Need to give top ups but baby refuses!

[MrsCT]

Paediatrician has real concerns about DDs weight gain dropping centiles and we have been instructed to give top ups, the problem is she completely refuses point blank to take bottles (four different types of teats), syringes, cups and even the medela supplementary nursing system! I’m at my wits ends trying to give her tiny top ups that stress her out completely and take up the whole day I could be spending playing with her.
I have breastfed her since birth and no one ever explained to me that an emergency c section birth can be so traumatic for baby that they carry so much muscle tension in their head and neck that it prevents them from latching properly. We’ve been to a lactation consultant, a tongue tie clinic, a craniosacral therapist and cranial ostepath which was utter nonsense!
ultimately she just doesn’t have a great latch but she seems well fed, she’s alert, happy, energetic and developing on track with everything and she just doesn’t seem to need or want more, I’m so confused and obviously I want to help her gain weight if it’s what she needs but I don’t know what to do because she seems fine and all it’s achieving is stressing her out and causing her to associate feeding with stress!

Would you not be better to just give extra breastfeed? Is she losing weight or just not gaining very fast?

Just not gaining fast.
I feel like I do give her extra breastfeeds but she knows when she doesn’t want it because she’ll thrash around and fight it. It really just doesn’t seem like she needs it but I keep being told she needs extra and needs to gain more weight.

How old is she? What was the weight like at birth? Have you tried different milks (including yours)? Are you offering the bottle before or after a feed? Is this the only reason you're seeing the paediatrician? Do you have any other concerns?

Sorry, that was a lot of questions. Some babies (admittedly very few) just don't thrive on milk (breast or formula), forcefeeding rarely helps those. If there are other underlying issues that's obviously totally different.

I don't really have anything to say to help, but just to say that I've been through this. It was a flipping nightmare. I even stopped breastfeeding in desperation- baby then went on a bottle strike. However, she did then go on infatrini (more calorific formula) and then gained weight. Early weaning didn't help btw. I followed a programme from Rowena Bennett which kind of helped, but not completely. Although the big thing was to stop trying to force feeds and stop stressing her out. Remove all pressure.

My baby went from 98th percentile to off the chart but is now a thriving and chubby 2 year old who has exceeded all her milestones. Loves her food now and actually still has milk!

Btw - I wouldn't recommend giving up breastfeeding. It makes it simpler in some ways, but there's zero support for bottle feeders and loads for bf. And apart from the infatrini it made zero difference anyway.

Just to add if they try and push bottles just so they can measure how much she's getting, they are quite capable of weighing her before and after breastfeeing.

And early weaning saved us so it really does depend on the baby. But I get the impression you're not even close to that stage yet.

She’s almost 12 weeks, was 8lb 1oz at birth and lost 10.6% initially. She was 50th centile at birth, between 50th and 25th at 8 weeks and between 9th and 25th at 11 weeks.
we’ve tried formula to see if she preferred and tried cold and warmed up expressed milk, essentially she will take a little from a bottle IF she feels like it which is rare but on those times it takes so long to achieve and then she’ll refuse to be breastfed so she ultimately takes less in.
We have tried top ups before a feed, after one breast, and after the whole feed, it makes no difference. Health Visitors can really only offer me the cup or syringe method both of which she rejects, and I’d give up breastfeeding if I thought it would make a difference but since she won’t take a bottle I don’t know how it would help. This is where my frustration lies because I don’t really persist hard because otherwise she associates feeding with stress which I want to avoid obviously!
we saw a Paediatrician on a completely unrelated follow up and it was supposed to be a bit of a box ticking appointment until they weren’t happy with her weight, but this frustrates me too as if we hadn’t had this appointment we wouldn’t have even known this because she just seems to be absolutely fine!
she has no underlying issues that we are aware of and her newborn blood spot was normal for everything. Im hoping she’ll just fine her own centile line and stick to a growth pattern but until she does they keep pushing this top up issue!

Also I don’t think her night feeds help the issue because she’s a great night sleeper, so much so that she barely takes any at all in the night because she opts to stay fast asleep and she’ll wake and be totally alert when she’s ready so it just seems to be her preference and again doesn’t seem to be an issue for her development and she certainly isn’t lethargic at all, she just wakes when she’s ready but she’s taking in less calories at night.

Will she BF in her sleep? Like co-sleeping.

Is she too little for rusks in a bottle of expressed milk? Sorry I'm not sure what age they're suitable from but an idea maybe?

Mine was born on the 97th centile and fell to around the 30th, however they stopped being concerned after a while as he started to follow his own curve. They felt maybe he was a bit over-inflated in the womb and was now at his natural weight!

Definitely not from 12 weeks.

Are you & husband tall & large people or small? Where would you fall on a height weight chart?

A friend who was physically small herself had a baby who was off the bottom of the charts and the HV kept saying to feed more. But the baby was in line with the family and stayed tiny and healthy.

I would wake her up at least twice during the night to feed her. Leaving then to sleep through is fine if they are gaining sufficient weight but not if they aren't.

So I let her sleep for around 4hrs at first and then wake to feed and then return to every 3hrs, she will take a sleepy feed it’s just not must and no amount of trying to wake her will get her interested in taking more.
My husband and I are tiny and so are both families so I partly think she was born bigger than she’s naturally supposed to be and she’s finding her own curve now. I understand their duty of care when it appears she’s just not gaining enough but their procedures don’t match my reality, my reality is that it’s just essentially force feeding and upsetting a happy content baby for no reason.
I do try to breastfeed more in the day but she won’t take it just because it’s there, she’ll put up a hell of a fight if she doesn’t want it

**just not MUCH

You may have already tried this. But what about giving up with the bottles and instead offering the breast every 1.5 hours AND every time she asks for a feed? Get some extra time in bed having skin to skin cuddles too as that can help with regulating appetite. If she will latch on, great. If she doesn't - try again later.

Also I’ll add that my frustrations also come from having no end of conflicting advice and a different Health Visitor every time, having a set one would be great because they’d get to know you and what’s normal for your baby and advice would be better.

It's so hard - I had similar with my first. He was born on the 75th centile (8lb 8oz) but had dropped to below the 2nd centile by 4 months. He also refused a bottle and despite a good start, wasn't a great breastfeeder. I tried everything - spent a fortune on different bottles and feeding systems, different formulas, expressed milk, seeing a laceration consultant etc.

In my son's case it was undiagnosed silent reflux that caused the issues. He was hungry but found feeding painful so pulled off the breast after a few minutes and was therefore barely getting any milk per feed, but refused extra feeds as they obviously hurt him. I remember crying trying to get my hysterical baby to latch.

We got him on omeprazole just before 6 months and it was like night and day. His feeding improved and he started gaining weight each week after the first couple of weeks. We also managed to get him to take a bottle of cows milk each day (he wouldn't touch formula or my expressed milk from a bottle) so that helped too.

Is your baby content when feeding, or does he show any signs of discomfort or pain?
It could just be that he's finding his centile, especially if you and dad are small, but maybe check for reflux too just in case.

Is she still gaining? Is she in proportion so also short, or long and thin - how skinny does she look compared to other babies her age? If she's refusing extra milk it does seem like she's just not hungry or at least not for milk. Would continuing to monitor weight gain closely but trialling cutting the top ups be an option?

If weight gain continues to be a problem, a friend whose baby had major weight gain issues was advised to wean at 18 weeks - her baby immediately started gaining weight rapidly. Would it be worth talking to the pediatrician about early weaning as an alternative strategy if concerns persist?

I would wake her up at least twice during the night to feed her. Leaving then to sleep through is fine if they are gaining sufficient weight but not if they aren't.

100% this. She is dropping weight because she is missing feeds. The night feeds are hugely important at this age particularly if breastfeeding and you want to sustain this.

Try a big nappy change if she want to sleep through!

Oh boy I've been where you are! My advice would be - ignore the HV and doctor for 5 minutes and LOOK at your baby.

Is she alert and engaged when awake? Looking around, moving energetically, showing progress with things like smiling, following objects, voices etc?
Does she look good? Skin seems healthy, good colour, not slack or papery?
Is she doing a good number of wet and dirty nappies?
When you lie her down on her back, is the soft spot on her head sunken? No? Good!
When you feed her, do you experience a let down? Can you hear her swallowing? Does she come off the breast when she's satisfied?
Is she seeming to be filling out her suits better as the weeks pass?

If you're answering yes to most of the above, your baby is FINE. She's just finding her place on the charts. If I were you, I'd sack off top ups, put her on the breast as much as she wants, and try and put the whole thing out of your mind.

Some children are just small. My DD was in 0-3m clothes until she was 12m, on the 0.4 centile despite being born on the 25th, and there is absolutely nothing wrong with her. We had all this nonsense from HVs too, I wish I'd ignored them rather than letting it make me so anxious and upset.

This is my personal opinion,I'm not a doctor but I have bf two children who are now 2 and 4yo.

If her weight is gaining albeit slowly, and she is happy and healthy overall, with good colour, and good nappies, I would stop offering the top up feeds, and focus on feeding on demand, but also offering every couple of hours or so. You're stressing you both out which won't be helping, and you're only worried because her weight isn't in line with what the chart says it should be, but in my experience babies can take a while to settle on their correct weight centile.

My dd was 90th centile ish when she was born 12 days overdue, she dropped to below 50th by 12 weeks. Health visitors were worried, naturally, but she was feeding, had wet and dirty nappies and was generally well, and gaining weight, but slowly. So they just monitored her weight with some extra weigh ins. She got to 25th centile, stuck to that line eventually and still does at 2.5y now. We didn't feed extra, just continued bf on demand. She's a little dot of a thing but full of energy and bright as anything.

@katmarie high five, I think we had the same daughter.

This all the way. The stress I got from HV worried me so much. My son was 2 weeks late and big, then dropped centiles- while still growing. He was a small baby. Is now a strapping 5foot 11 14 year old.

I'm not saying to always ignore medical advice. But if your baby is happy and growing then relax.