DD is v small, I'm doing mixed feeds, topping up, not sure about supply, HELP!

[kookiegoddess]

Anyone? Tiktok?

My DD is 12 wks, on 0.4th percentile, just a very wee thing and I've followed HV advice since birth to supplement (she lost weight during wks when I did just boob, but that was some time ago). She gets one bottle at 10.30ish usually, but recently I've been concerned about my supply as she's twisting off breast, crying and fussing, grunting during feeds etc and so i've been offering a top up at 7pm feed when she has taken up to 2 -3 oz. She is very clear about when she's full when she has a bottle, will simply shut her mouth and not take any more, or sticks out tongue and spits out any milk. She rarely looks satisfied after breast-feeds, never gets that milk-drunk look.

ALSO she is VERY SLOW feeding, takes about 45 min. This is not all active sucking but she tends to cry if I take her off before 30 min, fast distressed breathing and looking around for nipple so quite clear. I understand that I should put her on breast as much as she needs but she has fallen into a natural 3 hourly routine which I don't want to upset with demand feeding (which I find stressful and confusing because I'm never sure if she's snacking or not. She's a sucky baby). She will happily stay on nipple using me as a dummy which also makes me worry about demand feeding - but I don't know why she is twisting off the nipple. I'm loath to give her more time if she is getting frustrated by slow let down as my nipples are always sore by the end of a feed anyway - but I don't want to mess up supply topping up more and more.

What should I do?? I'm anxious about changing things in case she loses weight, don't want to make docs worried as she's on bottom percentile as it is. Any weight loss would also worry me.

WIll pumping for 10 min after evening feed help? say at 6pm and 730pm after feeds? then I can give her EBM top ups rather than formula?

ANy advice gratefully received, before I descend into top up hell!! THanks

Have you ever seen a proper breast-feeding counselor or visited a baby-bus or similar? I suspect they may be able to help you significantly. After the initial start of breastfeeding (first couple of weeks) it is unlikely that your nipples would still be sore if your latch is good. That may also explain why your DD is finding it frustrating to feed from your breast. I can't recommend that kind of help highly enough - but do find one who you like and stick to her. Getting conflicting advice is unhelpful (there are all sorts of ways of doing it that are all 'right'). I was pointed to a baby bus by my GP, so maybe call there first?

On supply, IME expressing can help up production, but I found it very hard to get much off in the evening. I was more successful after my morning and mid-morning feeds. So maybe try different times of day and see if there is a change? Pumping certainly does encourage your breasts to keep making more milk, so I'd stick with it if I were you.

Sorry if that isn't helpful. Best of luck and I hope things improve for you soon.

kookie, I hope I can help.

I am a bit confused with some of the info in your post. You say she has fallen into a 3 hourly routine but you dont want to upset it with demand feeding - so is this 3 hrly routine 'hers' or 'yours'? You are worried about feeding more often - is that right? because you don't know if she is snacking or not? There is nothing wrong with snacking at the breast - really and truly. And there is nothing wrong with 'using mum as a dummy'. Both phenomena - 'snacking' and 'using mum as a dummy' are normal, welcome, and mean more calories get into the baby and make more milk.

Whoever has warned you off these things is giving themselves away - they do not know enough about breastfeeding to resolve breastfeeding problems. I don't care who they are!

Of course your baby needs to be attached well, so when she is snacking/feeding/sucking she does not hurt you, and so she obtains the milk effectively. This is something you can get checked out.

The only way to be sure of making more milk is to remove it more often. Yes, you can do it by expressing, but if your baby does the job as long as she is offered the breast, then of course she can do it! If you do express, then this means you have ebm rather than formula, which is fine, but she can be 'topped up' at the breast - that is, by being put on the breast again. If she is twisty and uncomfortable and seems not to want to go back on, then give her a few minutes and try again before giving her the bottle.

45 minutes is not a long feed - some 12 weekers will take less time, but not all of them. If someone has been telling you 45 mins is too long then again you can safely ignore whatever they say about breastfeeding! We might worry if 45 mins feeding was associated with no weight gain and wonder what was going on - but the length of time spent on the breast varies between babies, and as I say, 45 mins is fine.

I hope this helps a bit and I haven't left anything out - post again if I have or if you need any explanation.

I agree you will be helped by seeing someone who knows what to look for and what they are talking about. A HV who has suggested supplements from the start is prob not a good help.

Sorry to hijack but a small question for Tiktok
I mixed fed my DS (born early with bad jaundice weighing 2kg) til 2 months and apart from other difficulties like not opening his mouth very wide he would twist and pull a lot. He's often twist violently and fling his head back without unlatching and it was agony, I felt like he was going to rip my nipple off. I've wondered why he did this, as to be honest it was one of the reasons I stopped (among others). He was very colicky, if that has any bearing. I'd like to have another go at bfing if I have another baby so I'm sort of doing detective work to try and understand what went wrong.

Hi Kookie - Just wanted to say GOOD LUCK and listen to Tiktok. My situation was slightly different, but I was topping up and stopped little by little (actually DDs decision in the end - refused the bottle after a while). I followed her advice and DD is still bf at nearly one. She is still small but has followed pretty much the sae growth curve and put on weight steadily since 3 weeks old.

I would also go to you local Breastfeeding Network. It really ehlped me to have them see my latch and eventually tell me I was doing it right, stop worrying!

mincepie - his behaviour may have had something to do with being born prem, or with use of bottles, maybe. Always useful to get someone to watch what's happening as they can judge how the baby takes the breast and make suggestions to change. In your case, I'd have suggested baby-self attachment and biologocal nurturing positions. Twisty, fighty babies are so hard to feed.

Kookie good luck, hope things improve for you.

I would also recommend pumping in the morning if you are looking to get a decent amount off, but if you are trying to increase supply then my bfc told me make sure I was either feeding or pumping - or both - between 12-3am because of higher prolactin then. It was a killer but it worked.

Tiktok, if I feed her for 45/50 min, she will play and be content for another 40 min or so, then down for a nap and will wake naturally about 3 hours after beginning of last feed. So from this p.o.v she is getting enough to "go" for 3 hrs. Offering more between feeds might lead to regular snacking no?? Also I find it very stressful not knowing when she will wake/need feeding and offering extra generally puts routine out.

Not sure how using me as a dummy helps - do you mean that when she is doing the fluttery sucking similar to when she has a dummy in her mouth still stimulates milk production?

Soreness I refer to I think comes from being on for a long time - and I find 45 min on one side a long time! Am I doing the right thing by keeping her one side for most of the feeding time? I am anxious to ensure she empties the breast so she gets all the hindmilk she needs - and I am unsure as to whether the twisting is because the boob is empty or if she is just tired/frustrated from working hard to get the hindmilk out. One boook I read said hindmilk kicks in after 18-20 min - so can I change boobs earlier, say after 30 min??

I really struggle with the bad press that HVs get on MN. Is anyone out there campaigning for them to get better/more training so that they all give accurate advice? It's frustrating to start motherhood relying on someone who ought to be an authority but can in fact be telling you utter rubbish!! That was one of the hardest things about feeding DD from the beginning - the conflicting advice about what to do with her, coupled with the fear of starving her/making my small amounts of slow-to-come milk dry up. My main concern as stated before is that DD is v small and as she is on 0.4th percentile, any weightloss will set alarm bells ringing with Docs and HVs - and with me too. So just want to do what's best for her. Guess I shall try pumping again during the day and offering her that, and offer more breast when I can. Will also try to see a BFC but wanted to see if anyone else had thoughts about why she is twisting off nipple.

THanks

have you tried squeezing your nipple to see if there's any milk when she's twisted off? My (20 week) DS does this when i'm out of milk. I have the same problem as you that my milk seems to flow slowly, hence 45 min. + feeds.

it sounds like you have a good plan of action in pumping.

best of luck!!!

just wanted to hijack too a bit and ask tiktok- you always have great advice but i do wonder about what you say about snacking. I often will feed DS on total demand, meaning whenever he fusses, no matter how recent a feed was. But the problem i then run into is that he still seems to have his little three-hour clock running, and he gets very frustrated when the milk isn't there for that longer scheduled feed.

and even all that snacking doesn't seem to ever really boost my supply.

I've had plenty of days where he must have fed 15 or 20 times.

My DD has drifted between the 0.4th and 7th centile since birth. She is perfectly healthy and full of fun.

I think it's difficult when your DC is small. I have often felt like I 'm being told off by Hvs. I've had 6 and had at least one really horrible experience with them. It puts something i your head which says that your child should suddenly jump up the chart, and anything less is a failure. But such a jump would in fact probably set other alarm bells ringing!

The thing I find difficult is that they all soeak to you as if what they are saying is the gospel truth, and my 6 have all contradicted each other! I don't know what the solution is,. In Spain, where DH is from, each fchild has a paediatrician assigned until 9 years old. You just get your baby weighed in the local chemist! I don't know if that system works better.

I mix fed my DD until 3 months ish. We fed her every two hours - and I mean every! Really, I let her suck when she wanted as long as she wanted. It got a bit draining sometimes and we had no established routine until about 6 months. This had it's own problems but I think more of a routine earlier, with trying to help her gain weight, would have been far too much for me.

My dd (now 7.5 months) fell from the 9th to the 2nd centile at about 10 weeks and has stayed there ever since. I didn't top up (she did have a bottle if I was going out and hadn't expressed) and she did put on weight slowly. Even if your dd is only putting on a bit that's fine.

She also took up to an hour to feed at that age before it gradually got less and less (now 5mins).

I also fed every 3 hours at this age (7,10,1,4,7 and then through the night) but did give her extra when she occassionally demanded it.

Sounds as if you are doing v. well to me

DS twists off so I squeeze my nipple to see if there is any coming out still. If there is then I put him back for another go. If he twists off again then I'll often move him to the other breast.

Answering the questions about dummies and about snacking:

Dummies: there is nothing wrong in babies sucking for comfort at the breast...all part of normal infant behaviour, and dummies are used to elicit this behaviour, anyway, as a substitute mum Well-established breastfeeding mothers can usually safely use a dummy without it undermining breastfeeding, but in the early days, informed opinion is to avoid using them in order for the baby not to use a dummy instead of feeding and not to interfere with the different, learned sucking technique. Any sucking at the breast, of any type, is 'good' for breastfeeding - even minimal removal of milk from the breast has an effect.

Snacking: if all a baby ever does is 'snacking' - taking tiny trickles of milk only - then this needs changing so the baby i) takes sufficient calories and ii) stimulates more milk prodiction. But short, frequent feeds is not snacking - this is some babies' normal and natural pattern, and they can take what they need with it.They're getting more than trickles. In addition, genuine snacking - the trickles of milk thing - can happen as part of normal feeding, and the baby takes more substantial amounts of milk at other times.

Sometimes, mothers of low-weight or slow-gaining babies are told to stretch the feeds out in order to make sure the baby is hungry and will feed 'better'. I am not saying this never works, but it is a high-risk strategy, IMO. The baby gets upset
and feeds less well as a result, and overall, takes in less milk. The other reason for this advice is that 'the baby gets the hindmilk' and he 'only' gets foremilk by 'snacking'. Foremilk and hindmilk have to be the worst understood aspects of breastfeeding. The best explanation of the way foremilk and hindmilk really work is at www.kellymom.com There, they explain that when the breast is relatively empty - as it is when the baby feeds frequently - the milk is fattier. Leaving long gaps between feeds means (in the short term) the breast gets relatively full and the baby gets foremilk. In the medium and long term, it reduces supply.

Hope this helps!

Bit concerned to see this nipple squeezing....if it works then feel free, but this isn't really telling you anything Babies never take every last drop in the breast, and squeezing is not the same action as a baby sucking - so the presence of milk in response to the squeeze is not giving any useful info as far as I can tell, sorry!

Tiktok I know, but I find it gives me an indication of how quickly the milk is coming. If DS is frantic and it's coming slowly then I'll switch breast for a while and then go back again. Seems to work for us

OK, Alibear I s'pose it won't make any difference to tell you that milk comes at different rates throughout the feed? That there are several let downs per feed, and if you squeeze close to a let down (in time) it will appear faster?

If ds is frantic then switching him over is a good idea anyway - squeezing is optional

tiktok, thanks for clarifying about hindmilk. hadn't seen it that way. will read kellymom too.

will have to start a health visitor thread and have a rant there...