16 week old drinking less than half recommended amount

[Bluesea14]

Hi, looking for some advice on how to get my lg to drink more milk. She is 12.5lb so needs around 840ml/28oz minimum.

I currently combi feed with Kendamil every 2.5-3 hours and she has breast at the 5am, 11am and 4pm feed. For 11&4 feeds I also offer the bottle as my supply is low but she is only takes around 30ml and even that's a struggle. Her biggest bottle is 4-5oz at 7/8am and she usually drinks this without any issues.

Does anyone have any suggestions on how to make her drink more or another way of combo feeding so she can get the best of both? She's only gaining around 15g a day and dropping percentiles (from 80 to 30 to 22) so she really needs the top ups otherwise she will likely drop another percentile. The most she will drink is 18oz a day.

so far we have tried -
6 different bottles
tongue tie cut
faster teets
distractions while feeding/no distractions
warm milk/cold milk
expressed milk
offering more 30 mins later
waiting longer inbetween feeds
pace feeding

She also has a bit of silent reflux so I have to hold her upright after a feed but it's not major so she can be put down/sleeps fine. If we try and give her more than she wants she always sicks it back up or holds it in her mouth and spits it out 5 mins later.

thank you
X

I should also add that she is very alert, happy, smiley, lots of wet and dirty nappies x

Offer her milk every 2 hours from the start of one feed, so start feeding at 12 then offer her milk again at 2.

Thank you I will try that!

You don’t need to give her the amount that’s recommended for a fully FF baby if you’re Combi feeding.

I would give one of the BFing Helplines a call and ask a BFC who will have all of the latest, evidence based, information.

Have you got the numbers?

You won’t know how much she’s getting from each bf.

Have you considered bf more.

She's only putting on a very small amount of weight and has dropped from 80 to 22nd percentile so I expect she's not getting a lot. She empties each boob in around 3 minutes x

I don't have a good enough supply to bf more. I've tried but she doesn't get anything out and ends up crying then refuses the bottle, so basically misses a feed x

What I would do if I were you is to set aside 4 days. Sit in bed or on the sofa. Feed her every 2 hours from the breast, both sides. Drink lots of water. When she’s done both sides, offer the first side again. Do that literally all day with lots of drinks and snacks.

How do you know if she is “emptying the breast” in 3 minutes? More than likely, that’s the initial let down of fore milk. The breast will then “feel empty and floppy”. It’s not empty. You keep making milk if baby keeps asking for it. But if you’ve been stopping there, you’ll not make as much. You just literally need to keep feeding beyond that point every time as long as possible. The hind milk that comes after that initial few minutes is the fatty putting on weight milk. That’s the milk you need if she’s dropping centiles.

There is no harm in offering a bottle every 2 hours after you’ve done all the above, but I wouldn’t stress about quantities. I’d expect her to be having 1/2 to 1/3 of what it says on the tin if she’s also bf.

Hey, thanks so much for your advice. I don't want to bf exclusively i just want to be able to get her to drink the bottle. I can tell they are empty as she gradually stops swallowing , sucks for a while and then comes off, if I try and express after I get nothing. I only bf 3 times a day so I wouldn't expect to have a huge supply x

Should also add if I try and put her back on after she comes off she will suck, not swallow and then eventually give up x

It might be worth looking into medical treatment for the reflux and potentially considering cmpa

My daughter fed very little due to reflux and multiple food allergies. At 16 weeks she went down to only breastfeeding for a total of 1-2 minutes during the day but fed better overnight all due to reflux and allergies. Not wanting to feed became and early sign I had eaten something she was allergic too.

She had slower weight gain too. She was following the 9th percentile but jumped to the 25-50 th percentile once I removed dairy and soya and she started on high dose medication for the reflux