Worrying baby not getting enough milk from BF

[stollen123]

Sorry this is going to be a very rambling late night post...

Yesterday at our 6 week check up with the health visitor, I got very upset as baby hadn't gained much weight - only 10g from the previous week when he was weighed at a breastfeeding support group. The HV wasn't worried but we had to go to A and E at the weekend as he was panting (was all fine in the end, they suspected mixture of a cold and gassiness) and when he was weighed there, they said he was 4.3kg but he's now only 4.24. They didn't record the weigh in from A and E anywhere though so only my word to go on. He's gone from 25th percentile to 9th. HV said that she wasn't concerned as he's had a tongue tie division which can cause slow weight gain but he had that 3.5 weeks ago and has gained steadily since then so I don't see why it would suddenly be an issue. His latch is not great on one side but I've had it checked multiple times and pretty much been told he'll get it eventually as he gets bigger. HV said if I was worried I could top him up with formula at each feed. We topped him up for the first 3 weeks of his life due to jaundice (he had to be admitted to hospital for treatment) but were signed off to stop at 3 weeks as he'd gone over his birth weight and I thought things were going really well. It was such a game changer to drop the top ups as it meant my partner and I were getting more sleep not having to prepare bottles on top of lengthy feeds! In the last week as well my partner has started giving him a bottle of expressed milk in the evening to give me a stretch of sleep which has been so good for my mental health. But I've now just become so anxious again and lost all confidence that the breastfeeding is going well. He's been feeding loads this week so I was thinking it might be a growth spurt but now am worried he's just not getting enough from me and is just really hungry. I hate getting so worked up as I know it's not good for me, partner or baby but I just get so teary worrying that I'm failing him.

Partner thinks we should see how things go till he gets weighed at his GP appointment next week and if he's still not gained or lost weight then we start the top ups which sounds sensible but can't stop worrying that maybe we should just start topping up ASAP... I think what j find most stressful is that there's no clear answer from health professionals about what to do and my confidence in my own instincts is shot...

Sorry not really sure if I'm asking for advice or not but just needed to share!

I would go back to basics for reassurance/to help you make decision re: topping up:
What is output like? At least 2 poos and 5 wet nappies in 24 hours?
How long is baby feeding for? Between 5 and 45 mins is normal.
How often is he feeding? At least 8 times in 24 hours?
Is baby generally alert and calm between feeds? Is he fractious/irritable at the breast?
Can you see a difference in size of baby?

It is likely that the scales in A&E are not calibrated the same as other scales. If possible it's always best to weigh on the same ones, although obv this isn't always possible!

I have been where you are recently, 9th centile baby with a tongue tie (snipped at 4 weeks). Slowly gaining after dropping from 25th centile. I had baby last weighed at 8 weeks and will get them weighed again this week (12 weeks). I've held off as I know baby is ok from the above questions, and I'm likely to keep obsessing about bf if I keep getting her weighed. I am mixed feeding already (about 2 or 3 bottles per day) but still swing between giving up BF completely and wanting to keep it going. It's so hard to know what is the right thing to do sometimes!

It’s stressful when they don’t gain weight I wouldn’t worry about the difference because the scales are calibrated very often.
I would make sure you are eating and drinking plenty. Drink a lot and try and get some rest. Spend your days sat on sofa with baby feeding, do skin to skin even in the bath.
The Hakka type pumps are good as they catch let down. Get one with a lid though. It’s much quicker that pumping separately.
It takes a bit longer to get going when you’ve had a bad start. Both mine for different reasons lost a lot of weight and ended up back in hospital with tops ups but bf worked out fine. Too well in fact I’ve got a 2.5 year old who doesn’t want to be weaned!

If you think formula will help your baby gain weight, and reassure you, then by all means start topping up. Even if it's just 1-2 bottles extra a day. My baby was so much happier once we topped up his feeds with formula, and steadily gained weight. And it does take some pressure off you.

If babies back to bottle feeding it changes breastfeeding. Not in a bad way, but boobs will adjust what they produce. If it's best for dad to give a bottle; then thats great, but does mean breastfeeding won't be enough because you Produce what baby needs.

If it wasn't for the scales how would you think it's going?
6 weeks is peak cluster feeding time. What is your instinct?

The back to basics advice is good.

Does your baby cluster feed? Often this is in the evening, so doing the expressed feed then is preventing the mammoth feeds that boost milk production and tank thr baby up for the night. What are night feeds like?

Look for wet and dirty nappies and a contented baby rather than tiny gram differences on different scales. And offer feeds frequently – feeding loads this week isn’t a bad sign, and it will be boosting your production. Sit on the sofa with TV, water and snacks and feed feed feed; plenty of skin to skin.

@FrenchTrellis in terms of all those metrics, things are going well - plenty of wet and dirty nappies, generally feeds for 10-45 mins per breast but has recently seemed to get a bit more efficient and more 20 minute sessions. He's feeding at least 8 times a day and is happy and content the rest of the time aside from some periods of fussiness but he's got a cold at the moment... I know I should trust more that things are going well judging by that but I just get so anxious about it. Not sure if I'm mentally strong enough for breastfeeding.. sounds like your doing a great job though. Good to know about the scales too and that they can be different.

@Orangesare I've been using a Haakaa which has been working really well although now starting to worry could it be taking milk away from the baby? Not sure if I should be using it at every feed or just a couple of times... I've been settling in front of the TV to feed and trying to eat and drink plenty. Skin to skin I find tricky though - it's hard in the winter! I try and do a session in bed in the morning but the living room is a bit drafty and also once I see the first feeding cues I want to get him on the breast quickly rather than upsetting him by taking his clothes off! But I know it's really good to do so need to try and figure out... glad to hear everything worked out for you!

@ThaiDye I just wish there was someone to tell me exactly what I should do re potentially adding in top ups! Should I, shouldn't I, how often, what time etc etc.... but don't want to waste away this time whilst he's so small and lovely worrying all the time so maybe if it saves my sanity I need to be more decisive and just do it...

@treasurefoil @BlueDiamondGlow @bussteward he doesn't seem to cluster feed at a specific time. I'm feeding him up until 9pm and then he's having the bottle between then and half past midnight/ one am. Do you think that period of bottle would cause a problem with my entire supply the rest of the day? One of the people at my local breastfeeding support groups actually suggested the evening bottle so I could get some rest. If it wasn't for the scales I think I'd think it was going well so maybe I need to hang onto that but don't want to be falsely confident when it might not be going as well as I think. Night feeds are currently every 2 hours or so. Normally I put him back to bed after he falls asleep at the breast eventually but I do offer the second breast if he's still awake

Hi OP, I went through this with my DS1, who was EBF and gradually dropped down the percentiles from 75th at birth to 25th at 12 weeks. Meanwhile he was 98th percentile for height. I was worried, but he seemed healthy in all other ways (like your little one) and I didn't want to stop breastfeeding, so I carried on and tried not to worry.

This was years ago! He's now 17yo, 6'4" and weighs around 11 stone, so still tall and skinny but very healthy and active. Some babies just aren't meant to stay on their percentile line IME.

“you Produce what baby needs.” This is factually incorrect and dangerous information. Some women do not produce enough milk. Even stress can affect milk production.

If your baby is underweight and hungry why on earth would you wait. Just give the baby a bottle.

@stollen123 Hello! I don’t think the bottle at that time will have any effect on your supply. Sounds like you’re doing great: breastfed babies do drop in weight, it’s not unusual. Did you have a lot of fluids at birth? I was pumped full of things that I sweated out postpartum and my daughter came out looking like a space hopper – she lost a lot of weight initially but she was recalibrating to her natural state that she’d have been without all the assistance.

It does get better and easier and you dwell on timings and nappies and everything less, I promise!

@stollen123 if I recall correctly when I first started topping mine up with formula (at 2 weeks, after he was always crying and we realised this wasn't colic but hunger) we started with one ounce at a time. It gave me more time for my supply to build up between feeds and had zero effect on his ability to continue breastfeeding. When my breasts felt full he got breastmilk, otherwise he got formula (also my nipples were horribly cracked so it gave them more of a chance to recover between feeds).

If you think he's hungry, why not try him with one ounce of formula and see how he takes to it? If he laps it up then you could try another ounce then breastfeed at the next feed.

I felt so guilty that I'd basically been leaving my baby crying of hunger for 2 weeks because I thought breastfeeding would be sufficient, but he was instantly happier once we started topping him up. I really wouldn't worry about giving it a try, fed is best!

@YearoftheRabbit23 thanks for that, I also spoke to a lovely health visitor this morning who gave me similar advice to try giving a top up and see what happens and he took a whole 120ml after what seemed like a good feed so he obviously isn't getting all he needs from me at the moment. Really stressed that it wasn't obvious to me until he was weighed as he seemed perfectly happy after feeding and with plenty of wee and poo but maybe it's a recent development and that's what the cluster feeding was all about. Anyway, just got to make sure I keep him well fed and stop getting upset about it as its not helping anyone

How much did he weigh at birth OP?

@Cuppasoupmonster he was 3658g but was induced at 39 weeks as he was measuring big. I don't think that helped with getting the breastfeeding off to a good start in addition to the jaundice and tongue tie...

Please ring the National Breastfeeding Helpline on 0300 100 0212 and chat to a TRAINED breastfeeding expert if you are worried.

@Bert2e I have spoken to 2 health visitors and will go to my local bf support group tomorrow. Belive me, I am seeking qualified advice, just posting here as makes me feel less alone.

I've previously called the helpline and la leche league with concerns about latch and advice was very kind but to just keep going, pretty much.

If you are worried about supply you need to do as much as possible to increase it. Eat and drink plenty of fluids and increase how often you offer feeding including all through the night. Avoid topping up with formula over night

The slow weight gain over just be that he has a cold so is burning more calories. Honestly just keep doing what you are doing if he genuinely seems content and is fending plenty with the wet and dirty nappies then the cold could be the culprit.

Just saw comment about top up, if that's working then do it. I had a jaundiced baby and know the sheer panic about putt on f on weight after that point. I think I worried till my ds1 was about 3 years old !!!

Op it sounds to me like it's going well and if I was you I would continue as I was.

With the top ups the advice here is well meaning but it might cause issues with supply. If you do top ups make sure you do paced bottle feeding - babies will take more from bottles because it's easier not necessarily that they are hungry. And you should probably pump when you feed the bottle too.
If baby is latching well and getting milk then breastfeeding directly the best way to ensure your supply.

I wouldnt do an evening bottle for now either - expressing is more effort than it's worth in my opinion.

@stollen123 glad it worked well, I know everyone is different but giving mine a couple of bottles a day did not affect my supply, as long as you remain consistent in still breastfeeding then the milk will continue to come. Lactation cookies did seem to help me, also drinking a lot of infused ginger (like properly fire-y ginger water, chop up a good handful of ginger and infuse it in a thermos and keep topping up the water. Nice warming drink!)

Hey everyone, just wanted to post an update on this - after giving that one top up, I decided to not give another until I'd spoken to someone else for another opinion. The breastfeeding experts at my local support group said exactly what others here had said - that breastfeed babies can grow over two weeks, that scales are different, that his cold might have affected things and that he was looking great and if plenty of wet and dirty nappies then don't stress too much about the weight and don't weigh again until his 8 week check. So I stuck with just BF plus the evening bottle from my partner and today at the check up he'd gained and was back on his percentile line! He's doing well and a really happy little guy and starting to emerge from the relentless cluster feeding 🎉 thanks for all the support and comments

Good news OP!