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?

What centile is he now, @Moonshine160 ?

My DD was born at 38w and she weighed 5lbs 12oz so not dissimilar! I can't remember the specific weights, but she dropped to the 0.4th centile. On advice of HV, GP and infant feeding team, i started topping up with formula. We success BF and topped up until she was 6months old, then i slowly wound down BF until 9 months old when I switched to formula. She is now happy and healthy 16month old on the 50th centile so doing amazingly well.

As others have said above, if you have an infant feeding team, they are more specialised than HV and can offer a second opinion. They helped me massively improve the amount of BF DD was getting from the breast. They are also free! Alternatively, you could pay to see a lactation consultant.

Also look at Kellymom website. There might be tips on there for babies that are snackers, which it sounds like yours is!

I’ve just had a look at my red book and taken a picture. It looks like he was born around the 2nd centile, went up to nearly 9th (when she visited at 10 days old) and now is on the 2nd again. For those first 10 days though he was feeding non stop and didn’t lose any birth weight. I would love to have those long feeding sessions now but I can’t lengthen his feeds and I have tried, and I always offer the other breast once he unlatches but it’s very rare that he wants it. His latch is quite shallow so we will try and work on this, he’s being checked again for tongue tie tomorrow as well.

Forgot to attach photo

I just looked at the centile charts and it looks like 8lb15oz is 3.7kg
8lb 15 is 4.05kg. Which at 7 weeks is on 2nd centile, same as 2.65kg at birth.

Sorry OP, I can't comprehend imperial measurements but following the same centile line means not needing to worry unless feeding is very painful or there's a lack of wet and dirty nappies.

Ok, so he's following the birth centile so not too much to worry about, but off the back of the HV comments, i would still recommend seeing your local infant feeding team and see what they say, even if just to put your mind at ease.

When i went, they watched me do a feed, offered some tips, checked latch etc. Plus chatted to me about tips to look after myself etc. So it was quite useful.

For your own reassurance, could you buy the small size pre made formula and just put one ounce in a bottle. Continue to feed as normal. If he will take from the bottle afterward your feed then perhaps he's not getting enough from you.

You can then either try measures to up your supply or combi feed.

If he doesn't want the bottle, then he's a snacker and you know.

I am very pro breastfeeding but formula can have a place in supporting that journey. It's not all or nothing and if you are happy with how he's feeding that's great and you should absolutely continue as it sounds like it is working for you both well.
But if he would thrive better with breast milk topped up by the occasional end of feed formula, that's also perfectly fine and not something you should feel guilt or stress about.

I'm trying to say that just because you might try him with a bit of formula does not in any way mean you have to give up breast feeding. The two can exist together.

can you afford a lactation consultant? or is there a free breastfeeding support group in your area?? they are likely to be more knowledgeable than a health visitor

This is inaccurate and harmful advice. A baby will almost always drink from a bottle after a breastfeed because the sucking reflex is stimulated by the teat. This leads to over-feeding and can damage supply.

Most health visitors don’t understand breastfeeding. Can you get him weighed weekly? As long as he’s tracking his centile and having plenty of wet and dirty nappies he is fine. HV’s love to push you towards formula.

DD1 was feeding for on average 3 minutes per feed by 6 weeks, and only ever one side. Her growth was fine, never needed to supplement.

Agree with others who say you could get a second opinion- when I struggled with BF I found the NCT helpline really helpful - and nice to speak to someone completely impartial, not my midwife/ HV / mum etc.

www.nct.org.uk/baby-toddler/feeding/early-days/breastfeeding-support-nct

My HV is lovely but I received some really AWFUL BF advice from her which threw off my BF journey and I ended up having to stop 😞

@Manamala and this is some of the problem. Advice conflicts because all babies are different.

Sadly I speak from personal experience of seeing just how rapidly a seemingly well baby can deteriorate due to feeding issues and it is not something anyone would wish to experience.

Yes seek advice and second opinions but number one priority is that baby is fed. The rest can be worked out afterwards.

I don't think it's particularly common for health visitors to say this and she has seen the baby so that shouldn't be ignored.

THAT WEIGHT CHART LOOKS PERFECT!

I am baffled what the HV thinks is the problem is here?! Sorry if I've misunderstood.

Your baby has not dropped any centiles, there should be no concerns.

Of course he is dinky, he was born two weeks early. Amazing work from you, it is not always easy to BF an early baby.

'she said he hasn’t gained enough weight and I need to be topping up with formula' - In your position I would make a complaint about this.

He suffers with reflux and she also mentioned early weaning which I don’t want to do - ditto this

He is quite a snacker and only feeds for about 10 mins - This is an absolutely perfect length of time for a feed. And they feed so sporadically at this age, sometimes very often.

but I have a very quick and forceful letdown and he gulps rapidly, this has caused some issues with wind - have you tried hand expressing into a muslin before a feed?

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 - what way?!?! He is gaining perfectly, this is really harmful advice.

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 - So sorry to hear you have been made to feel this way. If he is tracking his percentile and has plenty of wet nappies there should be no concerns whatsover and no need at all for formula if that isn't what you want to do.

If he seems full and lively with wet and dirty nappies you could weigh weekly as per a pp and see how it goes. If he is tired or floppy however, increase his intake.
Fwiw my oldest DC was a very efficient feeder and only needed a few sucks to last 3/4 hours almost from the start.

@Calmdown14 I agree with everything you said but none of it is relevant in this case. The baby is gaining perfectly so what is the concern here?

Thanks everyone. Yes as soon as she left I booked an appointment with a lactation consultant, she’s an hour away but it was the closest to me. She’s also a tongue tie practitioner just in case that’s an issue as I’ve always wondered due to the shallow latch. Health visitor and midwife said they couldn’t see a tongue tie though.

Other than mild reflux he’s happy in himself, filling out his clothes and we have loads of wet and dirty nappies. If she hadn’t have said there’s a problem then I’d have assumed there wasn’t one. I breastfed my first son for 8 months without an issue but he fed for longer durations than what DC2 does.

I think the reason why combi feeding worries me is because DC1 was combi fed after 4/5 months and ended up with a bottle preference which ended breastfeeding earlier than I was ready for. I wanted to avoid that this time :(

@Moonshine160 can you make it along to a local group for some reassurance? Most groups have toys etc. for your toddler to enjoy. Lots of areas have 'hubs' which have BF supporters and HV in one place so you can get double reassurance.

And/or as others have said the BF helpline is a nice quick way to get some reassurance. Sounds like you are doing amazingly

Thank you for this. Yes I too am a little confused as I thought the chart looked ok. I have paid to see a lactation consultant tomorrow so I’m hoping she will be able to help too.

That's great you're able to get some 1:1 support.

When you say shallow latch is it uncomfortable? That also could be a cause of reflux.

You may have already been trying these but just in case, on youtube 'flipple' or 'exaggerated latch' videos can be very helpful for getting a deeper latch. Also the 'laid back' position especially when combined with skin to skin can help deepen the latch.

Agree. DD had a poor latch at first and the HV's advice was to top up with formula. She could have pointed me in the direction of BFing support groups but no, formula was the answer rather than sorting out the latch.

I was a stubborn mare though, within 3 weeks DD could do it and I fed her for 2 years no problem. So glad I didn't listen to the useless HV.

No it’s not actually uncomfortable, he just never initially opens his mouth very wide and I don’t feel like he’s got enough in his mouth. I hadn’t heard of the exaggerated latch before but I’ve just watched a video and will try this, thank you.

My baby was born weighing 7lb and did lose some weight but was back over birth weight by day 10. At 6 weeks he was 10lb and at 9 weeks 11lb. He is staying on the same centile I think the 25th and is formula fed no one is concerned with his weight. If your baby is still feeding regularly and is putting weight on I wouldn’t be too concerned. He was born little so I don’t know what your HV expects!

This isn't true about them always taking a bottle if offered after a BF - it's a myth.

If they're content after a feed they won't take more- it's almost impossible to overfeed a baby, whether BF or FF.

It's actually really good advice to offer a small top up (EBM if you can manage it) after a BF and see what your baby does - if they refuse and are content then fine, if they glug it down and look for more then you know they need more.

Mine had to have top ups (paediatrician advised as my milk was delayed) and it was always clear when she'd had enough and when she needed more because you look for the cues. Sometimes I needed to add an oz or two to the bottle.

As an ex-HV it’s really bizarre advice. The only thing I can think of is that she was concerned that you were exhausted with feeding every 1.5hrs but that is not something that has come across in your post. Plenty babies feed for 10 mins every hour or two (mine did), some mums find this way too exhausting esp if have a toddler too. But like I say this didn’t come across in your post. Manamala’s summary and suggestions are very good. It’s great you’re seeing a lactation nurse for reassurance but it is annoying that a health professional has cast doubt in your BF abilities. It really does sound like you’re on it!

I am a health visitor
(also have a background in infant feeding)
That chart looks absolutely fine.
As long as there's no discomfort or issues with feeding than carry on as you are!
I suppose there could potentially be an undiagnosed tongue tie causing the reflux and frequent feeds, however some babies just like to feed little and often and that's normal.
I would go back to your health visitor and ask them to explain the rationale behind introducing formula in a baby that is gaining weight along its birth centile? They should have explained that this could impact on your milk supply and be detrimental to exclusive breastfeeding.
Is it possible that they have suggested the formula to reduce the frequent feeding? Have you voiced to them that frequent feeds are an issue? That's the only reason I can think of that it may have been suggested as a solution?