Health visitor said I need to top up with formula

[Moonshine160]

DS2 is 7 weeks only today. He was born at 38 weeks and was dinky at birth, only 5lb 13oz. He’s been weighed today and now he’s 8lb 15oz. The health visitor has been out today for his 6-8 week check and she said he hasn’t gained enough weight and I need to be topping up with formula. He is quite a snacker and only feeds for about 10 mins, but I have a very quick and forceful letdown and he gulps rapidly, this has caused some issues with wind. I don’t think a 3lb 2oz gain in 7 weeks sounds bad but she said from looking at his chart he was gaining weight quicker in the first month than what he is doing now. He suffers with reflux and she also mentioned early weaning which I don’t want to do. She said that if things carry on the way they are she may suggest switching to formula or exclusive pumping so I can see how much he’s taking. It’s all really upset me, I was enjoying our breastfeeding journey and now I feel like I’m not doing good enough for him.
I find expressing milk too difficult as it takes me ages to get a substantial amount and I have a toddler to look after too.
Has anyone been in the same situation and what did you do? Did you switch to formula?

Can you not just feed more often or offer an extra side at a feed?

@dementedpixie I feed on demand and on average he feeds every 1.5 hours in the day and 3 hours at night. He has loads of feeds in the day but they’re all just really short, I have tried lengthening them if he falls asleep and offering the other side but he’s not interested, like he’s full but then is hungry again a short time later.

How does that relate on the weight chart in the red book? I think it sounds like he's maintaining his curve at the very least. I wonder if she's thinking he needs to get to the 50th centile (which he doesn't).

There are some great bf groups on Facebook with BF counsellors online. If he's maintaining his line in the red book that's perfect.

Having BF 4 kids for most of 10 years and met several HVs I have to say most know absolutely shit-all about BF.

Ok OP, you need to take this seriously but it’s also fine to get a second opinion, I’m not sure who from in the UK, but someone on here will know. When is he next being weighed? Is feeding direct more often an option? Are you offering both breasts at each feed? Can you attempt to breastfeed more often until his next weight check and then make a decision about formula top ups then?
If a 2nd medical opinion says you really must top up with formula, or if after the next weigh in the medics are still not happy with his weight gain and recommend adding formula, then don’t worry, it’s not the end of breastfeeding if you want to continue. Mix feeding can be great - a bit more flexibility for you and you’ll know he’s getting enough nutrition.

He sounds like he's doing fine to me. Looks to be following the 2nd centile line. If he has plenty of wet nappies and seems alert you sound fine and I'd just carry on as you are

I combo fed my boy from about day 3, we did so untill he was 6 months old when he decided he'd had enough of the breast. Please don't feel like a failure

My DS1 was like this. He was 6lbs 13oz at birth, put on a whole pound in the week after his birth, I can't remember exactly what happened next but I do remember the rate of growth then slowed down. He was also a snacker. He's now 17 and 6 feet tall.

Of course it's a worry but unfortunately many Health Visitors don't actually know what they are talking about when it comes to infant feeding so don't panic.

What centiles was he on at birth, what was the highest centile he's been on and which one is he on now?

A couple of questions:
You say you've got a toddler, did you breastfeed them?
How do you feel he's doing, if the HV hadn't have weighed him would you have had any concerns (apart from the reflux) about his weight gain/alertness/nappy output?

I'm only asking as my second DC was a very slow gainer but I wasn't at all concerned as everything else was fine. I'd experienced early breastfeeding problems with DC1 but gone on to feed until he was 17 months so I had the confidence that I knew what I was doing and what I should be looking out for.

What centile was he born on and what is he on now? If he's not following the percentile line or is dropping then that's a concern. If he's maintaining along the line, then that's fine.

Do you have any reasons for under supplying? Not everyone can make enough milk to fully BF a baby and there are myriad reasons for that. It doesn't mean you can't BF - I only made 50% of what my baby needed but still BF to 3.5 years.

You could try expressing in addition to BFIng direct and offer that as a top up if he is dropping percentile lines?

My dc3 and 4 fed every 2 hours for about 10 mins, (and 3 hourly at night) would absolutely not take anymore and I couldn't stretch out the times between feeds either.
Dc2,3 and 4 also only gained weight slowly and they dropped centiles till they were 6 months old when they settled nicely on the 25th centile, the only difference between my dc and your dc is that my dc all weighed over 10lb at birth.
HV's Dr's and midwives were not worried about topping up and weaning early as they were happy, bright, alert babies that were feeding, pooing and weeing well. Is your dc doing all of these? Quite frankly a 3lb weight gain in 7 weeks compared to what mine put on is amazing. Personally I would keep continuing what you are doing, you do not have to take the HV's advice, some is useful most is not (nod and make uh huh noises) and if you are concerned about weight gain or anything else I would book in to see your Dr. Congrats on the new baby!

Is he having plenty of wet and dirty nappies?
If so and he's tracking on his centile chart I wouldn't be forced into supplementing personally.

With my 1st baby we introduced top ups of formula at 5 days whilst still in hospital due to big weight loss. We continued mixed feeding then I switched to formula completely after our 8 week check as she was only 7oz over birth weight.
My 2nd baby is 6.5 weeks old and mixed fed from 9 days old, again due to big weight loss. He's currently 1lb 2 oz over birth weight.
Both my babies had tongue tie.

Depends if they are tracking the percentiles.

They do seem very quick to suggest top ups. Which does complicate things.

I would not panic. Wait a week and if it’s still on percentile then ignore.

I agree it's sensible to follow medical advise but disagree that formula is the answer. (Some hv are quick to promote formula) personally I'd feed on demand, check your latch - CHIN - baby is close to body (think holding a rugby ball) head is free and in line with your body and nose is inline with nipple. Make sure there's plenty of nipple going in. Look for signs baby is eating- suck swallow. Express (if possible) while feeding. Speak to a breast feeding support group - children centres often have breast start run by nhs staff. After feeding check - Is baby happy, content, plenty of wet nappies. But of course if you are concerned get medical advise or a second opinion.

I had to do this for a few weeks from birth. Not really a big deal and it helped DD gain weight. Continued to BF successfully for about 18 months.

I just looked at the centile charts and it looks like 8lb15oz is 3.7kg which is pretty low weight for 8 weeks. I would imagine she is looking after your baby's best interests. It's not about you and whether you prefer to BF. On here you will always have people saying to continue with BF even when they're not qualified in childcare (like your health visitor).

I had HV going on about early weaning and switching to FF luckily we were in another area for first so I was more experience.
However many locals ended up FF and weaning vert early due to HV advice.

All mine were larger babies at birth and while gaining weight still coming down the centile charts and then finding their level - so with first HV in that area kept an eye - seeing baby putting on some weight and happy and alert - with second and third it was completely panic and pressure with same situation.

I'd see if you can access any local BF support (- get latch checked and try and make sure baby gets hind milk - so not switching breast mid feed as some HCP insisted I should be doing), or different HV or even GP and get another opinion about it.

Health visitors should be outlawed in my experience.

Formula top ups and early weaning is absolute nonsense.

That seems like a good weight gain. I would get a 2nd opinion before topping up. I would see your GP and maybe request a pads referral.

Sorry paediatric referral

I had a five pounder at 36 weeks and when she was less than a week old the community midwife told me I should give her a two day break from the breast because I was exhausting her apparently. I asked her to leave.

She is still breastfeeding at 2 and a half, have never known a child who loves it more!!

Unfortunately some HCPs don't really trust breastfeeding because they can't measure/control it. If your baby seems fine in themselves and you didn't think you had a problem before this woman arrived in your house and told you you had one, I would try to ignore her.

I had a very similar experience.
My health visitor got we all worried about the baby's weight. I saw the GP and he explained that the Health visitor had read the graph wrong.

So my advice is to make a GP appointment.

How many times had your child been weighed? Because if you only have 2 weigh ins after birth that's not much data to go on. My DC was in scibu and weighed every day, the numbers bounced all over the place! Feed time, wee and poo all make a huge percentage difference to a small child's weight so if all else is well don't worry. It's worth keeping an eye on of course but as part of the whole process not just that one off number. Many HVs seem to struggle with the concept of centiles too, so long as he is tracking don't worry too much.

If your HV wants to know how much milk your baby is taking each feed, it’s absolutely not necessary to feed from a bottle - you can just weigh the baby before and after a feed for a few days. This involves having access to accurate baby scale for a while though. Ask your HV or your child’s doctor about doing this.

I’ll be honest I don’t know enough to know if you’re situation needs remedied or not, but I swear from my experience and others I know, health professionals in this country will try to steer you away from breast feeding at the drop of the hat!

I would definitely get another opinion as others have said and try not to panic!