"Switch feeding" - a good idea or not?

[verylittlecarrot]

My tiny 9 week dd is very slow to gain weight, averaging just under 3oz a week. She has a good latch, and feeds enthusiastically for the first few minutes of each feed, but then she settles into lazy sucking with the occasional swallow...this can go on for 20-30 minutes, then repeats with the second breast. In the very early days of bf I worried about this "comfort sucking" but have subsequently chosen to go with the flow, as I believe she's still getting some milk when she swallows, and I guess it's still providing some stimulation to me. Feeds can take a long time but I just let her get on with it. I've never had sore nipples or discomfort from this, and during a long feed I'm aware of at least 3 or 4 let downs which get her gulping again for a little while. I tend not to interrupt her, although I try the usual tricks to keep her awake. Fedds roughly every couple of hors, sometimes goes a bit longer.

I have been advised today by a lactation specialist to "switch feed"; however I've tried this before and instead of awakening dd's interest each time I switch, she seems to get bored more quickly, if anything.

Is it really better to try to switch feed or should I just keep going at dd's pace, allowing her longer feeds on each breast and letting her tell me when she's done before offering the other side?

[MrsKevo]

Found this diagram of sucking patterns and the concentration of milk over a feed (the darker purple the more fat globules) which might help. They start off more vigorous to stimulate the let down (the milk is thin at this point like a drink) then 'active' sucking which is slower and steady with intermittent gulps, then slows right down to 'flutter' sucks when the milk is at it's richest and fattiest (the 'meal' if you will). It is really important they get to this bit as this is what will allow them to chunk up.

I was frustratingly told mine was done and just sucking for comfort when she did flutter sucking, and to take her off as she was 'using me like a dummy (don't get me started on THAT phrase lol. Am not anti-dummy, I used one, more mean that a dummy is a substitute boob and not the other way round). Anyway..point is it's not a problem that they have different rates of sucking over a feed, just make sure they get that good fatty milk as this is the key to increasing their gain.

Totally agree that Health Professionals can be too fixated about the graph - I stopped weighing my second baby after a few weeks as I knew she was growing out of her clothes, had some chub about her and was happy and alert. It's worth noting that the graph is based on formula and BF babies so isn't a fair comparison really. The reason it's not separated (other than cost) is that it's really hard to find enough 100% EBF babies - most will have had at least one feed, some are co-fed, some are EBF but then go onto formula at varying points on their journey so can kind of see how it's problematic, however if they're not going to produce a separate graph then it needs to be accounted for and allow BF a larger margin, before scaring the poor Mother into top-ups!

Edit: after writing my answer I have just seen this is from ages ago lol

[smileyhappymummy]

vlc,
only just read this thread and am so pleased to hear that you have a clean bill of health and have escaped the clutches of your HV!
just wanted to say... this is a minor thing but your HV is wrong on one thing at least - not possible for a baby on milk only to have a gluten intolerance causing problems - it isn't having any gluten! now, I know you didn't have any faith in her anyway... but that's just another thing....

[1dilemma]

can I just say vlc how fabulously well you've been doing and how completely chilled you seem for a first time Mum? Baby carrot is a lucky girl and will have you smiling at this when she grows up to be 5'10''!

[verylittlecarrot]

I have thought about complaining about the HV, but I was so incensed I decided to give myself time to cool off first. I think that she stuffed up royally on this occasion, and her actions have resulted in a complete loss of trust. I expect that at some point she will call me to see when I am coming in, at which point I will calmly (I hope) explain that her actions were both unnecessary and a betrayal of my wishes, and that I have made alternative arrangements for the monitoring and support of my child's health, and will not be seeing her again.

She is far too twitchy and anxious in general, but seems at least a little better informed regarding supporting bf than most HVs, so for "textbook babies" she probably is helpful to "normal mums".

It does irritate me though, that so many health professionals don't ever bother to spend a fraction of the time their layman patients do researching their own subjects. It's so bloomin easy to google topics like bf support, infant weight gain, health recommendations, co-sleeping research and the like, and even easier to discuss them on forums like mumsnet. Why don't they bother? I can't bear the ignorance.

Rant over.

Mossy, if you're around, I tried to email you again...wonder if I'm ending up in your spam folder. I don't think I'll make it tomorrow, sorry, but if you can email me I'd like to reply to see if we can arrange something next time I'm visiting my folks...I'd still like to see your fab bfc too.

My email address is temporarily on my profile.

[halogen]

Well done, VLC, so glad everything has turned out fine. If you have the energy, it might be worth saying something about your HV to the appropriate people - not least the fact that she escalated the whole thing when she had agreed with you not to do so. Not very professional, IMHO.

[BabiesEverywhere]

I am so sorry you have such an awful HV...It seems to be the only qualification to do that job

BTW my baby was born on the 90 or 95% can't remember which....by 7 months she was down to 50% and remained on that new band.

She was also a velcro baby, she did outgrow it but I honestly can not remember when. I still carry her in a sling instead of a pram but now at 13 months she wants to be running around playing most of the time instead of being carried.

I do remember walking up and down the street with her in a sling during the long winter months.

I would get a water sling...usually made of solarweave or solarveil. You can get them in a pouch, wrap, ring sling or mei tai and they mean you can shower handsfree.

HTH

[Mossy]

VLC that is brilliant news. So pleased for you!!


Are you going to complain about your HV, to stop her scaring other women too? Her "help" might just be the thing to put someone else off bfing.

[verylittlecarrot]

Thanks!!!!

Feeling much more relaxed tonight.

Despite being wee, everyone who has examined baby carrot has exclaimed how gorgeous she is (like I didn't know!) She smiled winningly at the paed today - that helped I'm sure!

[laundrylover]

VLC, I've been following this and wanted to say well done you!

Enjoy the bfing and your dinky baby - I've had 2 dinky doos and they're way better tham blubber babes IMO.

[prettybird]

Good news

[verylittlecarrot]

Well! Now I've had 2 GPs and 2 paediatricians give dd a clean bill of health, and the lactation consultant was very happy with the latch, the feeding, thinks I have plenty of milk and so on. I'm glad I arranged to see her first, as she helped to sidestep many of the concerns the paeds may have had. I've asked the paed to be very clear about dd's weight gain being satisfactory in her discharge notes to the GP so that I don't have to go through this pointless worry again.

And I'm DONE with my HV. No more visits to her.

On the way home from the hospital, dh and I bought a set of baby weighing scales from TK Maxx for £30. We'll take care of the weighing ourselves from now on, thanks!

Thank you all for your reassuring words of advice, solidarity and support. You are all superb and I salute you, you lovely Mums!!!

[prettybird]

It seems I was vey fortunate with the consultant peaditrician I saw - he was very supportive of breast feeding, told me that ds would evevntually start to move back up the curves - but not to worry about when. In fact, the only real comment he had was that I should stop the "faff" of expressing (which I was doing to "supplement" my ordinary breast feeds).

Indeed - he was more interested in what my dad, who used to be a colleague of his (paediatric radiologist), had been doing since his retirement!

But then, ds was the picture of health - happy, healthy and alert, if by ow just underneath the charts.

As my dh used to say though, he wasn't worried, as if my dad had thought there was anything wrong with his first , and long awaited, grandchild, he'd have been the first to whisk him into his former colleagues!

Thank goodness I kept away from HVs like the plague!

[Mossy]

Oh VLC you poor thing you know my ds has been dropping down the centiles since birth - erratic weight gain, sometimes as little as one ounce, once or twice (to my huge ) as much as seven or eight ounces!

And my HV has always been fine with it as he's always seemed healthy and my dh is smaller than average height for a bloke.

Why are some HV's so obsessive about those bloody charts?

Is there any way that if they do prescribe you formula you could just simply say "yeah, okay" and then not go again to weigh-in, or does it not work like that?

on your behalf.

[verylittlecarrot]

I just managed to speak to the hospital lactation specialist and she has agreed to join us in the paed ward when we go in, to ensure any feeding advice is from her, not a paed.

The daft thing is, no-one seems to be able to follow the basic logic. They all seem to be OK with the concept of a consistent gain of 3 oz a week, BUT not happy with a descent of the centiles. I can't believe that they don't comprehend that one inevitably means the other - the centiles curves require more than 3 oz a week.

I feel so stressed that I've just been feeding the baby and I couldn't feel a bloomin letdown.

Aarghhh

[tiktok]

I think you can fairly confidently assume the paed does not know much about breastfeeding. This does not necessarily mean they are indifferent to mother's feelings about it or unaware of the health impact of infant feeding choices - they just have no clue about how it works and how to support it.

This can be a good thing, as they sometimes concentrate on what they do know about - poorly/disabled babies - and when they see a baby who is clearly not poorly or disabled they do indeed send the mum away.

OTOH, they can be fairly cavalier about 'ordering' formula, as when they see a baby who is clearly not poorly or disabled but just small....I think the brain process is 'this baby is fine, but rather small...we can try to fix this by shovelling in more calories.'

So you will need to arm yourself with some questions:

• I intend to add solid food to my baby's diet at the appropriate time, around six months. Will this not permit her to have a more calorific intake then?
  
  
• what do you think I am risking healthwise if I don't give her formula?
  
  
• does this take into account foregoing the health benefits of exclusive breastfeeding and indeed my own choice to avoid formula ?
  
  
• is it possible my daughter's growth is physiological for her?

[verylittlecarrot]

Thanks Tiktok - but now that thw wheels have been set in motion I imagine seeing the GP again will just be a delaying tactic. I have called the GPs(on lunch), waiting for a return call, to speak to the referring GP and see why she now feels this is necessary (without seeing dd). Also my husband thinks we should go as he is convinced the paed will give us a clean bill of health and send us away - I agree that this is what SHOULD happen but am not so optimistic.

Assuming we go- what would your advice be?

[tiktok]

Oh dear.....can I make a practical suggestion? Just assume (or try to!) there has been a mix up in communication, and call your HV, and ask (calmly and politely) what's happening. You do not have to go to the hospital - it may not be convenient at such short notice, anyway.

Here's a sample script

VLC: oh, hi, [name of HV].....Carrot here....glad I caught you, just needed to check something out with you.

HV: Hi, yes, how can I help?

VLC: I've just had a call from the hospital...it's actually not convenient for us to go today, so I can't attend, but I needed to check 'cos we agreed, didn't we, that Baby Carrot didn't need a referral, and we agreed this would escalate things....is that your recollection as well?

HV: yes, I think we agreed I would mention it to the GP....

VLC: yes....I was ok with that. Something's gone wrong, I think, with the communication in this, just thought you'd like to know!

Now, the HV may say her 'mention' has led to the GP making the referral or suggesting the referral is made, and you can calmly, say you feel disapppointed that your wishes were not respected, but you are happy to see the GP again, the one to whom things were mentioned, and to talk it over with him/her, before any further discussion of a referral.

How's that sound?

[verylittlecarrot]

FURIOUS WITH MY HV TODAY - ADVICE PLEASE!!!

We've just had a call. Against my wishes, my HV has referred us on to the GP who has referred us on to a paediatrician - the hospital is expecting us today.

Yesterday I asked her - and she agreed - not to refer us on and escalate things, so she said she would simply "mention it" to the GP - the one who gave Lulu a clean bill of health 2 weeks ago.

Betrayal of my wishes? So now I'm forced into a situation, where, if I'm not lucky, I might find myself having to receive crappy feeding advice from someone "authoritative" who feels we must change things. I feel the need to go armed with appropriate bf medical guidelines/ papers in case IU get told to top up with formula.

HELP please.

I had a bad experience last time with the paediatrics department...The last time we saw a paed was 2 days after dd was born. I went in for bf advice because she was a little jaundiced and sleepy and I was made to feel concerned about her blood sugar by my mw. the paed left us with a crappy SHO who left us sitting in an assessment room for 6 hours till after midnight, and did repetitive heel pricks. I had to search out a mw myself to check the latch, and we left after the SHO told me he wanted to do another heelprick "1 hour PRIOR to her next feed" WTF? When is that exactly with a newborn fed on demand? The SHO didn't even bother to discharge us, he sent a message with a nurse to say it was OK for us to go, but then wrote a letter to my GP saying we had ignored his meical advice. I complained to the paed he worked fgor and she wrote another letter to my GP correcting the situation.

I don't have high expectations. I actually feel sick and angry about this.

Please help - Tiktok / hunker, mears???

[prettybird]

They picked it up early wioth me and my GP told me I had to watch my sugar. I had only just started drinking full fat Irn Bru (diet Irn Bru is nowhere near as nice) and eating sweets without guilt

However, I decided that Magnums didn't count as sweets!

[Mossy]

VLC no email yet... it is msrlmoss @ hotmail . com - take out the spaces, make sure it's .com and not.co.uk.

Prettybird I didn't realise that, it makes perfect sense though - I ate so much crap in my third trimester that I put on about four stone and still have to shift the majority of it!

[verylittlecarrot]

Interesting comment about the borderline gestational diabetes. I scoffed tubs of Haagen Daz daily throughout the last trimester and was spilling a lot of sugar into my urine. Gained 4 stone - OMG - over the pregnancy and consequently still wearing maternity pants .

Mossy - I've emailed you!

[duchesse]

I mean Prettybird.

[duchesse]

Absolutely Purplejenny. I reckon about four months for my babies to regain their natural curve. (just checked their red books)

Both were born weighing 7.5 lbs (about 50th centile), and joined the curve they were destined to stay on at around 24 weeks of age. In one daughter's case this was part way between the 3rd and 10th, and in the other one, below the 0.4th. Yep. And she has hardly ever had a day's illness in her life, is supernaturally bright, and eats like a blooming horse. Only with more meat. Than a horse I mean. Eats more meat than a horse.

[prettybird]

The HV is talking through her arsesorry) re her concern about the baby starting on a high centile and then dropping. The centile a baby is born on is more a reflection of maternal health etc (in fact I suspect I was borderline gestational diabetic, as I had a lot of urine sugar but never blood sugar). Once they are born, they then have to "catch down" or "catch up" to their genetic growth curve.

No-one ever boths about high weight gain - but they do seem to get upset abut low weghit gain withut looking at the healthy of the child in front of them.

As you have said - both of you are small (as are dh and I) - so what do they expect?

The probelm with "catch down" growth is that the baby then spends months first of all "catching down" and then, becasue they have slipped of the standard timings, then catching up again.

I alwys knew that ds would end up on the 50th, as they is where I'd have expected a combination of dh and my genes - and gues what? By a year old, that's exactly where he was!!! Actually, it's only approximately about then, as I only inferequnetly weigh/measure him

[prettybird]

BTW - ds is now 7, and follwing jsut below the 50th centil for both height and weight.

He continues to be *extrmely healthy, loves running around and is doing well at school.