Formula top ups - should I still wake to bf?

[Aberforthsgoat]

Started a new thread for this, previously had one about breast feeding struggles.

DS is two weeks old and not up to his birth weight yet. He was weighed Thursday and had put on 75g and was still 155g off birth weight, had been exclusively bf.

Over the last week he’s been seriously cluster feeding at night and taking less during the day as he’s sleepy during the day and wide awake at night.
Last few nights he was seriously unsettled between night feeds and just wanted to be on the boob the whole time.

Today we got weighed again and he hasn’t gained since Thursday and was showing slight dehydration signs so they recommended 30ml of formula after every daytime breast feed which I’ve done.

He’s just had a feed (bf) and gone straight down to sleep... which is unusual at this time as this is usually when the cluster feeding starts.
I’m wondering if he’s just been hungry this whole time and the cluster feeding has just been him not getting enough initially.
But now I’m also wondering - if he continues to sleep through do I wake him every three hours to bf as is my instinct? 120mls of formula isn’t enough to sustain him completely, even with the daytime bf as well, and I don’t want my supply to go down as I’m hoping he will hVe gained in the next week and I can phase out the top ups as the health visitor has suggested.

Just a little confused as to what to do for best. I’m also considering expressing from tomorrow as my boobs are now huge and uncomfortable, and He hasn’t been feeding as long on the breast since he’s had the top ups.

Apologies if this is long and rambling I’m very tired and stressed about his lack of weight gain as he was born at 37+3 and is tiny anyway - was 2.6kg at birth, went down to 2.4 and is now back up to 2.54 but can’t afford to lose much obviously.

Please see a lactation consultant if you can. Although well meaning, most hvs and midwives don't know huge amounts about breastfeeding.

I had midwives in hospital telling me how great I was doing with breastfeeding/great latch etc. But as it was my 2nd baby I knew something wasn't right. Turns out she has a thick posterior tongue tie and it is causing lots of issues.

Oh.....and breastfed babies absolutely DO need to be winded!

I would pump as well to keep up your supply. Also, do skin to skin. That helps with milk supply. Make sure your eating balanced diet and enough calories plus drinking enough water.

Thanks bertie I spoke to someone over the phone today who was helpful and mentioned weak suck.
I’m trying to find a lactation consultant.

In the meantime I’m really not convinced that vomiting is nothing - he threw up quite a lot of a bf tonight, one was definitely a little projectile and it’s quite chunky and curdled and smells sour.

Im wondering if I’m now over feeding him - as he had had two formula top ups prior to this.

He was rooting for the breast but didn’t take much and then seemed to sick it back up and be in a little distress, so I wonder if he just wanted the comfort.

He’s not due to be weighed again til end of the week but I’m tempted to take him to the health visitor clinic Thursday afternoon as I can’t shake the feeling that something isn’t right.

I don’t know how much of this instinct is anxiety though, I’m really struggling at the moment.

I’m so confused. He just had a bf, was on for a while, hasn’t been sick at all and has completely settled.
It’s so unpredictable, I feel like there’s something I’m missing! Sorry to keep rambling on, I’m finding this a lot tougher than I expected. I genuinely didn’t realise feeding could be so complicated. I’m going to try the paced feeding you suggested on the other thread @BertieBotts and see if that helps as I think he’s guzzling too much formula (even though I want him to put on weight) then going for the breast still but it’s making him sick because he’s full.

If you are expressing is there a reason why you need formula too? My baby lost 8% birthweight and then more again (not regaining until 3 weeks) and we were told just to supplement with expressed milk. He’s 5 weeks now and weight gain slowed a bit recently so the HV just suggested more top ups. Try and get a second opinion especially if the advice came from a single midwife - many just want baby to gain weight as fast as possible so you can be discharged quickly.

I’ve only just started expressing @GrumpyHoonMain the health visitor didn’t even suggest it just told me I had to go to formula top ups because he’s so small and he was a bit dehydrated.
I decided to start expressing because since giving formula top ups he’s not cluster feeding so much at night :(
He’s also started resisting one side and is only
Settled after feeding from the left, I have no idea why maybe my supply isn’t as good or is too fast or something he always comes off and cries on the right side now, on the left he’s good as gold.

I’m so confused about it all and what to do for the best and am just hoping he’s putting on weight but the spitting up is really bothering me as I keep thinking he can’t be taking it all in which isn’t going to help him grow!

Babies spit up. It's normal because their tummies are tiny and their valves are immature.

It's not particularly helpful to keep weighing babies. Much better to just keep an eye on output. I became obsessed with getting my first born weighed and ended up very unwell.

Have you looked at the kellymom site at all. It is really useful and reassuring.

Thanks pink I think I’m heading that same way, I am so anxious about all the feeding and whether the looks small or not.
I have been reading it’s really informative and helpful

I've felt quite emotional reading your posts because I can see so much of myself in what you are writing. It makes me so upset and angry that breastfeeding support can be so poor in this country.

Yes, paced feeding definitely helps with the spit up. I think with normal speed of FF they get overfull before they recognise they are full if that makes sense. But also you will come to find patterns. I can't remember exactly what DS2's vomit triggers were but I got to know them and so we could avoid posseting by avoiding the triggers.

Silent reflux is also worth a look - sometimes they keep feeding because the sucking helps with tummy pain but get too much. However people suggested this for DS2 and it wasn't right.

You could try football hold on the right side. Anecdotally, cranial osteopathy can help with one sided feeding especially if you had a tricky birth. Medically there is no evidence for it but I know people who swear it helped.

YY try not to worry about him looking small. Looks will not tell you much. DS2 looked chunky when newborn, then went a bit scrawny, then plumped up again, now he is a toddler he looks slim again but weighs over average for his age, so it can be really tricky to tell. Output is more important. And just that keeping the milk flowing and the baby close and fed. Supply is not as fragile as they say and it won't poof away as long as you are still getting the baby to the breast or expressing. You can do both, but you probably don't need to. Your baby will stimulate more if/when he needs to.

Whatever you do - make sure you are wearing your own oxygen mask first. That means taking a step back to breathe every so often, and evaluating decisions such as expressing for sanity - adding a couple of expressing sessions during the day if you feel well and able to do this? OK. Setting an alarm to express every 3 hours at night? Don't. Don't get so hung up on feeding that you make yourself ill. I think I actually found the formula helped in this regard. I didn't like giving it, and I'll admit to some meltdowns at DH because if we were going to give formula, it had to be perfect and he was not doing it perfectly enough for me - I think I would ideally have had a sterile lab box in my kitchen and an atomic scale :) - but I did come to see that DS2 was OK even with it and that it didn't have to all be down to me and that allowed me to breathe a bit. I even let DH do a feed skipping a BF so I could sleep occasionally, which I don't recommend you do yet, but did help a lot.

Ah pink and bertie your posts have made me a bit tearful I’ve been getting so worked up and worried about what will happen if he hasn’t gained.

I Think I’m also very anxious because I had a previous second trimester lost due to a heart defect so I get very nervous about potential underlying conditions for every little thing - which is probably not that illogical really. I just have to remind myself we are getting a LOT of dirty and wet nappies, he’s mostly contented and sleeping between feeds apart from at night - although since introducing top ups he’s been a bit more settled at night as well. He’s also alert when he is awake and looking around. There’s nothing really to point towards anything wrong aside from the weight issue and the slightly blue grey tinge around his mouth which I am assured is wind.

I feel like I’ve just got myself worked up into an anxious state this last week and reading through these posts with the advice and tips has really helped and shown me this isn’t an unusual situation. He may only be five pounds six but that’s bigger than some babies and he didn’t need special care - I think you’re right about taking a step back and trying to breathe so I’m not getting so stressed about everything

Just an update - he’s out on weight - over 170g in three days so is now above his birth weight and it
Only took until day 17 so not too far behind.
He’s eating well, and actually sleeping in blocks most nights now although he has a sniffle at the moment so that might change.

I’ve been worried about a slight grey purple tinge around his mouth but apparently it’s wind - and he’s definitely windier since we have been doing the formula top ups.

Thank you @BertieBotts I tried the paced feeding and I think it’s really made a difference - he seems to have more of an appetite now as well.

Glad that things are going better.

I recommend having a look at Themilkmeg on facebook, she gives really great breastfeeeding advice. Also have a look for local breastfeeding groups near you, face to face support from people specialising in breastfeeding (as opposed to health visitors) can be really helpful and comforting.

Oh that's brilliant :) Yes grey/blue tinge around mouth defo wind at that age.

I think they quite appreciate the paced feeding. Must be nicer for them as they can control it a bit.

I think so too @bertiebotts
The only thing I’m noticing is he’s feeding less at night, so not bf as often :( but I’m guessing that’s because he’s full

I feel like every time I think I’ve cracked it I get a new problem. Baby is now really windy poor thing and quite distressed with it, I can’t seem to wind him enough to get it all up. Infacol is helping a bit but not getting rid of the issues. He’s really noisy with the wind, grunting and squeaking and crying, so he seems really uncomfortable.

I’m using Dr Brown slow flow bottle for the formula feeds but recently baby has started coughing and spluttering at some point during the feed (only with formula, once bf but I think that was positioning) which is really scary. I think it could be me holding the bottle too upright, so am
Going to try and hold it at a right angle instead but now I’m starting to dread bottle feeding him as it seems like he’s choking :(

I don't have any practical advice but didn't want to just read and run. Can you speak to your health visitor and ask if there is an infant feeding lead on the team or a breast feeding specialist for advice around feeding. They're there to be used so don't feel bad about asking for help.

My mum swore by gripe water when I was younger and brought some for my daughter when she was windy but I never had to use it as the infacol was enough.

@Aberforthsgoat 💐 I’m so sorry for your loss. No wonder it makes you hyper vigilant to anything in your DS.

As Pp have suggested I wonder if you have a bf support group locally?

Thanks both. I’ve requested help from health visitor and midwife they are coming on Thursday. I think it’s wind or reflux that’s causing the distress after formula feeding, the coughing, arching back etc, louder breathing all seems to fit. I’m tempted to take him to the GP just to be checked out more for my reassurance!
He’s only noisy and grunting after feeding, he’s just gone down in his basket and is sleeping peacefully now. I think I need to position him better when I feed as well so hopefully Thursday will help with that

I wish I could stop being so hyper vigilant it’s exhausting! I just want to be able to enjoy him and not be scared of everything I feel like I’m just waiting for something to go wrong :(

How often are you burping with the bottles? My first had to be bottle fed in scbu for the first 3 weeks and we were advised to burp after every 10ml, then keep him upright for at least 20 minutes after a feed.

@Pinkflipflop85 I’m burping afterwards. I will try the every ten ml. I think I’m not picking up on when he’s done aswell, hence the coughing and spluttering as he doesn’t do it when bf.