BF baby not gaining, top up or not?

[codenameduchess]

Ds is 10 weeks and ebf, he was tube fed with formula for his first 5 1/2 days but latched on to me the first chance he got abs has fed well since with a few bottles of ebm weeks 5-6.

He was 50th centile at birth, 2 weeks ago he'd dropped to 25th and today he has dropped again to 9th line.

He's very alert and content, great head control, not crying or distressed so hv who weighed him is happy that it's not an immediate concern but suggested I could top up with the ebm I have stored to see if that makes a difference.

I have no issues topping up if it will help, he will take a bottle then come back for boob, however I'm confident he's getting plenty of bm from me- plenty of wet and dirty nappies, odd times he's been sick there's plenty and I can express 70/80ml from each side- is giving ebm actually going to help or will it create a cycle that depletes my supply?

I would just carry on feeding on demand. You've said baby has plenty of wet nappies so he has probably just settled onto a centile.

I couldn't even tell you what centile my 13 week old is on. She hasn't been weighed since she was 6 weeks old.

I would try to breast feed more rather than the faff if pumping and using bottles. When he has "finished" feeding, switch him back to the other boob and see if he'll take more. Spend time snuggled in bed together skin to skin and warm. Take a break from doing things and go back to bonding basics and see how you go?

I would stick with feeding on demand. My baby was 91st centipede when born and went under the 25th by 6 months. She was big in my tummy for whatever reason but wasn’t meant to be a big baby.

My friends son was 50th born and is now 1st!

If happy and alert, plenty of wet nappies and regularly dirty ones then absolutely healthy and fine

I had the same thing, and was referred to the paediatrician in the end (for crossing 2+ centile lines). She was the first one to suggest measuring baby's length and head circumference too - and she said the HV should have been doing this but hadn't. If the baby is settling on a centile, all three measurements should be similar (not necessarily the same) centile. In my case, it showed that the lack of weight gain was not "just finding a centile", it was insufficient feeding. (But I'd had been ill so there was also reason to think my supply might have been affected.)

We started formula top ups, which I prefer to expressing, and it seemed to improve my supply too (totally counterintuitively...)

Thank you,

UPDATE:

Saw gp who has referred to peads and suggested while we wait switch to bottle feeding ebm and logging everything. I'm not going to doubt the gp, his years of training and experience definitely outweigh anything I have to offer! But, selfishly I don't want to stop bfing, I love it and ds loves it- nothing else settles him, he'll have a bottle but won't sleep after it and still wants boob, even after a massive amount of ebm (more than double what the guides say he should have).

So, I'm not going to ignore the gps advice but I'm thinking I could give a bottle, finish off with boob and pump the other side then pump the side he's fed from to empty it to keep my supply and ebm stash going- so I can say he had X oz from bottle plus X time bf with X oz expressed- does that sound reasonable?

Im really not ready for our bf journey to end yet, I felt robbed of it with dd so it felt so wonderful to get to do it with ds.

Do what feels right. You dont have to give up breastfeeding.

GPs dont often actually have the best advice when it comes to breastfeeding, as it isn't something they specialise in. I've had some absolutely shocking advice from GPs in the past when it came to breastfeeding but I went to a lactation consultant who was much better to support me!

Your baby might just be finding his natural centile line. As pp said, gps are not experts in BFing. Can you see a lactation councillor who can observe some full feeds and give you advice? They may not be any problem at all especially if your baby is happy and alert and it would be a shame to give up due to poor advice from one gp.

I think that is overly medical advice from the GP. Knowing how much milk he is taking is not particularly helpful. I think what you said before about wet nappies, alert etc are better signs than amount of milk. I would keep bf and maybe try some top-ups.

As a midwife, GP’s advice is bad. Do you have a health visitor? Local drop in breastfeeding clinics? Funds to access a lactation consultant?

How much weight is he gaining per week? My HV was happy with 3-4 oz, which meant a slide through centiles but he was happy, developing and loads of wet/dirty nappies etc. He then did a massive gain at about 18 weeks and gains 1/2 pound a week for 4 weeks so he caught up eventually!

Far be it from me to be critical of doctors, but in the context of breastfeeding advice the majority I have encountered in my professional life have shown a shocking lack of knowledge around the subject. Absolutely do not stop the breastfeeding if you wish you continue. The GP advice sounds very questionable to me, and I would be inclined to seek a second opinion. Having cared for many babies with faltering growth who were admitted to hospital, stopping breastfeeding was never suggested and certainly not until all other avenues had been explored and investigated. What needs to be established is whether your baby’s dropping down the centiles is a) natural catch-down growth b) a lack of adequate milk intake or c) a metabolic or physiological issue affecting growth. The GP is suggesting you give milk via a bottle as it makes their life as health professionals a lot easier to answer these questions when they can refer to a neat log of intake and output. However, it is by no means the only way to establish the facts and you should not be pressured into doing this. I can’t stress enough how much I recommend a second opinion, even if it means presenting to your local hospital A&E (preferably one with on site Paediatricians). Did the GP say how long the Paediatrics referral would take?

For what it is worth, all your descriptions of your baby suggest that he is in every other respect thriving, and this makes me even more dubious about the GP’s advice. How many breastfeeds are you doing in a 24 hour period? Can you spend a few days in bed doing nothing but feeding and see if that makes a difference.

Sorry if that has come out as a jumble

Thanks everyone,
@NotYoutHun I'm seeing my HV next week and there is a BF support group Thursdays that I will go to next week. I'm happy to get a consultant in if it's needed after that.

@Hollyhead he gained 7oz in 2 weeks, before that it was 5oz in 2 weeks... but gained nearly 1lb in 3 weeks in December.

@Puddlelane123 thank you for that reply! The referral was made as urgent, should be a week or two and I'll have him weighed weekly too. I gave him a bottle of ebm yesterday but bf the rest of the day and night, he took 6oz but was equally happy after bf which again leads me to believe he's getting plenty (everyone knows about it if he's hungry!). He bfs around every 2/3 hours, but has a long feed of an hour or more in the afternoon right before his nap and another longer feed around 7/8pm then every 2/3 hours overnight. Unfortunately doing solid days of just BF isn't an option as I have older dd so we have to do school runs, make tea, do baths etc too but you I'll be spending the time she's at school focusing on baby and feeding.
I had GD so I think he may have been bigger because of that and is now just finding his natural place, he's almost exactly the same weight my daughter was at this age.

Will reply properly later but everything you say really makes me think that he is genuinely just experiencing catch-down growth rather than an issue with milk supply / nutritional intake. Even more so now you say you had Gestational Diabetes which makes catch-down growth even more likely. Trust your instincts which sound spot on and don’t be bullied into doing anything you don’t want to do. I would put money on the Paediatrician reassuring you when you see them, especially when they look at full picture of head circumferance, length etc

I think given those weight gains as long as he’s settled between feeds, lots of wet dirty nappies etc, I’d be taking your GP’s advice with a pinch of salt too.

That's what I think @Puddlelane123 he's just getting to where he's supposed to be.

My dh is now panicking so I've given baby a bottle of ebm the last 2 evenings, he's had 6oz both times and still had his usual bf at the same time after it. The only benefit has been I've been able to cook tea with both hands!

He feeds around 9/10 times any 24 hour period which is about right... he's asleep on me now after a bf and so happy.

GPS are not experts on breastfeeding

You will probably express less then your baby would take at the breast

Plenty of wet and dirty nappies - keep a count and see - are the best indicator.

Feeding formula does to increase your milk supply that is nonsense. It might lead to enforcement but that’s it.
Expressing is a ball ache and unless you have to do it in a neotnatal unit for a tiny premature sick baby it is better to directly offer the breast. Expressing is a mini industry and you must over compensate for the bottle of your milk you feed.

Basically like others are saying on here I would seek some expert advice about centile settling and an otherwise thriving breastfed baby.

Feeding formula does NOT increase your milk supply
It might lead to ENGORGEMENT but that’s it

Doctors are horrendous at issuing advice on breast feeding. I work with them, specifically in terms of breast fed babies not gaining weight well, and the advice they give out is incorrect and shit half the time

My BF baby was 91st percentile at birth and within a few months he was down at the 25th. He’s now 2.5 years old and still on the 25th percentile.

Is your baby actually losing weight or just gaining it at a slower rate than the charts say he should?

How well he feeds, how often he feeds, how content he is and his nappies are a far better indicator of how well breast feeding is going as opposed to a chart.

As an aside though, when he was 4 months old I was advised to get him checked for tongue tie (even though feeding wasn’t painful) as it may account for his slower than expected weight gain, and it turned out he did have one. I had it treated and his weight gain did improve although he still remained in the 25th percentile.

Just something you may want to consider.

Thanks @QueenofmyPrinces
He does have quite an obvious tongue tie, he's been assessed at the hospital and they observed him feeding and were happy it wasn't an issue.
He's not lost weight, just slow gain, 7oz in the 2 weeks leading to this drs appointment.

There's a bf support group and weigh clinic on thursdays that I'm going to take him to this week. The ladies there are really good and one specialises in tongue tie so I can ask her to check him again.

I’m you’re getting some more face to face support from people who are far better to advise you than a GP.

It sounds to me that your baby is absolutely fine with how things are so don’t let a GP cast doubt on you