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Infant feeding

Get advice and support with infant feeding from other users here.

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Original poster

EBF baby, 11wks, dropped off centile - supplement with formula?

27 replies

sleepwhenidie · 18/03/2010 11:37

I wonder if anyone has any words of wisdom for me on this. My DS's birth was induced at 37 wks due to IUGR and reduced amniotic fluid. He weighed 4lb 5oz at birth and is fine, he is EBF and until this week had been growing along the same centile (just above 0.4th). Yesterday at 11 weeks old, he was weighed and is 7lb 15oz, so fallen just below 0.4th centile. GP has referred him/me to a feeding clinic. She also suggested I might give him one bottle of formula in the evenings to boost his calorie intake. This sounds sensible to me and I am hoping it wont affect my milk supply as he feeds like a much younger baby, sometimes every 2 hrs and 3-4hrs at night. Any advice/opinions about this would be welcome. TIA

OP posts:

PacificDogwood · 18/03/2010 11:42

Hi, sleepwhenidie, IME giving him 1 bottle of formula/day is not a bad idea but I would vary the time of day so he and your boobs don't get used to having it. It is less likely to interfere with your supply that way. Having said that, at 11 weeks it should be pretty well established anyway.

It is odd that he is not maintaining his growth along his centile though, isn't it? Is he a good feeder? Sounds like he is certainly feeding frequently enough, well done you!!
Have you considered expressing your milk, maybe after morning feed, and giving him that in a bottle?

Feeding clinic sounds like a good idea, I wish we had one here...

Good luck!

Original poster

sleepwhenidie · 18/03/2010 11:47

Thanks Pacific - I did wonder whether my supply is dropping in the evening. He still cluster feeds through evening, which I have been putting down to his size, but maybe he's not getting enough. I have just started expressing so could try a bottle of EBM but it is a real hassle to express every day, especially as I have a 1.5yo and 4.5yo as well! To cap it all I have mastitis now . Good advice on varying time of day though, thank you.

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belgo · 18/03/2010 11:52

Does he have plenty of pooey and wet nappies? Has he always gained weight or has he lost any weight? Is he otherwise healthy and developing well?

If you think he might not be getting enough milk then you can contact a breastfeeding consultant who can check his latch and made sure the milk is getting from you into him.

If you think his latch is fine but want to increase your milk supply, then feed him more often. Put him to the breast at every opportunity. This will stimulate your milk supply.

PacificDogwood · 18/03/2010 12:28

Oh, mastitis, nasty, my sympathies!

Quite often blocked ducts/mastitis are due to poor milk transfer, ie nowt wrong with production/supply but baby not v efficient at getting it off the breast.

Have you had a trained BF adviser watch a feed in RL, or even better, several feeds?

And re expressing, yes, it is a faff, particularly with other children to look after. Do you have a double pump ie Lactaline or similar? I also had one of these rather fetching bras when I exclusively expressed for premature DS2. Really really makes you feel like a dairy cow, but kept my hands free for DS1...

I would of course second belgo advice on feeding v fequently. Also consider galactogues such as Blessed Thistle and Fennel. Or Domperidone - 'tis a prescription drug and you need a sympathetic dr who is prepared to prescribe it at much higher dosed than usual when it is used for nausea/delayed stomach emptying.

Original poster

sleepwhenidie · 18/03/2010 12:34

Very pooey and wet and I'm not sure it would be possible to feed him more often than I am, as I say, he is still like a newborn in that respect, which I believe is because he is so tiny. He hasn't lost weight at any point, he was even back to birth weight a week after he was born and has climbed steadily up until the last weigh-in, he went from 7lb 2 to 7lb 15 in about 2 weeks but this wasn't enough to keep him on the same centile.

OP posts:

Original poster

sleepwhenidie · 18/03/2010 12:42

It has just occurred to me that I have had ds in the sling a lot more the last couple of weeks, he sleeps for ages in it which is of course great for me but I wonder if it could be making him sleep too much in the day when he should be waking for feeds

OP posts:

Bramshott · 18/03/2010 12:51

There is no reason why a bottle of formula would give any more calories than an additional breast feed. If I were you, I would try upping the number of feeds first.

belgo · 18/03/2010 12:53

Yes the mastitis could be due to poor milk transfer which is why a breastfeeding expert can help tell you if all is going well.

To get rid of the mastitis you need to feed very very frequently from the infected side, preferably in different positions. Massage using hot shower water. Rest plenty, preferably with the baby next to you so you can feed frequently.

Take paracetamol for the pain and high temperature and if it doesn't start getting better after 24 hours then you need to see a doctor.

Be careful usign the sling when you have mastitis as this can put pressure on your breasts.

Original poster

sleepwhenidie · 18/03/2010 13:00

Thanks Belgo, I'm not using the sling today for that very reason, that is why I suddenly realised it has been a while since I had been out with the pita phil&teds! I have been feeling ill and sore for more than a day so I saw gp today and have antibiotics.

Bramshott- I thought formula was more calorific than bm?

OP posts:

belgo · 18/03/2010 13:03

Breastmilk as long as it is being transferred effectively into your child, as as long as the baby can feed on demand, should have all the calories your baby needs for the first six months of life. Breastmilk is very efficiently absorbed by the baby. To increase breastmilk supply you need to increase feeding and have some skin to skin contact with the baby, that should help as well.

I don't know anything about the calorie content of formula milk but I do know it is not absorbed so well by the baby's gut.

RubyBuckleberry · 18/03/2010 13:13

love the name sleepwhenidie! i feel just like that!

your lo sounds ok to me! he is only JUST dropping off his own line isn't he and very wet and pooey .

my ds did this and i started feeding him every 1.5/2 hours for a while and he went back onto it. he now feeds every 2/3 hours and every 3/4/5/6 at night and he is 18lb . breastmilk is sooooo good for your little one and so ideal that he will digest it very very quickly so i would simply say add a breastfeed somewhere.

well done with older children too - i only have one and we want more and i am still trying to get my head round how i would cope, knowing the amount of time i spend with ds bfing/getting him to nap etc etc etc - so hats off to you!

bearcrumble · 18/03/2010 13:14

Another possibility is to add a fortifier to expressed breast milk. I know the nurses in the SCBU said they might have to do that when I wanted to cut out the formula and feed my son (also delivered early because of IUGR) exclusively on my milk but it wasn't necessary in the end.

Original poster

sleepwhenidie · 18/03/2010 13:57

Thanks everyone. I think for now I will try to increase feeds and use sling for shorter periods, go to feeding clinic and see what they say about latch etc. Will ask about fortifier there too. Instinctively. I think what you say Ruby, about him being ok, is probably right, but they are obviously being extra cautious about the drop off the curve because he is so tiny.

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Bramshott · 18/03/2010 14:31

I'm not an expert, but I don't think it is more calorific, because the calories in breastmilk are so easily absorbed.

Sounds like you have a good plan for the short term.

humptyismarriedtoanumpty · 18/03/2010 14:37

Another vote for getting a good bf advisor, ime many doctors will jump on you to start introducing formula. While this might help your lo to put on weight, it won't help your supply...
Do you have somebody who could help you out for a few days with your other kids so you could have a mini-babymoon and just you and baby chill out and get some rest... Perhaps you are exhausted and together with the mastitis it ain't helping!!

RubyBuckleberry · 18/03/2010 15:41

"but they are obviously being extra cautious about the drop off the curve because he is so tiny."

yes i hadn't thought of that. and good idea about the sling. i have one of those wrap ones and it is (was - ds older now and more awake) like a sleeping pill!

Original poster

sleepwhenidie · 18/03/2010 15:43

Ahh humpty - a mini babymoon sounds lovely, I am shattered, we don't have anyone who could take them for a few days unfortunately though. To be fair to the GP, she didn't push the formula thing at all and she certainly wasn't suggesting I stop bf, but she did say that if DS was hers she would supplement with one bottle a day until his weight got up a bit....

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RubyBuckleberry · 18/03/2010 15:47

my ds's 'own' line has fluctuated above and below the one he was born on, and the midwives did say this can be quite common with breastfed babies. You never know, round the corner might be a growth spurt, and that can be a bit bonkers - they want to feed very very often! But they are simply upping your supply, and it DOES work. I find it amazing, but your brain and body do respond without anything to do with you .

humptyismarriedtoanumpty · 18/03/2010 16:48

sleepwhenidie I know how hard it is especially having a small age gap between kids, I have 13 months between my first 2 and you have 3 altogether!!
Try to be kind to yourself, the washing etc can wait and so can housework. Is there any way your dp can help e.g. making some sandwiches in the morning for your lunch, to save you a job, or could you get a load of easy food in, you know, just chuck it in the oven etc.
I am planning to live of sandwiches and cereal and yoghurts etc for the first few weeks after dc3 is born!!!
Will see if tiktok is around to offer more advice.
I agree, the formula will help him to put on weight, but I think it would be easier to get your own supply up and frequent feeding will clear the mastitis.
good luck!!

belgo · 18/03/2010 16:50

I have three children with similar age gaps and I did get mastitis a few times not because of bfing problems but because I was absolutely shattered, so you have my sympathy!

PacificDogwood · 18/03/2010 17:51

I am currently BFing DS4 (8 days old ); he did not have IUGR but is the titchiest of mine . Anyway, the MW said the other day that smaller babies often feed more efficiently than larger ones. Now, I realise your DS is not a newborn anymore, but I wonder whether he would take the opportunity to feed more if you can manage.

I am bumping this again in the hope that tiktok or hunker are around...

tiktok · 18/03/2010 18:05

sleepwhenidie - I think it's reasonable for your GP to have thought about the feeding clinic. It's good to check your little one is just a bit little 'cos that's the way he is, rather than for any other reason. They're likely to suggest more frequent feeding, using both breasts, on the basis that it can't hurt, and because some laid back babies really do need mummy doing some of the pro-active offering for them

I don't see anything in your posts that makesit sound that giving formula (or fortfier - which is formula too) essential, given he is an apparently healthy baby and he's growing too. But check this out with the clinic

Original poster

sleepwhenidie · 19/03/2010 15:48

Thanks very much everyone, will hold off on the formula for now and see how we get on!

OP posts:

NotQuiteCockney · 19/03/2010 18:52

Mastitis is an indicator of over supply, not under. So you definately are making enough milk. As others have said, I would like to see your latch etc checked, as bad latch or position is a common cause of poor weight gain and mastitis.

(Is it full-blown mastitis now? Or "just" a blocked duct? Either way, if you feed with the baby's chin to the lump, that often clears it ...)

Original poster

sleepwhenidie · 20/03/2010 09:11

The mastitis is getting better now, I think the antibiotics are kicking in. Two lumps are less painful than they were although I am still fluey.

I will get latch etc checked but doesn't it seem odd that he was gaining steadily for 2 months and then not so much after that? Surely if there was a problem with latch there would have been problems earlier?

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