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?

Sounds fine to me my daughter is 8 weeks old and was 5lb 3oz at birth and is now 9lb 4oz. Following the 2nd centile. Is be tempted to get a second opinion if I were you.

I can't understand this chronic HV advice. To even suggest topping up, would only be done if baby weight or baby well-being was so bad, dropping badly, that there was serious concern for dc welfare, surely?

After this is all over, consider a complaint?

The 'snacking' has to change.

He is not getting hind milk which has the essential fats for weight gain and brain development.

Do you have an electric pump?

Can you offer a dummy for about 15 minutes when the 90 minute interval between feeds comes to an end, and whike he's sucking on that, express a bit before breastfeeding so your letdown doesn't result in choking, sputtering, etc?

While he is feeding, you need to try to keep him awake so he drains at least one boob.

Your boy is doing fine as are you. I personally would ignore what the health visitor has said.

You’ve had lots of advice on this thread, some of which is not helpful or current, but you’re seeing a lactation consultant tomorrow and that will really help.

But I’ll happily join the “my health visitor gave me shit advice about breastfeeding” club.

luckily by my third I’d sat for hours in breastfeeding support groups listening to trained professionals (so, sadly, probably knew a lot more than they did) and was able to call them out on it.

Thanks again everyone. It’s made me feel a little better. She’s back again next week to check his weight. She said to me earlier that ideally he should be at least 9.5lb at this stage. I don’t know where she got that figure from or what she was referring to to say that, I should have asked, so I will ask next week.

No I didn’t express any concern about the feeding every 1.5 hours. As his feeds are quite short it’s never really been a problem. It would be exhausting if he did that during the night but he does tend to go around 3 hours between feeds in the night which as far as I’m aware is fairly normal for his age.

We have tried him with small amounts of expressed milk in a bottle previously. If it’s soon after a breastfeed then he isn’t that interested and won’t even drink 1oz of it but I will get DH to try again this evening.

@mathanxiety both of mine never fed for more than 10 or 15 minutes (and both were EBF until weaning). They weren’t snacking they were just enormously efficient feeders…I know this because they both piled on weight, to the confusion of my friends whose babies took their time over eating. So I would t assume that’s an issue unless OP can rule out other things.

Check the percentile and if it’s on track ignore her. I’d Suggest a breastfeeding support specialist - le Leche are good. My youngest was a little 6lb baby and was very sleepy during the day for the first 2/3 months, I couldn’t get him to feed for long before falling asleep, but took bigger feeds at night. I found I got very engorged during the day so feeds were fast and the thirst quencher milk so perhaps wasn’t what he was needing and had to tweak my diet and do some pumping to get into a better rhythm and try to get him to take more milk during the day. A breastfeeding support specialist will help you. If you do decide to formula that’s okay too but if bf is going well then it’s good to explore the options. Best of luck.

I was told this by a busybody anti breastfeeding health visitor at 6 weeks. I ignored her as I was moving a week later overseas - the paediatrician had no concerns at all. She was just small and is still slim as an adult

I know it's a bit against the grain but my experience was really helped by a little formula and/or breast milk top up that I gave once a day (100ml) until my baby didn't need it anymore/regained a bit of strength. It wasn't just his weight, it was that he seemed dehydrated. He had loads of nappies but I was counting the tiniest bit of wetness as a wet nappy. HV weren't hugely helpful, but I added the top up for a few weeks and then exclusively breastfed after that.

Are you using a Haakaa pump by any chance? It's just a little silicone suction cup and you don't need a whole contraption. You put it on the breast the baby is not on and it uses a little natural suction to catch the let down. If you use throughout the day you can get several ounces and top up with very minimal effort and without a big impact on your supply.

Worth speaking to the breastfeeding hotlines to get advice of course - this was just my experience.

It's so emotional in the early days and the conflicting advice is so hard. You're doing amazing regardless and in your situation, whatever you decide to do your baby sounds like they'll be just fine.

If you decide not to take advice of HV, please do tell them that so they can help support your choices.

You're doing great, keep it up! It only gets better

The 'snacking' has to change.
No it doesn’t .
**
He is not getting hind milk which has the essential fats for weight gain and brain development.
This is a myth which a quick Google and tonnes of evidence will reveal.

Do you have an electric pump?
OP is not keen on pumping or giving bottles. Baby is gaining perfectly and has good output - so why add this hassle? There is no justification for it

Can you offer a dummy for about 15 minutes
Why introduce a dummy when BF Is going well and mum and baby are happy with it?!

While he is feeding, you need to try to keep him awake so he drains at least one boob..
If there are no weight concerns then No you don’t, Google ‘responsive feeding’

Misinformation can cause unnecessary worr and a worst destroys BF journeys

@mathanxiety see above! You are trying to be helpful and offer solutions but there is no problem here to solve.

@RidingMyBike

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.

Do you have evidence to support this? Because La Leche League, Kelly Mom and countless IBCLs say the opposite. All babies are different. Some will refuse and some will glug regardless.

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.

This is not good advice, see above. A BF baby will sow hunger cues if they are still hungry. However OP has said her baby is uninterested after a BF. No need to try again tonight @Moonshine160! Save your energy, you are doing everything perfectly already

If there's one bunch of people I'd do away with in society it's HVs.

Offer both breasts at least once per feed and maybe dream feed at night too.

I think everything has been said that I wanted to add. Just had to write that I was in a similar position, my boy had reflux and was gaining but not ‘as he should be’. Through reading different forums and looking in to alt BF pages, I realised that if he hadn’t have been weighed I wouldn’t have had any concerns. HV have a set rulebook as such and have to advise as they should, I’m not knocking HV either as they and midwives are worth their weight in gold and so greatful we have them to help us. I carried on and am so pleased I did! You do you!

@Manamala

I've breastfed five babies over a total of about 150 months, and I don't need to Google anything, thanks.

Your ideas are wrong, and breastfeeding is supposed to be nutritious as well as a great way to deepen the bond between mother and baby.

Sucking a little foremilk with short intervals in between feedings and falling asleep at the breast means the baby isn't getting the nutrition he needs. It's also contributing to the problems which are being identified as reflux.

The baby is getting a lactose overload from the snacking on foremilk and he isn't getting the fatty hindmilk that is needed for growth and weight gain. The lactose from the frequent nursing on foremilk is causing the reflux issues. The baby needs hind milk to promote slower digestion and give him enough time to metabolise the lactose.

A dummy will help to space feedings better. Keeping the baby awake to get enough fatty hindmilk will help him to get the fats he needs, which in turn will help him go longer between feedings, making digestion of the lactose possible, and the OP will find his reflux issues easing.

@Manamala
Topping up with formula at 7 weeks will not lead to overfeeding and damaged supply.

What will damage supply is feeding formula overnight, especially between 10pm and 4am.

@mathanxiety yes he does take a dummy, but it’s not about keeping him awake long enough to take the hind milk, regardless of whether he’s awake or asleep he is done at 10 minutes and there’s nothing I can do to keep him going. I’ll offer him the other breast, change his nappy in between then try again, he just doesn’t want any more. When breastfeeding support came out to me about his latch a couple of weeks ago they observed a feed and said that he just seems to be a very efficient feeder and I have a fast letdown.

Agree with @Manamala

Honestly, I don't know how these HVs can get away with such terrible advice.

@Moonshine160‘s baby is gaining weight perfectly for his centile so no need to worry @mathanxiety and fwiw this is what La Leche League says about foremilk/hindmilk:

Length of feed is irrelevant – some babies take a full feed in 4 minutes per side while others take 40 minutes to get the same amount. You can’t tell anything about fat content from the length of the feed, so let the baby determine it.

@mathanxiety ”I've breastfed five babies”

This is wonderful, you are clearly very experienced. It is not a sufficient sample size on which to base medical advice, however.

The OPs baby does not seem to be exhibiting symptoms of lactose overload.

The OPs baby is feeding for 10 minutes every 1.5-3 hours - this is perfect and does not constitute “Sucking a little foremilk with short intervals”

The only discernible problem here is that OPs confidence has been undermined by a HCP giving out harmful misinformation. She is doing an absolutely fantastic job and there is no reason at all to change anything she’s doing or go against her own wishes and introduce a bottle.

The only discernible problem here is that OPs confidence has been undermined by a HCP giving out harmful misinformation. She is doing an absolutely fantastic job and there is no reason at all to change anything she’s doing or go against her own wishes and introduce a bottle.
Absolutely this. DC2 was the same, fed for no more than 10 minutes a time. She was just efficient.

I had a HV who started on about top ups and daily weighing because mine wasn’t quite tracking her centiles.

the next visit I saw a different HV who solved all the issues by advising we stopped weighing completely and went on how the baby actually was.

honestly when you take the numbers away and just look at overall health you can’t see what the concern is.

I see no issue with the centile chat. He started off on the 2nd, gained, and is now back to the 2nd.

Looks like you're doing a great job bf.

I'm really interested in the reasoning behind her advice. would be interested to hear any updates op regarded the lactation consultant and again when the HV returns. X

My DD was like this, HV pushed me to top up with formula as well. I did it twice & she promptly vomited after each feed. So I stopped & told HV that clearly she didn't need to be force fed formula & I was going to carry in BF on demand. As long as your baby is continuing to gain weight & feeding well I personally wouldn't be too worried.