One week old suckles poorly and falls asleep at breast - any advice?

[commanderprimate]

Hallo there

My lovely little DS was born 1 week ago today by emergency caesarean. Seems incredibly sleepy a lot of the time, bf well sometimes, but won't latch, or more often, will latch then comes off or takes two sucks then falls asleep at breast. Then he'll wake up a minute or so later and searches madly for nipple screaming angrily, but will not settle on either breast. Other times he latches, sucks a little but then goes fast asleep. Rarely seems to feed for more than five minutes at a time. Have absolutely NO problems with nipples, so I'm assuming that latch is OK!

He slept through night from 1 to 10 on first night home then was exhausted and dehydrated in morning, so we've been waking him and giving him a feed of expressed milk around 4 if he doesn't wake naturally - can't rouse him enough to bf at that time.

Have had a lot of advice from various midwives/bf drop in clinic woman, on positions, timing etc, much very good, some contradictory, but none of them seem to have a real answer to the falling asleep at breast/hardly suckling. Anyone any advice?

ds1 was a very sleepy baby. Things we found that helped;
keep clothing light - just a vest - especially if hot.
try to ensure a decent length of time sucking and swallowing at the breast,not just 'nibbling'
if he's falling asleep at the breast, wake him up by;
blowing on face
tickling ears
tickling feet
verbal stimulation
change nappy (esp if on a cold changing mat)
cold water trickled on face

you could try expressing a little milk to give as a top-up (I wouldn't give an expressed feed INSTEAD of a breast feed as your breasts need the stimulation, esp at night)

don't let him go longer than 2-3 hours without a feed

keep lighting low

lots of skin to skin - try feeding in the bath or in bed

switch feeding - keep swopping sides to keep the milk flowing easily

How is his weight? And what about his nappies? Wet/yellow poo?

Hope that helps!

Cheers - that does help a bit, I will try the cold water next! What did your ds tend to do then?

Take your point about top ups rather than replacement, we were kind of switching to that anyway.

We've been doing most of those things, he doesn't care about any noise so that doesn't work but stroking and tickling usually helps a bit. The nappy change certainly does usually get another burst of energy.

Unfortunately he seems to hate one of my breasts, so switch feeding is tricky. I've tried swaddling him and putting him on that breast and it seems more successful, almost as if he'll suckle properly if there's nothing else (wave hands about, kick, struggle) for him to do.

Poo is yellow and wet yes, don't know about his weight other than initial weight loss (7lb 9 to 7lb) at moment but he'll be weighed tomorrow. Bit jaundiced at the moment, another reason we want to get as much food into him as possible!

My DD was sleepy feeder, so fed her in nappy only (and she was born in October). Changing nappy can also help.

Try feeding little and often. DUring the night if you have to feed him by bottle then express the milk - its too long to fo without breast stimulation at that stage.

Apparently this is normal for CS babies (to be a bit sleepy at the start) he should wake up soon.

The cold water was our last resort, he would tend to go completely hard off after that, but it would get a little bit more milk into him!

Tbh, with ds1, he never managed to b/feed exclusively, he had formula topups, but I did b/feed him up till 13 months, so I was pleased with that. It is Hard Work when they are sleepy I think!

The nappies sound good, so hopefully he will have gained some weight tomorrow to give you some confidence!

Good to hear that this might well be just normal CS baby behaviour. Will move to breastfeeding followed by topup if need be I think at each feed, that way I should be able to maintain the supply and feed him up.

Both my two were CS and v sleepy during feeding. As well as the suggestions above, I used to find lying them on the floor (carpeted but still) woke them up v v quickly.

Both of them also had a favourite side (the same one in fact) and I used to be able to fool them by holding them in the rugby ball position on the side they didn't like, so their position was the same as on their favourite side rather than their feet going the other way (if that makes any sense).

How did the weigh-in go? Hope you were reassured!

Hi there

Thanks for all the messages, much appreciated.

Weigh in turned out to be in a couple of days more, so it's actually tomorrow - feel a bit better today as he's fed perfectly a couple of times, though is now worrying me again by still being asleep after 4hrs - hate to wake him up but think I'll have to!

Will post tomorrow once we know how much he weighs.

Good luck with the weighing today!

If it helps, when ds3 is feeding manically I worry that he is not 'satisfied' and needs more milk. When he is contentedly asleep, I worry that he should be waking up and feeding. I think mums are preprogrammed to worry!

My dd was like this: found out much later it was because she was hypotonic and therefore not able to suck strongly enough

otoh ds who was premature (36 weeks) and born by caesarian did much better

ds2 would only feed from one side... took him to cranial osteopath, who showed us that baby's left shoulder was totally hunched up (huge baby, small me, 2 weeks overdue, very long labour with him badly positioned), straightened him out, hey presto he fed fine from both sides - was obviously just uncomfortable for him to lie on his hunched shoulder

also, i personally wouldn't be expressing this early, milk supply not established at all, esp after c-section, i would get into bed and stay there skin to skin letting him feed pretty much constantly - worked for me with all 3!

The reason we expressed with ds1 and ds2 was because both of them needed a bit of help - they needed 'easy calories' to get them going, and it is much easier to drink from a bottle than from the breast. But they had both lost 12%++ of their birth weight and were either maintaining a static weight or losing further, so action was clearly needed! If the OP's baby is gaining weight (and it sounds like he will be), then I agree, no need to express at all.

Posted yesterday, but it seems to have disappeared somehow. DS has lost another 80g - still not over 10% of initial bodyweight so midwife says to carry on as I am until Monday, when we'll see if he's put anything on. He does seem to be feeding a bit better now, hopefully that'll do the trick - it's at 4 hrly intervals pretty much.

May ask about hypertonia, but he's pretty strong, especially when grabbing at my nipples with his pinchy little hands!

LadySanders - I sort of see what you mean, but I'm not sure I totally understand - why would expressing be a problem at this point? Tried staying in bed but just got bored, and he didn't feed any more often, just slept as usual!

should still be under guarentee

I just meant that when you've had a c section it often takes longer than usual for the milk to come in properly, and for the baby to want to feed.

With DS1 i had no milk til day 7, and he wasn't really feeding much until he was about 2 weeks old.

If you express you may over-stimulate the supply, rather than letting the baby dictate it, so you may end up very uncomfortable/engorged, and with such a fast strong milk flow that the baby finds it very hard to suckle, so it becomes a bit of a vicious cirle.

My instinct is to just let the baby do what he wants to do if you really want to breast feed - if he's hungry he'll wake up and feed, if not he won't. They can be affected by the anaesthetic for several weeks in my experience.

commaderprimate - I am trying to do the maths, and your baby is 12 days old and still losing weight? Is that right?

I think you are right to be concerned about this - weight loss should stop in the first few days. I am surprised your midwife is so relaxed about this, but it's good she has seen him and this means a lot.

4 hourly feeds is not usually enough for a new baby or enough to build up a milk supply. The worry is that the baby is sleeping a lot to conserve energy and so the downward spiral of poor and infrequent feeding gets worse. Keeping your baby close and skin to skin will ensure more feeding.

It's not correct that CS means milk comes in later - this used to be thought to be the case, but it's now known to be not true. Babies born by CS are only very briefly affected by anaesthetic.

If the baby is not feeding well, then frequent expressing is really quite important to preserve the milk supply and to have milk to give the baby by syringe/cup/bottle/spoon - whatever - to get it into him.

Sorry not to sound reassuring...I think this is still a very tricky situation that needs careful watching.

I'm glad you saw this tiktok! I was quite surprised the mw was so relaxed as well.

Ds3 is the only one of my 4 that has fed well (and he still lost LOADS of weight, but the difference was that after day 3 he started slowly but steadily putting it back on, and is now putting it on a bit more quickly). The main differences with the previous 3 were that he demanded more milk (feeding almost constantly for 3 days solidly), and I felt really rubbish after his birth so wasn't trying to be up and about, and just sat and fed him.

If you can take a couple of days to just feed (and if he is sleepy, express and give as top-ups) then you might find it makes a real difference to the milk supply. With ds2 (my 3rd baby), I had a routine where I would sterilise the feeding equipment, express from one side as much as I could, a little bit from the other, then feed ds2 from the side that had only hada little expressed, switch feeding until he really wouldn't take any more, then give the EBM as a top up, wash up the expressing stuff, and repeat at 2 hourly intervals (from start to start iyswim). That did eventually get him putting weight on, and the EBM topups did quite a lot to wake him up (and stimulated the milk supply too).

I've no idea if that is good practice or not, but it worked for ds2. I did feel that had he been my 1st child he would have ended up f/fed as it was SUCH hard work, but only for a couple of weeks.

HTH! And hope feeding is going well this weekend.

OK - that is a bit worrying then, but does help. He was weighed on day 6, then again on day 11, the 80g loss took place between the two. I will carry on expressing as I'd rather risk overstimulation than under.

He'll get weighed - on the same scales - tomorrow. With luck he'll have put on some weight. He's been feeding, unenthusiastically, for hours today, hopefully a good sign.

@bobbalina - knowing the manufacturers, I don't think they'd be very reasonable about that.

How are things today? Hope you've had a good weigh in!

Hallo there, sorry to go dark on you. Thought the nice people who replied would like to know what happened next.

On the following weighings, first he stalled, then started to put on weight - last weigh in he'd put on 6oz in a week, which sounds good, but only puts him 1oz over his birth weight at 4 weeks. Still, if he keeps it up that's ok. HV coming to weigh him again next week.

Now he's feeding much better, in fact he's been feeding for hours this evening, but I'm concerned that he's not getting enough calories. I've read about the foremilk/hindmilk thing, and am worried he's not getting to the hindmilk, due to odd incidences of green poo, and weird behaviour from him such as rooting constantly then pushing away and arching before latching on, latching and then pulling away, that sort of thing.

All the advice I've been given is to make sure he's finished one breast before swapping to the other - but - how do I know when one's "finished"? All the answers I've had have been pretty vague. To me it seems like they're never really finished, there's always something there if I check. It seems like he'll never get to the other breast at this rate! Has anyone got any advice on this?

Oh yes, he's still jaundiced too, which is also worrying - I'm going to ask for a blood test if it hasn't gone by the HV's visit on Monday.

Don't worry about him emptying a breast, they don't empty but when he loses interest and stops feeding, burp him and offer the other breast. Weight gain sounds good

DS was v sleepy too, also CS, and lost 17.5% of birthweight and it took a while before he really got awake and feeding with gusto. But he did, and is still feeding now at 18m.

Have you got a baby cafe/breastfeeding drop in you could get to?

Cheers, that's the first sensible answer I've had. I'll do that.

There is a breastfeeding clinic/baby cafe - but it's in such a chavvy area I don't think I can deal with it. Paid the NCT a big wodge for advice I never got to use, so I should ring them really.

commander: my son's initial weight/feeding patterns were very similar to what you describe. He was 5 weeks prem, small (5lbs7oz) and was jaundiced for 6 weeks. Because he didn't feed much in the beginning (very poor latch, due to his prematurity), I expressed like mad so I could cup/tube feed. This led to me over producing and then becoming engorged. It was a nightmare: I thought he was feeding like mad, but actually he wasn't getting much milk from me because I was engorged. Then he would fall asleep at the breast .. .then wake up hungry ... then .. .aaaaaaaaaaaaagh. I went a bit mad, really.

Anyway, I had to clear the engorgement before he could get to the milk. Are you happy that your supply has settled now?

Also, have you received sufficient advice/reassurance re the jaundice? It does tend to make them more sleepy, but as long as a normal level of wet and dirty nappies are produced, it's unlikely to be an issue. I am hoping someone has told you that breastmilk will prolong it: it's perfectly normal, but that fact really threw me as I was so desperate to a) breastfeed b) clear the jaundice, and I was gutted that they appeared mutually exclusive. For what it's worth, the midwives and HVs were always far more worried about the jaundice than the doctors (both consultants and the 2 GPs I saw): I think there are guidelines forcing community carers to refer after 2 weeks, but the actual risk of harm as a result of jaundice is very low.

Re changing breast to ensure he gets hindmilk - I didn't bother too much about this, but tended to offer same breast if the last feed was a) within the last hour and/or b) short-lived. Otherwise, I'd change breasts to keep my supply even.

Good luck - it's all so difficult and you seem to be doing a marvellous job.

Cheers Druzhok - I'm not expressing that much, just enough to have an easy middle-of-the-night bottle feed if I can't get him to bf well then, so I'll probably avoid that problem. Supply seems to have settled - at least now I'm worrying that I don't have enough rather than too much!

The advice I've had about the jaundice has mentioned breastfeeding jaundice, and I've read about it, but it's all been quite vague - an acknowledgement that it exists but no real hint as to what to do about it. So your comments about it are very helpful. Did it just clear all at once in the end? With mine the skin yellowing seems to come and go, more or less in relation to how recently and well he's fed, but has stayed at the same level overall since he was about a week old.

Well, another weigh in on Monday, so hopefully he'll have carried on piling on the ounces!