4 week old breastfed baby not gaining weight

[plusbump]

My DS is 4 weeks old and still has not regained his birthweight.

I struggled with my milk supply for the first week and he lost 15% of his birth weight (8lb to 6lb15 in 5 days). I was determined to breast feed so started expressing after every feed and things improved. But now he doesn't seem to be gaining much weight, last week only 1.5oz, which makes him 7lb8 at 4 weeks. I am loathed to give him formula but he feeds for 1hrish every 2hours day and night so not sure what else I can do except start expressing after every feed again which I can't do indefinately as I need sleep.

Any thoughts/ideas would be greatly appreciated, thanks

Sorry to hear that, plusbump - it is a real challenge when a baby who's not gaining weight well then sticks....is he still 7.5 pounds? Was the HV able to refer you to anyone more specialist?

Is there any flexibility in the plan - ie topping up at fewer feeds, keeping the amount of top up to a minimum?

Offering top ups is NOT necessarily a sure fire way to end breastfeeding. This is very doom and gloom!

I had exactly the same problem as my DS did not regain his birthweight by 4 weeks and was below the 0.4th centile. I knew there was a problem with the feeding, and was very worried but I was told to just continue. But I knew he simply wasn't getting enough food and started adding formula. He then gained 1 1/2 pounds in 1 week!

Everyone said that giving formula would stop him breastfeeding.

But 1 - he clearly needed food so what else could I do?

and 2, its not true anyway - 12 weeks later I am still breastfeeding (with a bottle at night that I could have dropped but decided to keep going).

I think that if you are doing mixed feeding it is generally better to fully replace a feed rather than top up after a breastfeed. This does two things. Firstly, it encourages a full breastfeed when you do do it and so gives the right breast empty signals to help improve milk supply. (otherwise you don't fully empty it).Secondly, it then allows you to express at the time you give the formula. If you do this every time you miss a feed this keeps your supply up, and also gives you some expressed milk which you can then give in place of formula later on.

It worked well for me.

So am I! Thats what I meant - even if she gives formula for a while she can probably still go back to fully breastfeed, if she wants to of course.

Don't be put off by doing what is the right thing for your baby (giving formula if that is advised and neessary) by thinking it will take away breastfeeding, it doesn't have to.

I have heard this 'there is no such thing as an empty breast' thing said before.

This may be technically true. But in reality I don't think it works like that.

When your baby has been feeding for hours continuously, your boobs feel soft and achy and just 'dry', there is no let down and the baby is clearly getting frustrated, screaming and head bobbing and not getting any milk at all, that is to all intents and purposes an empty breast surely? Even if there is technically a bit there? Your body does sometimes need a little bit of time to allow it to produce a bit more!

Otherwise, what is happening?

plusbump, just wanted to sympathise, you are where I was with my DD 2 years ago. You've had good advice here, particularly from tiktok. I just wanted to emphasise what others have said.

1. You can still breastfeed. Every bit of breastmilk helps

1. Your baby needs more than he's getting directly from the breast right now - sounds like it will have to be a combo of EBM and formula for now

1. If everything seems to be ok with latch etc., you may have a supply issue. It's worth thinking about whether you can bear to pump more - this will build your supply but I know how painful it is having pumped after every feed and sometimes between feeds for 7 months - and/or to take herbs/drugs which will help supply. Domperidone worked for me and for others on here, there are other threads you can search. Your GP may prescribe this but you will prob need to take him/her evidence about it, this is available at jack newman's website nbci.ca/ and at kellymom. In addition you can try herbal remedies such as fenugreek (you need to take A LOT to see any effect - 12-16 capsules a day), fennel tea etc., or a supplement like 'more milk plus which you can get from www.expressyourselfmums.co.uk

1. If you are going to pump, get a hands free pumping bra ( expressyourselfmums has them) or construct one following instructions from kellymom.

1. Think about how you want to give top ups. With DD I used bottles (breastflow) after each feed. With DS now I am using an SNS system to deliver the extra milk at the breast to make the most of his sucking at the breast - it cuts out time but is fiddly. with DD I used to pump while I gave her the bottle top up. With DS I put him on a pillow to watch me pump, working ok so far!

1. It will be ok. It feels awful right now but it will be ok.

Thinking of you.

Jimbobsmummy - I hope you don't tell your patients about empty breasts.

Hmm, still displaying your ignorance Jimbobs.
Deary deary me. Do you give this sort of advice to your patients?

Unless the OP gets her bfing fixed, no she can't. Using formula will mask the fact that she needs expert advice.

Yes, of course. That goes without saying. There is clearly something going wrong somewhere and that needs fixing. But if she needs to give formula for her babies health while getting the problem fixed she should not be put off by thinking you can't do both at once. You can if you do it properly.

Here's my take on this:

• when bf is going well, there is no such thing as an empty breast. When it is not going well, the breastmilk can diminish to virtually nothing...I think it's unlikely there is not a drop left in it but the amount may be small and unavailable quickly to the baby

using top up bottles is not good news for bf, that's for sure, but it does not have to mean the end of bf, or rule out a return to full bf. The key is to protect the breastmilk supply at the same time as topping up - this means bf frequently and effectively (and getting the effectiveness checked), possibly expressing as well; the other key to it is not to 'over top up' either in volume or frequency, which is why I asked if plusbump had been given other options and flexibiity - I asked*, I did not tell her or even suggest she did not do what her HV had told her

no one here has seen this baby. Even if they had seen the baby no one is in a position to tell the OP to ignore or modify what she has been told - this baby is very underweight and is not* growing. The HV may see an urgent situation where the baby needs calories and lots of them urgently. She may have made an informed assessment that the baby should be topped up at every feed - on the other hand, she may not understand much about the need to protect the breastmilk supply, but we don't know

if topping up is needed, then it is a judgement* call whether this is a small top up at x number of feeds, or a replacement bottle for a breastfeed - no one can be dogmatic about this. The key is to minimise the gaps between breastfeeds, and to encourage effective removal of milk from the breast - the more milk is removed, and the more often it is removed, the faster it is replaced and obviously, this means overall, total volume production is increased - but if for some reason the baby is not breastfeeding well (and we don't know if this baby is bf well), then there could be a case for replacing a breastfeed with a bottle feed in order to get in a good volume of calories (not to 'give time for the breast to make milk' because leaving time between feeds reduces milk supply, in the medium term. Short term, it means more milk, but this increase is spurious and does not last)

Hope this clears things up - main thing to remember is this is a talk board, and we never know the whole story.

I'm getting really fed up of this 'oh showing your ignorance again...' 'do you give this advice to your patients' rudeness. It is completely unnecessary and is what gives this website a reputation that is not very pleasant among doctors.

I don't know why I bother, but...

If you can clearly see that your baby is not getting any sufficient milk after hours of suckling and is becoming distressed at the breast and you have already tried all the suggestions that have been listed above, and it still isn't working, yet if you find a way to have a bit of a break for a short time and then the baby feeds fine and you get a let down again... then for all practical purposes, your breasts were empty.

You may argue about the technicalities of it, and it may not be the 'correct' wording. BUT This is an incredibly common experience and just telling people they are wrong about what they clearly perceive and see is happening to them is unhelpful. 'Your breasts can't run out of milk' was said to me when I could see that actually, in prcatice, they COULD. 'Just let him suckle constantly, it will bring up your supply...' well yes, of course that is true - to an extent. But after hours and hours it just ended up with us both getting more and more distressed. But having a break for half an hour to allow the supply to build up again, well funnily enough then there was milk there again!

If my breasts can't get empty then there must be something wrong with me or my milk or my baby because he obviously isn't able to get the milk and is distressed and starving... What a great way to make people feel!

OP, listen to Tiktok.
She knows more about this stuff than anyone else who will post on here.

jimbobsmummy - some people are being rude and dismissive to you, I agree. I hope you realise I am not doing so

Your experience of waiting half an hour and then getting another let down is very normal, and I too get cross when people are told (or allowed to think) that constant feeding with a miserable baby is the answer to anything.

It isn't.

I don't think it's actually the supply 'building up again' - I think what is probably happening is that the normal production of milk is indeed taking place, and the mother and the baby are relaxing a bit (someone else cuddling the baby, mum having time out) and this enables the necessary chill-out to happen and with it, comes let down.

But that's based on observation and experience, plus inferring from the technical understanding of how bf works, rather than any 'proof'.

Hi!

You sound like you are going through something v similar to me.
I struggled on through and DS is now 17 months and still breastfeeding happily.

At your stage, I topped up with formula (because medically necessary for baby's health - same as you, excessive weight loss and then failure to regain birth wt).

Then I got some serious, real-life breastfeeding help. This was much easier when baby was well-fed, alert and happy not having the screaming hab dabs due to my low milk supply.

He got bigger, we worked on the latch, and I gradually tailed off the formula until we were exclusively breastfeeding again.

Let me know if you have any questions or want any tips - am not expert like tiktok but I have been through this and I think that you made the right decision to give the formula top ups and that you can still get back to exclusive BF if you want to - it will just take a little while.

Lots of helpful advice here. I was in your shoes with DD and ended up topping up with formula. The good news is that it didn't end BF for me, it helped with weight gain and DD slept better as a result.

I don't know if any of the following experiences were factors in why weight gain was non-existent for 4 weeks with DD, but on hindsight I felt that they all combined to contribute to the problem:

• I was utterly exhausted, and the strain of daily weighings added to my lack of energy and confidence. The expressing regime also added to this exhaustion as I was either feeding (DD was a very long feeder), topping up, expressing or sterilising my pump before it all started again.
• I certainly felt that my breasts were empty a lot of the time, and expressing only yielded 10-20mls.
• I didn't feel a let-down until 6 weeks, when BF dramatically improved for me. I didn't do anything different, it just turned up one day. I'd had several people see me feel like OP, so it wasn't a technique thing. I don't know why this was - some say an emcs can delay successful BF, DD may have just got the knack, who can say.
• DD turned out to be dairy & gluten intolerant (via my BM - this took months to work out as a result of silent reflux symptoms which went unnoticed for a long time)

I struggled with the sense of panic and urgency generated by the MWs as a result of the weight gain thing and kept wondering what would happen in other cultures, but I'm sure there is good reason for it somewhere. It's just that with the post-partum hormones the worry is toxic.

The good news is that it can be fixed with formula and that BF can continue (and did, for 13 months very successfully). I topped up until I wasn't at the mercy of the weigh-ins any more, and then rested easier which I think is when things (coincidentally maybe) began to improve.

good luck

I was an obsessive weigher! I even weighed the wet nappies to try and estimate DS's daily milk intake!

Weighing is ok but only if you are in control of it. I bought my own baby scales so that I did not have to endure the agony of taking DS to weigh-ins and not know what the result would be. Was also helpful once I was back at work and could not take time off to get to baby clinic to have him weighed.

Somehow these things helped me cope when I had the long nights of self-doubt.

Thanks TikTok, I know you aren't getting at me - some people are though - and I actually think we agree about most of what is said, although we moght express it differently.

I actually don't think it matters particularly what the exact physiological reason for a problem is - eg in this case 'empty breasts', poor milk production, letting mum relax or most likely a combination of all of the above, and getting picky about terminology certainly doesn't help (not referring to you BTW). Understanding that a problem exists is important whatever the cause. Empty breast may not be 'accurate' but it is a term that many people use and everyone understands. If someone says that, it is immediately apparent what the mother feels the problem is, and that should be listened too rather than just dismissed. In my case, being told 'just keep suckling' when that was clearly making things worse just made me feel like I was doing something wrong - if instead someone had said 'have you thought about having a little break?' that would have been great! But no, your breasts can't possibly have no milk...

I agree that the exact physiological reason is less important than supporting the mother to deal with the result...and there's a lot we don't yet know about how breastfeeding actually works. What is feels like is the issue for the mother.

I do avoid using the term 'empty' though, because using it reinforces the idea of breasts as containers and milk production is more dynamic than that implies. Instead, I talk about 'less full' or the 'milk not being as available to the baby as he'd like' - while acknowledging the mother feels as if they are empty (and in some extreme cases, they just about are....sometimes when the mother has been acutely ill, or, of course, if there has been a long-standing problem and milk is diminishing).

I share your frustration with the 'keep on suckling' approach - in some cases, that's all that's needed, but in others, it really doesn't fit the needs of the mother and baby.

Am a bit concerned about what you say doctors think of mumsnet....care to say a bit more?

Am a bit concerned about what you say doctors think of mumsnet....care to say a bit more?

Mmmm... ?

Well, lets say the overall view is not terribly complimentary. The general feeling is that it is full of rather radical people with fairly single minded and sometimes (how can I put this?) 'not very medically evidence based' ideas. Things that most doctors would regard as unproven at best or dangerous at worst.

Now personally, I think that in fact there is an awful lot of support and extremely useful information available on here. The vast majority of postings. And a lot of my colleagues read this site and find it very useful. I certainly do. But there is also an awful lot of nonsense , and sometimes dangerous nonsense, that crops up from time to time. And there are also a lot of fairly rigid and dogmatic attitudes around.

The general perception is also that doctors are viewed on here as either stupid, incompetent, dangerous or out to ruin peoples lives in one way or another. You only have to look at the response I got on here today as a mild example of that. You won't find many doctors that do post on here admitting that they are doctors.

Sorry for derailing this thread...

jimbobsmummy: "But there is also an awful lot of nonsense , and sometimes dangerous nonsense, that crops up from time to time. And there are also a lot of fairly rigid and dogmatic attitudes around."

Aha - bit like real life, then, eh ?