How to juggle expressing for bm top ups with feeds?

[Tier500]

I need to start topping up my 9 week old baby as her weight gain is slowing. Practically, how do I do this? Should I pump after every feed? And then when do I give her the top ups - small amounts after every feed or do I save them up and add in a bottle only feed? And when can I stop the pumping regime? I’m gutted that this is necessary and feel completely overwhelmed by the logistics.

If the gp and hv aren't concerned then I don't think you should be.
If she's healthy looking and meeting milestones etc then I wouldn't worry.
I wouldn't even know if either of my ds weight gain had slowed down. Ds1 was weighed at 14 days, 6 weeks then never again (until he wanted to stand on the scales as a toddler), ds2 as I said hasn't been weighed since 14 days. Ds2 had a tongue tie which was cut by a private LC and she didn't even weigh him.
I sometimes think weighing babies so often causes unnecessary worry. If she hadn't been weighed would you be worried about her? Does she seem like she isn't thriving?
What centile is your toddler (if you know?)

I just did a quick google conversion and it seems like she's gaining about 5.4 ounces per week? That's well within the normal range of 5-7oz per week.
Remember they have a couple of growth spurts at 2-3 and 5-6 weeks so weight gain would be faster around these times.

Sorry should say the normal range is 4-7oz per week !

Thank you @shouldistop. I wasn’t at all worried about her weight - she looks fine, is growing out of 0-3 now at 8/9 weeks and meeting milestones, good nappies etc. I suppose that’s because she is average weight now, it’s just that she started out so big and her growth has been on a downward trajectory - her centiles when weighed have been 96, 81, 75, 67, 53 and 47. Her latch hasn’t been good and has got worse which is why I got the LC back.

My toddler was born on 75th, dropped to 25th while I breastfed her (undiagnosed tongue tie) and is now somewhere between 50th and 75th for weight (90th for height). I had so much anxiety in her early months but no support at all. I had hoped to avoid the same thing happening again this time (hence private LC) but it is pretty much the same story.

It sounds like your kids are meant to be slim tbh.
Keep trying laid back nursing (I know that's tricky with another child too), maybe bring your toddler into bed with you for special story time during feeds (or a cartoon on a tablet occasionally).
Personally I don't think expressing on top of breastfeeding and looking after a toddler is sustainable. If you had to top up then I'd just give formula although I appreciate it's a personal choice there.
If you're still worried though you can always ask hv or gp for further advice.

I would absolutely give formula at this point I think but I’m worried about the impact on my supply. Would it have a different impact if I gave small amounts after each feed vs a whole extra feed? I’m hoping that if I can express for a couple of weeks it might up my supply and in the meantime we fix her latch so she’s more efficient and can then take the extra milk.

Other issue is that she won’t take a bottle atm and I’m wary of trying to introduce that while working on her latch. It all feels so complicated. I feel so sorry for her.

You could also try breast compressions and encouraging her to suck on an empty breast x

I'd try offering feeds more frequently instead of topping up to start with - the more demand the more supply you get and no pump will get milk out as well as a baby! If nappy output wasn't good I would advise differently. What type of birth did you have? Sometimes that can inflate birth weight and throw charts off? The other thing to bear in mind is that the charts are based on formula fed babies, not breastfed ones. NCT have a free breastfeeding helpline you can call, or can you ask your HV to refer you to your local infant feeding team? Mine were amazing and were a crucial factor in helping me to keep breastfeeding.

Thank you both. I had a natural birth without pain relief but I had polyhydramnios and she had so much water retention when she was born. She looked like the Michelin baby then weed it all out in the first couple of days. She’s tall with a big head (100th centile) like her sister so I think weight should be 65-75th centile and she’s definitely not heading in the right direction.

We co sleep and I already do breast compressions but will try a few days of putting her to the breast more often and see if it makes a difference. Would be great not to have to pump. She’s such a happy smiley little thing I hate to think I’m letting her down.

You're absolutely not letting her down. She sounds great op, you're doing a brilliant job.

Would anything at all give you cause for concern if you hadn't had her weighed? In terms of nappies, frequency of feeds, how she acts generally? I know how stressful it can be with feeding and actually when the weigh clinics got closed in March I found it a bit of a relief! Honestly it sounds like you're doing a great job and it's normal to worry, but if the GP and HV are both happy that's also a reason not to jump to pumping all of the time too. There's a great group on Facebook called Breastfeeding Younger Babies and Beyond that might be worth you looking at if you have chance - lots of helpful advice there and might give you a bit of reassurance.

The only thing that worried me was that she makes a loud smacking noise when she feeds like the suction is breaking. But otherwise all was good until the tongue tie division. Now she seems to have taken a massive backward step and is struggling to feed properly at all. I really regret it now and feel terrible. I’m afraid my supply will dry up and I’ll have to stop feeding her.

Please do call a breastfeeding support helpline. There are quite a lot of factors and really good skilled support could make a huge difference for you.

LLL helpline 03451202918

A well attached baby is the first part of the puzzle. Growth spurts can look like baby isn't getting enough. A growing baby may also need to be held at the breast in a slightly different position than they were held at birth...they are just getting bigger. Baby needs to have the space free under their jaw in order to feed effectively.

Thank you. I spoke to the NCT feeding helpline today and yesterday - no one is answering on LLL. They suggested I try nipple shields so will order some today online but will obviously take a while to arrive. Also not sure they will help? I think I need to get the lactation consultant back to help me in real life, though it’s so expensive. I’ve tried multiple positions and none of them stop the smacking noise. She’s got a high palate so I think the combo of that plus tongue tie was causing the problems.

I would try and speak to my HV if I were you.
My DD didn’t regain her birthweight until she was 6 weeks old and she was last weighed at 12 weeks, she now 5 months. She is still on the consultants book but no one is worrying.
Your baby is clearly growing out of her clothes and the HV will be able to weigh/measure her and advise accordingly. There should also be a breastfeeding advisor employed by your local nhs trust. Your hv or community midwives should be able to organise some support. There may be a hv that specialises in feeding. They all have a specialism in our area.

If you were keen to increase your supply then you could try power pumping.
Pump for 20 mins, 10 min break, pump for 10 mins, 10 min break, pump for 10 mins.
It mimics cluster feeding and 'only' takes an hour out of your day.

Another vote here for power pumping although when I did it ended up with too much milk for a while! It does sound like you need to get your baby's latch checked. One of my four would get latched on correctly but the slip down a little so the milk would only trickle out. It took a lactation consultant watching a whole feed to work out what was going on. If she had just checked the initial latch then all would have looked fine. So I think it's not always easy to tell how well a baby is feeding. I was advised to unlatch using my little finger I the corner of DS's mouth to break the seal and keep relatching until he managed to stay in the right position. It only took a day or two for him to get the hang of things. I hope you manage to get things working better for you and your baby.

I would pump after each feed and then use the milk from the pump in an sns at the next feed. FreeZe any excess.

I agree with @sproutnbacon - contact your HV and ask what specialist support there is in your area. My HV told me that our local infant feeding team is doing video consultations which might be more helpful. Also Google the flipple technique, that can be useful in getting a deeper latch. I follow Lucy Webber IBCLC on Facebook and she always seems to have good advice too. It seems like you need to get confidence in the latch and then everything else should fall into place, and you can make a more informed decision on whether pumping is needed.

Also regarding the smacking noise - does feeding feel comfortable to you? Does baby seem happy? Are your nipples misshapen afterwards? I was told to look out for the lipstick shape which shows that the latch isn't right. Covid has a lot to answer for but one of the things it personally frustrates me with is how it has further reduced breastfeeding support (which is pot luck in normal times) - women need access to face to face peer and expert support! (Sorry for my side rant)

Op just to reassure you, my dd was on 98th centile when she was born. At the 6 week weigh in with the hv, she'd dropped to 50th centile, so the hv asked me to bring her in for extra weigh ins, asked how bf was going etc. For context her brother was also 98th centile, and at 3, he still is. Eventually she settled around the 30th centile line. She's 15 months now and still a little dot, but hitting all her milestones, and I bf her for 9 months in the end.

At no point did they suggest expressing or topping up, just asked if she was getting regular nappies, wet and dirty, had good colour, was alert etc. She was so we just carried on. The hv suggested that she was just finding her normal weight, and she was healthy and happy so after 3 months they stopped bothering to weigh her.

Ask yourself seriously whether you would be so worried if you hadn't weighed your baby. Try the nipple shields, I found them brilliant with ds. And just keep feeding. Adjust the latch every single time to get it right, baby will get the hang of it eventually.

Thanks so much for all the replies - it really means a lot. It feels very lonely struggling to feed a baby and all the input is so appreciated.

Feeding feels comfortable, no pain at all. I had awful pain and cracked nipples for the first month with my first child who had a tongue tie that wasn’t picked up until she was 8 months old so I’m not sure whether my nipples have just been desensitised from that. They are elongated when she comes off but not misshapen.

I’ve been getting her to suck my finger to work on her suck and she’s much stronger now but there’s still a gap at the sides of her mouth so not a complete seal around the finger - I guess this is the problem. I don’t know if that will continue to improve (second tongue tie release was Wednesday) or if there’s any more I can do?

I will contact my HV. She’s been useless so far but fingers crossed she’s got some good contacts.

We had a good feed this morning - seems easier when there’s more milk in there for her - so feeling reassured at least that she’s not starving.

Hi OP,
My DD has 2 tt divisions too, I had the same problems as you after the second one. I was in such despair that I’d completely broken breastfeeding but she did eventually stop the clicking sound and started forming a proper seal. I am sorry I can’t remember how long it took but I was told it might just be because her tongue feels uncomfortable and she’s getting used to the new movement. Have you had any follow up with the lactation consultant who did the division? They’d be the best person to advise. It will take time but things will improve. I’m still feeding at 11m.

@June628

Hi OP, My DD has 2 tt divisions too, I had the same problems as you after the second one. I was in such despair that I’d completely broken breastfeeding but she did eventually stop the clicking sound and started forming a proper seal. I am sorry I can’t remember how long it took but I was told it might just be because her tongue feels uncomfortable and she’s getting used to the new movement. Have you had any follow up with the lactation consultant who did the division? They’d be the best person to advise. It will take time but things will improve. I’m still feeding at 11m.

Thank you SO much for this - so reassuring to know it can get better. I feel so guilty that I might have basically wrecked bf by getting it done the second time. If I know it will improve i can hang in there!

Sounds like you’ve had some excellent advice so far. Babies who have had a “later” tongue tie division commonly have a bit of oral aversion for a few days afterwards. Try just to keep her close and breastfeeding as relaxed as possible. Lots of side-lying or laidback if you can - take the pressure off both of you and go back to making it an enjoyable time together.

After about 6 weeks or so your milk supply is less reliant on pregnancy/birth hormones and instead driven by demand (how often and how much milk is removed). It makes sense that if there have been any background issues with your baby removing milk, they’ll start to show up now.

I didn’t see any mention of how often your baby is feeding? Day and night? Both sides? Not block feeding?

It might be worth getting back in touch with your LC. They really shouldn’t mind or charge for just a follow up phone call.

A couple of suggestions...

1- Breast compressions - if she stops actively feeding, gently compress the area of breast above her nose (google will explain this better than me), to give her a bit of extra and entice her to continue suckling.

2- Give a small “top up” after most feeds. If you give her one big extra feed, you won’t be giving your breasts the regular stimulation they need and she’ll be receiving it at a much faster flow than your breasts.

3- If feeding, pumping and giving a top-up feels too much (especially with another child), only do it every other feed. Or look up “power-pumping” instead. Dropping 2 centiles, the smacking and the tongue tie all suggest that if you do nothing, your supply will likely start to fall further and she’ll be very frustrated. But it’s also not a crashing emergency - she’s healthy and gaining weight. So there’s a middle ground for you to find between increasing your supply and not driving yourself mad in the process.

4- I would use the pump/haakah when she’s on the second breast. Babies of her age most likely will get frustrated with the slow flow if you pump beforehand.

5- Save yourself the stress of giving top-ups by bottle. Most LCs can also provide you with a feeding tube - it’s taped onto your nipple and dipped into a bottle or syringe of expressed milk. Sounds and looks complicated the first time, but easy once you know how. The advantage is that she takes it simultaneously as she breastfeeds - so you’re stimulating and she’s getting a top-up, saves a ton of time.

Take care, it sounds as if you’ve got a lot on right now x