Breastfeeding has become stressful - looking for advice please…

[MintGreenLife]

Am looking for general support/advice…

My baby boy is 9 weeks old and has been exclusively breastfed since birth. We had trouble with his latch to begin with, but got the hang of things after a few days. Breastfeeding was going well and he’s gaining weight well, however over the last three weeks he has been becoming increasingly fussy during feeds. He latches on and off off and screams, and takes anywhere from 40 mins to a max of 2 hours per feed! Sometimes I can be feeding him all evening with only 10 mins in between feeds, mostly enforced by me because of him fussing. I do sometimes have to stop him feeding all together and distract him when he’s latching on and off every minute and crying. It’s become really stressful and upsetting for us both. When I stop him feeding I can maybe distract him for 30 mins until he realises he’s still hungry and we start all over again.

We had breastfeeding support last week and the woman spotted he has tongue tie, which may be the source of all the issues we’ve been facing (fussy feeding, very gassy, silent reflux). While we are waiting for the referral, I am wondering about introducing formula for a couple of feeds a day, just to see if it helps fill him up/settle him. The poor thing puts all his energy into the epic feeds and is asleep most of the time otherwise. I desperately don’t want to formula feed him, feeding was going well for us and I’m finding it really upsetting that it’s become so difficult. I am also wondering if I might be able to fill him up better/ if he might be a bit more settled if he didn’t have to spend so long feeding. Does anyone have any advice on combi feeding? I wouldn’t even know where to start when it comes to choosing formula for him, or even how to prepare it to be honest! Thanks x

I'm combi feeding my 12 week old after we struggled to establish bf as she was in NICU / SCBU for two weeks and my supply never really recovered. Much of the info below came from our infant feeding team and is working for us but there are lots of different options. I found kellymom.com to also be a good source of info.

On choosing formula, at NCT we were told that all formula in the UK is so highly regulated that there isn't a great deal of difference. We just went for cow and gate because they sell it in the corner shop at the end of the road (incase the supermarket is ever out of stock) and they do the premade little bottles that come with sterile teats and are really handy for when we are out and about. They also do 1l bottles of premade formula that is great for when we are staying with family. For at home, we bought a perfect prep machine - this is like an espresso machine for formula and adds a shot of hot water then a shot of cold water to make up a formula feed in a couple of minutes. They aren't strictly recommended by the NHS so do your own reading but many parents swear by them. Otherwise, you can just follow the instructions on the back of the box of formula which has a step by step guide.

Our routine is 7-8 feeds a day, up to 20mins on each breast and then up to 70ml of formula at each feed. This keeps each feed to less than an hour. I know others do formula for some feeds and breast for others but i find this keeps my supply constant and means shes used to having the breast at every feed. We've not had an issue with nipple confusion but have used nuk teats / bottles. She didn't really get on with the fancy tommy tippee bottles we bought (of course)

My DD also has reflux / silent reflux. We were prescribed baby gaviscon which we add to the formula and it has dramatically reduced her sickness. It doesnt work for everyone (you can then go onto something called omeprazole) but it's made our feeds much calmer. The GP was able to prescribe it for us.

Hope that helps! My baby was tiny to begin with and dropped below the 0.4th centile when we were struggling with feeding. It was so soul destroying. She's so much happier now and back to 2nd centile, which is where she was on discharge, so whilst it's working, we are sticking with it!

I've combi fed both of mine, my second is 9 weeks old and I've just given up the breast feeding due to tongue tie and him being horrendously difficult to get to latch. My personal choice which my husbands disappointed with but you know what.... we are all happier.
Can you pump? If so do that when he has a bottle to maintain your supply. Or bottle fees him.your expressed milk?
We use aptamil Pro futura which is going really well. But essentially they are all the same nutritionally. But I have noticed that the pro futura is not as sticky and never blocks the size 1 teats, where as the regular aptamil does.

@GuidingSpirit thanks so much for taking the time to write such a detailed response ☺️ Great your DD is doing well now, although sorry to hear about the reflux, it’s such a horrible thing. We tried Gaviscon but don’t think it made much of a difference. In our case it was silent reflux we thought he had, but I’ve been questioning that recently. Brilliant thanks for all the info about formula feeding, I hadn’t thought about doing it that way so that’s interesting. I’ll check out the info on kellymom also xx

@Blabbyoak sorry to hear your DS also had tongue tie. Have you had it assessed/considering having it cut? I’ve pumped here and there, but it’s so tricky as my DS protests greatly at being out down. I have to hold him all the time, so pumping with him on me is tricky. I bought a manual pump as thought perhaps I could hold him one handed and pump with the other hand, instead of using my double electric pump which needs two hands, but I’m yet to try that. Just not sure how I would fit pumping in, but I should maybe give it a try, even if it’s just once a day and then I do a couple of formula feeds too. I’ve used size 1 teats when I have given him a bottle of breast milk, so that’s good to know. Really hope we can figure something out that might help him be a bit more settled/comfortable xx

OP yes we had it assessed and it was mild. As he was putting on a lot of weight we decided not to go through the trauma of having it cut as we were told it will resolve in time.
It's all trial and error and you'll find you're own rhythm with it all. Xx

@Blabbyoak that’s great news that the tongue tie should resolve itself ☺️ My DS was 6lb 12 at birth and now 11lb at 9 weeks, so I think that’s a good weight gain, so maybe we will find the same with his tongue tie. Waiting for the assessment at the mo xx

The fussiness could be a dairy allergy. I BF my first (not without stress and problems) and then my second was fine for the first few weeks. At about 8 weeks it became so stressful. He would latch on, come off screaming after a few mins. And repeat what felt like all day long. It got to the point I was stressed to leave the house with him as feeding was so fraught. At around 10 weeks I saw a consultant, showed him a video of me trying to feed him a bottle of expressed breast milk where he would take a few sips, arch his back and start screaming and told me instantly that is was a dairy allergy. I cut out dairy completely and everything changed. They did skin prick tests and it showed he was also allergic to nuts and egg. He outgrew dairy allergy around 4 egg at around 2. Please DM me if I can help you by discussing xxx

I haven’t got any personal experience of combi feeding but am exclusively breastfeeding my five month old. I’d definitely recommend a Hakka if you’d potentially like to express or have the option to - I popped mine on the other side for every feed and built up a good little stash. It probably wouldn’t be enough to do lots but you could probably do a feed or two with that expressed milk. You can also try cup feeding if you’re worried about nipple confusion etc. I would definitely wait and see how things are after the tongue tie snip as that may change everything! If you introduce formula in the meantime just make sure you’re feeding or expressing regularly (express every time you bottle feed etc) if you do want to continue breastfeeding. My little girl didn’t have a tongue tie but went through a phase of having a 40 minute to 2 hour breastfeed every night before bed. I got to grips with side lying feeding and that was amazing as i was hands free and could at least read my kindle/sit on my phone and it didn’t feel like such a chore. (I love breastfeeding, but sometimes an hour into a feed you can get a bit down!) I also tried to make feeding something I looked forward to by making myself a hot drink/having a snack or watching something I enjoyed. My little girl is very fussy at the breast when she’s got wind, or if we’re out somewhere busy/lots going on at home. If he is fussy I would pop him off the breast and try winding him for a couple of minutes. My little girl has always liked being put really far over my shoulder so it’s pressing her tummy - really calms her down. Wonky winding is also brilliant! I would also say that in general even though my little girl didn’t have any issues with feeding it did get much easier as she got bigger and became more efficient, she only feeds for about five minutes now and about 20 minutes for that bedtime feed, so as he gets older and stronger it should naturally reduce a lot. I would keep going to breastfeeding support and look at having the tongue tie cut privately if there’s going to be a long wait on the NHS if that’s an option for you. I’d also ring the national breastfeeding helpline for some advice, I’ve found them really useful. If you feel things aren’t improving I’d also strongly suggest looking into a lactation consultant - it might seem expensive but it’ll work out much cheaper than a years worth of formula! I really hope things improve for you, has the GP given any advice on the silent reflux? There’s a brilliant lactation consultant called shel banks who specialises in unsettled babies, colic and formula feeding - she has a website and offers remote support too, may be worth a look. You’re doing so well! I hope things improve for you, it can be so tricky without any issues and you’re doing amazingly to have gotten to 9 weeks. If it’s any consolation everyone at my breastfeeding group (and myself!) say it gets easier from 12 weeks onwards!

Is he napping regularly in the day? By this age babies need more regular sleep and often use the breast to try and get themselves off but over tiredness prevents them dropping off so you have a constantly feeding grumpy baby on your hands.

The awake times on this are useful

This is also helpful

@SB53 sorry to hear you had similar issues. I actually cut out dairy almost two weeks ago just in case that was causing the issue, but not seen any improvement yet. Can you recall how quickly you saw an improvement? This is one of the things that’s putting me off trying a bit of formula, in case he does have CMPA x

@Twodogsandababy thanks so much for your lovely reply ☺️ It’s things like this that make me pause and think maybe I can push through and keep going without formula. Is the Hakka the hands free pump? If so have you used one and do you find it to be effective in getting plenty with each pump? When I’ve pumped in the past I’ve given him 130ml in a bottle, but then he wants to breastfeed straight after, so seemed kind of pointless to give the bottle of expressed milk. I’m wondering if this could be cluster feeding, as he was born at bang in 37 weeks, so is technically 6 weeks corrected. He’s fed near enough constantly since 5pm this evening and has only just stopped (or so I hope!). Xx

@poptartsRUs thanks for this. I think he sleeps as much as he should really. He seems like he’s permanently exhausted from the endless feeding to be honest! X

I don't think you need to combi feed. However, the best time to give formula (supplement rather than full feed) I was told was at about six in the evening when your supply is lowest and the baby is very tired. Feeding at night increases your supply as you probably know.
The pulling off and screaming can actually be plain wind, you just need to keep winding in course of feed.
Six weeks or 9 weeks corrected can definitely be a growth spurt so follow baby's lead.
Wind problems can come from poor latch. I was told that as the baby gets heavier imperceptible positioning changes mean you can be latching baby in less than ideal fashion compared to earlier on. You need proper support under baby and your arm so that he isn't dragging down but properly level mouth to nipple (lots of pillows)
The most important thing is that someone should be looking after YOU, meals snacks drinks gentle exercise so you can get through this stage and keep breastfeeding if you would like to, and not jump on the runaway train of extra formula to make life easier, because breastfeeding can make life much much easier in the long run, but you will find there are a lot of doommongers along the way
Best wishes

Sorry, nose to nipple not mouth to nipple (it's been twenty years

I breastfed till mine were 10 months and 23 months respectively, and I mixed fed the twins in first six months but I wouldn't recommend that unless there are weight gain issues (which mine had, being low birth weight twins) lots of latch issues but you get through and it is very rewarding (and convenient!!)

You’re so welcome! There’s nothing wrong with introducing some formula if you want to, but formula fed babies tend to have more wind due to little bubbles made in preparation and the milk will be harder to digest so it may end up creating more problems than it solves! I did have a Hakka and used it quite a bit in the early days because I had a really forceful letdown and it stopped me and my little girl getting soaked! It’s not a pump as such, more of a milk collector, so it will catch the milk that is letdown on the other side as you feed. I used to get about 100ml from two feeds if I remember rightly, so not loads but it wasn’t much faff because I just popped it on when I was feeding anyway. I’d then pour it into a medela bag and put in the fridge, and once the bag was full I’d freeze it. (All milk collected in the same day, at the end of the day I’d label and freeze whether it was full or not). They’re cheap too, about £10/15 on Amazon I think. Have a Google for the technique - you want to invert the flange and then put it on which creates more suction so you get more milk and it won’t fall off! Babies breastfeed for lots of reasons other than just food, it may be the connection/sucking/closeness that he wants more so than the milk. Yes cluster feeding is definitely real and can feel relentless! I remember my little girl feeding from 5-11pm pretty much non-stop at around 6 weeks and I was convinced that I was broken/didn’t have enough milk/she was starving. She then went up a clothes size, slept LOADS for a couple of days and then it started to calm down so it was definitely a growth spurt! My doula told me that latching and unlatching/fussing at the breast can also be a babies way of boosting your milk supply when they’re having a growth spurt so can actually be a positive thing! I found it really helpful to just take it a day at a time, thinking about 6 months or a year could feel overwhelming so I’d think I’ll breastfeed tomorrow and see how I feel after that. They say never quit after a bad feed or a bad day! Make sure you’re getting as much rest between feeds too - don’t run around trying to tidy whenever you have a spare minute! 😊

@Nettleskeins I’m feeling much better today knowing this is probably normal and down to a growth spurt, so have parked the formula idea for now. He seems more settled today too ☺️ His wind has definitely improved since we had help with our latch last week, so at least that’s something! I got it into my head that something was really wrong and he was having to feed for hours just to get what he needs, and was worried that it wasn’t fair on him as meant not much time for ‘play’ etc, but actually in hindsight I think this is probably just a phase/growth spurt, so will push through, although if it goes on a long time will reassess x

@Twodogsandababy this is what I’ve worried about - making things worse with formula with his wind and possible reflux etc. I feel much better today and have parked the formula idea for now. I had a look at the Hakka online last night - looks like it could be really helpful and am wondering if it might give me a bit of a break if his dad could do a bottle of expressed milk here and there. If you’re using it several times a day, do you have to sterilise it between each use? Like you I’ve worried that something is really wrong and he’s struggling to get enough milk hence the epic feeds, but actually in hindsight and from speaking to you/others it seems like it’s probably normal! I’m not sure why I’m always looking for answers/solutions, instead of just going with the flow 🤦🏻‍♀️ Xx

So glad to hear you're feeling better! Yes 100%, it's nice to have the option to have a break and will keep your supply up, and of course it's still your milk so you avoid the negative effects. I would have a read up and follow paced bottle feeding to minimise wind and to mimic how milk is drank at the breast. Also don't panic if he always guzzles the milk that he's not getting enough from you - babies have a swallow reflex which means they may drink everything from a bottle even after a feed, it's not an indicator that he's not getting enough at the breast. I've just had a little look online for you and I think you just have to clean between each use and then sterilise before the first use of the day. I bought some microwave sterilising bags and just popped it in there - super easy.

It can be so tough to have confidence in yourself! Especially as we don't see a lot of breastfeeding in our culture and aren't surrounded by women who have/are breastfeeding the way we would have been once so it's hard to know what's normal! I'd have a look for a breastfeeding coffee morning or support group near you, there's one I go to and find really helpful just to talk about feeding and meet new Mum's. There will probably be a Facebook group for breastfeeding mum's in your local area too which can be really helpful. I used to track every feed to the second on an App and found that actually that was making me more anxious, not helping as I thought! When I stopped I felt much more relaxed. What helped me most was going to the health visitor weigh in's once a month and being able to see her following her centile - one we'd had a couple of those I was confident that I must be doing something right! Always worth googling when they're feeding a lot to see if there's a growth spurt at that week too. It's okay to look for answers! I found reading some books on breastfeeding really helpful too - there's one called the womanly art of breastfeeding which I read cover to cover. That was really comprehensive and a big help. The national breast-feeding helpline are brilliant too, even with little questions. Hope feeding has gone well today for you. :)

From memory a couple of weeks.