Poor to non-existent weight gain - is it possible to go back to ebf after giving formula top-ups?

[Minshu]

My 13 wo DD is mostly happy, healthy and alert, producing enough wet nappies, etc, but has not gained any weight in the last 3 weeks, and only 5 oz in the 3 weeks before that, so plummeted from 91st centile at birth off the bottom of the chart .

The HV has just been and, inevitably, advised formula top ups after each feed. I had the mature and rational immediate reaction of sobbing uncontrollably and I feel like a total failure as a mother, but that's another story and am being referred to PND group...

Anyway, does this spell the end of exclusively breastfeeding my DD? I've found tips on stimulating supply, including expressing after each feed. Assuming DD gets back on track with her weight gain, will it be possible to go back to exclusive breast feeding? Any tips?

I've mostly enjoyed BF, in spite of sore nipples, recurrent blockages and a bout of mastitis (which may be the root of the poor weight gain), so am incredibly disappointed that it has not turned out to be the best thing for my DD.

Hi Minshu Firstly you are not a failure - look at your healthy, happy daughter and believe that!
If your baby is well,happy,alert, etc as you say then IMHO I don't see a reason to react immediately with formula top-ups. All babies grow at different rates...If you do use formula, your milk supply will definitely reduce, thereby creating more need for formula and hence less breastmilk.....you see where this is heading....The only way to increase breastmilk supply is to increase the demand, ie feed, feed, feed.I would also suggest you take a good look at the BF situation in detail: are you, yourself, well physically and emotionally (you mention PND),feeling supported,adequately hydrated, well-nourished, getting enough good quality sleep? Attend to any of these if the answer is no. Get appropriate help if necessary. Check your BF positioning, latch, and time on each breast- this could be a contributing factor to the mastitis, sore nipples etc (on that note check that your bra is not restricting any part of your breasts)and will have an effect on baby's ability to get milk. Seek help, if necessary from BF counsellor - NCT/La leche etc. And .... let's remember - formula-fed babies do fine. Give yourself a break - you are doing great, by the sounds of it, despite your difficulties. There are so many important and different ways to nurture a baby besides breastfeeding. Wishing you all the best.

Minshu, not possible to say if there is anything 'wrong' , obviously, but a slowing down of weight can be normal, even over a period of several weeks.

Top ups after every feed sounds like a lot of formula to deal with this....would the HV discuss it again or would you ask another opinion?

If all there is to be concerned about is lack of calories, then the first thing to try would normally be extra breastfeeds - switching from breast to breast so the baby has at least two and hopefully three breasts at each 'session'.

Unless it is thought to be very urgent indeed your dd gains weight now, then this simple response (extra feeding, extra breasts, day and night) could be the first thing to do, even before the expressing. Ask the HV if a week of this could be done, and then if there is still an issue, you could express and use the ebm as top ups.

Deffo think you are justified in exploring this further, especially the amount of formula - she needs to convince you this is the only option.

Minshu - Tiktok has given the best advice, but I just wanted to say that I experienced this with my dd. She gradually dropped down the weight chart from 50th centile at birth, until at 17 weeks I was advised to start weaning by a hv

I stuck with the bf, increasing feeds wherever possible and offering both breasts at every feed. My dd continued to gain very little weight each week, but in every other way she was a happy, content baby who slept, wee'd and poo'd as you would expect! She is now a strapping 4yo whose health has never given us any cause for concern.

With my 17 week oldds, I think I have had him weighed 4 times in comparison to dd's weekly weigh-ins. I think constant weighing and analysis of every ounce is not healthy or necessary - and promotes worry among parents. Look at your dd - are you happy that she is happy, content, satisfied by feeds, and producing plenty of wet and dirty nappies? These are all good signs - you are not a failure, have a week of increased feeding, try expressing if you can and start offering ebm as a next stage. Good Luck

Thanks for the responses.

To be honest, the local MWs and HVs err on the side of not weighing BF babies for fear of discouraging mothers - but I'm worrying about DD's lack of pudginess.

I have been trying more regular feeding since the weigh-in three weeks ago, which I asked for as I was concerned about her appearing to be long and skinny, especially after my bout of mastitis. I was forewarned about the possible recommendation of top-ups at that point. I think the HV wants to rule out there being any other reason for the poor weight gain by using the top-ups.

And thinking about things, she's also been a bit difficult to settle at times, which I was putting down to being over-tired, but could be hunger

We agreed that we wouldn't do the top ups during night feeds, and the HV will be ringing me on Thursday to check how things are going, and coming back for another visit next Tuesday.

Everyone (many MWs and HVs) who has looked at my latch has said that it was fine, although one MW did suggest I could shove more in. I have a tag on my right nipple, so that could be a reason for DD not latching so well on that side. I'll try to get to an NCT group tomorrow and find a local BFC. I do normally offer both sides at each feed - often starting on the right when it's blocked, going back to it, etc.

I'm confused and overwhelmed at the moment (so apologies for me rambling). DP has just given DD a top-up and I've expressed what I could. I'm going to try to get a bit of shut-eye now and go with the top-ups for the rest of today. Hope to be able to make a bit more sense of things tomorrow and will get DD to the breast as often as possible - babymoon time I think

Today I have mostly been doing the usual breastfeeds - normally 3 or 4 sides, finishing when DD appeared to have had enough by falling asleep or turning away - and then offering a top up of ~2 oz formula or any milk I'd managed to find time to express a few minutes later (by which time she'd have started sucking on her fingers). She has been a lot happier, but still hardly slept for more than a few minutes at a time all day (until about an hour ago, when she conked out on her Daddy).

I guess I've been misinterpreting her giving up on the breast as having had enough, when she's really just been worn out from the suckling Then thinking she was cranky due to being tired, rather than hungry. Feel like I must have been starving my baby for weeks - no wonder she's not been happy.

My right breast is producing milk, but I think DD finds it hard to extract. The left is spouting...

Oh good - DD is back in the room - time for more food.