Ok so is it time to start topping up with formula now?

[Peshasofeight]

Hi, ds2 saw the paediatrician today. His weight today at 21.5 weeks on different to normal scales was 5.34kg. On mon it was 5.32. He had gained 80g over the previous 2 weeks. The fortnight before that he had gained only 40g but had had a cold and he has also been teething, he has a tooth and a half! Anyway he is now off the bottom of the charts. This has been a gradual decline since birth which some of you will know as I've posted fairly regularly for advice about his slow weight gain.

He had blood taken this afternoon to be tested for all sorts of things and urine which initial tests showed to be normal. She felt he looked pale which I agree he does and others have also commented on.

The paed wants me to give him a bottle of formula each evening to see if that helps. I went to a new bfing support group yesterday and the mw there suggested I ask what was the risk to him from not giving formula compared to the risk from formula iyswim which I did and the paed said the risk if his growth continued to falter was significant which I'm not sure is exactly what I was asking but there you go. I said I would give formula if I felt it was really needed, of course I would, but I consider it to be a last resort and would rather try other things first.
I also said if she felt that low supply was the problem could we not try domperidone to increase my supply. She said it had not been established that low supply was the problem so would like me to give him formula and see if it made a difference so that we could establish this. I'm not sure why giving me domperidone would not also be an equally successful way of establishing this.

She is going to write to my HV and ask her to come and observe a feed but I'm really not sure my HV is really the person to do thisd considering some of her previous advice.

I said I would be happy to express milk in the evenings after his final feed on a regular basis to give to him as a supplement after a feed. She felt that that seemed like alot of hassle and formula would be easier for us.

I told her i knew of someone (Piffle!) whos ftt baby had been given supplements from the dietician so she has referred me to see a dietician to discuss this and wrote that I view formula as a last resort. But really she made it clear she wants me to give him formula.

SO...what do I do? Am i now past the point where its sensible to resist formula and try other methods? Am I just being selfish and stubborn now? And I'm honestly asking that btw so please tell me if I am (people who know what they're talking about only! ). I dont want to but only because I want to do my very best for my baby, have I now reached a point where the very best is formula?

Pesha - I have to go so can't answer this in depth, but if the paed's only reason for saying 'no' to expressing and using that as a supplement, is because it would not be as 'easy' as formula, then seems to me you have a green light to do this.

But I hope others will come along and give more in depth replies.

In short, I can't see any reason for not expressing, given you are happy to do it.

Remember if you do end up having to give him formula it would only be one bottle a day and the rest breastmilk. At least he would still be getting lots of breast milk. Does he feed at night? At least he is gaining weight and not losing. I doubt its your breast milk thats down to him not gaining though.

I think its probably a good idea to express, that way you increase your milk supply and you can see how much milk you give, at least you can think well Ive expressed 6oz at least you know he has a full tummy. Perhaps give him the expressed bottle at 10pm to see him through the night a bit.

I really, really am on my way out....but had to say this:

The expressed supplement really has to be given as an extra, not as an 'instead of' to make the baby go longer at night without feeding...the idea is the baby gets more breastmilk, not less

So maybe you could give baby his feed before bed then express give whilst he's still asleep say an hour or 2 after he goes to bed then do normal night feeds as many as your normally would. then he's getting an extra feed.

He was sleeping through but has been teething/growth spurt/whatever and started waking quite regularly. He is now going about 6 hours but then once he wakes up he comes into bed with me and seems to cluster feed from then (normally aroung half 3, 4) until we get up about half 7.

I would express milk once he's gone to bed and at present can normally only get about 3 oz but am hoping that would increase when my body got used to the extra demand? Although I could probably manage to fit in a little bit during the day as well.

When would be the best time to give it to him? I know its after a full feed so it is an extra otherwise it will just replace a feed, or I believe thats right anyway! I suppose it depends on him really doesn't it? Might try after mid morning feed as the older 2 dc are out at school so he normally has a long leisurely feed then so I'll know he's taken a full feed from me first. Does that sound right?

Sorry Lornaloo took ages writing that so x posted. What you say sounds good but I'm not great at waking up in the night so if he didnt wake up as normal having had the bottle I would find it very hard to wake myself up and feed him when he was still asleep - it goes against everything i believe in!!

How easy do you find it to express?

I think the paed saying it's more hassle to express is patronising in the extreme and doesn't take into account how you feel about bf and ff.

Can you try (and it takes a bit of practice if you're using a hand pump!) expressing at the first feed of the day on one side while you feed on the other? I found my let-down was better that way.

It sounds like the midwife at the bf group is a bit more on the ball - paeds seem (imo and ime) to view formula as "the answer" and get pissed off with women who stand in the way of it because they view it as arguing for the sake of it.

Oh no I didn't mean you should wake up, I ment put him to bed after feeding him then at say 10pm depending on when he goes to bed give him the bottle whilst he's still asleep (dream feed) the he will prob still wake at 3/4 for his night feeds as usual.

Do you use a pump to express? I had the avent one and the electric avent one and found I could express alot more using my fingers.

I got thrush on my nipples when bf so used formula while I was recovering because it was so painful to feed. My milk almost comletely dried up. I always fed ds breast first then gave a bottle and express in between feeds. After about a week my milk supply was back and he was exclusively bf again. At first I would express maybe 2/3 oz then after about a week Id get 6oz in 10 mins. I'd get a let down and it would literally spray into the bottle Sorry tmi.

If you are consistant in the times you express you should start having a let down at that time each day in anticipation of feed.

Hunker - I did really like the mw and felt she shared my view on things. She mentioned formula damaging the lining of the gut which I knew but had only learned recently from MN, no hcp had ever mentioned this to me before. I did find the paed incredibly patronising actually and I'm sure she found me very annoying for questioning her advice, repeatedly!

I'm ok with expressing - get about 3 oz in about 15min but then it seems to all but die out and I give up! But untill now theres been no real need for it other than to build up back-up supplys. I'm hoping if it becomes regular it'll get easier. I think i mat try expressing from one side while he feeds on the other, i did do this once or twice when he was tiny and did quite well. Am I right in thinking i can keep the pump in the fridge with the cover on and keep pumping every now and then through the day?

Lornaloo - i have the avent isis pump and its pretty good for me. To be honest hedoesnt seem like he's hungry for more ever so I'd worry that giving him a bottle at night might make him sleep longer and miss a feed. Today for instance as we were at the hospital he spent much less time feeding than normal, then we were busy in the afternoon and had to go to different hospital for blood tests and he didnt seem bothered at all, he wasnt crying for more. Although when we did sit down about 3 for a proper feed he fed for a long time and obviously got more in one go as my supply had been building up all day, but didnt seem to have missed it till then iyswim.

perhaps just wait for blood test results and see if there is any other reasn for slow weight gain. If they can't find anything then perhaps there is no need to worry. If he seems alert and happy and has plenty of wet and dirty nappys then I'd say he's getting enough.

Hope all goes well

Thanks Lorna