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?

DD1 was 5lb 6oz & had to be BF via a nipple shield (due my inverted nipples). As a result I was told she wouldn't be able to BF for very long & my supply would dry up if I continued with the shields.

She feed happily for 19 months - always via a shield as even when she got bigger & could attempt more if latch, my nipples never stayed out between feeds. I never found any studies of the newer, thin silicone shields - only ones for the thick, 70's rubber ones so I have no idea where the HVs were getting their "info" from.

The fact that children should stick to their birth percentile for long term good health has been known for ages - the children born in the Netherlands during the Hunger Winter of 1945 were used as a long term study group for this.

This foremilk/hind milk is nonsense.

Implying that breasts produce 2 types of milk is misleading and incorrect. A baby who is BFing effectively will get all the nutrition they need, regardless of how long they feed for. Some are more efficient than others, and have shorter feeds.

Actually 8 15 is over 4kg

La Leche League info here

*This foremilk/hind milk is nonsense.

Implying that breasts produce 2 types of milk is misleading and incorrect. A baby who is BFing effectively will get all the nutrition they need, regardless of how long they feed for. Some are more efficient than others, and have shorter feeds*

I’m fairly sure this was debunked nearly 20 years ago when I fed my first.

I don't think you should be telling the op to ignore professional advice. How about a second opinion
That's really irresponsible

Has she measured his length? If his length is on the 91st centile I could see her point, but if it's around the 2nd then he's just perfectly dinky! Also ask to see the faltering growth policy and check if her advice is in line with that (which I highly suspect it isn't...)

I would get a second opinion definitely. You shouldn't ignore what she's said but get advice

With DC2 a HV told me he wasn't gaining enough weight and I needed to top up with formula. However, DC2 was a bottle refuser so that wasn't going to happen.

I made an appointment with my GP (who had a paediatric background) who checked DC2 out and told me he was fine and top ups weren't necessary.

So I never went back to the weight clinic and never saw that HV again.

I ended up weighing nappies over a 7 day period (then deduct the weight of however many dry nappies) to figure out how much dc were 'getting rid of'. Then got dc weighed again in a week.

It showed that I was bf-ing MORE milk than the ff recommended amount.

Isn't the red book based on ff babies?

@mathanxiety do you have any formal BF qualification? With your experience you would be great as a peer supporter / BFC and the evidence based education you would gather whilst training would mean that you could offer accurate support to families.

My 5 month old had dropped some centiles and it was suggested that I needed to give him formula (by the health visitor) however he won't take a bottle. I was referred to the specialist infant feeding team who watched me give him a feed and gave me advice etc and said that I absolutely did not need to give formula. They were brilliant, do you know if there is a feeding team that you can be referred to in your area?

You are doing the right thing. Trust yourself. You feed him on demand. What use is is adding a bottle. Well done for this journey it's so special. My baby is weaning and doesn't breastfeed more than ten minutes now and it's so sad

What a shame your hv doesn’t have the knowledge or skills that’s he should have . Her practice is bizarre and if there was a feeding issue (and it’s hard to see that there is) then there are lots of bf suggestions. Hope you have. A much better time with the LC.

When it comes to breastfeeding then pretty much anyone with experience of doing it can offer a second opinion as valid as the advice OP got from this HV.

Baby is following his centile line. That's the biggest indicator, along with plenty of wet and dirty nappies and little pain feeding that he's doing fine. All of which OP has confirmed.

My DS went from the 91st percentile down to the 9th and my HV never once suggested I top-up. She encouraged me to continue with exclusive BF as he was content and plenty of wet nappies. He’s a slim but tall teen now.

3lbs in 7 weeks!?! It's been a while since I had mine but my son didn't regain his birth weight for three months (he was a whopper though) and no one said anything - oh wait, possibly because I didn't have a HV as there was a big shortage! Well if that was going to be their advice I'm glad I didn't.
You don't need to top up (though do get a second opinion) - I'd say if your baby is gaining and is content leave it. HV do say some rubbish ;like at the clinic we went to my son was apparently teething from a few weeks. He didn't get a tooth til 13 months.

I dont think you should top up with formula, as long as baby feeding, and producing wet and dirty nappies and is content you are doing fine.

@Manamala thank you for your support, it means a lot.

Thanks for all your kind comments. I will update tomorrow with what the lactation consultant says. For now I’m just going to continue feeding on demand.

Im not sure what his length is as she said they don’t measure it so early but his head circumference is on the 9th centile, same as it was at 10 days old. He just looks dinky all over to me.

I was told to stop giving him breast milk and use formula because DS 'wasn't putting on enough weight'. He was exclusively feed breast milk by expressing as he wouldnt latch. He was tracking the curve perfectly. So continued. I got the same again at 8months, though he was dipping on the curve in the red book. He was fine and simply wouldn't take any more milk. I had bags of the stuff in the bloody freezer. I could also tell the HV exactly how much he was having. She didn't know how much was right for breast milk though. Only formula. And was saying it wasn't enough even though when we looked it up we found info saying it was. We then looked a bit further and found that the curve in Norway was different to the uk. DS was perfectly tracking the Norwegian curve.

We then worked out the issue. The British curve reflected the low breast feeding rate. Norway with a much higher breast feeding rate was more appropriate for us to look at.

At that point given the HV freely admitted she had no clue about expressed breast milk we ignored her and simply made sure he ate as much as he could and as much as he wanted. I literally couldn't stuff anymore into him despite trying.

At my twelve month appointment a different health visitor had a massive whinge at me for still giving him over night feeds and said I should be weaning him completely.

At this point I was bloody livid. No information they told me was helpful and tbh they only caused me massive amounts of unnecessary stress and they didn't actually have a clue what they were talking about or what recommendations actually are.

Keep weighing him and checking nappies and for behaviour. If you see drops then you will need intervention but genuinely considering his low birth weight, I don't think you need to be concerned just yet.

I swear the HV just wanted babies on formula cos it made their life easier, and they didn't give a shit about individuals. It was factory conveyer belt mentality.

I genuinely don't know what the point in HV are. Properly trained professionals rather than made up bollocks ideological idiots would be helpful.

I came across one who was helpful out of about 6 or 7 who were just anxiety inducing wastes of judgmental space.

If you are concerned see a GP who has a fucking clue. They will most likely tell you not to worry.

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

The OP's baby is exhibiting what she is describing as 'symptoms of reflux'.

@Manamala have you tried offering a top up to a baby that doesn't need it? They won't take it. Mine very clearly did, as she had 8 x 1.5oz top ups per day at the end of the first week, under paediatrician guidance, which she took after BFs. I then followed her cues about the frequency and amounts, ignoring the HV who was very anti-formula and poorly informed.

You ALWAYS make sure the baby is fed, THEN figure out what is going on. It even supports that in the LLL book! In this case, I'd suggest plotting the weights on one of the baby tracker apps as they're much more reliable than the paper charts and easier to read (and HVs are notoriously bad at plotting charts!). That will indicate whether there is a problem or not. It sounds like it might be ok, but it's better to make sure because the consequences of not getting enough milk are dire.

Then there are a number of ways of accessing help. It sounds like the OP is in touch with one. In person is better as they can check the latch properly. That can hopefully get to the bottom of whether there is a problem with the latch, or a TT, or whether the OP had risk factors for low supply. Although some BFing support isn't great - I had an IBCLC miss signs of dehydration, for instance!

Good luck OP and please don't worry. Even if you do have to use formula it's perfectly fine to BF alongside it for as long as you want.

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

I agree this is not good advice. Bottles are easier and mine learned very very quickly that the breast was hard work and refusing would lead to less work (bottle). It was a job to not only stop the top ups but to get her back on the breast at all.

she always, always “glugged down” a bottle. When I stopped offering one she stopped looking for it and was fine with breast only.

i figured it was similar to if you’re full after a meal. Someone brings out desert and oh go on, you can squeeze in a bit more.

If I did have to top up with formula ideally I wouldn’t want to have to introduce many bottles per day. With my first DC I combi fed and he ended up having three “breastfeeding strikes” because he quickly developed a bottle preference. In the end we had to stop bf’ing as he was totally refusing in favour of the bottle. Funnily enough he gained weight quicker when he was breastfed than when I solely formula fed. Although combi feeding has worked for many mums for me it didn’t and I found it stressful, hence why I was really hoping so solely breastfeed this time to avoid the same happening again. That’s why I’m so upset by what the HV said today.

@RidingMyBike

You ALWAYS make sure the baby is fed, THEN figure out what is going on. It even supports that in the LLL book! In this case, I'd suggest plotting the weights on one of the baby tracker apps as they're much more reliable than the paper charts and easier to read (and HVs are notoriously bad at plotting charts!). That will indicate whether there is a problem or not. It sounds like it might be ok, but it's better to make sure because the consequences of not getting enough milk are dire.

The OP’s baby is fed. The OP’s baby’s weight has been plotted and it is tracking the 2nd centile. The OP has first hand experience of bottle feeding causing an end to BF before she was ready to stop. Top ups are very useful in some cases and can save a BF journey. But indiscriminately throwing them at all situations is not wise and can be harmful.