Mixed feeding /Over feeding / Wind and Puke...(sorry bit long)

[Peaches174]

Hello - if anyone has insights on the following would be v v grateful as am getting mightily confused...

DS, 7 wks tomorrow, was putting v little weight on and so I've started topping up with ff after each bf. On hv advice is 20 mins of bf followed by 2oz /60ml ff (aptimel). He guzzles bf (often v gurgly sounds - I wind him half way through) then does little sick.

Then wait 20 mins+ to give ff, when we often get massive sick (was quite pukey before mixed feeds but not as bad as now). I feed him 10ml at a time and he screams , am presuming because I take the bottle away regularly to wind him. But is it because he is stuffed and in pain?

He drains the 60ml every single time, cries the instant bottle is taken away and is fed total of 7 times in 24hrs.

Is he getting enough? Or does need more/less??

Of course silly new mum has gone from feeling guilty about starvation to feeling guilty about being a 'feeder' - pls help!

Peaches - this sounds a really hasslesome way to feed

The best way to guage if your baby is well-fed is to look at weight gain coupled with overall development and behaviour, plus nappies in the very early days. It's just not possible to look at the quantity of milk and say 'this is/is not enough'. It sounds to me that you would be helped by working on ways to make the bf go better though....

He's getting a lot of formula. This is going to impact on your breastmilk supply. I wonder if it already has, and he would benefit from stimulating your supply more.

How about putting him back on the breast after he has finished the top up? I know it makes the feed even more 'cumbersome' but it would be good to stim. more breastmilk as well as to get more breastmilk into him, if you get me!

What you are doing now will mean the end of bf. You may be ok with that, but if you're not, then you need to be aware of it, and of the fact there are ways to preserve your milk and to fix things to help your baby gain well and thrive on breastmilk without top ups. Ask if you want to know more

Hi tiktok
Thanks so much for your post, initially hated the ff idea and went to local bf cafe and phoned nct helpline where they advised to carry on as I was and not to worry about weight gain.. He was putting on less than 1oz per week though and I was really panicing. He would bf feed all day and night and still seem unsatisfied, v unsettled, screamy etc so when hv advised bit of ff I decided to try as had lost all confidence. He put 9oz on last week and is much happier so even though is a total faff (am still spending every waking min feeding!) I've kept it up. If you can offer more advice would be great, I just want to do the right thing for him and was so scared by his weight as he was still only 7lb6oz at 5 wks.

Oh re poos, before they were probably min of what's acceptable, now prodigious!

Thank you x

Thanks for the extra detail, Peaches.

(Poo quantity not really relevant at 8 weeks, BTW)

What puzzles me a bit is that he cannot really have established a pattern of weight gain before it was decided that it wasn't enough...rather than addressing the issue of making bf more effective.

I understand you felt panicked, and wanted to do something, anything, to get him to gain weight more. If all we were talking about was a baby who could benefit from more calories, then these can be breastmilk, of course

So that would mean observing a feed if possible, to check for effective transfer of milk, unpick the 'feeding all day and all night' to get a clearer picture of what was happening (I accept this is what it felt like - it can't have been literally true ) and just generally improve his intake of breastmilk.

From what you say about his behaviour, it could well have been that full bf was not keeping him happy, so working on making bf more effective should have been a first step....rather than building up to 420 ml of formula a day which to repeat myself is a lot.

To preserve any breastfeeding, then you will need to find a good person who understands the situation and who can help you work out a way of reducing that amount, while ensuring your confidence is maintained, as well. You can't just stop the formula and expect your supply to magically increase by this amount....you'll have an unhappy and hungry baby So this needs a plan. Maybe your HV is the one to help you work it out, not sure.

Hope this helps

Hello again
I've been trying to express but when was exclusively bf was impossible as he would be crying so much and then after 1hr + feed would want feeding again an hour later! I could only get 20ml or so out and found it adding to the stress of situ greatly..
Since the ff I've been able to set him down a bit better which has meant I've been able to build a small stockpile of ebm for when my milk does go so at least he'll have some bm for a few more weeks- is still taking me 3 sessions to get enough for 1 feed though.

At bf cafe I told bfc that he kept pulling away and fidgeting during feed and she said was wind! I always thought it was due to him not getting enough milk maybe due to poor latch but was confused by the face full of milk/ sick that would still get at end of a feed. Also he appeared to feed properly with swallows, gulps etc...

Re the doctors and hv advice to top up with ff was taken as he didn't put more than few grams on per week over course of 3 weeks- do you think was taken too quickly?

I have tried to put him back on breast after ff and he gladly takes it but is still screamy/pukey and I worry it's making any overfeeding worse.

I have, in short, got myself into a right mess!

I'll try the bf cafe again today to see if they can offer more help but anything you can suggest I do would be v appreciated!

Thanks again

Hi,
I can totally understand how you are feeling. So much so, that I have felt compelled to post my 1st message. My dd is now 22weeks and from what you have said we had the same problem. Hv worrying about her gain. So at 2weeks old told BF 20 mins a side, top up with ff and then express. Same as you, not much diff, and feeling at wits end, same feeling of guilt etc. Really perserved with BF and am still BF, top up when convient, ie when at home/friends. For my dd doesn't seem to matter I top or not wt stll on bottom percentile. All that happens is that she sicks up more when top up. As Tiktoc says more important are the nappies and behaviour. Also, what is your and other family members build like? If you are all skinny, then stands to reason your ds may also be lean. Is your ds mega active? Hope this helps.

Hello and thank you for post! Is hard, hard work no?!

All way through his nappies have ticked the boxes but def went from being basic 6/8 wees + 3ish small poos a day to a prodigious output.

He is a screamer and rarely seems that calm and settled, I find he cries the minute I put him down so he spends most of day in sling. This has got much better since the ff top ups started. He will feed,feed,feed and has no issue with breast/bottle as long as one or the other is in his mouth!

He's still on bottom centile too and whilst we are both tall and slim ( well not so much me at the moment but I live in hope!) before the top ups ds's ribs were practically visible and I was sick with worry.

Do you find the expressing/bf/ff combo is driving you loopy? I love ds so much and want to enjoy his babyhood but am spending all my time in a total flap.

Have you tried diff brand of formula? I thought maybe an easy digest type might make diff...

I too use aptimil, just cause HV suggested it. Did drive me loopy for a while as really wanted to BF and felt a total failure. Eventually, once I relaxed, things got better. now dd 90% bf, 10% ff. In my case ff diid nothing for wt gain but don't know about your situation enough. Get the hv to measure ds height as if this is ok then maybe just skinny too. This helped me and them relax. Also perhaps feels too full from consant feeding, (think how we feel post xmas dinner!). I fell into a cycle of snacking with dd as I was trying to feed v often and then loading her up so much she was never getting hungry eniugh to take decent bf. so then fed every 2-3hours from end of feed at that age which seemed to do the trick and help make her happier and settled. Don't know if this helps but know I felt like the only one who couldn't get child to put on wt and worried that I was being pig headed insisting on bf.

Peaches, I'll cut and paste bits of your post here as it makes it easier to comment.

"I've been trying to express but when was exclusively bf was impossible as he would be crying so much and then after 1hr + feed would want feeding again an hour later!"

I don't see a reason for expressing - it is one way of getting milk out, but in your case, the situation cried out for someone to observe you feed and find out more about what was going on. Bf, expressing, formula feeding and feeding with EBM is the hardest way to feed a baby - but it often happens that mothers find themselves on this treadmill and it is hardly ever necessary.

" I could only get 20ml or so out and found it adding to the stress of situ greatly."

Precisely. That is what happens

"...stockpile of ebm for when my milk does go so at least he'll have some bm for a few more weeks- is still taking me 3 sessions to get enough for 1 feed though."

This is too much like hard work!

"At bf cafe I told bfc that he kept pulling away and fidgeting during feed and she said was wind! I always thought it was due to him not getting enough milk maybe due to poor latch but was confused by the face full of milk/ sick that would still get at end of a feed. Also he appeared to feed properly with swallows, gulps etc..."

Expertise varies hugely when it comes to assessing a baby's feeding. Can you get a second opinion?

"Re the doctors and hv advice to top up with ff was taken as he didn't put more than few grams on per week over course of 3 weeks- do you think was taken too quickly?"

I don't know - it sounds to me as if they did not know how to improve your bf

"I have tried to put him back on breast after ff and he gladly takes it but is still screamy/pukey and I worry it's making any overfeeding worse."

Again, someone needs to see what is happening.

No substitute for this, I think...

Hi Peaches, sorry to hear that things have been going so badly with bf-ing. I had a similar problem with my ds when he was born. The midwives at hospital were topping him up with formula from his first day and that continued for about 4 or 5 weeks.... I couldn't stand the thought of him having formula so refused to make any up and left it to my mum and DH. I would feed him first and then one of them would top him up with ff. Luckily tho he would go for long stretches in the day where he'd sleep giving me loads of opportunity to try to express. I think this helped as by the 5th week he didn't seem to really need the top ups plus he was gaining weight well by then so i just stopped with the ff and thankfully he was fine. i know your problem is different to mine but I just wanted to encourage you to keep trying if that is what you want to do.
Looking back I wish i had sought better help from La Leche or NCT.
Also i think that because breast milk is much more nutritious than formula you shouldn't make a direct comparison with regard to the amount you express and the amount of formula your DS takes.
Good luck