Feeding plan for underweight baby

[Asiama]

DS was born in the 9th percentile for weight and steadily fell off. At 13 weeks he fell below the lowest curve and although he is putting on weight, he has fallen further behind. He's now 17 weeks and today I started topping him up with GP prescribed high calorie formula. The plan is that I BF him and then he gets the additional milk.

The same thing happened with my older DS and I had lots of support from the dietician, paediatrician etc. This time resources are stretched in the NHS and I don't have this support available.

Can anyone tell me if my plan sounds sensible? I want to BF as much as possible and protect my supply, while helping DS to gain weight more quickly.

1. No top ups at night, only BF in order to stimulate milk production.

1. BF during the day, at least 10 mins on each side. Then top up each feed during the day, as much as he wants. Judging by how today went I expect he will have a total of 150ml per day.

DS was born on the 25th percentile for length and has maintained this, so his growth doesn't appear to be negatively affected by the lack of weight gain.

Thank you.

I am having a similar issue with DD (15 weeks). She was born on 9th centile, dropped to 2nd on discharge from SCBU and then dropped below 0.4th after we came home. She is 50th centile for length,
which she has maintained. We have had lots of support from our local infant feeding team (SW London) via the health visitor - are you sure support isn't available?

In case it's helpful, our plan is:

• 20mins on one breast, 10mins on the other (starting the next feed on the last breast)
• 50-70ml of top up formula (not high calorie though. Just bog standard from the supermarket) after each feed
• pumping as much as possible but definitely a 20mins 3am pump each night using a rented hospital grade pump (i was advised most home pumps on the market just aren't powerful enough to increase supply. I saw a big increase when i switched from a home medela to a medela symphony we hired).

My supply has definitely increased on this plan and she is feeding much better. Sometimes she doesn't even want 50ml of top up formula and will only have 25-30ml. She also had reflux so is taking baby gaviscon in the top ups. She is back to the 2nd curve and is maintaining that at the moment. Next weigh is next week so im eager to see how she has done as we've been at my parents for a week and so dropped the 3am pumping for a week.

So in terms of your plan, I'd say the only thing is considering pumping more? My medela pump is £47 a month to hire and the feeding team thought i could probably get away with 2 months hire to make a difference before returning.

Thank you, that's really helpful to see! DS put on weight beautifully until about 10 weeks ago. I had to pump with my older DS and I absolutely hated it, pumping over 8 times a day. I own a hospital grade pump but really don't want to use it if I can help it. I don't know how I would cope with a toddler too. But maybe I have to find a compromise to keep up my supply eg pumping twice per day.

In terms of support I'm going round in circles. The HV days I need to speak to the GP, GP says I need to see a dietician, dietician says I need to see a paediatrician, and the paediatrician can't see me for 3 months. It's too long to wait.

Really sorry that you're struggling to find support. Is there a La Leche League Group near to you or have you got the support of a BFC or Lactation Consultant?

Obviously follow advice from whatever medical professionals you see (and hopefully you'll see paeds soon!) But if his weight isn't showing an increase next week I would maybe consider offering a top up after night feeds as well? As long as you are still putting him on the breast first that shouldn't affect your supply? I'd also make sure he's having feeds ideally 3 hourly, but if not that a max of 4 hours between feeds.

How are things going now @Asiama?

Thank you all! So for the past week I have been topping up DS with 200-250ml per day. I can only get him weighed once a month but I think his face looks chubbier already.

I am very fortunate to have access to other breastfeeding support eg La Leche and the advice has been to carry on as I am doing but also pump. I know this might make me sound like a selfish mother but I just can't bear the idea of pumping. I did it over 8 times a day for four months with DS1 and it was awful, my life revolved around pumping and feeling down each time because after pumping for 20 mins I would have about 30ml with a hospital grade pump. I think for my own mental health I will have to accept that we may need to mix feed. I guess we will be weaning in 2 months so the formula milk will be replaced by the food.

I can totally understand your reluctance to pump given your past experience. So glad that you’ve got some decent support as well