I laughingly replied - well that's easy, I won't get him weighed again!) But I honestly don't think there is any problem with him at all apart from not growing very quickly. I just don't want to starve him unnecessarily.

bobsmum, glad to know I'm not the only one with a languid feeder! I know what you mean about the fluttering feeling, but sometimes if I keep prodding him to suck rather than snooze(!) I can get more let downs even after feeding for a long time. Your comments about expressing made me smile though - I seem to have spent half my life expressing and I still can't get a whole feed out in one day....I give an occasional bottle but if it is instead of an evening feed, I can rarely express more than about an ounce at that time. I stopped the late feed because he was still waking once after it and I get more total sleep if I don't have to stay up to give it. I do suspect that he doesn't get a lot from his bedtime or late feeds as he'll sleep a lot longer on a decent bottle of EBM....

I knew you were all going to tell me that breast milk has more calories than pureed mush while of course I can see the truth in that, surely at some point solids need to be introduced so that they can become an increasingly important contribution to the diet? My experience with ds1 was that he very quickly starting taking pretty substantial quantities of solids - and became much more settled and had better weight gain as a result. I didn't manage to feed him beyond 6 months - interestingly he had the same pattern of slowing growth at 3-4 months, but he always appeared much more hungry than ds2. I guess that is the experience that's made me lack confidence with ds2, even though they feed very differently.

thanks marina. it is reassuring to know that other people have had the same experience. Common sense tells me that not all babies will have the same growth rate, but it doesn't help you feel like mother bountiful, does it?
I'm sure his 9lb birthweight was an aberration - too much sitting on the sofa eating chocolate! His brother is a skinny shrimp too so maybe he's just finding his level.
I'm actually not planning to see the HV again - she doesn't know as much as you lot anyway

He's gaining weight, growing, is contented and happy and wets and poos appropriately and sleeps well? Then he's clearly not hungry or starving! I honestly don't think you have a problem here. As for solids, the advice is to delay until six months so no rush at all atm. If I were you, I'd carry on as you are and give thanks every day for your lovely baby. However, if he starts looking thin or listless then you might need to rethink. if he's healthy and looks well then just carry on.

That's the girl, Elliott. A solidly chunky smiley little star.

Yes, elliot, eventually they do need solids, but the main reason in babyhood is not for growth, but for iron and for other nutrients they start to need from about the middle of the first year (but mainly iron). Even babies who are exclusively breastfed for a lot longer than this, and who have been studied, don't actually show up as 'suffering' in growth (some risk being low in iron).

Interesting you say you find it hard to pin down what you are worried about - I wonder if it's just because you know you are doing something a bit different (continuing to excl bf to 6 mths with a baby who is on a lower centile than before) and want reassurance.

Hi Elliot

Not for nothing do most 2nd time mothers refer to their health visitors as 'The weight police'. My HV is clearly a rare beast, inasmuch as she's a fount of sensible comments, one of which may cheer you up.

When I was fretting about dd2 (who must be about the same age as your ds) not having regained her birthweight by 3 weeks, and how all the other babies with lower birthweights had overtaken her, she said tartly: "Take no notice of other people, it's not weightwatchers in reverse, you know."

My GPs comment at the same time was; "Well, if she looks all right, and feeds all right, and wees all right, then she is all right."

I think the thing about children finding their level relative to their birthweight is very true. A friend who had an eight-pounder was persuaded to bottle feed because of inadequate weight gain. Her dd is now 3, has loads of energy and the appetite of a truffle pig,but is still on the 0.2nd centile.

FWIW, since dd2 regained her birthweight I've just carried on breastfeeding and kept her well away from the scales. She looks OK, is very cheerful and sleeps pretty much through, so I can't see that plotting a line on a weight chart is going to add anything to our lives.

I took dd to the hv for a check when she was around 5 months and exclusively bf. \first she told me weight was fine then asked what solids she was on, I said none. HV then said must be on solids as needs more weight!! She'd never heard of the WHO and dept of health recommendations. Needless to say dd is doing very well and wont start solids until 6 months, nor will be revisiting the hv.

According to a book written by a very ancient nanny who trained in the 30s, babies weren't given solids until 9months.

Ahh yes I remember now I had to fend off overzealous health visitors with blatant lies like

1. yes she loves her formula top up (she never had one ever)
2. started her on babyrice just as you said (lies never did til 6.5 mths)
3. I am forcing tit on her every waking minute as you advised (never did - if dd asked she got it, if not then she didn't) My lovely lovely paediatrician said in his learned old and wise way. "Madam, we look at the babies you know, not the scales when it comes down to it, your daughter is effervescent, you have nothing to worry about. Health visitors are one step between doctors and God, ignore them in this case please." I have a small but fizzy daughter who is as happy as pig in poo - I learned to stop getting her weighed...

thanks all for comments. it isn't really the weight that is the root of my anxiety, it just isn't helping. I think tiktok that it is mainly that I don't feel confident in my milk supply - if the weight gain was good, that would give me hard evidence to the contrary, but since it isn't, its harder to keep the faith. At the moment I feel ok that it is ok, but I am nervous that once I start solids and go back to work then I won't be able to keep it going - as happened last time.
But hey, maybe I should stop worrying in advance and wait until I do run into problems - who knows it might never happen

elliot - not much to add just lots of support. I go back to work this week and we've had 'centile drift' too. No one is really hassling us but I just feel vaguely anxious that my not being around as much isn't going to help - ie no handy boob, plus the fact that ds is a bottle rejecter.

Know just how you feel as we went through a very similar stage at about 17 weeks (ds now 22 wks) and found that what I saw as increased feeding didn't do much in terms of gain and when I started solids about 2-3 weeks ago (and maintained same milk feeds) I was SURE he would put on at least some weight - he lost 0.5 oz in a fortnight (gnash!). What I have noticed is (marina has put her finger on it) that all the babies in my postnatal group are bottle fed and are whacking down 6 8oz bottles a day - and they're all on really high centiles having moved UP (the total opposite to us) so I'm telling my self that maybe breastfed babies go a bit steady at this stage and catch up later? Interested if anyone has any theories that are better informed!

If your baby is gaining weight (any amount) and is happy, sleeping, weeing, pooing etc. there simply is not a problem with your milk supply. I have a very skinny 13 month old ds who was bf exclusively for 6 months and then bf with solids until now. I suspect he has fallen off the chart completely now but I don't know because I gave up weighing him once it stopped being useful (ie once I could turn his car seat around).

I found the length of feeds shortened at about 5 months, and then I missed being able to sit down for 30 minutes with a book!

He doesn't need formula, or more breastfeeds, if he did he would ask for them.

That is so true bm!
I thought it must just be me who only cares about the weight so I know when to buy a new car seat.

I've sure I've heard - probably here - that the weight charts are based on bottle fed babies, not breast fed. So don't worry about them! I know I worried about whether my milk was enough for ds even though he was OK on the charts. He did drop a centile around 4 months, just at the point when many people start hassling you to wean, but picked back up by 6 months. Would be really helpful if breasts came with some sort of indicator but they don't so as everyone says, if he's happy, don't change anything. He sounds gorgeous anyway!

Well, here I am again, feeling a sense of deja vu that its all going the way it went with ds1.
I started ds2 on solids a few days ago, and decided to get him weighed again today. He's gained a princely 1oz in the last 5 weeks
He's taken to the solids very well and so far has eaten all I've offered and is looking for more. I've been giving the solids as close as possible after a full breastfeed and he's not cut back on feeding at all.
I'm unsure really how to take it from here - shall I let him eat as much as he wants, or does that risk him cutting back too much on milk? But on the other hand, how can I justify keeping him hungry when his weight gain is non-existent - or should I try to get him to take more breastfeeds during the day? I just have a feelign that, as before, I'm not going to be able to sustain bf as long as I'd like. I'm going to try to avoid formula bottles as long as possible but return to work is imminent and I don't know how long I'll be able to keep up with ebm - and I know my supply will suffer once the feeding frequency reduces.
Sorry for stream of consciousness ramble - just not sure how to reconcile potentially conflicting needs to a) have a thriving ds2 b) keep bf as long as possible and c) get enough sleep to be able to function at work....

forgot to say that he's 5 months old on Sunday (so 21 weeks).

elliott, if your baby needs more calories (and it might be a big 'if' ) then it's fine to give him extra breastfeeds if he'll take them. Extra breastfeeds may be a more efficient way of getting calories into him - you can do the maths on this, if you like, and compare the calories in whatever you give him with the estimated calories of a breastfeed for a five month old which will prob be anything between three and six ounces, so anything between 75 and 150 cals.

But honestly, he's probably just fine, if you are feeding him what he seems to want and like : )

Hi tiktok. It is hard to see your baby failing to grow on your breastmilk and difficult not to conclude that really he could do with something more. And its not as if he is too young to have solids really. Do you really feel that he is thriving if he's not gaining any weight at this age?
I would be really interested to know the calorific values of common weaning foods (yes I'm sad I know) - but it seems to me that most of what he is getting now is breastmilk mixed with babyrice or similar - so prob reasonably high in calories.

elliott, I can't see your baby and you can.....as can your health visitor. Ask her if she thinks your baby is thriving. Weighing babies is a way of screening them, not diagnosing them. You also need to check if the weights are accurate - that is, on the same correctly calibrated electronic scales, with the baby naked each time, and preferably neither just before or just after a wee or a poo (though of course you can't judge this and this is why weighing can be inaccurate!). It certainly is possible for babies to thrive and gain weight at a slower rate than others.

Baby rice is not especially high in calories - it's fat free and has no sugar, and while it is higher in cals than jars of pureed veg, most of its calories come from the expressed breastmilk or the formula it is mixed with. The packet will tell you the details.

As I said, if he needs more calories, what's wrong with breastmilk?? No, solids aren't actively damaging to him, but he prob doesn't really need them if you are happy to give more breastmilk. It's up to you