4 week old dd dropped below her birth weight :(

[squashimodo]

My 4 week old dd has now dropped below her birth weight.
I have been told to supplement with formula, and by the way that is a blimming faff.
I have tried to handexpress and can only get 10 mls each side after she has stopped or around 25 mls at other times. This isn't much is it?
I am taking fenugreek to up my supply, and expressing at the end of feeds, then giving her that and then formula. She takes around 50 mls of formula.
I am trying to keep up my supply, and increase it, but have heard that expressing will not help my supply long term.
Please could someone advice me on what I can do, is there anything else that worked for others in this situation?

A baby needs to suck on a empty breast to inclease supply. Topping up at the end of a feed will end up decreasing it as they will fuss and then you'il give a bottle. Exspressing at the end of a feed is also streefulso won't work. Try giving formula first with a very slow teat. Then breast feed. A baby needs to gets the fatty suff which they only get at the end of a breast feed. Make sure you are eatting enough. My friend Gina ford has some useful advice on mix feeding which you might find easyer than switching within a feed. ( contented baby book). There are feed that are better for keeping as breastfeeds to keep suply up. You could the change them back to breastfeads as you both get better at it. It does takes until they are about six weeks until you feel happyer about breastfeed. good luck

squashimodo, sympathies, it's really hard isn't it, especially when you're told before the birth that 'breast feeding is easy'.

My babies all dropped away hugely from their birth weights - I can tell you about each of them if it's helpful.

Ds1 - born 9lb12. At 10 days he was 8lb10. He simply hadn't been feeding enough to stimulate the milk, and I wasn't someone 'gushing' with milk. The mw suggested expressing to help increase the milk, but I found the whole thing too overwhelming, and was getting really distressed by it all. I ended up supplementing with formula, but he did b/feed until he was 13 months. I always felt a bit of a failure

Dd - born 10lb0. She dropped to about 9 and a half pounds by 4 days, but I had been determined not to repeat ds1's experience and had been feeding her every 2 hours. She was also a homebirth, which helped as I could just stay in bed with her. She started picking up, and although she took a good 6 or 7 weeks to get back to birth weight, she was fine, and was exclusively b/fed to 6 months, carried on b/feeding to 14 months.

ds2 - born 10lb2. Again I fed him every 2 hours. However he did drop by about a pound, and I could NOT get him to put on weight. He had maybe 2 supplements of formula (sometimes they need it because they don't have enough energy to actually b/feed and it can become a vicious circle).

I then got an expressing routine going - which was a PITA but worked! I would express as much as I could get off one side, a little bit off the other (the idea being that as milk becomes more calorific as you progress through the feed, that he would be getting the more calorific milk quicker). Then feed him off the side that had only had a little taken off, keep switching till he really could take no more, then give him the expressed milk as a supplement. Then wash everything, sterilise, and 2 hours later (2 hours start-start) start again with the expressing.

it was really really hard work, but apart from the 2 formula supplements he was exclusively b/fed to 6 months, and fed to 15 months.

As you're 4 weeks, you may need to supplement with formula while you re-establish the milk supply. Can you take a few days to just stay in bed with the baby and feed as often as possible?

Good luck - it can be so hard I know, but you'll get through it!

Can you tuck yourself up in bed and spend lots of time skin-to-skin with your baby?

When you feed her, do you feed one side, then the other and then put her back on the first?

sorry to hear your probs, squashimodo.

I don't think a talkboard is enough really....I am a breastfeeding counsellor with NCT and I'll try and put in a couple of penn'orth if you give more info:

• weight of your baby at birth? Now? And interim weights?
• health of your baby?
• how many times do you feed in 24 hours inc at night? do you use at* least both breasts at every feed?

Your own diet is pretty irrelevant both in quantity and quality, though it's good to care for yourself, natch.

You can also call any of the bf helplines.

It is a real concern when a baby loses weight. I'm assuming the weight was done accurately on digital scales and your baby was naked?

I totally don't agree with what 3l15a8eth said - ie giving formula first. When the baby is hungriest this is the time that they are best at getting the milk out of the breast (ime), and filling them up with 'easy' calories will make them less inclined to feed at the breast.

Just to add, I used formula supplements with ds1 when he REALLY wouldn't take any more breast milk, as milk from a bottle can be taken with very little effort from them, whereas breast milk isn't so easy (hence putting them on at their hungriest).

One last thing - great that tiktok's here, she is fab! And she saved ds2's b/feeding on here - will try and find you a link!

Here's one thread

here's another

Hi Squashimodo. I am in exactly your situation only 2 weeks on. My dd also lost a pound in weight and I have been mixed feeding. My heart sank when I was told to top up because I thought that dd would 'give up' the breast and prefer the bottle. However she is now six weeks and she is still excepting both. I have read other people's replies with interest.
I have a 3 year old who has been quite poorly over the last 4 weeks so I can not stay in bed and breast feed or spend too much time expressing. I am just carrying on and seeing where it leads. My moto now is 'one day at a time' and 'each day she is getting a little bit more breastmilk'.

I guess what I am saying is don't give up, your milk won't disappear if you put her on your breast first before feeds and if you have the time and opportunity you will be able to increase it as proven by LilyBelero and tiktok. Good luck

(Just realised those threads I linked to were started when I was in my 'old' name).

squashimodo - come back - has any of this helped you?

Hi everyone thanks for all the messages!
Wow Lily, yhat is really inspiring and very helpful to hear about you bf career.I think I need more of a routine for expressing,my new lactaline is arriving today which should make expressing easier.
Tiktok, shall answer your ques:
Birthweight:3450
After 2 weeks:3455
At 3 weeks:3450
At 4 weeks: 3220
She developed jaundice at2 days old, stilll has a yellow tinge. She is not a good feeder, and it is difficult to get her latched on, she often slips.
She has always been a sleepy baby and very difficult to wake for deeds and difficult to keep her awake.
She has grown longer, out of newborn and now in 0_3 months size, but I dnt knoe her length in cm.
She feeds 10 times in 24 hours, I offer her both sides and often switch nurse, but she does refuse sometimes, and appears to eat alot less than my other dc ever did. For example after feeding at 3am, she will refuse at 7am and it will take ntill 10 am to persuade her. Last night she took a last feed at 4am, and am feeding her now, having started trying at 7.30.
She is quite unsettled during the day, and since she has had formua supplements, has 'woken up', and wants to feed all day, and was attached to me all of yesterday. I think she didn't have the energy to cry before .
She was weighed on digital scales and was naked.

It's the sleepiness and lack of energy to cry that would concern me. Dd was like that, and I did find out (many years afterwards) that it would have been her hypotonia that made her too weak to feed.

Can you get a RL breastfeeding counsellor to come and see you? Our local hospital had a brilliant counsellor who gave lots of support.

Breast first before topping up would seem the way to go anyway.

squashi - I can certainly see why there is concern.

The risk with babies who are difficult to feed is that they get progressively worse - they don;t take in sufficient calories to have the energy to feed. This is why formula may be needed to break that vicious circle - unless the mother is brilliant at expressing and gets good quantities which of course can be used instead. Often, the expressing is not that great as supply is down - so formula becomes an urgent necessity. When to give the formula is a judgement - before the feed at least ensures the baby gets it (and doesn't fall asleep before it's offered); after the feed is better at protecting the milk supply. Sometimes, one option is in the middle of the feed.

With a baby who's compromised like this, deciding what to do has to be done with the doctor's input - I get a bit twitchy when I see people on talk boards telling mothers they don't know to do something different from what the doc has said (unless the doc has said something clearly wrong!) .

Doctors do sometimes get it wrong and not all are aware of breastfeeding issues, but they can at least assess the state of the baby - you can certainly discuss other options with the doctor, of course you can, but on what you have said here, I agree doing nothing's not an option.

I agree a breastfeeding counsellor might help, too, and a proper paed assessment to check there is no other reason for her poor feeding.

Hope things get better.

I had to top up my DS when he went from 7lb6.5 at birth to 6lb8 at 20 days despite my best efforts.

Will link to my thread but I topped up with FF to start with and replaced it with EBM when I could, after about 3 weeks all top ups were EBM, off the bottles at 8 weeks and still feeding now at nearly 11mo

heres my thread from January

What I found with ds1 and ds2 who were both sleepy was that the end of the feed was the best time to give a top up, as they seemed to be able to drink from a bottle when virtually asleep (which they couldn't do at all from the breast).

With ds1 we developed a complex rigmarole of waking him up through feeds - first thing was to offer a feed as soon as he squawked, so at his most awake. Within 2-3 minutes he would be asleep, so I would switch sides lots (so he was always getting the most easily accessible milk to wake him up). After another 3-4 mins, I would take ALL his clothes off, which would wake him up enough to take a bit more, then I would lie him down on the changing mat, where the cold would wake him up for a few more minutes. Finally I would flick cold water at him! But it was the ONLY way to get him to take any decent amount of breast milk because what he really wanted to do was to sleep.

We also had to set alarm clocks through the night, because he would quite happily sleep 8-10 hours as a newborn, which was not good! I think everyone thought we were mad, to wake up a baby in the night, but he needed the milk

Interestingly, he is still not a good eater, at 8 yrs old - he is by far the fussiest of my 3, and is the least interested in food.

how are things going now?

Hi LIlly.
She does seem a little more settled when I give her a little formula. I think my supply has increased, I seem to have more when I wake up in the morning.
I have noticed that she takes around 10 to 15 minutes to drink 1 fl oz from a bottle, and doesn't find it as easy as babies usually do. I think what Cory said earlier about hypotonia around the mouth sounds like a possibility. I have a ds with autism and hypotonia, and he had similar problems, so could be hereditary.
Got to go, kids are calling!
Thanks for your help.