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.

@Tier500 that's great, getting her weighed should hopefully give peace of mind and the zoom group is a good idea too. No pain and good nappy output means it all sounds ideal really! My DD was an 8 poo a day minimum kind of girl before she went onto infant gaviscon for silent reflux - that had the fringe benefit of reducing her down to a more manageable amount of poo not sure if you've said upthread but what was feeding like with DD1? I can imagine that sometimes that can put more pressure on with the second child to 'do better' or feed for as long as with the first one which could be mentally draining? I've just got the one but still feeding at 14 months. I'm not sure if we'll have another but I think I'd feel more pressure with breastfeeding to do the same for them which is a bit daunting because although it's easy now, it wasn't for months and months!

Thanks @KatieKat88. The problem is I’ve had no pain and good nappy output (albeit less than now) all along, even when she was dropping down the centiles so I can’t rely on that!

I fed DD1 for 14 months. The pain for the first couple of months was horrendous but everyone just said it was normal. She dropped from 75th to 25th centile and fed all the time. It wasn’t til she was 8 months that I realised she had a tongue tie. I now know that she was a really inefficient feeder and that had an impact on my supply. I feel massively guilty about it and it’s definitely why I’m paranoid now, and determined not to let it happen again.

It can be normal to change percentiles though, so long as they continue to track the new percentile. My four were born on the 50th, 2nd, 75th and 25th but they all went on to track the 2nd percentile. Their birth percentile depends on how many weeks you were when they were born and the level of nutrition they received in the womb. It doesn't mean their isn't a concern but dropping percentiles on its own isn't necessarily a bad sign. It's if the child continues to drop percentiles or there are other signs like not enough wet nappies, or they're very sleepy or disinterested. I do think health professionals can get too hung up on weight and focus in on the numbers rather than the child.

@Tier500 that makes a lot of sense. It's easy to be paranoid about these babies even if there isn't a reason! But I understand why you'd be worried. @StuntNun has some good advice there. Have you asked your HV about the centiles and tracking and when to be concerned? I'd say dropping centiles would be a bad sign combined with poor feeding, output, behaviour changes but not necessarily a bad sign on its own? DD dropped a bit so we had some more frequent weigh ins around 2-4 months - then the first lockdown happened so no more baby clinics. It was a bit liberating actually - we could only use our instincts about how she was doing. She'd also just been put on meds for silent reflux which made such a difference that I was more confident that she was ok. Finally had her weighed just before her 1st birthday and she had shot up the graph which was no surprise because she bloody loves food

How are you getting on with keeping hydrated and eating enough op? I hope you're looking after yourself xx

@KatieKat88 that’s similar to my DD1 - she took to weaning like a dream and shot up the centiles, has always been a great eater. Obviously I manage to make myself feel guilty about that by thinking it’s probably because I starved her as a baby! But she’s a very happy healthy child.

I do agree that centile dropping on its own doesn’t necessarily mean anything is wrong, but I think DD2 was starting to look a bit thin in the face. I’ve got an appointment for her to be weighed next week and I’m so hoping for an improvement. I’ve been taking fenugreek and brewers yeast and drinking so much more water. It might be a total placebo but I feel like I have so much more milk and I think the baby has got an extra couple of fat rolls on her legs so cautiously optimistic.

I’ve done a few nighttime power pump sessions but haven’t pumped during the day - going to see how it goes on Wednesday before resorting to that as I found it so exhausting and hard to fit in with both kids.

This thread has been so helpful and supportive - thanks so much for all the advice.

Great to see your update OP! Sounds like things are getting better. Well done for persevering. It’s so hard when you’re doubting yourself because it’s all on your shoulder and there’s not much support out there at the moment. I became so obsessed with reading about tongue ties and attributing everything DD did to that. Was convinced she won’t be able to eat solids/ will have speech issues etc etc. She eats like a horse, now sticks her tongue out fully and has no restriction in movement. I absolutely hate tongue ties!! Keep us updated OP, really hope the weigh in goes well for you

I think we all have our stuff that we're paranoid about, it's so easy to blame yourself even if things actually might be ok! I don't think dads do this (my DH doesn't, and he's great) - why do we?!

Good news op, all sounds promising.

Ds2 is 6 weeks today and is having a growth spurt, I feel like my poor nips are going to fall off. Currently have him in a sling so he'll sleep and give me a break. Ds1 is at the park with my mum just now.
Dh is going to look after baby all day tomorrow just bringing him to me to be fed so ds1 and I can have some quality time together, really looking forward to it.

Let us know how the weighing goes. Ds2 will be weighed on Thursday as HV is coming out for 6 week check.

So just had her weighed and thought I’d update. She’s gained 340g in 14 days which is 24g per day. It’s an improvement from 22g/day but the lactation consultant told me she’d like to see 28g. I suppose the few days after the tongue tie was cut when she was struggling probably affected it but I’m still really disappointed. The HV wasn’t bothered but she’s rubbish - didn’t even look at the baby. I feel torn now because baby is 50th centile and seems well, but lactation consultant told me she needs to be heavier than this so I just don’t know what to do. I’ve asked her whether I should now consider top ups so will see what she says.

The problem is Tier if you start topping up with formula then it's likely to impact your supply. As she reaches different development stages then she's going to feed and feed and feed to increase your supply. Interrupting that process with top ups might mean you always need them. I really don't understand why the consultant has a problem with her being on the 50th percentile and has set a seemingly arbitrary target for weight gain. Children don't gain weight that way, a consistent amount each day, it goes on in fits and starts. One of mine was under the care of a dietitian because he was off the bottom of the percentile chart. I remember one three month period he only gained 200g (he was 6 years old) but the next three month period he gained loads of weight.

Thank you @StuntNun it does feel arbitrary. I think it’s because she was born on 96th centile (9lbs at 39+6) so has dropped two centiles. 28g/day gain would get her back up to 75th (where she was for first 4 weeks after her initial post birth drop of 8%).

I don’t want to give her formula if I can avoid it for the reasons you say (nothing against it in general) so would try to express my own milk first. Just would find it almost impossible to do that hence starting this thread in the first place. I’m so confused about it all.

I mentioned before that some children do change percentiles after birth and start following a completely different one. My mum is a health visitor and she wouldn't even refer a child for additional support unless they have dropped or gained at least two percentiles. She is quite scathing about her colleagues who, she believes, often don't understand the percentile charts at all. For example, by assuming that all children should be on the 50th percentile.

What do your maternal instincts tell you about your DD?

Honestly I think she’s fine. She’s ahead on the few milestones there are at this age. But I also think she isn’t feeding particularly efficiently and I haven’t been able to sort that out. I think she should be around 75th centile. She has never been measured but she’s long like her big sister who was 90th centile for height from birth to this day. Her head is also huge - above 100th centile. So for her 50th is perhaps underweight, and she has dropped 2 centiles from birth so I guess even your mum would have raised an eyebrow?

You seem like such a great mum. It's a shame the consultant can't let you just relax and get on with it.

So the lactation consultant was pretty unhelpful. She said if expressing was hard then not to worry about it but if I did give her one bottle of expressed milk a day id see more weight gain. I mean that’s fairly obvious but I don’t understand (a) whether I need to do this and (b) why it has to be via pumping - is there no way I can get her to take more milk from me? She’s also never had a bottle and I’m loathe to try to introduce one when I feel like her breastfeeding latch still isn’t right.

She’s 11 weeks tomorrow and I feel like I haven’t enjoyed her newborn days because of this stress. I’m wondering about getting a second opinion from another lactation consultant but DH says I need to just stop worrying now and forget about it.

It's a lot of stress for you, that's for sure. I'm a firm believer in a mother's instinct so I would go with your gut.

Bless you OP. Sounds like you’re trying really hard to get the support you deserve! As crossing 2 centiles is normally when HV get involved, did yours say why she wasn’t worried? (Not saying she should have been). What makes the lactation consultant know your DD should be on the 75th centile? I think your plan to see another lactation consultant might be a good one, if you don’t trust this current one. I’d also try to get a second HV opinion although I know that might not be easy during a pandemic.
If your DD is thriving, and it sounds like she is, then I’m sure you have nothing to worry about! It would just be good to get some answers to put your mind at ease. To me it sounds like you’re doing a great job and the weight gain you describe is good!

The HV said she’d been tracking the 50th centile since she regained her birthweight, and so wasn’t worried on that basis. That’s wrong though - she was born 96th, dropped to 75th when she lost weight after birth, stayed there til 4 weeks then dropped to 50th at 6 weeks. The fact she couldn’t interpret the chart doesn’t give me much faith in her. She just gave me the number of a breastfeeding helpline and said they would weigh her again in 4 weeks. She was desperate to get me out the door and didn’t even look at the baby - just got me to put her on the scale and read out the number.

The lactation consultant thinks 75th was right for her as during that 4 week period she was gaining 25-35g/day, whereas since then her weight gain has been slower and on the lower side of average. I’ve been doing everything the same and the tongue tie redivision hasn’t improved things seemingly so I don’t understand it at all. I just feel at a loss.

I also think that because she’s 50th centile which is objectively not a low weight she’s not concerned. If she’d dropped from 50th to 9th or something then I’m sure her reaction would be different.

Realistically there's no way to know which percentile she should be on. Also that can change over time. My DS2 was born on the 2nd and tracked it for ages then went off the bottom of the chart, required supplementary nutrition to get back to the 2nd percentile, then a few years later jumped up to the 50th percentile and stayed there. I can't give you medical advice obviously but the facts that she's on the 50th percentile and gaining weight are both very good signs. Maybe your HV is right to give it a few weeks and weigh her again and then make a decision on whether to top up or not depending on whether she's still tracking the 50th or has dropped further. Honestly it does sound like your medical professionals are making a simple situation much more complicated than it should be.

Oh OP I'm sorry this is so hard. It can be really difficult when you want the best for your child And you're listening to all of the advice. But if listening to that advice means you're stressed and anxious and not enjoying your baby then it needs to stop.

Please, listen to your own instincts. If you didn't have that stupid book, would you be concerned about her weight? Is she growing out of her clothes?

If so then I'd be inclined to listen to your husband as it must be difficult for him to see you struggling with this.

Please. Chuck the red book in a drawer. Do not weigh your daughter anymore. If she's not growing then ask the HV for help. If she's not feeding. As above. Likewise if she's miserable and poorly. But if she is otherwise fine then let her get on with it and give yourself a break.

If I didn’t know her weight I don’t think I would be concerned at all. She’s growing out of her clothes (into 3-6 now at 11 weeks) which isn’t surprising as she is gaining weight, just apparently not enough. She’s got rolls of fat on her thighs, a double chin, she’s rolling over, sleeping well at night...but the lactation consultant told me her face looked thin and she should be heavier. And I know her latch isn’t good 🤷🏼‍♀️

Poos means baby is getting milk.
Your LC is seriously getting you worried about 3grams a day? That is unreasonable.
Alot of babies drop weight after birth. 2 percentile drop can be fine.
What percentile was baby on at day 3?

Keep feeding you are doing great.

She was first weighed at day 5 and had lost 8% of birthweight which took her to around 75th centile. She looked like the Michelin man when born - really puffy and obviously a lot of water retention (I had a natural birth but polyhydramnios) so I think her 96th centile birthweight isn’t really where she should be. The nurse at her 8 week jabs also commented that she hadn’t put on as much weight as she’d expect as apparently babies normally gain 1kg by the 6 week check and she’d put on 700g at that point.