SNS - how much milk to use for small 8-week-old

[fififlores]

has anyone used one of these? DD (3.24kg, 8.5 weeks, exclusively breastfed so far) is a really slow weight gainer - 500 g in second month, nothing in first - so i want to give her a bit more - EBM when possible, if not formula. she cries loads and doesnñt sleep much in the day, which i am pretty sure is down to me not having enough milk. had same problem with DS.

my question is, how much should i give her in the SNS? it´s the equivalent of a top-up, as i am still feeding 8 times a day, just using the SNS 2 or 3 times. any idea how many ml would be correct? any advice would be much appreciated.

is this the tube supplement thing? have you spoken to a bf counsellor?

i think you might need to go into a fair bit of detail and probably better done as a conversation than on here.

500g in a month doesn't sound like a tiny weight gain necessarily , though it does depend on other factors. Isn't that something like almost 4oz a week? If she gained nothing in the first month, then it could be that things are still picking up. How is she generally? Meeting developmental milestones? What are her nappies like?

Have you spoken to someone qualified in breastfeeding? e.g. at a support group or on one of the helplines?

There are other ways to try to up her breastmilk intake than supplementing, though perhaps you have already tried these. This has some helpful stuff. For example, is there any way you could try to feed her more than 8 times per 24hrs?

Generally she is fine, Grendle, she had her 2 month check-up on Monday, and the nruse said apart from her low weight, she is OK. loads of v wet nappies, so i think not getting/iñm not producing enough rich hind milk.

500g is 125g a week, which is 4.5oz - they said that´s the minimum amount, below that would be a cause for concern.

no bf counsellors here, sadly, fishie - I live in Spain - we have got la leche though, so i might ask someone there. iñm also in contact with an NCT counsellor in the UK by email, but she didntñ want to suggest amounts. but she also suggested feeding more frequently, which i will try, but i also have a toddler and my husband works away during the week, so not always possible to do that.

So the advice you have been given is that there's no cause for concern at the current level of weight gain ? Well then, after a slow start that sounds like great news. It sounds like things are picking up for you, so introducing formula now might just be an added complication? If you have a look on the link I posted, then there are some tips about increasing her intake without going to the faff of using an SNS -which with a toddler to deal with as well might mean more work for you (sterilising etc). LLL are likely to be able to support you if you can make contact.

Using breast compressions towards the end of a feed as her suckling slows can be a simple but really effective way to keep a baby feeding actively as the flow slows, and this is really useful as it is at this point when the milk is fattiest.

It can be really hard juggling a baby and toddler. Another thing to watch out for is to be sure that she is ending the feeds herself, so that she has unrestricted time at the breast, especially before swapping sides. As I've said already, the end of a feed is when they get the highest calorie milk. Likewise, it's helpful to feed as soon as she asks if you can manage it, so that she's coming to the breast as often as possible. Some mums worry that their breasts feel less full, but again, softer breasts indicate that the milk the baby is getting will be richer. When breasts fill up, then a baby has to get through all the high volume waterier milk before getting to the righ creamy milk, and sometime their little tummies fill up on the lower calorie milk.

It sounds like you are doing well and so is she .

thanks for that Grendle. I think i am very confused by conflicting advice - on one side, the conventional medical people saying, ooh, she´s very small, you should give her a bottle, won´t do any harm; and on the other, the pro-bf lot, who say, breast only, doesn´t matter if she´s small. the ones i see face to face are the former, and obviously if someone tells you your baby is very little, that is bound to affect yoru confidence. also, she hasnñt grown much lengthwise which worries me too.

re your advice - i have never found that compressions work - she just stops feeding. she feeds for horus and hours, has had about 1 hour´s sleep so far today, there is no end or beginning to feeds, so i cannot say how long feeds are, or how many times she feeds. but when she does stop, ie come off the boob herself, she sleeps for about 10 minutes, and then wakes up crying again, so obviously i assume she´s hungry again, and that she is not satisfied, with a full tummy, i havenñt produced enough milk to fill her up, and therefore i donñt have enough milk for her. i am taking fenugreek and have ordered some bf tea.

basically, she is always hungry and hardly ever content - she never wants to be in a chiar, on a playmat, playing or cooing or whatever it is that they´re supposed to do at this age. as for developmental milestones, i havenñt the faintest clue as she is always feeding, so she doesnñt do anything else.

i darenñt pump to increase supply, cos i donñt know when she´s going to wake up after a feed wanting more; and anywa, by the time our on-and-off 3 hour feed has finished, i need to look after the toddler/eat soemthign/go to the loo etc.

she has very odd pooing patterns - basically, she doesnñt for days, and then she does loads, so that´s not qutie as simple to read as the loads of wet nappies.

on the one hand, i would like to ´´fill her up´´ once in a while with formula, for some peace (and peace of mind) - after those feeds yesterday, she slept beautifully. if i cannot provide that kind of rest for her, then surely something is wrong?

I'm sorry to hear you are getting such conflicting information. That must be very difficult and confusing for you as you try to decide how you want to proceed.

The feeding for hours and hours sounds exhausting for you, especially with an older child to care for as well. If she sleeps so little during the day, are you managing to find ways to cope? For example, some mums find their baby will nap for longer if carried in a sling, and that way they also have hands free to do something (even if not sleep). It is really common for babies of this age not to like being put down, whether on playmat, pram or whatever. It's also common for them only to take very short naps and to feed very frequently. It can be very tough to cope with if it's not what you expected. Does she smile and look around her sometimes? Is she interested and alert?

I can understand why you feel expressing would be too much for you at the moment.

After the first few weeks, it's fine for babies not to poo every day, as long as when it does arrive there is plenty of it, it's yellow and soft. Some babies go once a week or less often. The regular wet nappies are a really good sign .

The one thing I would suggest is that if you can get in touch with your local LLL you do this. If she is literally feeding for hours at a time, then this may suggest that she's not transferring milk as efficiently as possible. She obviously is getting a good amount, as she's gaining and the other signs are good, but possibly at the expense of you having to endure very long feeds. It could be that there's something that could be suggested to improve the way she's attaching to and feeding from the breast (her latch). Are feeds comfortable for you? Pain or soreness isn't always present, but would point to the same thing. Has anyone checked to see if she has a tongue tie? Has anyone trained in breastfeeding observed a feed?

I do hope things improve for you soon.

Hi Grendle, she is asleep, hurrah!

Yes, she does look around her and smile, and is alert, and watches her brother, and turns her head from one side to the other when I move her a toy from side to side in front of her face, and she can turn over on her side. so i think she´s fine devt´lly.

re the poo thing, the fact that she´s doing it less now that iñve given her smoe formula puts me right off using it.

today she had put on some weight, but overall since last week, not much (I weighed her on Monday, and she´d lost a bit of weight over the weekend, which is waht put the wind up me in the first place - only 20g in 4 days, but i had a feeling something was wrong with the feeding when we went away over the weekend, so i was very worried). so 55g since last wk, but 75g in last 3 days, which is good.

re LLL - i went to a meeting and the lady said my latch ´´could be better´´, and kept trying to shape my boob into a ´´baguette´´, and shoving it into dd´s mouth, and then pulling it out cos she said it wasnñt right. also, showed me a feeding position where the baby lies on my tummy, kind of on top of me length-wise, and then sucks - when i tried at home, she jsut fell asleep. they also do phone consutlation, but in spanish, which i do speak but itñs hard work with something like this! i do know someone who´s training to be a lact cons and speaks Eng, so might ask her for her advice and opinion re my latch.

yes i would absolutely love for someone trained to watch me feed her, as i am trying to improve my latch but my boobs are so soft theyre like pillows, but there is noone. she can stick her tongue out so assume not tongue tie.

thanks for your help Grendle, this is the longest and msot detailed (and probably most helpful) consultation i´ve ever had with anyone about my bf situation!!

You're welcome . She sounds like a delightful little girl.

I can understand why you are feeling concerned about her weight and so want to check it regularly. However, weighing every few days is counter-productive really and also not that accurate. Even if the same set of scales is used and assuming she's naked, the difference between having just done a big wee or whatever can account for quite a few grams (20 isn't much at all). Usually it's recommended not to weigh a baby more often that once a week even where there are concerns, and if all's well then every 2-4 weeks is more usual.

Was the LLL lady actually touching your breast and shaping it for you? Most UK supporters would use a hands off approach. There are some tips here and here that might be useful regarding latching? There are also some video clips with commentary here -try 'first latch' and 'third latch'. Did you know you can also email several of the UK voluntary organisations and get support via email? E.g. here, here or here, though ABM and LLL say to allow up to a week for reply. NCT may offer a similar service, I'm not sure.

It would be worth speaking to your trainee lact cons too, as they may be able to help you further in person.

I hope you got a little break while she slept .

PS the technical term for baby on your tummy is biological nurturing. Some mums find it fantastic, whilst others seem to get on better with a more upright position.

"she is always hungry and hardly ever content - she never wants to be in a chiar, on a playmat, playing or cooing or whatever it is that they´re supposed to do at this age"

Something to consider is that not all babies sit and coo and play! Maybe this is just her personality? Mine was just like that...constantly feeding, always wanted to be on the boob (not necessarily for food sometimes comfort) it was just her favourite place. She never wanted to be put down. To be honest she never really settled until she could get around herself - she had things she wanted to do and was frustrated at being put down until she was able get to where she wanted to be under her own steam. She is 10 months now and is crawling and walking (with support on the furniture) and has just taken her first few steps on her own and she is MUCH happier. She will now play by herself. Still not very keen on being strapped into her chair though!

I know that it is very hard at the moment but hopefully before you know it she will be sitting, playing and cooing!

yes, LLL lady was touching and shaping my breast. the NHS stuff on the link was cool, thanks for that, but the Kellymom pages´ links to stuff on latches didnñt work, though they sounded really interesting, so i´ll try again tomorrow.

the lady iñm in email contact with is NCT.

thanks again.

hi grendle, donñt know if you´re still checking this htread, but if you are, having a bit of a crisis.

last week dd had only put on 55g, then this week, nothing. i really, really, really donñt understand why, and it pisses me off intensely that after all the hours and hours and horus i have spent breastfeeding her, she has stopped putting on weight. she is now 3310g, 10 weeks. iñve been feeding her every 3 horus, a bit more often if i can manage, like every 2.5 hours, but it´s so tricky with 2 kids and esp with no help in the evenings.

to add insult to injury, she hadnñt taken my boobs all day today - she just popped her mouth round my nipple, took a few sucks, then pulled off again, for ages. quite painful, too. so decided we would have to give her her first full bottle of formula, 110ml, which she took really well. not messing around with teh SNS. then i pumped my boobs so I can give her my milk later, at least.

i really donñt know what to do, or why this has happened. all very frustrating.

any suggestions?

PS now i realise how crazy i was to complain and worry when she was putting on 120g a week - much better than nothing!!