top up feeds

[user1492282695]

Hello.

My 3 week DD has had slow weight gain since birth and hasn't gained anything in the last week! I have been trying to increase supply by pumping, feeding frequently. HV and GP advised to supplement, which I have been doing with one bottle a day of 2oz (formula as unable to pump enough to give)! DD has breastfeed then formula then goes back on breast again after so I was wondering if this will ensure that my supply does not suffer so I can drop the supplement when she starts gaining better?

Sorry bit of a ramble

Has she been checked for tongue tie?

Are you.in any discomfort? Does she struggle.to feed at all?

She hasn't been checked but I will do! I had sore nipples for first few days but fine now, would this be the case if it was tongue tie? she seems to latch on well lots of sucking and swallowing!

My ds had posterior tongue tie, I wasn't actually sore after the first week or so, and he seemed to have a good latch from the outside, but his weight gain was too slow and his nappies were green and frothy. He was only managing to draw down the thin watery milk, leaving the fatty goodness behind. I used breast compressions to help him get the full fat milk into his mouth, but getting his tongue tie divided made all the difference.

You can check for TT yourself if you have a feel around your dd's mouth. It feels like a band of skin from the bottom of the.tongue.to the base of the.mouth. google.images should help.

I checked my ds almost immediately after he was born, and diagnosed him myself straight away. I am admittedly a bit tt obsessed but I had a hellish time with his big sister! He was a breeze in comparison.

Ah may well be worth a look then. The midwife is coming tomorrow so will ask her too! I've started using breast compressions, she seems to do well at the start of feeds but does slow down after five/ten mins. I just hope this one stand alone feed a day doesn't compromise my supply!

I'm so keen to keep going as only managed a few days with my first!

When you say you’re feeding frequently, how often is this? What is happening through the night?
How many wet and dirty nappies is your baby doing each day? And do you use a dummy and/or nipple shields?

No dummy or shields. She feeds every few hrs day and night, sometimes more! Over past 24hr she wanted to feed nearly constantly, but not sure if this is growth spurt related! She has plenty of heavy wet nappies, poos aren't as regular, she has been a few days with nothing then has 3 in a day!

How long ago did your medical team advise the 2 ounces? If a week ago or more, and if she is still not gaining steadily, then I would think about increasing by another ounce or more - ask their advice. At this young age, a baby's capacity for mill increase pretty quickly and fully-formula fed babies will be moving fairly quickly from tiny bottles to gradually larger ones.

I'd suggest the priority is establishing good strong weight gain. This may mean for your baby more frequent or larger supplements if your current pattern of BF ands pumping isn't working for her right now.
When that weight gain pattern happens, you can then address moving away from supplementing if that is what you wish.

Have you spoke to your GP about domperidone? That might help increase your supply. And you could always look at giving your top-up as a supply line feed at the breast?

OP it's good this is being addressed. No weight gain in a week with a new baby is concerning. However there's not enough info here to be sure what's going on.

What are the actual weights?

Are you feeding at least both sides every time?

How many times is she bf in 24 hours?

It would be good to share this info with someone who understands and supports bf in real life, who can observe a feed and properly assess what's going on, which would include looking at the tongue.

Ask about expressing your milk, too, and using this as a supplement.

Hope things go well.

Can you go see a breastfeeding clinic or lactation consultant?

She was 9lb 4oz at birth and lost 7.5% on day 4 at 8lb 9oz. She then remained static at this weight at day 10, gained only 20g by day 15, went up to 8lb 12oz on day 18 but has remained at this weight when last weighed. She has always fed frequently and have had NCT breastfeeding specialist out to check latch etc. I rented a hospital grade pump but only pump about 1/4-1/2 oz after feeds so difficult getting enough to supplement! Baby feeds to often to do it in between! Do GPS still prescribe domperidone? As I do wonder if I have a low supply issue linked to me as I never got engorged or leaked even when milk first came in! it has been so stressful doing the pumping feeding coupled with half term last week too haha! Thank you for everyone's replies just trying to get to the bottom of what's going on!

I'm going to go to a breastfeeding support group tomorrow and going to ask midwife to check for tongue tie today :)

Thanks for info.

She's some way off birthweight. This needs addressing asap. I don't think a bf support group is enough unless they have a highly qualified and experienced person there. If there is, great.

Domperidone is rarely prescribed these days and it's not appropriate until a proper assessment has been done.

This is what you need op - a proper assessment and observation. A baby half a pound below birthweight at three weeks is in a very concerning situation. This might mean more supplementing - your own milk, donor milk, formula....whatever. But two oz a day may not be sufficient - do get proper help.

I'm seeing the midwife shortly so will discuss with her then. The GP is also aware. It just feels that the issue behind why she's not gaining is not being looked at! I will also see how her weight has been with the supplements so far. Hopefully she has gained.

I agree with tiktok - focus on getting her weight up asap. :) With my dd, once she put on weight everything else sort of clicked into place; the lactation consultant called it the 10 week growth spurt. Apparently a lot of babies' mouths suddenly get bigger at that age and they start feeding at the breast easily!

I hope you find a solution.

Feeding every few hours doesn’t really sound very often, especially given the weights. The lack of poo for days is also a sign she’s not getting enough, for whatever reason.
As well as looking at increasing the supplementing (ideally with expressed milk) could you offer the breast more? Aiming for at least 12 feeds a day?
Agree that you need one to one qualified help, this is probably beyond the remit of a bf support group.
Hope you get some positive news today.

She has gained 70g in 3 days so looks like she just needed that small amount extra to gain. Midwife wasn't concerned at this point.

Thank you everyone for your support😊

As well as observing a feed, has any medical professional examined you directly? Not getting engorged a few days post birth can be one of the signs of IGT I believe. It would be worth asking about hopefully to rule it out.

Congratulations again.

That weight gain is welcome, OP.....good care from the hcp would be to weigh her again in a few days. She's still well under birthweight so not out of the woods. But the signs are good :)