HV advising me to top up with formula while I'm trying to excl bf - help please!

[monthlymayhem]

My LO was 6lb 2oz at birth and at 11 weeks is now 10lb 5oz. BF'ing has been a bit of a nightmare and my LO never seems to be particularly content. We've tried everything imagineable (remedies for reflux, wind, cranial osteopath, one sided feeding, etc, etc.....) but feeding him is still often a battle.

Anyway, I am trying to keep going but my HV advised me today that because of 'slow weight gain' I should be topping up with formula. His weight gain this week was only 4oz (and last week he only put on 5.5oz over a fortnight, but in other weeks it has been a gain of 10 or 11oz. He was on the 3rd centile at birth, went up to the 9th and is now back around the 4th.

I need a bit of perspective on whether I really should be worried about his weight gain and therefore topping up as she suggests. The stubborn side of me really wants to keep going with excl bf'ing him and not topping up, but obviously not if his weight gain is really an issue.

Tell her to feck off! the pattern of weight gain is exactly what you'd expect in a breastfed baby - he's obviously of the small but perfectly formed type and is levelling down back to his birth centile - I'm sure Tiktok or one of the other BFC's will be along shortly to reassure you, as long as he's peeing and pooing lots and getting more snug in his clothes then he's fine!
he's about ready for a major growth spurt so be prepared to feed and feed and feed for a few days when it happens!

i had this problem too. my ds is now 15 months and still weighs under 20 lbs but he is just slim like his parents.
how often are you feeding him?
are yoi making sure he is feeding from one breast at each meal as the first bit of milk is the thin stuff like a drink and then the hind milk comes which is the thicker fattier stuff.
if you are concerned then jsut topping him up with a bottle of formula at bedtime will be fine.
as long as he is gaining no matter how small is ok.
HV sometimes forget about genetics and that not all babies gain weight at the same speed.
HTH

BTW, why are you getting him weighed so often - That can really skew the chart , try plotting the 4 week points and look at that -it sounds like the trend is an upward one anyway.
to put it in perspective, if you weigh him when he's had a big poo and he's not been fed yet, then the difference from if he's not poo'ed and has had a good feed could be a few ounces -i know DD2 gets perceptibly heavier after a good feed

He's keeping on his centile, small variations up and down. Sounds like you have the good idea with keeping exclusively BFing him.

Thanks for the reassurance! HV has been 'helpfully' coming out every week to weigh him...

I'm feeding him pretty much on demand, which generally works out every 2-3 hours during the day, and every 4 hours ish at night. He gulps down feeds in 5 mins flat which is I think why we've had so many wind etc issues, but I have been sticking to one side per feed (and often using the same side for 2 feeds in a row) so hopefully he will be getting the hind milk too.

Bethoo, 'topping him up with a bottle of formula at bedtime' is NOT fine if monthlymayhem wants her son to continue to benefit from all the advantages of exclusive breastfeeding.

monthlymayhem, well done for carrying on through your difficulties. Have you had any breastfeeding support to try and identify why feeding him is still a 'battle'? What exactly makes it difficult for you? How often are you feeding him?

If your HV was doing her job properly, she should have referred you for breastfeeding support rather than suggest formula. Giving him formula will reduce your milk supply, and might make it harder for you to continue breastfeeding.

Do remember that babies are just like adults - all different. They gain weight differently, and can gain quickly and slowly at different times.

nooo bethoo!
the hindmilk/foremilk thing is old hat - the milk is made to order and changes through the feed - thats how switch feeding works, you trick the breasts into thinking that baby is drinking little and often to up the fat content and increase production. kellymom describes it as like turning on a tap - if you go a long time between feeds the fat globules in the milk stick to the sides of the milk ducts,and the rest of any milk hanging about seems thinner, like when you turn on a hot tap and it starts off cool, as the flow increases with each letdown more of the fat globules are washed out,and gradually at the end you are getting the milk exactly as it is made, just like when the water turns hot, it's very gradual.
giving a top up of formula, when you want to assure a good supply is totally counterintuitive - if you miss a feed then your production goes down, the same way as when your older baby starts drinking water and drops a feed, the more feeds you replace, the more your production goes down

simple then, if she's coming out, tell her not to bother -she has no right of access, if that's too hardcore -go out shopping when she's due until you get an irate phone call , then gently decline her input on this issue

LOL Jamila - my answer machine is now switched on!

Monthlymayhem, I have two suggestions if you are still worried about his weight, both of which will help him get more milk:

1. feed him more often at night. Your body makes more milk at night time, and feeding him then will help up your supply in the daytime too. You could have him in your bed (as long as you don't smoke or drink or take meds which make you drowsy) if getting up more often at night doesn't appeal!
2. Feed both sides at each feed. The whole 'hind milk/fore milk' thing is a bit misleading - there are not two kinds of milk in your breasts, the milk GRADUALLY becomes more fatty as baby sucks. As it is, each of your breasts goes 4-6 hours between being fed from. It is his feeding which will encourage them to make more milk.

x posts jamila!

Monthly, if he's thriving for his age, I don't think you have anything to worry about. He was small at birth and so should remain around his birth centile (approximately - bearing in mind the centile charts were based on formula-fed babes) as he progresses.

Babies are very sensitive to their wellbeing balance. If he's hitting most of his developmental targets it means his weight suits him down to the ground. If he's not keeping up with any of his peers you might want to see a paediatrician. However it is tricky to work out, because children do develop at different rates for the first three years of life.

One other thing - in my experience (only one child so far) it will probably take you between 3-6 months before you feel that bfing is totally 'settled'. Until then you may experience more concerns and unsettling worries than after 6 months. So you're not alone.

Oh, and be careful about feeding twice in a row from the same breast as you may end up with one boob like a Zeppelin!

bethoo - what you say is not helpful to the OP, sorry, and it's based on misunderstandings.

OP, it doesn't sound to me remotely that there is an issue with your baby's weight, health or growth, or your breastmilk supply.
But if there was, then the easiest way to address all these issues would be to get more breastmilk into your baby by feeding more often, by offering more breasts at each feed (switching breasts back and forth). It is pretty simple

I think you will benefit from speaking to a breastfeeding counsellor who can perhaps help with the unsettledness you describe.

Your HV sounds very unhelpful

OP - I see you have been routinely offering one side only per feed and sometimes the same side twice in a row.

This might be fine for you, but for most people in the early weeks at least it's not good routine practice - someone has been giving you poor advice, I think (the same HV who is 'helping' you now??)

Thanks tiktok! The reason I'd been offering one side per feed was I thought part of the gulping/wind issues was due to a fast letdown, and so I thought one sided/block feeding might help.

I've put in a call to a local bf counsellor so hopefully she can spot if there are any issues with how he's latching etc, etc

It's reassuring to know that his weight gain doesn't sound worrying

Hey monthly, I had a letdown that was faster than a rollercoaster. I'd be interested to see if there's anything you can do about that, but I found that over time (after about 4 months) it all settled and my DS stopped having to 'attack' my breast. Poor angel.

Good luck!