I must top up but baby refusing bottle

[Shantotto]

11 week old DD had a GP check up yesterday and she sent us off to hospital to get her weight checked. She’s only gained 200g over her birth weight after taking 6 weeks to regain her birth weight. So we’re formula topping up after each feed.

Thing is she won’t accept a bottle! Just looking for tips or bottle recommendations. She’s so tiny I’m getting concerned and I know it’s super important t get some more calories into her!

Just doing a bit of research on Amazon for you, Medela do an "advanced cup feeder" which may do the trick if she still won't take any of the bottles recommended for breastfed babies.

If you search Axifeed sterile feeding cup, that looks like the same cup I used for my baby when I needed to top him up and he wouldn't take bottles. Once i found Lansinoh bottles I swapped to them because he would accept them, but the feeding cup was quite good because of the lip it had. With yours been 11 weeks you may have to fill it up numerous times but at least you'd get milk down.

Good luck, please keep us updated!

smartplay If I pump first I won’t get anything out to top her up with. The suggestion was to feed first for around 20 mins as otherwise she’ll be using too much energy on feeding. Then offer the formula. This was suggested so I wouldn’t replace a feed entirely and make supply even worse.

I can’t face feeding, pumping, formula every feed. It will triggers my PND like with my first and I have to think about him too. He was mix fed from day two - severe jaundice, no weeing. Given formula again on advice of a lactation consultant. It feels like I’m just going to be dismissed as one of those mums that just doesn’t try hard enough when they claim to have low supply and I just don’t think that’s fair or true.

Thanks everyone for the suggestions so far. I’ll give some a try.

Hi OP, my baby also had to be admitted to hospital and tube fed. They told me it was me not producing enough milk. It turned out she had a tongue tied. Once they snipped it, it took 3 weeks for her to put on weight but since tgen she regained back to her centile. The hospital didn't check for tongue tie, I had to find out by researching on the internet and then showing health visitors etc. It was a pain in the arse. Please get her checked for tongue tie by someone trained in it.

@Reallybadidea I believe that increase of 200g in 11 weeks is the indicator of low milk supply. Op is under the specialist care and already and unable to increase milk production.

I have low milk supply, it was better this time but DC3 is an appalling feeder and like your baby had very poor weight gain, we got a lot of the premature comments and DC3 couldn’t take a bottle. We used an SNS and she has eventually learned to take a bottle. SNS got her weight up.

I’m an IBCLC and people still doubt I have low supply. 200g over birth weight at 3 months is not normal.

OP you are doing great focusing on getting nutrician to your baby. Slow teat, warm milk and one of the teats they have to suck a bit worked for mine. It does take time for them to get bottles and to increase the volume they are happy to take at one go. I hope your baby starts gaining soon and take care of yourself too - a poorly mum is going to be no use to her baby. If you want to keep bf / mix feeding then of course do - but it might just saying might be easier to switch over altogether.

There are a lot of different tests to try.
Mine preferred the narrow Dr Browns.
But these worked ok too:
www.chemist.co.uk/aptamil-first-infant-milk-starter-pack-1-from-birth.html?gclid=Cj0KCQjw1MXpBRDjARIsAHtdN-0edqhlPxPpv9_BC8PbugRdmaB0SlJSFfDtNjYoHogjMeQlVmPUfKcaAmDZEALw_wcB

• teats!

Honestly if you feel like you may slip into PND if you are combination feeding then I would just move fully to formula. I know she is not taking a bottle now but she will not reject it if there is no breast on offer.
A supplemental nursing system is also an option but again it is quite a lot of faff and you have another child to take care of too.
You have persevered with breastfeeding round the clock so your baby has had an amazing start in life. But please take care of your needs too.

In reply to your bottle question, I second the recommendation of Munchkin Latch made up thread - baby has to 'push' against the bulb of the teat like they do the breast when breast feeding. Also heard good things about the Medela bottles, but not tried them.

Secondly, has baby been referred to a dietician due to 'failure to thrive', we were and found her quite helpful, especially later when it was appropriate to reduce the top ups. Also ask about being prescribed a high cal formula - we had similac high energy. It has more calories per ml than regular formula, which amongst other things means that you don't have to try to get baby to take as much. Our poor weight gain was eventually linked to a few issues including CMPA, however even though the she was reacting to the Similac she was still able to gain weight on it due to the high calories.

Crikey, OP, that sounds horrifically stressful. I'm not an expert but I think I would:

1. Use a syringe - fasted way to get more into her
2. Try a cup
3. Try some of the teats suggested here by people who've been through similar.

I would do all those things, in that order. I would also probably ditch the breastfeeding altogether, once I'd found a way to get sufficient amounts of formula onto her. If she's gaining SOME weight via BF, you probably need to keep up with it till you find a good way of getting her to take formula, but it doesn't sound like it's worth the hassle in the longer term.

Really hope things pick up soon.

My twins were prem and so really struggled with feeding.

The nurses in neonatal recommended the cheap supermarket/boots own bottles as the easiest ones for them to learn with... certainly worked for us so might be worth a try with your little one before you spend a fortune on the more expensive brands?

If she starts taking the bottle then there are prescription formulas which are higher calorie that she can have to boost her weight, so she will be able to catch up. Xx

Oh and yes I agree with the above poster that moving to full formula feeds once you've got the bottle bit sorted might make you feel better. With small babies I found knowing how much they had drunk was very reassuring.
I know you said you're not keen on pumping, but if you manage to get her on the bottle and you don't want to give up on breast feeding then you could always try pumping while you feed her the bottle, that way not losing any time?

Sorry you’re going through this!

It’s frustrating with low supply and people suggest oats, breast compressions etc which is obviously the first methods. But when you’ve been dealing with it for months are standard practice. I’d assume you’ve also requested domperidone from your GP (it helped us after 5 days) so have exhausted supply except for adding in pumping and power pumping which is I find tough going mentally.

Practical advice

Nipple shields will help baby accept plastic teats - try a set (your Feeding support can issue you an NHS one) or amazon / boots / mothercare. Just check the sizes before you order.

You can also request the feeding team to review you both and supply you with a supplemental nursing system - it’s fairly faffy but not too bad as baby is still nursing at the breast.

Syringes are okay if your only doing small top ups - we used for up to 30ml but when we were forced to do 90ml top ups I switched to bottles.

Mine takes the anti colic Tommie Tippie as the teats are similar to the shields, so she’s happy to interchange. Just be aware with bottles that a preference can be formed as they’re easier.

Feel free to PM and you have my sympathy. My baby has finally begun to gain well but it took weaning to start the gain, simply can’t get enough milk into her alone to get her to gain.

Oh OP I really feel you.

Mine is 16 weeks and only just out of newborn clothes. She was always small but hasn't bloomed like other babies. I too am tired of being told she's so small, she looks like a little doll etc etc. She's too small and it's very upsetting and stressful.

Mine is also a bottle refuser... I don't have the same issue re supply as mine is frankly, over generous.

I have found the syringe a really good way to get a bit more in. Remember, if she's only used to little feeds her stomach isn't going to accommodate a huge top up which might be why you're having issues with a bottle?

Have you been given a feeding plan by the infant feeding team? Have they indicated what the top up should be? Ask for a referral from your HV or self refer (I did).

If they have suggested 50ml as an eg, then I would syringe that into her. Have they provided a build up plan? I started by adding 10ml per feed on day one and built up over the course of a week to 50ml. It seems slow but remember that every little helps. You want to see her thrive but it might take a little while to get there.

I found the following helpful:

• it should be warmer than I thought.
• give baby time to adjust, it's a new skill. Wait for her to swallow before adding another syringe. It can be longer than you think.
• give her a break if she's getting stressed. Don't want to build a resistance to the syringe!
• keep the end volumes in mind BUT remember even a little extra helps and you'll get there with each feed.
• don't let her go longer between feed of you can. The aim is to build her weight and capacity!

Fingers crossed for you and your little one.

Oh and in terms of bottles, mine just won't. I'm now using a soft teat sippy cup for volumes over 60ml and she's much more accepting of that. I literally spent £££££ on all the bottle/teats to no end.

She is now gaining weight, which is fab so you will get there too.

I know it feels horrible right now but it does improve.

We used medela calma teats for a while (until baby decided she didn't like them), and then MAM. The MAM bottles are pretty handy actually as they "self sterilise" in a microwave.

Ridiculous that the advice is to top up with something with basically the same nutritional value as breast milk. Also pumping is not an indication of supply.

I think OP has been let down and this should have been sorted sooner. There are breast milk fortifiers available and high calorie formulas in this case it sounds like those are needed and specialist support. This is unfair on OP and her baby that they’ve been left to get to this point

OP if you feel strong enough to go back and demand more help or a prescription for one of the above

Also a supplemental nursing device medela do one

Thanks so much everyone! I did write out a huge reply, my browser decided to refresh and I lost it. Then I’m trying to unpack a house and host in-laws and visitors over the weekend! I’m sorry if I miss some of your comments - going to try and cover it all and not tag everyone again.

Right - I guess I can’t blame the people who were involved trying to encourage me to keep at it - she’s hitting milestones, strong and alert but weight has reached a point where ‘keep going you’re doing great’ isn’t cutting it anymore.

She has taken a bottle quite happily now - munchkin latch. So that’s a huge relief. I suppose this should be a thread on how can we gain weight now! 😁

Sorry to hear a lot of you have had similar issues - it’s such a worry and I have anxiety issues at best of times. As for maybe knocking bf on head completely, I feel like that would make me feel even worse! I want to be able to comfort her on breast as long as possible even if she’s not getting much in way of nutrition!

I too feel like just small top ups won’t cut it
now. I’m back at hospital tomorrow and I’m going to raise the suggestion of prescription formula and look into domperidone. I did take that with my first to no effect but wonder if the hospital more likely to give me a larger dose?

I’m still putting DD to breast a lot so might skip the SNS for now.

Should I think about weaning with high calorie food a little early? I’m hoping tomorrow they will come up with a better plan than just 30ml after breastfeed - seems a little vague. There’s no mention of referring to a dietitian.

Did people who experienced this find the weight gain was quick? I’m so worried it’s just too late and I’ve prevented her from growing as much as she might have done when she grows up. Am I being ridiculous?!

Oh and quickly talking figures - she was gaining 4oz a fortnight but I did feel feeding was going better so it was decided to leave 4 weeks between weighings. When she was weighed at hospital, the three week point, she’d gained 1.5oz!

I’m So upset - I feel like my instance on bf has caused this. Although I was checking in a lot with the breastfeeding specialists and the HV and going to cafes. Was just met with oh she’s just a slow grower shrugs.

Gah sorry one last thing - I’m being told to up 30ml of formula every 3 hours / after each feed roughly. They worked it out out as half her calorie needs from formula and rest from me.

Evening OP, so to answer from my perspective - my baby didn’t gain anything at all some weeks (nothing) in fact lost weight occasionally. She had over 300ml of formula / expressed milk plus breastfeeds every day from fairly early on (upper again to 500ml then 650ml) and was still not gaining. I think a week I gave her pretty much all feeds by bottle she took over 1100ml and still only gained grams at the weigh in which is when the paediatrician sent off for bloods. She is just a slow grower it seems. Finally putting on weight with weaning plus all her milk feeds too, but the weekly weigh ins and scrutiny were exhausting for me. I felt constantly judged and under pressure to prove I was a good mother feeding my child - not their fault but it’s hard when also obviously concerned.

I can’t remember the age baby needs to get to .., think it’s from 4 weeks they average between 750-900ml intake. But you’d be able to work it out kellymom.com/bf/pumpingmoms/pumping/milkcalc/

She’s currently screaming so I’m afraid I’m struggling to concentrate - hope I haven’t missed anything. And I didn’t want to stop as it really helped me going back to work to not feel so bad personally.

mrsgrannyweatherwax thanks for your post! Went back to hospital yesterday and she's gained 150g since Thursday!

I’m so happy considering until then she was only 200g over both weight at 3 months!

Please don’t beat yourself up if you find you need to give up on breastfeeding. Please. I did this and in hindsight giving it up was actually the best thing I did for us. Our mental health improved and my relationship with my older child improved as did my relationship with my husband.

If you find that you struggle with bottles again I found that the cheap pound shop bottles with skinny tests worked best for my child. Also, if you struggle again get baby checked for tongue tie - tongue tie is a major cause of your supply tanking - especially around the 12th week, and of poor infant weight gain. Not everyone is aware of tongue tie - paediatricians have the tiniest amount of training on it - and lots of health visitors and midwives wouldn’t know one if it hit them in the face. Worth reading up about it and then seeking out someone who is trained in tongue ties.

Lastly. Take care of yourself. Your mental health is far more important than whichever method of feeding you choose. ((Hugs))