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

My 6 month old feeds every 3 hours pretty much like clockwork during the day. Will be starting her on solids next week. I don't think the fact he guzzled the bottle of formula means anything as well fed breastfed babies will do this.
As pp said breastfed babies tend to level off around this age. If he's happy and plenty of nappies etc it sounds like he could just be a small baby.
At this point I honestly wouldn't do anything drastic re weaning but just make sure you're offering lots of boob to ensure you don't create a problem that wasn't there in terms of supply.

A lot of posters saying if he'll drink formula after breastfeeding then this means he isn't getting enough - that's not true!! It's because it's a bottle. This is a good post on it (I've had to copy and paste as can't share link but it's from the facebook group I named earlier)

Sharing again.

This is a question that is asked a lot.

It's very common for babies to be fussy and unsettled at times, and even quite often in some cases.
But it may be unnerving for parents who become concerned that perhaps the baby isn't getting enough milk.
So a bottle is given to 'test' this theory and the baby wolfs it down and then crashes to sleep. Parents are left feeling utterly deflated that the they were letting their baby go hungry.

So why is it that those of us in the world of lactation say that drinking a bottle after a breastfeed isn't neccessarily sign that the baby was hungry?

To understand fully we need to look at two things, firstly normal behaviour at the breast, and secondly, normal response to a bottle.

Society would have us believe that babies latch onto the breast, feed and then settle. But that's not actually the case. There is usually quite a lot of fussing and bashing while they figure out where they're latching, then lots of quick sucks and tugging and hitting while they encourage your milk to let down. Then there is likely a period of calmer feeding while they have a good quantity of milk (look and listen for swallowing!) and then they may start to qet squirmy, tugging, gumming and hitting again as the flow slows down. This is all VERY normal behaviour.
Keep in mind in an evening, when most parents find their supply is running slower, and during growth spurts, babies will often be a lot more fussy at the breast, and that's ok too! Its stimulation behaviour to get the milk flowing. And the more milk that's removed, the more milk is replaced.
Babies have tiny tummies, digest breastmilk quickly, and use the breast for plenty of reasons other than food, so it's also very common for babies to decide that actually they would quite like to go back to the breast please, even though they had appeared to have finished not long before. Again, normal. (I didn't say easy, I said normal!)
Looking at all of the above, we can completely understand why parents may assume their baby is unhappy or not getting enough. Usually once they've had the information about it all they feel empowered to carry on the way they are.

But, if they don't have that information, they may carry on and give that bottle. So why would the baby take it?
Well, firstly, because babies love to suck. Its soothing and comforting and releases pain relieving hormones and means they are next to your body and in your arms. They're clever little creatures.
Plus, it's pretty easy to get a bottle teat into a baby's mouth, they barely need to open at all compared to latching at the breast.
But why once the teat is in do they drink? Well, sucking is a reflex that happens if something touches the back of the roof of the baby's mouth. So they can't actually help themselves.
When a baby feeds at the breast, sucking is only a part of it, the tongue compressing the breast against the roof of the mouth in a wave like motion moves the milk. But the feeding action with a bottle is very different. Even gentle sucks will cause milk to flow, and we've already seen that babies can't help but suck the teat, so end up with a mouth full of milk whether they want it or not. So they swallow, because once again it's a reflex in babies.
They end up sucking and swallowing until they're so exhausted that they stop.
By this point they're overly full and exhausted so their body shuts down to work on digesting the heavy meal.

So a baby will take a bottle because of their reflexes, not necessarily because they need it.
If they're doing plenty of wee and poo, and gaining weight as expected, there's no need to offer a bottle (unless you choose to). If you're concerned about your baby and feeding in any way get some skilled support to fully assess and reassure you that all is well. But try and trust your baby and trust your body, they know what they're doing x

So don't feel disheartened if he'll drink a bottle, it doesn't necessarily mean he's not "getting enough" from you. Also as far as I know breastmilk doesn't deteriorate with age. I suggest calling la leche league for specific personalised advice especially around the best way to fit top up feeds in (if required)

I'm so sorry op, it sounds like you've had lots of horrible advice. There is so much confusion around all this but it's really quite simple. Here's what you do:

Totally forget the whole 'routine' of giving a feed every 'x' number of hours. What you need to do right now is to keep attaching baby to the breast as often as possible. The more frequently the better. That sends signals to your body that you need to increase your supply and, I promise, your body WILL respond. Crikey, if you're only feeding baby every four hours then your body won't be receiving the memo that it needs to make more!

When breastfeeding you really need to be flexible about timings. They don't run to a schedule I'm afraid! There will be times when you might go for much longer without feeds. Even 6 hours or more! That's absolutely fine but then you might need to feed much more frequently at other times. Don't watch the clock, watch your baby, and look for signs that he wants boob.

Remember, this is what babies are programmed to do. Even during phases where they seem to be attached constantly to the breast it doesn't mean it's because they're starving or that they're not receiving enough milk. They are simply programmed to do this to signal to your body that you need to increase your supply because they'll need it soon. Once your body responds then you'll find baby will start to feed less frequently... until the next time they're ready to increase their feeds again and then you'll go through another round of 'cluster feeding'! Honestly, it's perfectly normal and is exactly what's supposed to happen! The issue that a lot of people find though is that once they start to introduce formula baby no longer needs as much breastmilk so will feed less and in turn your body will stop receiving signals to maintain or increase your supply and then you suddenly find you really aren't making enough. Simply put, unless the demand is there from baby you body will stop making milk and that's why most people find it's the beginning of the end of their breastfeeding journey.

Do also remember that calorie-wise there is really very little you could possibly feed that is more calorific than breast milk! Flipping baby rice doesn't even come close. It's bulky so fills their tummy but that's about it.

I also wouldn't worry about the breast pump either. Pumps aren't nearly as efficient as babies are at extracting milk and you also won't get the same hormonal-initiated milk letdown that you will from nursing baby. It means that the amount you'll get from expressing isn't nearly as much as baby will get from you! Honestly it can be so disheartening pumping for hours on end to see practically nothing coming out and often leads mums to believe they're not making enough milk when it couldn't be further from the truth!! Don't put yourself through that. Instead just keep putting baby on the boob. They do a much better job!

Good luck, OP. You'll be fine! This is all really, really common when it comes to breastfeeding. Just remember to keep sticking baby on the breast as frequently as possible, that'll increase your supply and then baby will have as much as he needs. You don't need the formula at all and you CAN turn things around if breastfeeding is what you want to do. It's tough at first but it really does get so much easier, I promise!

This is part of it too as another excellent poster wrote above (and I'm going to post it again so it sinks in!)

'A lot of posters saying if he'll drink formula after breastfeeding then this means he isn't getting enough - that's not true!! It's because it's a bottle. This is a good post on it (I've had to copy and paste as can't share link but it's from the facebook group I named earlier)

Sharing again.

This is a question that is asked a lot.

It's very common for babies to be fussy and unsettled at times, and even quite often in some cases.
But it may be unnerving for parents who become concerned that perhaps the baby isn't getting enough milk.
So a bottle is given to 'test' this theory and the baby wolfs it down and then crashes to sleep. Parents are left feeling utterly deflated that the they were letting their baby go hungry.

So why is it that those of us in the world of lactation say that drinking a bottle after a breastfeed isn't neccessarily sign that the baby was hungry?

To understand fully we need to look at two things, firstly normal behaviour at the breast, and secondly, normal response to a bottle.

Society would have us believe that babies latch onto the breast, feed and then settle. But that's not actually the case. There is usually quite a lot of fussing and bashing while they figure out where they're latching, then lots of quick sucks and tugging and hitting while they encourage your milk to let down. Then there is likely a period of calmer feeding while they have a good quantity of milk (look and listen for swallowing!) and then they may start to qet squirmy, tugging, gumming and hitting again as the flow slows down. This is all VERY normal behaviour.
Keep in mind in an evening, when most parents find their supply is running slower, and during growth spurts, babies will often be a lot more fussy at the breast, and that's ok too! Its stimulation behaviour to get the milk flowing. And the more milk that's removed, the more milk is replaced.
Babies have tiny tummies, digest breastmilk quickly, and use the breast for plenty of reasons other than food, so it's also very common for babies to decide that actually they would quite like to go back to the breast please, even though they had appeared to have finished not long before. Again, normal. (I didn't say easy, I said normal!)
Looking at all of the above, we can completely understand why parents may assume their baby is unhappy or not getting enough. Usually once they've had the information about it all they feel empowered to carry on the way they are.

But, if they don't have that information, they may carry on and give that bottle. So why would the baby take it?
Well, firstly, because babies love to suck. Its soothing and comforting and releases pain relieving hormones and means they are next to your body and in your arms. They're clever little creatures.
Plus, it's pretty easy to get a bottle teat into a baby's mouth, they barely need to open at all compared to latching at the breast.
But why once the teat is in do they drink? Well, sucking is a reflex that happens if something touches the back of the roof of the baby's mouth. So they can't actually help themselves.
When a baby feeds at the breast, sucking is only a part of it, the tongue compressing the breast against the roof of the mouth in a wave like motion moves the milk. But the feeding action with a bottle is very different. Even gentle sucks will cause milk to flow, and we've already seen that babies can't help but suck the teat, so end up with a mouth full of milk whether they want it or not. So they swallow, because once again it's a reflex in babies.
They end up sucking and swallowing until they're so exhausted that they stop.
By this point they're overly full and exhausted so their body shuts down to work on digesting the heavy meal.

So a baby will take a bottle because of their reflexes, not necessarily because they need it.
If they're doing plenty of wee and poo, and gaining weight as expected, there's no need to offer a bottle (unless you choose to). If you're concerned about your baby and feeding in any way get some skilled support to fully assess and reassure you that all is well. But try and trust your baby and trust your body, they know what they're doing x'

Hi OP, it might be worth reaching out to la leche league or the national breastfeeding helpline. Has anything changed recently for you? You mentioned getting less sleep. Could you nap in the day? Diet OK? Enough water? Have you got your period back? I noticed a dip in the week before each period and seemed to feed more in that time.

Good luck and please don't feel bad x

Fed is always best.
There is some thought that it is easier for a baby to get milk from a bottle than a breast (it flows they don’t have to work at sucking it) so can get lazy & stop BF correctly ... ideally get somebody else to give the bottle so baby not only accepts feeds from someone else but starts to separate mum-milk from bottle-milk. If you can give expressed that would be fab & another way for Dad to bond with baby by feeding ...

Have you had a look at the KellyMom website? It's a fantastic resource for breastfeeding mums, it saved my breastfeeding & sanity when I was breastfeeding my son

Thank you all so much 😊.
I will put him on the boob as much as possible. Pump when he naps ( ill give it a go now I've got it here). Compress when he feeds. Eat oats more often. Switch over during feeds....
Should wake him? Its never worked out well when I have in the past.

And in reply. My periods haven't returned (though they were scarce before pregnancy). And the only difference is the lack of sleep. But fingers crossed we're over the worst of that now

Can I also say, that "not having enough milk" is actually rare, and assumed to be the case when it is not all too often. Please have a look at kellymom it is an excellent site.

Hi OP I would recommend your local laleche consultant if you dont have a breast feeding support group or midwives in your area. Try not to put too much stock in HV. If your baby is happy and healthy and have plenty of wet and dirty nappies I wouldn't worry too much. Your LO will right themselves in the end.

While feeding LO try breast compressions. I was also suggested to use the koala hold but I'm short and baby is long so that didnt work for me.

My LO dropped from 9th centile to 0.2 when he was born. I used expressed milk as top ups rather than formula. I would suggest using a hakka silicone pump overnight on your opposite breast every time LO feeds. You will be surprised what you get out. You can also use this in the day and due to time between LO feeds you should get a good amount out then too.

Hey everyone, you've all been great. Last night a had a great call with my local la leche advisor. She was great and confirmed what had been said here, formula shouldn't be necessary. HV's thinking was outdated and in some instances completely wrong.
So I'll be attached to bubs most of today, when I'm not ill be pumping a bit and eating my oats 🤞.

A massive thank you for all your advice and support.💐 I'll report back at the next weigh in xx

@Flipflop22 fantastic 💪🏻 ... good luck xxx

The national breastfeeding helpline is amazing! Give them a call. :)

Just seen the latest post - good on you op!

I second giving the national breastfeeding helpline a call. I was also wondering why your baby is being weighed so much? Maybe it differs from area to area but here they are weighed at their jabs at 2, 3, 4 months and then not again until 8 months so we'd have no idea of their weight dipped a little and as long as they are growing, contented and have good nappy output then there would be no cause for concern.
I also notice that you mention that you are taking fenugreek. There is some evidence that it can reduce some mothers supply instead of increasing it.
Breast compressions while feeding can help increase the amount of milk baby is getting as well and have a look at paced bottle feeding for the top ups.

1 bottle out of all milk for the day isn't going to reduce your production. Don't listen to militant breastfeeders, do what's best for your baby and you can enjoy bfeeding for a long while yet.

At 5 months you should be able to do odd bottles of formula with no problem, if that's what you want to do. I had some days back at work from 5 months and my baby had formula on those days no problem. But I'd only do it if you actually want to! By 5 months breastfeeding is often much easier than making up bottles.

And you are absolutely not a failure! You've done brilliantly so far, well done!

Sounds good, OP. Just wanted to add that sometimes it does happen that babies feed almost constantly and still don't gain weight and it has nothing to do with maternal supply. My eldest actually ended up in hospital with malnutrition. We only found out years after it was almost certainly because she had hypotonia so wasn't strong enough to suckle effectively. Wasn't laziness: she was exhausted by the effort.

Obviously a rare case and no reason to believe anything like that will happen to you. Still worth keeping a bit of an eye on the weight, just in case it keeps on dropping. Dd was being fed night and day and still dropped down to the bottom of the chart.

Corythatwas, I hope little one is doing well now. I will of course keep an eye on him. Thank you for sharing xx

Thanks, Flipflop, little one is 23

I just wanted to mention it because there is always such a tendency to focus on the mother in cases where something doesn't seem to be working for a baby: what she is doing wrong, what she should be doing. And it was only long afterwards that I found out that in this particular case, it wasn't about me at all.

My second baby was very big and I gave the occasional FF, please don't worry about it.

I almost speechless with everyone's kindness in taking the time to respond. I've spoken to ntc, and to a la leche league consultant and they've echoed what so many of you have said and in my heart I believed to be the right thing.
Thank you ladies, all of you. 😘xx

You are not a failure you are a mum who will always do her best. Your son will love you and be fine no matter how you feed him, please do not beat yourself up, if he is happy well fed and cuddled lots all is well.

Someone said something about babies sucking bottles and swallowing by reflex, and eating too much... Sorry, not my experience at all. I've seen my son play with the bottle teat and not actually drink anything. And I don't think the milk flows quite that easily, or it wouldn't have taken him over 20min to finish a 30ml bottle as a newborn...

That said, if you can make breastfeeding work for you that's great OP ! Just keep an eye on nappies and weight and his general health/activity levels.