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?

@Maria1982 sounds similar to my situation. Tongue tie was checked by the midwife after birth, GP, HV and breastfeeding support worker and all said he didn’t have one. I am thinking maybe I should just get it cut instead of waiting to see what happens

Op what's his weight gain? Is he following his centile in the red book? Is he above the second centile?

Don't stop weighing him. That's crazy advice. Weighing him is the only thing that will reliably gell you if he's gaining sufficient weight. Just not weighing him is like removing the warning lights on a car rather than fixing the problem.

If he isn't gaining weight then just top him up. If you persist he will take a bottle at some point. Breastfeeding is great but don't do it if it comes at the cost of your baby growing and thriving.

Yay OP so glad it went well. Good luck going forward!

Really glad for you OP. I hope you're feeling more confident now :) honestly the worst BF advice I've received has been from HVs...I don't understand how they can be in their jobs with such inaccurate information! Well done for seeing the LC.

I honestly wouldn’t start topping up with formula and pumping, if you want to breastfeed. It starts to mess up the supply and demand balance and I’m not sure baby need it. Baby sounds fine.

Apologies if I’m repeating but haven’t time to read it all.

Have you had his tongue tie properly assessed by a specialist (not the midwife or health visitor). They need to use their fingers and check for anterior & prosteior (basically one is harder to see).

The reason I ask is -
it causes a fast let down as they don’t latch or suck correctly.
Causes snacking on the breast
can be the sole cause of the reflux as they take in much more air due to the latch.

a few clients of mine had this issue. All resolved once tongue tie sorted. If already cut then might need looking at again.

If you’re topping up with formula I’d recommend expressing whilst doing this.

There is nothing wrong with topping up but I would do two things.
see a lactation consultant
See a new tongue tie specialist who can perform a division whilst young.

Also recommend catching some of your let down before latching and seeing if that helps. It can be very useful for those with a fast let down. I would use a muslin cloth or a shield to collect then store milk

I’m a Neonatal Homecare nurse. I’ve worked his weight out and he has gained 28g per day over the last 7 weeks. When we visit our preterm babies in the community we are looking for a weight gain between 20-30g a day so from what you have said he is gaining perfectly. You are doing an amazing just keep going and don’t let it dishearten you.

Call the NCT helpline on 0300 330 0700 for advice. They have breastfeeding advisors available from 8am until midnight 7 days a week. They will be able to give you tips for coping with a strong let down, for example. Topping up with formula at this age could upset your breastfeeding journey. Keep feeding on demand - you’re doing an amazing job.

I’m so pleased you sought out proper advice. From his chart he looks to be following the curve perfectly. You’re doing a great job.

The quality of HV advice is not good in my experience. I hope yours takes on board the feedback the expert put in your red book, and rethinks her advice to other new mums. It would be good to report her, if you have the energy.

If your child is struggling with reflux and wind and you know why and that it's being breastfed that's causing it, Surely pumping milk and bottle feeding with an anti reflux teat is the best of both worlds here, he doesn't suffer reflux and he still gets your milk and you can monitor his intake. I would get him checked for a tongue tie aswell just incase as that can often cause them to not take enough milk.

@Moonshine160 ive not read the whole thread. But I have read all your comments. Your post resonated with me. I hope I can provide you with some reassurance.

I had a 5lb 12oz baby boy at 40 weeks. He weighed 10lbs at 10 weeks. He was exclusively breastfed until 6 months. Other than I expressed and topped him up from the lid of a bottle, like a cup. So he was sipping rather than sucking & no nipple confusion with a bottle. I really only did this for about a week when he was a week old when the midwives wanted to know what he was having.

I too had a heavy let down and would often end up covered in milk at the start of a feed. I found a squeeze of my boob into a muslin cloth or Breast pad got rid of the first rush and then feed. It was less messy and he had more hind milk than fore milk.

i know what you mean about him looking dinky. My son had a massive head and a tiny bony body. Even at the time I thought he looked like ET ! He bounced below the graph in the book for a long time. Often below the 2nd centile.

at 6 months he was chubby. Till he learnt to move!
he is now a very lean rapidly frowning 14 year old. He is only gaining to average weight for his height because he’s focusing on muscle growth in the gym! He’s also now taller than me.
despite now being a fantastic cook/chef he doesn’t overeat. He knows his limits in the moment and only eats what he wants. This regularly means he eats smaller meals and a bit more later ……… JUST LIKE WHEN HE WAS BREASTFED !!! He doesn’t like me saying that now - but it’s who he is!
I wish I had the self regulation he does..

just keep doing what you’re doing. If his nappies are wet and dirty regularly he’s getting enough.

the only trick I’ve not seen you mention, is giving him a wash to wake him to feed more. Either a damp flannel or a baby wipe down the back of the neck and back to wake him to feed for a few more minutes. You may have to wind and settle him and feed again for 5 minutes. It might give you longer stretches between feeding.

but ultimately you’re his mum. & what you’re doing for both of you will be the best! You’ll get there. You just may or know it until you stop and look back. xx

Health visitors are not lactation consultants. They are advising you that your baby's weight has dropped.

Baby's weight drops anyway but will drop more if you've had a medicalised birth as all the medicine goes through baby too.

Contact la leche League, breastfeeding network and ask for some support with breastfeeding with weight gain.

Do lots of skin to skin and let baby latch as much as they need.

Your body grew a baby for 9 months. It's rare that a mother doesn't produce enough milk to feed their baby.

If your baby is happy, doing wet nappies and poos, and gaining weight, then the HV needs to back off a bit. You are enjoying breastfeeding and babies do not all gain weight at the same rate. My HV advised me to breastfeed ds2 less as he was apparently too fat when he was exclusively breastfed and barely few months old. For DD, they were freaking out that she wasnt interested in solids at 5m. Honestly. Im sure theres plenty of good ones, but some have some odd ideas and just stress parents out.

Sorry if this has already been mentioned. You said you have a fast let down? He’s probably not quite getting enough of the fatty milk. You can express a few mins and then put him on to feed. Also if he’s got reflux, are you using gaviscon?

Haven’t RTWFT but if you can manage it, try lying back/lying down when you feed him. Gravity will help reduce your letdown and make it more manageable for your baby.

From your latest update with the lactation consultants though it sounds like you’re doing brilliantly so ignore the HV and congratulations on your baby 🥰

Great outcome OP.

Just came to say that remember health visiting is an optional service and If you don't like your HV you can request a change of person or cancel them coming if you feel unhappy with their advice (which in this case was terrible)

Maybe you could rent a baby scale for a while and weigh your baby just before and after a feed, so you know exactly how much he drank. This was done where I live (Belgium) a few generations ago. Now people are more relaxed about it, but it is still recommended if there are any concerns. (A baby scale can be rented real cheaply from a pharmacist's or your health provider in Belgium)

You need to seek the support of a breastfeeding/ lactation consultant to support you to continue your breastfeeding journey

You are enough and you are good enough.
You HV is letting you down by thier lack of skills knowledge and experience of breastfeeding

Do not early wean onto solids that's is not helpful and outdated advice and can cause issues for baby

@Purple52 thanks so much for that, our experiences sound similar and you have helped put my mind at ease.

@Herewegoloobyloo1985 thanks so much for doing that calculation, that really helps.

Re some of the new comments - I have seen a lactation consultant who said that he has gained a normal amount of weight since birth and advised not to supplement with formula at this stage. She has written in my red book that the HV advice goes against the NICE guidelines. She also discovered a posterior tongue tie. It’s only a minor one but I think we are going to have it cut to give DS the best chance of feeding properly. I’m still struggling with his latch.

Hi mums, my LO is 9 weeks and has reflux and been having breathholding attacks that we think were triggered by reflux. A week ago he started hysterically crying out of the blue, arching his back, clenching his fists, red in the face and he was like that the whole day. He was fed, nappy changed so no obvious reason for the cry. We thought its the reflux but because he didn’t settle we took him to A&E. they did confirn reflux and we agreed to put him on anti reflux formula for a week and see how he does before trying Gaviscon (I’m really not a fan of medicating him straight away). So we were doing okay for a few days then he started being fussy in the early afternoons, behaving as described above so we gave him Gaviscon (started 2days ago).He still brought up milk after, not so much though, however the screaming carried on. So now we think he has colic on top of reflux, so we went from Cow&Gate anti reflux to Aptamil Comfort plus giving him infacol (started yesterday)
I am worried that he is taking Gaviscon with the Comfort formula (1sachet only) and infacol at the same time😩 just seems to much meds to me at this age.
anyone has any recommendations please or has been in the same boat? I hate the fact that we need to experiment with different stuff until one will finally work, babies just shouldn’t go through this and it breaks my heart!

thank you

My DD was very much like your DS, from about 6 weeks she was a very snacky feeder, only ever fed for around 5 mins at a time but I just fed on demand. I also had a strong let down so she got a lot at the start. I started her on formula at 4 months at the 10pm dream feed, but only because she had me up every 1-2 hours through the night so I hoped it would help her sleep longer, not because I didn't think she was getting enough from me. The main question is, is he having enough wet and dirty nappies in a 24 hour period? If so, then he's getting enough from you. I would definitely speak to an infant feeding specialist though for further advice, definitely don't just take the HV advice as given. Some babies are just snacky eaters, even at 13 months my DD still only has small portions, I weaned her at 5.5 months and she's never been a big eater. You definitely want to be cautious with trying a bottle, they say to wait until at least 12 weeks before you do, otherwise a baby may become confused and refuse the breast. I was very lucky that my DD took both, but not all babies do. Sounds to me like you are doing everything you should be, definitely worth looking at how he's latching, as you say if he's only got a shallow latch then try working on that, but again, this is where a BF specialist can help with latching etc.

Definitely get it cut. Even a small tongue tie can affect teeth and speech eventually, and snoring etc in adults.

I breastfed. It's hard work. Do not feel like your not doing good enough. Keep going, your doing amazing. Your baby gained weight not lost it.

Personally my opinion is that if your baby is happy, not screaming hungry for more milk and gaining weight then I would just continue as you are. It's your baby, not theirs.

Get other advice and join a breastfeeding support group if you can.

Good luck