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?

If you aren’t expressing much, have you checked that the flanges on your pump fit you correctly? Incorrectly sized ones extract significantly less milk! Also make sure that all of the pump parts like valves are new, they need replacing regularly (monthly if you are pumping often)

I didn't take mine to be weighed after my 6 week check, apart from needles. An alert, healthy baby with plenty of nappies is enough.

you know your baby better than anyone and you’ll know whether he’s happy and thriving.

HV are more often than not just interfering. You do not have to see one of you don’t want to.

continue breastfeeding if that’s what you want to do - as long as he’s continuing to gain weight, he’s happy and there’s plenty wet nappies then there is no problem

Just as an update. I managed to express 3oz
milk yesterday afternoon so DH tried to give this to DS about 30 mins after a feed and he wouldn’t even take 1oz, he just wasn’t hungry. He then had a normal 10 min breastfeed just over an hour later. I am worried about what the HV is going to suggest next week if he hasn’t gained the weight that she’s happy with.

You don't need to do anything OP, your baby's weight gain sounds fine. And he's adding which is great. I had the same issues constantly thrown at me and by 4 months my tiny underweight little thing was a chunk. He took a 3 months to get into breastfeeding well. I never topped up as I knew it would damage my supply, I kept going on demand and sometimes would tickle his feet etc and encourage him to empty the breast. Sometimes he'd chuck it up other times it would stay down. Definitely get a second opinion.

Do you actually have to keep seeing the health visitor? Seems a bit strange to me that you have all these appointments, I never even met mine! And my baby was never weighed after the first two weeks.

@Moonshine160 have you tried nipple shields? Mine had such a shallow latch till 14 weeks. Nipple shields are the only way I continued breastfeeding. One day at 16 weeks I just stopped and he never realised the difference and by then had a good deep latch. No one ever found a tongue tie or issue and I saw so many people. Something was definitely wrong as he was hurting my badly and no one knew why. Magically at 16 weeks when his latch deepened it no longer hurt at all. That's also around the time he rapidly gained weight (9th- 85th centile).

Your baby is following his birth curve so I would do what PP said and just get him weighed weekly for ease of mind.

Try not to worry @Moonshine160 , you can just nod and say ‘ok’ to whatever the HV says and then do your own thing. If they want you to come back weekly for weighing you can tell them you’re going on holiday for two weeks/going to stay with family elsewhere and will take him to a clinic to be weighed when you get back. Be vague. Don’t make another appointment. You’ll just fall off their call list.

This. Honestly. As I say they are creating anxiety where there is none to be had.

The baby won't eat more cos the baby if its full. You can't force feed a baby.

If the baby is continuing to gain weight and is following the curve ignore and don't listen to her bullshit advice about top ups. You know it leads to problems of its own.

Cover your arse with a GP trip if she's difficult. GP will just say to continue what you are doing.

If nappies aren't right or there is a failure to gain weight and the baby isn't alert that's a different story. But nothing really is suggesting there is a problem apart from a feckless hv who thinks top ups work (they don't).

@greenerfingers i haven’t tried nipple shields no but I’ll look into that. Even though his latch is shallow it’s not particularly painful, I get sore when he pulls on and off all the time which I think is when letdown is too fast for him.

My baby has a shallow latch, always has had. I tried flipple, breast sandwich, all the different holds etc etc, even if I did get more breast tissue in her mouth she would pull back. She’s fine. Feeds well, weight gain and nappies fine, no pain for me etc. It’s not always a problem.

My letdown is like a burst pipe, it will spray anyone in a metre radius. My baby nearly always pulls off when it comes (unless she’s very sleepy) I let it spray into my breast pad until it calms down then she will relatch.

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.

That's interesting and I'd wished I'd found that fact out years ago.

We were first given ff charts - even though bf charts were supposed to be used - but even with UK bf charts my children tracked down the centiles. I'm sure there supposed to be much more of a general guide than some people seem to use them as.

Later on ff niece and nephew also tracked down the centiles from their birth weight - large babies seem to be a think in DMum family - and we know it wasn't gestational diabetes as were had full checks as Dad an insulin dependent diabetic.

Thinking about it now I suppose any bf babies with greater variation from expected ff growth curve would be under much greater pressure to switch - thus skewing data for bf charts.

Anyway Moonshine160 I hope the lactation consultant can provide the reassure now needed.

My HV told me my iugr baby needed top up at 6 wk check. She was talking BS. I was in tears. Hubby luckily had some sense that day and said no and to carry on bfing, which I did. She went from 0.04%ile at birth to 75%ile at 6 months.

Stick with your guns. You don’t need to follow every recommendation from the HV. Kellymom website is amazing for all questions bfing related.

Just another thought to consider (sorry if already mentioned). Try sticking to one breast for a period (eg 2-3 hours) for each feed within this time, then switch for the next feed and keep the second side for 2-3 hours (or longer if needed). It might make you feel uncomfortable and engorged - and you need to be alert to mastitis - but it would increase hind milk consumption without changing baby’s feeding pattern.

Hi everyone. I’ve seen the lactation consultant. She’s also a midwife and tongue tie practitioner and was absolutely amazing. It turns out DS has a posterior tongue tie. She hasn’t recommended to get it cut at this stage as she thinks the main issues are his latch and my positioning and once she guided me he fed so much better in her clinic than he ever has at home (although still for only a few mins!). She’s said to give it a couple of weeks to see if there’s improvement and if not then it’s best to go back and get it cut - although from reading about it online I’m not sure whether to just get it cut regardless?

She has written some notes in his red book for the HV and referred her to the NICE guidelines stating that any feeding intervention is not necessary at this stage. She filled me with so much more confidence to carry on exclusively BF.

She also observed a couple of feeds and said the 10 min feeds are not an issue as I have a plentiful supply and very fast letdown.

Thank you so much for all the advice and support on this thread.

That's great OP!

Ah, brilliant update! Glad she was good. Health visitors are the biggest waste of space and money.

Id always recommend having any tongue tie cut - healing is much more difficult the older they are, when they put their hands in their mouth etc

She's literally written a message to the HV saying she didn't know what the buggery bollocks she was talking about. Take note of that and have more confidence in yourself.

Your HV will now either back off completely or double down. Ignore if she does the latter. She's demonstrated her lack of knowledge and someone else with professional qualifications is verifying that.

Yay!!! So glad to see your lovely update. Lactation consultants are worth their weight in gold !!! (Honestly, it’s such a shame some HVs are quick to suggest/push formula..)

PS my son had posterior tongue tie, not spotted by midwives or HV (despite concern about weight loss as a newborn). We had it snipped privately at six weeks and it was transformative to breastfeeding.

Great news! Well done, @Moonshine160 ! Good HVs are worth their weight in gold but they are so rare. Glad your LC has been so supportive and hopefully your HV backs off now!

@Nowisthemonthofmaying if you have a prem, IUGR, or poorly baby, you often go onto an enhanced HV service, which means more visits. Unlike a lot of HV, mine was amazing and has got me lots of extra support as DD was IUGR and then had sepsis at 24hrs old. We had weekly home visits until DD was 12w and her weight had stabilised. Then monthly home visits until the 1yr check to monitor any long term impacts of the sepsis. But if your HV is a bit rubbish, i can see how that wouldnt be wanted.

Fantastic news. Getting that 2nd opinion was definitely the right way to go.