Breastfeeding baby loosing weight advised formula top up

[arthurbaby]

My son lost 9% by day 5. He had started well latched within minutes of birth and at least every two hours etc I never got an engorged feeling but definitely fuller breasts by day 3/4.
We were advised to ensure he drained the breast by feeding every 2-3 hours and staying on the same breast for at least 20-30 min. easier said than done he starts well for 5/min then falls asleep, I change his nappy etc to wake him up and return to breast etc
Day 7 even after all he lost again. So I was advised formula top ups after every feed and expressing. When I express I get nothing at all, tried medela swing and tommee tipee. So instead of many small bottles per day we tried breastfeeding then 2/3 bottles of formula per day up to 3oz is what he takes one at mid morning, mid afternoon and later at night.
Hr is satisfied and sleeps after a bottle. After breastfeeding for often more than an hour he still screams and cries and we don't know if he is still hungry or just an unsettled newborn.
I'm at a loss, we have a toddler (2.4) I feel sorry for as mammy is always busy and I'm worried about my baby as could my breast milk could be poor quality? as he was having 6/7 wet nappies and a couple of soiled yet losing weight and this also happened two years ago with DD who ended up combination feeding until 7 month.
Any advice on what to do? Can you get the quality of your breast milk checked? Can I overfeed if I allow him at the breast whenever and still give a couple of bottles?
If you made it through that long post and have some advice thank you very much

Oh and my latch has been checked by a couple of midwifes in different holds like cross cradle/under arm

I'm hoping someone will comment with more knowledge but I've been breastfeeding for 15 months.
There's no such thing as poor quality breast milk.

A good thing to do is as much skin to skin as possible & as you were advised feeding baby every 2-3 hours. Keep trying him on the breast & try & get the latch checked as he could be taking in a bit too much air hence the crying.

Formula is a lot heavier than breast milk so that's why he's falling asleep after that.

He could have reflux/gas hence the crying is he red? Or straining?

Oh saw the latch check, if he starts crying keep offering him breast? He may still well he hungry & this way your supply will build up too.

If he's crying he's most likely hungry. You can't over feed. Try feeding him and if he's happy after you know he was hungry.

I have a 4 week old so I have very limited knowledge.

Don't worry about not getting anything when expression, lots of people with plenty of milk can't express. If you are formula feeding as well you need to pump as it tells your body to make more milk. Pumping for you is to increase supply not to get milk.

Make sure you wind him after every feed and consider giving infacol.

Hi OP.

Firstly no it's not possible that your breast milk could be poor quality. Breast milk is breast milk and there is no change in "quality" - no matter what you eat, drink, sleep, stress etc. You should try to eat and drink of course but that's for you - not for your baby.

It's odd that you have been advised to stay on the same breast for a longer time than the baby wants. This is called block nursing and is usually advice which is intended to lower supply in the case of oversupply. It's normally better to feed until baby comes off or gets fussy, wind, and offer the other side. When they come off or get fussy again, wind, back to side 1 again. You don't need to worry about foremilk and hindmilk, as this is old advice. It might be worth asking why they recommend this. If they can give you a good reason then it might be that they have a particular point for this advice, but on the other hand unfortunately sometimes HCPs have outdated information. Or perhaps they meant they want you to be feeding for at least 20-30 minutes overall, rather than just from one side?

You can read this article for more information:

www.analyticalarmadillo.co.uk/2010/07/foremilkhindmilk-and-lot-of-confusion.html

The advice to feed at least every 2-3 hours is sound, though. When babies are reluctant feeders or losing weight it can be important to prompt them if they are going too long between feeds. Of course if the baby wants feeding more quickly it's fine (and a good idea) to offer the breast again even if it hasn't been 2 hours. Frequent feeds also help increase supply.

What it sounds like to me is ineffective milk transfer. The reasons for that are not always clear cut. It could be latch issues (a latch which "looks fine" is not always fine) or physiological issues with the baby such as tongue tie, or sleepiness from a difficult birth. If you have the opportunity (and I realise it might not be possible with a toddler) it would be really useful to take yourself and the newborn off to bed or into a warm bath and just lie there skin to skin, for as long as possible, to encourage lots of feeding. Using a wrap sling under your clothing (baby in a nappy) with him in a position he can reach the nipple would also be beneficial, but again, not always practical.

You do need proper real life support to sort this out unfortunately - it's not something you can really do over the internet. If you're still under midwife care can you ask if they have an infant feeding specialist? Could you afford to hire an IBCLC? Ask them specifically for support with increasing milk transfer. Yes of course mixed feeding is important so that your DS gets enough food right now. But it would be beneficial to you both if you can get feeding sorted.

Here's another Armadillo article about how to check milk supply and things you can try (for some reason it's only visible through the <a class="break-all" href="https://web.archive.org/web/20110618111601/www.analyticalarmadillo.co.uk/2010/09/is-my-breastfed-baby-getting-enough.html" rel="nofollow" target="_blank">Wayback Machine)

The missing "breast compression" video - you can literally just place pressure on the breast with your hand while he's latched on in order to increase milk flow.

Whether or not it's okay to give 2-3 medium feeds rather than a small one after each breastfeed, I want to say yes this is better, but I'm afraid I don't actually know with a baby that young. Something you might want to look into is an SNS - Supplemental Nursing System. This allows baby to receive formula while latching from the breast which can be helpful in terms of encouraging more direct BF.

Good luck with it - I really hope things work out for you.

Good info from Bertie.

OP, on the face of it you have been getting poor info and poor care from the people whose job it is to give you good info.

Staying on one breast deliberately longer than the baby would otherwise want is especially rubbish advice. If they say, when asked, it's to get the hindmilk, then I'm afraid this is a sign they have misunderstood how effective breastfeeding works. Formula top ups after every feed can be disastrous for BF.

Do seek more help. Follow Bertie's links. Hope the next few days go better.

Tiktok, you probably know better than me about the top ups - is it OK for OP to do it as she has been doing rather than after every feed? My gut says OP's way is better if they must top up, but I don't know enough about newborn feeding to say whether that's true.

There might be something in what you are being advised. Sometimes in NICU they will throw away the first oz or so of foremilk so the baby just has the hind milk. Is there a hospital dietician you can speak to?

Very hard to make a judgement here about the 'best'way to top up. We don't know the baby's weight or how often he breastfeeds. I don't think there would be any justification for expressing and discarding the first milk expressed - that might be thought beneficial for tiny vulnerable babies who have little energy but that does not apply here.

Giving two to three feeds of formula a day means the baby will breastfeed less often - it increases the gaps between breastfeeds, just as topping up with smaller formula amounts does. Either way is potentially undermining to breastfeeding. Yes there are situations where it is clinically justified but on the info shared here, I can't see the reason for it.

Nine ounces of formula over a period of twenty four hours with a newborn is a lot and does not leave a lot of room for breastmilk. If an average sized newborn was fully ff, that would be a large proportion of his intake. Easily as much as half.
Op, I hope you can get your feeding plan reviewed.

Thank you all for the advice. He was born 8lb 13oz and dropped to 7lb 15oz which is why the formula was introduced as I was doing long feeds regularly and he was still dropping. The breast compressions seem to be helping to keep him feeding.

Oh good! I am glad the breast compressions are helping.

Following to learn more from what others suggest and I really hope you can get the support you need. Congratulations on your baby and yes, can be tough with no2...!
I agree with those who said "milk can't be poor quality" - whatever your diet is, your milk will be great. Only reasons for probs in milk would be things like specific medications that babies can't take, street drugs and those types of things. It does sound like help in positioning and attachment by someone who knows what they are looking at, may be needed. That's not quite the same as "getting latch checked" although I can't quite find the words to explain why just now!
Things you might want to look into, or discuss with a lactation consultant might include at breast supplementer (baby takes formula via tube to your nipple, so breasts get stimulated, and baby still learns how to attach at the breast) and the jack Newman thing of "finish at the breast" (give the top up FIRST), just enough to take hunger edge off, then latch to breast - theory is, a less hungry baby is easier to latch and suckle effectively, and baby and mum learn the pleasure of baby finishing feed, satiated at breast.
But you prob want to see someone good in person who can talk through with you the pros and cons of all this and other possible avenues.

Best of luck xx

Op, obv you need to discuss it all of course, but the whole thing sounds like it deserves a fresh look. The loss of weight was within normal limits. Your baby was born hale and hearty at a good weight. What you may need now is just frequent, effective feeding, inc breast compressions if needed, and lots of skin to skin....it doesn't sound like you need more complex interventions at this stage.

I'm no expert but was in a very similar situation with my DD1. She lost weight, I was advised to top up after each feed with formula and express after this to try and boost my own supply. It was impossible to manage and I ended up solely FF from 3 months. With DD2 I wanted to try BF again. She also initially lost weight - it turned out she had quite a bad tongue tie, although feeding wasn't painful. Has your DC been checked for that?

There were some other things that seemed to help. Firstly, switching fairly frequently, so after about 10 minutes or so (which also helped when she fell asleep on the boob) and offering 3 or 4 sides, so returning her to the original breast after she'd fed from the first side until she seemed to have had enough. I also did breast compressions while feeding.

Secondly, I did try to express a couple of times a day after feeding to encourage my supply. It could be hard to fit it in but I had a good electric pump and it seemed manageable.

Thirdly, I took fenugreek tablets as fenugreek is supposed to help boost supply. I did end up with a good supply, although have no idea if the fenugreek had anything to do with it. I did notice I had a vaguely curry-like smell after taking them for a while though!

Finally, not sure if this is an option, but I found co-sleeping really helped me establish breastfeeding. She pretty much fed on and off all night and I could just switch her over then go back to sleep.

I hope everything works out for you. I know people who did return fully to breastfeeding after initially topping up by gradually reducing the top-ups. It's also not the end of the world if it doesn't work out. I fed DD2 for 18 months in the end, but don't notice any differences in the long run between her and DD1 (although DD1 is a much less fussy eater, ironically!)

Forgot to say, when I was first expressing, I didn't really get anything out. I did it more to send the message to my breasts to produce more milk.

I tried and failed for 4 months to feed my first. Tried fennel, domperidone, skin to skin, feeding constantly on demand, expressing. You name it I tried it.
Just never made milk.
By all means take the advice available BUT if it isn't working ff is an option.
Good luck.

A little update. It seems he has a tongue tie. I have an appointment later this week to have it assessed.

Ah, that would explain the weight loss. Dd2 had hers snipped at 3 weeks. It took a week or so for her to start feeding more effectively ( something to do with learning how to use the tongue muscles - cranial osteopathy seemed to help), then she suddenly put on about 10 oz in a week. Hope the appointment resolves things for you.

Thank you, that gives me hope. Starting to find it a bit hard feeding for hours and him not gaining weight. He's still having formula until we see how the appointment goes Friday.

arthurbaby I had the same thing with DD. Her tongue tie cause chaos in the first three weeks. She fed one day from 9 am until 3pm without break! She would feed one side for an hour and then drop off and scream for more. I was at my wits end.

Having the tie snipped made a world of difference. The feeding time dropped straight away but it took a week or so for my supply to level out and she still cluster fed constantly until then. Have you tried hand expressing between feeds (I know that's often a blink and you'll miss it moment)? The breast feeding consultant at the hospital advised me to do that the help stimulate my supply while I was waiting for the appointment to get the tie cut.

Good luck! It does get better. Xx

I haven't tried hand expressing, thanks for the idea. I took him to a breastfeeding group at my local sure start today too, I'm now just really hoping Fridays appointment offers a solution.

Weight up to 8lb 10oz after seeing a lactation consultant, he is switching breasts over and over at each feed and I am using breast compressions. His tongue Tie gets cut tomorrow. Thank you all for the advice.

Great news OP. I'm a bit late but came to say ds was the same, 9lb1, dropped to.....Can't even remember now! But hv and mw all of a panic and made me feel rubbish. ALL I did all day was feed yet he lost weight. Didn't regain birth weight til 21days.

Breast compressions and switch feeding worked for me.