EBF baby is it time to supplement feed?

[Slipthroughthenet]

I have a five week old DS. He is EBF on demand. The problem is he doesn’t seem to demand very much. There are a couple of times in the day when he’s alive alert awake enthusiastic! The rest of the time he sleeps when he is sleepy I tried to wake him to feed, he sucks a couple of times and goes back to sleep, i strip him off nappy change he sucks a couple of times and goes back to sleep. So his stretches feeds are sometimes longer than the recommended 2 to 3 hours, and this will happen a couple of times a day where he’ll go through long her sleepy patches. At night, he is very considerate and chooses not to wake me for big feeds and again just snacks all night as we co sleep he is on my boob as much as he wants, he is sometimes a bit fidgety but newborns often are in their sleep and they offer him the boob lots. He rarely cries but when he does, he does so loudly. He has two fussy periods in the day where he cluster feeds and does seem to be hungry but again, I know this is usual infant behaviour.

I wouldn’t have thought anything was up until we weighed him.

He was born on the 94th centile. He dropped less than 10% of his weight but took about 3-4 weeks to regain birth weight.

The last two weeks he has gained 170 g a week. Overall, he’s gradually been dropping through the centiles and now is around the 34th centile. The lactation consultant (NHS) did a calculation and said they would expect him to be putting on 250-260g a week at this stage.

Does oodles of wet nappies. Like loads of heavy ones. But only moves his bowels once every 2-3 days. has done the same pattern since birth.

I know this can be another sign that they are using everything and maybe not quite getting enough. When he does go, it is a poonami!

A bit of history on me, I have had two breast augmentations and have one breast that was underdeveloped. it does give a little bit of milk but i’m heavily reliant on one breast to do the work.

The lactation consultant has suggested that we supplement. I could do this by pumping or I could to go on a pumping blitz to try to up my supply to see if I’ve reached my max or not. However, I did a blitz with my DD my first child and it was so hard it gave me mental health issues and i can’t fit it into family life. I’m not against using formula so I’m happy to supplement this way, she suggested he is about 160 mL short a day and so to supplement 4×40ml a day with a bottle of feed.

If you have I am so grateful I know it’s a long story and a big picture. I am wondering if there are other experiences of babies dropping centiles like this are growing slowly but being totally fine?. What might you do in my situation? are the signs pointing too low supply and although he seems happy right now this could be an indication that we could run into trouble in a few weeks so we should catch it now? He also seems to not be a fan of the bottle. But he will need to take one in the ideal world this is a long time goal anyway as I’d like to give him to other people occasionally and i start back at work in three months slowly but surely. Let me know if there are options I’ve not considered.

If he's dropped so much in his centiles has Tongue Tie been ruled out?

I don't know if this article on feeding sleepy babies will help at all?

Mine was a very similar story except at 3 months old, gradually creeping down the centiles. She fed a lot, 30 mins at a time, sometimes falling asleep exhausted. Cosleeping too so boobing all night. I also fed off one breast only due to complete lack of development on other side.
The cause in my baby was a tongue tie. When this was diagnosed and snipped, feeds became much shorter and more efficient. Weight centile went back up to what it had been within a month. I did it privately as the NHS wait time was long. Well worth it IMO.
If that's been ruled out, I think supplementing is the only option. I personally would pump after feeds whilst you give the formula to keep your supply up, but I appreciate that's not easy with another child. Maybe do it when you can rather than aiming for every time. And obviously you've got the formula to give too so no worries about the pumping not producing enough. I found a Medela hand pump much quicker to use on the go sitting on the floor next to toddler than setting up electric pump. Easy to put down, pick up, do 5 mins more kind of thing.

How many feeds is he having in 24 hours? The first step would be to get another bf in- if he has one of his longer sleeps in the day you could try waking to feed. Breast compression and switch feeding also worth looking at. Breastfeeding.support has good articles. I'd look at these before supplementation. Any skilled support available to you?

How are you both this morning @Slipthroughthenet?

all really good suggestions. a health visitor came and looked at him and she looked in his mouth and said ‘looks like he can lift his tongue fine no tongue tie’ so i had forgotten this is a thing but i know if can be more complicated than this so im going to book privately today to get this ruled out thankyou for the suggestion.
Im going to wake him during his sleepy patch during the day, he’s sleeping like a champ at night and i don’t want to disrupt him and we dream feed laying down to keep him going through the night. yesterday i woke him to feed in the day and i don’t know if it’s just luck or timing but we got an extra bowel movement out of him so two days ins row which is a good sign.
i had also been pumping a little after feeds to create a stash so he can take a bottle now and again so i’m giving him an extra couple of ounces a day by bottle which will require less effort from him and i’m pumping to replace before i supplement with formula. i think i will keep going pumping and supplementing breast milk until i can see a tongue tie specialist. he seems very well in himself snd was a bit more awake yesterday so i think we can manage until we see the tongue tie specialist to rule that out, if after that he is still dropping and it isn’t a tongue tie i’ll supplement.
thankyou everyone for your input

I wish HVs wouldn't do this. Unless she's a Tongue Tie Practitioner she probably hasn't got a clue what she's looking for. The number of times I was reassured by HCPs that everything was fine was ridiculous.