newborn weight loss

[Rocket1982]

sorry for the long post. I have a seven day old boy. I am trying to EBF from the right side only- the left side has all the ducts cut from surgery and cant produce. Baby was weighed on day 5 an had lost 10.5% of his body weight, which is slightly higher than the 10% limit. He was weighed again today on day 7 and has lost a further 10g, bringing him to 10.8%. We are being advised to start supplementing either with formula or expressed milk.

With my DD a similar thing happened, except she had lost 15% in 2 days. We (in the US at the time were put on a 2 hr schedule of feeding, then pumping, then feeding whatever had been pumped and/or formula to total 30ml through a supplementary feeding system (straw) while breastfeeding the next feed. This did not go smoothly- DD had lots of digestive issues. The paediatrician advised us to try different brands of formula, then they thought she was sllergic to dairy, so we tried soy formula, then they thought she was allergic to dairy and soy, so we tried something else. DD never liked the supplements and it was always a struggle to get her to eat them. we were using the supplementary feeding system, but after a while DD rejected it and eould stop sucking when she felt the straw. We tried many different bottles and she wouldnt really take any of them - sometimes dhe would when almost asleep. At 5 weeks she refused all supplements for 2 days and I decided to try EBF. Things basically went fine and I EBF until 5.5 months.

I later discovered when I had built up a freezer supply via pumping that my pumped breast milk tasted diagusting andI had to throw it all away. I think I produce an enzyme which causes digestion of the breast milk - when I looked into it this seems to be a relatively common problem, and I even know several people who have the problem amongst my friends.

The experience with DD has made me extremely reluctant to go down this route again. I know that with her I was able to EBF.

I am feeding continuously through most of the night, with baby dosing for half an hour here and there between feeds. He sleeps gor longer chunks in the morning where DH takes him and I get some sleep with a feed every 2-3 hours. Until about 5 pm he is still aleepy and I feed whenever he wakes up. Then he starts cluster feeding.

I would try pumping before formula and perhaps he would take it if I give it to him immeditely before it has a chance to degrade. However, I never used to get much pumping (about 10 ml) and there is not much time available for punping as in the morning I sleep and most of the rest of the time I am feeding. At night DH sleeps and baby is awake, so there would not be an opportunity for me to pump.

Another factor is that baby seems to have silent reflux, which makes him a bit fussy when feeding. Also, I started fenugreek yesterday which seemed to help my supply last time.

So what should I do? Start supplementing now or give it more time? We are at 10.8% and they say 10% would be consisdered normal. Baby is poohing and peeing well. On the other hand he doesnt end feeds satisfied ever, they go on until he falls asleep. What would you do in this situation?

This sounds really stressful. My baby lost 12% by day 3 and like with your dd we were put on a feeding schedule and when she wouldn't take a bottle they used a feeding tube. We did this (I expressed and bottle fed) for 6 weeks until she finally latched.
However I was lucky in that I can pump a fair amount.
I think cluster feeding in the early days is very normal and they are also so sleepy. If there's lots of wet and dirty nappies then that's a good sign.
You could just keep bfing and keep a close eye on weight and if it continues to drop add a bottle of formula.
I know people are very quick to suggest supplementing and it can be disheartening when you really want to bf but it sounds like you're doing everything you can with regards to bfing.
Have you seen a lactation consultant? Has anyone checked the latch/for tongue tie as this can affect feeding efficiency.
I hope everything picks up soon. Early weeks are so hard aren't they. Good luck op x

Thank you freewheezy! I started pumping today and the plan was to pump straight after feeding and give DS what I'd managed to pump straight away in a syringe. We have done this twice and he really doesn't like the syringe- crying after every mouthful and it takes two of us to feed him the supplement. On the other hand in 2 cycles of this I pumped 20 and then 30 ml, so DS clearly isn't emptying the breast. So hopefully this will increase my supply, so its mainly a case of how to get the pumped milk in to him so it doesn't get wasted. Should I try a bottle on day 8, or would I risk ending breastfeeding because of nipple confusion? Milk is yellowish so not fully mature yet.

I know his latch isn't that great, he fusses a lot at the breast like DD did in the early days, bobbing on and off. His latch is a bit shallow, it was better in the first few days than it is now. However, midwives take a look and they say it looks fine!

If you're pumping and there's too much lipase in the milk you get the washing up liquid/hair spray taste in it. If you boil the milk it breaks the lipase down and gets rid of the taste. Just make sure it's really cooled before you pop it into a bottle for her!

Rocket, I'm not an expert but I would think that 10.8% is within the range of normal including the margin of error for scales. Is he a particularly small baby or jaundiced or any other reason to be extra concerned re weight loss?
Baby is producing lots of wet and dirty nappies, feeding enthusiastically, transferring milk ok, decent latch, seems alert when awake, etc?
I understand your problems last time (which sound really stressful) but perhaps they are making you more anxious than you need to be this time.

I would find a lactation consultant to make sure that latch is optimal. In terms of the milk spoiling problem, are you sure it's not just when the milk is frozen (lipase)? My milk I think has a similar issue; it's fine for a few days in the fridge but if I freeze it it seems to get rejected.

In terms of introducing a bottle, I have done bottle feeds with both mine from very early (4 days with second when nipple was flayed, 2 weeks or so with first) and neither suffered nipple confusion.

You can also get lip cups if you're worried about nipple confusion.

We used these as I was concerned about nipple confusion.

Lifelong, thanks, I never tried blanching last time and will definitely give it a go this time. How was feeding with a cup, it looks tricky! Does the baby suck rather than parents pouring it in? He might be happier if he is more in control of the situation! He's not jaundiced. He was born just above 3.5kg (7lb 14oz) and is down to 3.18, so still above 7lb I think. He is producing wet and dirty nappies, though poo has only just turned yellow today - it had been green.

Quodlibet, thanks, good idea to get a lactation consultant, I will look for one! Also it's good to know that a bottle can be introduced early without necessarily causing problems.

Yellow poo is a good sign :) the weight loss doesn't sound too worrying. Mine went down to 5lbs in three days it was very sudden and you could really tell she wasn't getting enough milk. No poos. Maybe one wet nappy a day.
With the syringe, when I have to give calpol I let dd suck on the syringe a bit and that encourages her to swallow, otherwise she just spits it out.
If you think the latch is shallow do try to get some support for that. Midwives can sometimes be a bit dismissive (oh no, that c section scar looks great, next night 12am rush to a&e bleeding everywhere and a huge infection). Not that all are!!! But just get some second opinions and push the issue if you're not satisfied.
I used bottles from the start and managed to get dd back on the breast (via nipple shields) so it can be done but it is hard work and very stressful.
Keep offering the breast and try pumping after the feed to see if the breast has been drained? Have you tried hand expression? I find after I use my electric pump I can still hand express another 10-20ml. Then try giving any of the extra via syringe straight away so it doesn't get the bad taste.

You hold it to their lips and they gulp from it but obviously you control the flow by how much you do/don't tip the cup.

Today DS was weighed again and he has lost a further 15g, which brings us to 11.2%. We are told that if he loses 12% he needs to go to the hospital to be checked. I staryed pumping yesterday abs today we started 30cc supplement with whatever I manage to pump topped up with formula. I have pumped 30cc so far but pumping now and only got 15, so I think this will be the first formula. It does feel like history repeating itself, but on day 9 perhaps this is what we have to do. I have it a good go, and hopeully may be able to re-establish EBF like I fid with my daughter. I cried a lot when he lost the extra 15g.

This all sounds stressful, but I understand that breastfeeding direct is more efficient than pumping anyway (you see very small amounts in expressing but baby usually gets more), so are you expressing at all?
so why not just keep feeding from the one breast all the time, and do it more frequently than your 2-3 hour intervals?
The more you feed from the breast, the more milk you will make, as it receives signals to boost production. Just keep offering it to the baby and see if they take it.
Falling asleep at the boob after a feed is pretty normal in a newborn unless they are very weak and are falling asleep before getting a good meal IYSWIM.
But you should definitely find an IBCLC advisor to check baby is drinking well in the first place.

Do you have a decent pump? Is there any way you could hire a hospital grade double pump?^^ I have fond memories of the medela symphony.
Agree with pp, try offering the breast more often to increase supply. I used to just sit topless in front of the tv for hours just swapping breasts.
Get as many opinions as you can on latch/tongue tie.
Have you tried going to a bf group? I put off going for 3 months and when I finally went to one at the hospital it was so so helpful.

The good news is that DS gained 95g after 2 days on the supplement regime, which is about 75% breast milk and 25% formula. He's being weighed again after another 3 days. The bad news is that his latch seems to have gotten even worse and I'm not sure how much milk he's actually taking from the breast. The latch is shallow and I just can't seem to fix it- my daughter's latch was good. He takes a bottle very well. During breastfeeding there's a lot of sucking and not very much swallowing. In one session I counted 40 swallows in 40 minutes! I have hired a lactation consultant who will visit tomorrow- really hope she can help me with the latch!

Bless you, you are doing amazing! It's so stressful. Please make sure you are looking after yourself. We had tongue tie with DS even though midwife said he was fine. He was not transferring the milk, sounds like you have something similar. Hopefully the lactation consultant can help you. And don't beat yourself up if you have to continue with formula. We had to do formula top ups. Good luck

It turns out that DS doesn't have tongue tie, but the official diagnosis is that my nipple is too big for his mouth!? It is big, I think it might be swollen from being chomped. DS is still gaining well though on about 350 supplement (half breast milk half formula) every 24 hours. Looks like we may have to keep to this schedule until his mouth grows!

DS is at 4% weight loss now at just over 2 weeks, so I hope he will be back at birth weight later this week.

I had the same problem haha. Dd didn't latch for over 6 weeks. I bottle fed expressed milk and then used nipple shields for a few weeks then worked on the latch until she was bigger. Now she just suctions on no problem haha. Just work on keeping up your supply until he's able :) it's hard work but doable.
I expressed every 2-3 hours. Never went more than 3 hours. You get the most at around 2-4am and that's an important time to stimulate your supply.
It really is exhausting so well don't on the weight gain. You're doing great x

Well done on the weight gain! I have opposite problem (small nipples) so using breast shields, have you tried them? Might help him latch on if they are swollen... good luck you are doing great

We are at 4 weeks and still on the same feeding/pumping supplementing regime, which is tiring! DS is gaining weight but on a lower centile than his birth weight. 75th at birth and 25th now. I am pumping about 300cc per day and using about 100-150 formula. Do you think that formula is critical, or do you think that because most of the supplement is breast milk I could ditch the formula? I do feel a bit stuck with pumping, as I think DS can't be draining the breast if I am able to pump 40-60cc after a feed? With my DD I could only pump about 10cc after a feed. I think the latch is still sub-optimal. Thanks for all the good advice and support on this thread!