Does my 8 day old need formula top ups?

[Sleeeeeepy]

For context I had dreadful issues feeding DS1, he kept losing weight and only put on when I added formula.

DS2 is 8 days, he lost 9.3% of weight up to day five, and only slightly recovered in the following 3 days so is now 7.8% under birth weight. I only get a very small amount when I pump (with my hired hospital grade pump) and I’ve been feeding him at least every 3 hours but usually much more frequently (on demand)

He had one formula feed between day 3 and 4 as he was distressed, my milk hadn’t come in and he was so hungry. Other that that he’s been EBF.

I’m worried about the tiny weight gain and that I might be starving him in my quest to breast feed. His latch and positioning are fine apparently so I can’t think what else to do to boost supply. Am I being selfish, should I give him some top ups to make sure he’s getting enough? I’m so torn.

If he's on an upward trend for his weight now, then it seems like breastfeeding is working for you so far. Don't go by the milk pumped it's not a good indicator of how much he's able to get, so I would doubt you need to try and boost supply at this point (although it's important to drink enough water, eat, and rest). What did the health visitor or midwife say about his weight are they worried? If so, why?

This website my sister recommended has a lot of really good advice: kellymom.com/category/ages/newborn/bf-basics/

My DS2 and your DS were born on the same day! It’s ok he hasn’t regained his birthweight yet- once it reaches two weeks is when they start to intervene (or 10 days in some Trusts). Do you have a local BF support group to get your latch checked etc? If he’s feeding well and has the right number of wet and dirty nappies/no signs of dehydration then it is a really good sign. If at all possible spend as much time as you can skin to skin and let him graze to encourage supply. DS1 was a nightmare to BF and I was constantly worrying.

Is he generally content (ish)? Is he producing wet and dirty nappies? If so then he's fine. So long as he's putting on weight, even a little bit. Just feed him loads!

And please stop expressing! The best way to boost supply is to feed.

Think of it the other way round - in three days, he has gained 1.5%, which is fine!

At this stage, feed as often as you can, and go by the nappies: 6x wet nappies and 1-2 poos every 24 hours. They can’t pee it out if it hasn’t gone in!
If that’s not happening, it’s possible he’s not feeding terribly efficiently yet, so hit the BF group to get some tips.

The WHO recommend supplementing with expressed milk as a first resort, donor milk as a second, and formula as the third choice, so if it is the case that top-ups are required, your own milk would be the first port of call (also prevents the formula interfering with building up your supply).

Topping up doesn’t mean an end to BFing either, as long as your milk supply has been maintained.

It’s still very early days, and he’s just learning a new skill. The upward trajectory is the key at this stage - it means he’s worked it out enough that he’s gaining, which is the main thing.

The National Breastfeeding Helpline is brilliant for information and support without pressure.

It's so hard. And tiring. And frustrating.
I'm a midwife and often come across variations on this theme.

If his latch is good, it doesn't hurt and when he comes off the nipple looks like a normal shape, not compressed. If that is the case, I recommend a 24hr feeding boost. This is choosing a day when you have support, no visitors and are feeling well. Plenty to eat and drink. Then feed this baby as much and for as long as he will do it for a full 24 hours.

The efficient physical draining of each breast and the maximum stimulation of the milk hormones will tell your body to increase supply. The next day, your breasts should feel fuller and the baby should be producing more poo and urine.

However, lots of women mixed feed. The baby is still getting the benefits of breast milk. And it works for them.

And bottle feeding, even if it was not your first choice, is still ok!

My DS2 had slow weight gain too but got there. In my case I was feeding him until he finished/came off the breast and I just stopped then. I had oversupply issues with DD1 so that had worked and he never took a 2nd breast at a feed. Turned out that DD2 needed more. Midwife told me that babies feed until hunger is gone, but it's not always enough so maje sure you put him on 2nd breast at every feed. Once i started doing that his weight jumped up.

Agree with Loraline, in this situation, it's usually best to offer both breasts at each feed.