Topping up with formula...How much & how often?

[startingagainafter14years]

Hi everyone.

I have been exclusively breastfeeding my 3 wk old son since birth and this last week he has been constantly pulling away from breasts and squirming when on. It's not fast flow so I think it's the opposite and he doesn't get it fast enough or enough of it. He has also been sleeping ALL the time when not feeding.
I checked his weight hoping that he had been at least putting on the minimum amount (100 gms per week according to the Doc) but to my dismay he only put on 50gms.

Worried he will start loosing weight, I have started to top up with formula (only over last two days) after he has been on the breast.

He breastfeeds exclusively at night where I can feel my breast are full and he passes out with a full tummy and sleeps at least 4 hours without waking.

My questions are:

• How much should I let him have?
• Should I offer it after every breast feed or only occasionally?
• Should I go back to exclusive breast feeding once he reaches his ideal weight?

I really want to be able to give him breast (even if it's not exclusively) at least for a few months so I want to get this just right. Any suggestions or advice would be great. Thanks!

How was his birth? Difficult? Have you considered a cranial osteopath. Is his mouth opening wide enough when latching on or does he seem to find getting a good gaping mouth difficult. Does he seem to find in particularly uncomfortable lying on one side or does his neck appear twisted when feeding? I ask this because one of mine was particularly fussy at the breast to start with and it was due to a fairly traumatic caesarian birth - went to see a cranial osteopath and she was fixed within an hour and went on to shoot up the weight charts.

However to answer your question, the more formula you give him the less your breasts will make and catch up with his demands so I would give him as little as possible and just allow him to latch on as often as possible.

What percentile is he on and was he born early/on time/late? You may be being given duff weight advice depending these things.

Try not to be driven only by weight charts as these are guidelines and won't be accurate for every baby. If you want to keep exclusively bf-ing, I'd ditch the formula for at least another few days and see how it goes. If you still want to keep open an option of returning to EBF-ing, you should probably pump when your lo has the formula top-up or, as whomoved said, your own supply will find it very difficult to catch up later on. And it's possible he'll get lazy as it's much easier to take the ff than bf and some babies just give up if they know there's an easier option.

Good luck and try not to be discouraged by your baby's progress just because it's not exactly tracking a line on a graph.

I think it sounds like he has the wind, that is why he may be squirming and pulling away. I would sit him up and try winding him before continuing with the feed.

I am sure DS2 was about this age when he did this sort of thing. TBH I would stop the ff at least for a few weeks until your milk is established. Topping up with ff will effect your supply of milk. Youu don't have to feel 'full' to actually have milk for your baby.

The pulling away and squirming can be really annoying (especially if he takes your nipple with him so that it hurts). Hard to work out why without being able to see what's happening. Is it possible to get to a breastfeeding drop in session (ask your HV where and when or ring the maternity hospital to find out if there are any in your area)?

It's great that he's filling up on breastmilk at night. And honestly, for 3 weeks old, 4 hours sleep is a lot! If you keep offering breastmilk whenever he seems interested (when they're so young that can be every hour or so, though it will stretch out as they get older) your body will replace all that he takes so he will magically get what he needs. It's a horrible feeling when you're worrying about whether they're getting enough but try to trust your body to keep on providing what he needs in the way you trusted it to grow him in the first place.

Well: the birth was amazing. It was exactly on the 40 weeks date and I dilated without any pain within 1 hr 30 mins and managed to get to the hospital just in time to book in and have the baby within 35 mins. So, I wouldn't say that the birth was traumatic at all!

He doesn't seem to open too wide but then again my nipples are quite small. I thought all he had to do was get all the nipple in his mouth to breast feed correctly?

Anyway, the nurse as the hospital told me he was latched on perfectly and I was feeding him correctly, so I don't think it could be that....?

I was hoping that by offering the breast first and letting him get all he could out of them before offering the formula, he wouldn't get lazy....

Can I risk just doing it for another few days to "Fatten" him up then go back to breast full time...?

Beanbearer: I live in Southern Spain so I'm not familiar with any breastfeeding drop in sessions in the area!

Will carry on offering him breast first everytime. At the moment I only give him a feed equivalent to one measurement(90mls of liquid) divided over the day in 3 feeds approximately. So basically 30mls after the breastfeed.

Will find out if there are any clubs out here.

Thanks!

If you've just been told to pit the nipple in his mouth, then it's entirely possible that you may well be able to easily improve the amount of milk he is taking by making minor changes to the position in which he feeds and how he attaches to the breast.

Perhaps try taking a look at some of the videos here for inspration? Or there's a diagram here or photos here. He needs a nice big yawning mouthful of breast with his top lip just sliding over the nipple and the nipple pointing at the roof of his mouth. Babies feed from the breast, not the nipple. The nipple is just where the milk shoots out of. To get him to open really wide he needs to be able to tip his head right back, so try not to restrict the back of his head with your arm, hand or finger, instead support it underneath by his face or ear. Also, in order for him to have to really open wide and reach, it can help to start with his head in your cleavage and then move him across as you need to, rather than starting with your nipple right by his mouth.

As he is gaining weight, then offering top-ups now may be a little hasty and could impact on your milk supply. Usually it's suggested to work on the breastfeeding first before considering supplementing. How often does he feed? Every couple of hours during the day would be fairly typical at this age. You could also try using breast compressions to keep him feeding actively at the breast. Are you offering both sides each feed?

Local support could be v helpful too. Do you speak Spanish? If so you may find a local La Leche League group near you. Try looking here.

If you do give top-ups, then generally it's better to give it once a day, rather than after every feed, as otherwise your baby may come to expect that easy bottle after each feed and not persist with each breastfeed for as long. Sadly, this can become a downward spiral for breastfeeding.

Hope that helps!

Thanks for the info Grendle.
Yes I do speak SPanish and will call them to arrange to attend a meeting.

He has been gaining weight but didn't quite put on enough weight over the last week which made me get worried and turn to topping up. I have noticed that he drinks well at night when my breasts (particularly the right one) is very full thus making it easier for him to get the milk. He doesn't open very wide but he does get most of the areola in his mouth. I think he just stops milking when he notices the flow slow down.
He has been slowly loosing the knack to suck, probably due to the bottles I've been offering....
I will try compressions to see how we do.
I offer both sides at every feed although due to breast surgery 10 years ago, my left breast is very small (and doesn't get as full) so I always start with that one more often so that his hunger will hopefully cause it to make more milk. But he does get the fullest when having had my right breast at night.

Once a baby starts getting nipple confusion - is it possible to re-learn how to suction correctly?

Thanks

Grendle's given you some good advice - please do try to see someone from the La Leche League, as all the best advice in the world online is not as good as someone competant watching you feed and giving you tips. You do want him to take as much breast in his mouth as possible, and, particularly, his lower lip should be as far away from the nipple as possible. This makes a huge difference. As they say, it's breastfeeding, not nipple feeding!

Babies absolutely can re-learn to suck correctly, but as others have pointed out, the more they use the bottle, the less they are encouraged to feed properly.