16% birth weight lost at 5 days old, MW recommends top-up feeds, any advice?

[Juwesm]

DS was born on Wednesday morning after a difficult labour and a forceps delivery. He was very bruised, and for the first 3 days or so was very fractious and difficult to feed. We now appear to be getting the hang of feeding, but when the MW came to see us today, he had lost 660g from a birth weight of 4140g. She suggested giving him formula top-ups, or top-up with EBM if I can produce it.

The main problem is that at the moment I am basically feeding all the time he is awake, so I don't really see where I'll fit in the top-ups. He struggles to latch on his own, I have to help him each time by poking lots of nipple into his mouth. Throughout most feeds he is bobbing on and off the breast, and each time he comes off, he then struggles to get back on. He often falls asleep after only feeding for a short time.

At the moment I let him have one breast until he comes off, offer the same breast again a short while later if he's still awake, and then offer the other breast if he still seems unsatisfied.

He appears well otherwise - bright eyed and lively. Plenty of wees, poos still green.

Does anyone have any suggestions/ advice about top-up cup feeds, or any ways of helping him to have longer, steadier feeds on the breast?

TIA

Hi, am sure an expert will be along later but the constant feeding is normal at this stage. My DS2 did that on/off thing and also fell asleep at the breast all the time. But gradually he got better at feeding and we're still going strong nearly 11 months later...

I think most on here will advise you to steer clear of top-ups as they are the slippery slope to fully ff.

Have you tried one of the bf groups? Do you have a bf cafe in your area? I personally would not have succeeded without the help of La Leche League who offered invaluable support and assistance in getting the latch correct.

Your hospital/midwife should have given you a list of bf groups in your area - it might be worth getting someone to come and watch your baby feeding.

Sorry, havent answered your questions at all really just wanted to offer some support. The early days can be hellish but hang in there and don't let this ruin your confidence. You sound like you are doing really well.

hi congratulations. sorry you are having an exhausting time. i'm worried that if you do do top ups of formula in a few weeks time your milk supply will have totally gone and you will be totally formula feeding.
my DS lost over 10% of birthweight by 5 days and we were referred to hospital - actually stayed in a couple of days. but then he wasn't really weeing or pooing, so your situation does sound quite a bit better than mine.
i was told to feed all the time but had the same problem, he would howl, stay on the boob for hours, or fall asleep straightaway.
my milk didn't seem to come through until really late (around day 7). i also had a traumatic birth experience and DS was ill at birth - needed resussication.
you could ask to see a paediatrician (via midwife or GP - our GP surgery has a thing which refers you straightaway to children's ward at local hospital) before resorting to formula, or you could ring one of the breastfeeding advice lines. my local nct breastfeeding counsellor was very good. so much better than midwife. may be able to help with posiitioning and attachment for you. You might need to get more of the breast (rather than just the nipple) in his mouth.
for me, getting some rest was key. because he was on teh boob for like 9 hours at a time, falling asleep, then waking up when boob removed, i was really exhausted - if your baby has fed a lot maybe getting a couple of hours sleep and get someone to wake you up having danced around with the baby for a bit may give you a break. i found when we did this my milk supply did improve. then feed for say 45 minutes max, then another two hours sleep for you(away from howling baby) then try again. if you do this a few times you may find things improve. i don't know that this is any technical breastfeeding stuff, its just what worked in my experience. i know the thing is feed them all the time as much as they want, but you need to rest too. when things start getting better perhaps adopt the sleep with your baby (if you feel comfortable with this) carry him around all day etc.
also drink lots of water esp when your baby first latches on.
sorry for garbled message, bit tired, hope some of it helps - good luck. btw after our initial stress i bf my dS for 14 months, so there is a happy ending.

juwesm - hope mumsnet can help. You have had a difficult first few days, and fractiousness after a bruising labour and birth can mean the baby takes a tad longer to get bf going. Good support in those early days means encouraging you to have your baby close to you, skin to skin, for as much time as possible and this may not have happened...hence the weight loss which I can understand causes the midwife concern.

However it is still early days and his other signs are mainly good (though we'd want to see plenty of yellow poo....hope this happens today). It's all consistent with a slow start, but it does mean you need to ensure things turn round soon.

Feeding all the time he is awake is normal at this stage, but of course he has to feed effectively, not just hanging on in there doing not very much. You dont say if the m/w has observed a feed - can she do this today?

If he is removing milk effectively now, then the need for top ups of EBM (no need for formula) is reduced. It's hard to say from your description if the feeds are effective - someone who knows what to look for should observe from start to finish.

Have you read about biological nurturing positions and self attachment? Both these help the baby latch well.

The pattern of 'breast offering' in most situations would be to feed the baby on one side until he shows by his behaviour he has lost interest in it, and then swap sides. It is fine to swap back again, too.

You can also try phoning any of the bf helplines. Hope things go better today.

Plenty of wees is a good sign, but the poos need to be getting yellow now. I agree with tiktok's suggestion of getting a feed observed by someone who knows what they're looking for - do you feel your baby's getting milk during the feed? Does he look/sound like he's suckling and swallowing? If you can be sure he's feeding effectively, then frequent feeding will probably be all he needs.

Thanks so much for all your advice.

Starlight - MW gave no explanation about why she thought top-ups are the way forwards. It sounded like an auto-response: "weight loss >10% = advise top-ups". The longest he goes without a feed, albeit sometimes just a 5 minute 'snack', is 3 hours, usually less. Most feeds are 15-20 mins max. though we occasionally have a 40min+ one.

Tryharder - thanks for your support. There is a bf support group on Thursdays, so will try to go along. Our local NCT counsellor is also supposed to be excellent, so we'll give her a call today too.

Concordia - we spent three days in at the local MLU after his birth, and he was seen by a paed, but mainly re: bruising and pain. He had a thorough general check-up and was given a clean bill of health. It's good to hear that you were able to bf successfully after a difficult start.

TikTok - feeding was observed by multiple MWs and bf supporters during stay at MLU, though never a whole feed, mainly just to help with initial latch. Interestingly, only one MW advised stripping him off for skin-to-skin feeds. Wide range of advice given from this, to swaddling, to expressing some milk to bathe the nipple - so we've had lots of tips to try, but no consistent approach. He was given a single cup feed of formula on his first night as he hadn't fed for ages, had been screaming for hours and I was too exhausted to think straight.

As far as I can tell he is removing milk effectively. His latch feels comfortable to me, I can sometimes hear swallowing, and when he goes to sleep at the end of a feed he often dribbles out a last bit of milk.

I have tried biological nurturing, but again he doesn't really seem to get it. He moves to the sides and bobs and headbutts my boob, but often he bobs his way right off my chest, and really can't seem to latch on his own. Is it likely to be a problem that my aereolas (aereolae?) are (I've always thought) really quite large? Slippery nipples seem to give him real issues when he tries to reattach during a feed.

We had our first yellow poo this morning!

I think on the whole I will avoid the top-ups and continue to just bf at every available opportunity. I'm just dreading the possibility of him having dropped more weight tomorrow, but fingers crossed we'll have turned a corer by then! We're spending the day in bed today for lots of cuddles.

I wouldn't really let him go 3 hours without a feed.

Mine used to feed every 2 hours til they were about 6 weks old.

I'm sorry to hear you're having a difficult time, it sounds very worrying for you.

I'm wondering what it is about your areola that you are concerned about? The areola is really pretty irrelevant to breastfeeding. When a baby is well attached their top lip just slides over the nipple and underneath they take a nice big mouthful of breast. In some women with large areolas the baby will not take into their mouth all the areola below the nippls and a portion may be visible by the baby's nose. Where a woman has a smaller areola, only a very small part may be visible by the nose and the breast in the baby's mouth may include tissue behind the areola as well. Areolas come in all sizes from 10p to side plate! The crucial thing is that the nipple does not go into the mouth central like a bullseye and that the baby has a nice big mouthful of breast.

There are some diagrams here (scroll down).

If your nipples are slippery with milk or perhaps a nipple cream then sometimes it's helpful to gently wipe them with a clean muslin or tissue.

I hope you got hold of the NCT counsellor and are getting some more consistent help now. Support groups can be realy great, so it is worth getting along to one even if it does feel like a mammouth effort.

Not really sure what I'm getting at with the areola thing. When he's trying to latch, he just seems to mouth at the nipple, unable to get a good mouthful unless I help him by pinching some of the areola together in a bunch and helping it in. If he does latch on his own, it is usually painful, as though he has only grabbed the nipple tip. We seem to be getting on okay today, Had some big (for him) feeds this morning, though they've tailed off this afternoon as he's been sleeping much more.

Just to be prepared, if he has lost more weight tomorrow, what are the next steps likely to be?

What you describe sounds like quite a central latch. Could you try starting with his whole head further away from your breast (maybe more in your cleavage), so that he has to really tilt is head back and have a yawning wide mouth as he goes on? The aim is not to get the whole areola into his mouth, nor to shape your nipple like a bottle teat.

There's a video here that may illustrate visually more clearly what I am trying to explain?

Some mums find that pressing their thumb into the areola by the base of the nipple on the opposite side to the baby's body (by his nose) helps to elongate the amount of breast for their baby to latch onto. It's called exaggerated attachment.

Has anyone checked to see if he has a tongue tie?

Hope your weigh-in gives you more confidence tomorrow. Just wanted to say that I feel for you, and have been there. DS1 was 10lb 2oz and dropped to 8lb 10 oz in the first 5 days, before gaining 3oz on the 6th day. So you might have turned the corner now too.

Lots of excellent advice here. Also, your milk is probably more copious now than in the first few days. Try not to get too anxious, have an early night, go with frequent feeds and offer both breasts (and back again) at each to stimulate your milk supply. Try to rest and eat well, and I am sure tomorrow you'll get the result you've been working so hard for. It is so hard to believe at the beginning (especially with your first) that this "miracle" will happen - despite all the scientific evidence it seems bizarre that you can feed your baby this way - you have no real way of quantifying how much of your milk is getting into your baby and it's a leap of faith sometime. However, it does work, and you'll get some evidence tomorrow I am sure. In the meantime if your baby has pooed, is able to thrash about and cry a bit, then am sure all is well.

Let us know how it goes.

Well, he's been weighed today and has put on 80g , so it looks like we've reached the low point and turned it round! Thanks for everybody's advice - it is so helpful to have the support, and to know that other people have been in the same situation. We're still working on 'the perfect latch', but I think its getting better, and he's even latched on his own once or twice! The MW I saw today didn't seem that keen on top-ups, so wasn't too fussed that I'd ignored that particular bit of advice! Anyone want a tin SMA gold (panic buy!)?

Well done, you!
*shakes pom poms>

Fantastic news . Just goes to show what a great job you are doing. Lovely to hear that the HV was supportive too. I hope things continue to improve. Do keep us updated.

Brilliant news. You've believed in your ability to feed your own LO and that's half the battle. I do hope you have a long and successful time BFing.

IMHE the first couple of months can be tricky at times (e.g. mastitis, thrush, sore nips etc.), but you can get through it if you are determined and well supported. Don't try to do too much other than sit and cuddle your baby and accept all offers of housework, cooking, shopping etc. But you sound pretty well informed and sensible, and very determined, so am sure you will be fine.

For latch stuff, you might want to google Dr Jack Newman, another BF specialist. I remember watching one of his vids in which he says that despite "poor latches" loads of women breastfeed successfully as they produce sufficient milk for their babies regardless. So I wouldn't get too stressed out about this. That said, it can impact on the health of your breast (e.g. can be a cause of mastitis), so worth trying (but not getting too stressed over, IYSWIM).

Well done you.

I have just gone through the same thing. My baby is 5 weeks old. In the first 2 weeks she lost 11% of her birth weight.

For 2 weeks we had constant crying and put it down to colic. It was suggested i feed her every 2 hours but that didnt seem to help.

After seeing how much weight she lost from her birth photos i took her to the hospital. It was then suggested that i breastfeed her and then offer a bottle of formula to see if she takes it. After each feed she was taking between 2 - 3oz of formula.

The crying has now stopped and she is a completely different baby. She put back on her birth weight within a week. I still offer her the bottle after every feed as i clearly cannot produce enough milk for her.

Good luck with everything and give it a go.

bec, you and your baby have had a difficult start...it's good she (and you) are happier.

What you are doing now will resolve the weight issue, but you need to know that breastfeeding with top up bottles, especially a bottle offered every time, will soon mean formula takes the place of breastfeeding. Now, this may not be something that concerns you, and you will (as many mothers do) prefer to know for sure your baby is getting the milk she needs to grow.

If it does concern you, you may be able to fix the breastfeeding to make it more effective, so you don't need formula.

It sounds to me that you were not given good, knowledgable support in the early days - a baby 11 per cent below birthweight at 2 weeks who's constantly crying has had problems from the very start which should have bee picked up by midwives

If you want to know more, start a new thread, or else phone one of the bf helplines.

Hope this helps.

Thanks again for all advice and suggestions. Another 100g put on at today's weigh in !

Bec13 - glad everything is going well with your feeding. It's brilliant that your baby was able to get back to her birth weight so quickly. Continued good luck to you both!

Juwesm - that's great. Sounds like you did need to take action, and it has worked

Thanks!