I feel a failure for topping up my 5 month old bf baby with formula. Is it the right thing to do?

[Flipflop22]

Hi, im a long time lurker but now I really need some advice. I apologise in advance im sure I will ramble on a bit...
So I've just turned 40 ( in case that's relevant) and my little one is nearly 5 months old. I've exclusively breast fed. Its not all been plain sailing, I've had blisters, cracks, plugged ducts... but lovingly got on with it. Littleone has always been small....at the low end of the centile chart ( between 2nd & 9th) and had hovered around his curve. I've fed every 3 hours in the later months and when he wakes at night which until the 4 month sleep regression kicked off, was at about 4 am. Since the regression ( started about 2 weeks ago) he's barely napping so getting cranky and waking up often at night, then he's difficult to settle. His feeding has been quite fussy.
So. 2 days ago hv came to weigh him and he's just dropped off his line (5.44kg)
Hv wants me to top him up with formula. She's recommended 1 ready mix bottle a day (200ml)
I've done as I'm told as I want little one to be healthy. But last night I sat in bed bf the little man crying because I'm so worried this is the beginning of the end of our breastfeeding journey.
I've got a tommee tepee pump on the way to try and increase my supply, I've been taking fenugreek for 2 months ( and I'm stinking!)
I've fed him as usual then popped 40ml in a bottle for him at the end. He's taken it with gusto.
Is this the right thing to be doing,?
I'd love to breastfeed for as long as I can ( until he's decided he's had enough)
Aren't I just swapping my milk for formula ?( surely he'll just want feeding slightly less often, )
Does the quality of breastmilk deteriorate? that seemed to be what hv was implying and that's why I've mentioned my age.
Will 1 bottle make a diffence to his weight anyway?
She said try this first, if it doesn't work try him on purees & rice top ups.
She's back in a week to re weigh
I might sound a bit like a drama queen, but I so love feeding my baby at the boob I don't want to be doing things that will be detrimental to that. But obviously his health comes first
I've found lots of threads here with younger babies in this situation but not so much with a five month old
If anyone can help or advise I'd be truly grateful

Would he breastfeed more often? Do you swap sides and then swap back in the same session? Giving formula will interfere with your breastmilk production

Hi yes I swap sides, I've just started doing left, right, left, right. And I'm now trying to get him to feed every 2 hours. Will that be enough,? I worry if I don't use the one bottle of formula and he doest gain enough in week ill look like a terrible mum

Puree and rice top ups at 4 months? This sounds like really outdated advice to me. Typical HV in my experience. If you’re worried it’s worth speaking time your GP and a breastfeeding helpline.

When he starts solids it will change things, but baby rice is crap - full of sugar and no nutritional value so whatever you do don’t give him that!

Your supply will drop unless you pump at least the same amount of formula. Pump early in the morning to get the most out.

& then freeze what you pump in 50ml batches to give him once a day after you stop breastfeeding - that's enough for him to continue getting the immunity benefits

Breastmilk or formula is far more calorie dense than purees (and baby rice has barely any nutritional value) so I wouldn't be following that advice.
If you want to carry on breastfeeding look up paced feeding for the bottle top up. But giving him formula doesn't mean the end, lots of mums successfully combination feed. Are you on facebook? If so I highly recommend the "can I breastfeed in it breastfeeding support" page, really great advice to be had there including about how to successfully combination feed if required.

If he's having a long feed on you then downing formula on top it doesn't sound like you're making enough for him atm. I think make sure you're doing everything they've said above Re swapping breasts etc but if he's hungry, what matters most is he's fed. You aren't a bad mom if some of thst is formula, you aren't a bad mom if all of it is formula.
Is avoid rice, it's just fillet. Lots of parents wean early but personally I'm keeping mine on extra rather formula than puree for a few weeks until they're 6 months

Thanks for all the advice so far.
Re. The baby rice, thats exactly what I thought. It would fill him up with no nutritional value.
I'll be pumping as soon my new pump arrives, and I'll top him up with that.
Is it possible my milk is a bit crap though? Does that happen?
As for pumping....if say I pump half hour after a feed...Will there be enough for him at the next feed?
Should I continue with formula top ups for the week, because it was what I was advised to do, or replace with expressed milk if I can produce enough?

I'd talk to a breastfeeding helpline and get expert advice - HV are notorious for giving sometimes inconsistent advice and an expert will be able to tell you if this ones points are valid or not (or try your local leche group). However, given his weight has only dropped for one measurement my instinct would be to try offering more sides and feeding more frequently for at least a week. Have you tried breast compressions while feeding? Expressing after each feed and giving the top up will help too. Is he moving more, that can massively increase how many calories they need?

I had to top up DC3 at 5 days old and I was absolutely gutted - and simultaneously wracked with guilt I'd let him get to the point he needed top ups. It's not your fault, and it is ok to not like giving formula top ups - if you persist with the formula would giving it as one extra big feed once a day be less disruptive emotionally than having to top up every feed?

Hi OP, just wanted to chip in that combi feeding is totally possible and does not herald the end of breastfeeding! I know someone who combi fed and breastfed for 2 years (obviously dropping the formula once her baby was on solids). There's some good stuff on the kellymom website I think. Sounds like you are doing a fantastic job - don't beat yourself up!

A friend had this issue with her DS.

Her breastfeeding journey was very hard for her but she struggled on regardless. Her DS lost a lot of weight around the 4 month mark so she decided to switch him to formula. He put on a significant amount of weight and slept better (not brilliantly, but better) throughout the night.

Sometimes you have to do what's right for mum and baby. Please don't ever feel guilty for moving for formula - fed is best. Each woman is different, some BF for 1 day, others for a number of years. There is no right or wrong way - 5 months of BF is a wonderful start to life for your little one.

Be wary of taking the HV advice - some of them are shit and it sounds like yours is given the advice on purées and baby rice.
Speak to breastfeeding helpline.

You have loads of very valid questions about her advice - it would be good to talk through them all on one of the bf helplines really. They can help you work out what is happening with feeds as it’s possible you can tweak things (breast compressions come to mind) during breastfeeds to ensure more milk is transferred. They can also answer your questions on when it’s best to express, and there’s things you can do to increase what you get.

All babies will put on more weight with formula and guzzle it down quickly (it's easier for them) - this doesn't mean formula is always the right solution.

Thank you 😊. Yes he's very lively, even when he's chilling out his arms and legs are all over the place!. Im lean and struggle to gain weight so I'm assuming he's the same.
Yeah it would be less emotional to get the bottle out the way all at once, but it would then be taking the place of a feed rather than an addition wouldn't it

I agree with @KatnissK
It does not mean the end of breastfeeding at all. Ive given my baby an extra bottle most days since he was around 6 weeks (either expressed milk or formula). I too thought that I was a failure and that was the end of breastfeeding. This was not the case my son gets to have a bottle with dad which is good bonding for them. Breastfeeding is still going strong and still his preference ( my DS is now 4 months).
I agree HV can give random advice, talk to a breastfeeding specialist if your unhappy and feeling pressured.
Your doing great

Who woukd you recommend I call for help? Xx

I'm not sure. Im part of a local Facebook breastfeeding group.
Is there something like that in your area? They helped me when I had issues plus they have numbers for specialists.

If he drinks formula and finishes it after you're done breastfeeding, then clearly he isn't getting enough from you. It's unlikely to be a matter of quality, more likely to be a matter of quantity. If he is not gaining enough weight (as in dropping off the chart) that can be a serious issue. The most important thing is for your baby to be fed and healthy, that is more important than breastfeeding ; however nothing says you can't do both. As per the previous advice I would :

• top up with formula if he's still hungry after he's finished breastfeeding.

• pump to make sure your supply doesn't dwindle and feed him this (could be interesting to see if he is still hungry after having a specific quantity of breastmilk, that would help détermine whether the issue really is quantity).

• call a lactation consultant and ask for their opinion

Someone suggested feeding more often but I'm not sure if that is feasible/practical. If he already feeds every three hours, he already spends a lot of time at the breast.

I think it is normal for breastfed babies weight to level off a bit at 3 to 6 months so I wouldn't worry too much.

You are also not too far off weaning. I know others have warned against it but in most of europe the guidelines are 4 to 6 months if your baby is showing signs of readiness. I introduced solids at 5 months and found they did help with weight gain but focussed on the most nutritionally dense foods e.g avocado, ground oats mixed with breastmilk etc. I also found eating oats really helped with my milk supply.

PS - you are in no way a bad mom. I read somewhere that up to 1 in 5 people have not enough milk through no fault of their own. Don't beat yourself up and drop the guilt, it's a cumbersome thing to carry with you.

A well fed baby is happy, don't feel guilty about that. You're doing the best you can and looking for other options which is no mean feat with a 4 month old.
Nothing wrong with formula feeding exclusively even so don't feel like a failure.

You are definitely not a failure. I'm breastfeeding my two year old and she had odd bottles of formula in the beginning. Because it was hard going sometimes! Before we discovered she had a dairy allergy 😬 On that note, allergies can cause slow weight gain so that could be something you might want to investigate if you think it fits and there's any other symptoms. My dd jumped up 2 centiles after I cut dairy. However some children are naturally smaller, that's just who they are.

Lots of women combi feed successfully. I wish I'd pursued it more sometimes but my dd completely declined dairy free formula. You may find you need to pump the missed feed to keep your supply up. And this can be frozen for use in weaning etc. On that note what you get from pumping is also no indication of supply. Some people don't get a lot when they pump, I basically used to get just enough for a bottle for nursery 3 days a week over 7 days.

Also weight loss isn't necessarily due to supply, it could be an allergy, inefficient latch, milk transfer issues due to tongue tie etc. If your dc is having plenty of wet and dirty nappies that indicates that the milk is there. Babies will drain a bottle after a breastfeed and then go back for a breastfeed. The sucking reflex brings them a lot of comfort. And the flow of the bottle is a lot easier than feeding from the breast. Pace feeding is what they normally recommend for bottle fed babies. That can help prevent a preference for the bottle too if you did want to continue breastfeeding.

I've never heard of the quality of breastmilk changing. Only it changing in the heat etc, or if the child/mother is ill. Lots of people do swear by drinking lots of water, and/or eating oats to boost supply. I think there is definitely something to keeping well hydrated.

There's an amazing Facebook group called UK breastfeeding support that helped me so much this time round. There's also la leche league who have a helpline. Or there might be a local breast feeding support group with a Facebook page/email/phone number you can get in touch with.
Sorry that's all a bit rambling. Hopefully some of it is useful.

Also another poster mentioned every 3 hours at the breast being a lot. Sorry to pick that apart, but feeding on demand, which is really important before weaning, doesn't always work like that, especially during a growth spurt. Sometimes mine would go hours, sometimes as little as 15 minutes. My youngest once fed over 20 times in 12 hours in her early weeks. I stopped noting it after that day 😂 We know now that breastfeeding doesn't always work to schedules and routines. And that's ok.

Google power pumping

At 6am every morning i pump 20mins each side then go again for another 10 mins each side. Gets loads.

It can also help to initially pump every 2 hours to get supply up regardless of if much milk comes out or not. Try this for a week. It is a bit soul destroying though but it works!

You can also have baby on one side and baby on the other to save time.

Also agreed baby rice etc is just nonsense food dont give it to baby