To combi feed or carry on ebf?

[shinypurplesparkleyunicorn]

Hi there, apologies if this is long...

DS is 4 months old and he seems to have an issue putting on weight. Despite this, he’s generally happy in himself and is reaching his developmental milestones.

At the moment he’s breast fed on demand but with 2 bottles of expressed milk last thing at night and first thing in the morning. He’s being monitored by health visitors and a paediatrician. His weight gain has improved with increased breast compressions and massage but it still isn’t where the professionals want him to be. We’ve been told to top up with either more expressed milk or formula.

My question is, should I just confine myself to being strapped to the breast pump for longer or should I give him a few ounces of formula after a feed? Have you had experience of this, if so, how often would you top up? Can you ever retain your breast milk production and use formula? Or would it be best to keep trying to express and bf?

The paediatrician wants to rule out quantity (despite other health professionals confirming I appear to be producing enough) causing low weight gain before investigating possible allergies (DS is possibly presenting a CMPA).

It’s very definitely a personal decision. I personally would persevere, but that doesn’t mean you have to.
Pumping can be hard work so I can completely comprehend why it can be off putting/daunting.

It is difficult to maintain supply when you top up with formula, but it’s not impossible. You just have to be rigid with making sure you’re pumping regularly to keep the demand there.

Could you offer a formula top up, after a BF? So you’re still BF and you’re body is still getting the ‘demand’ but you’re more reassured baby is getting plenty.

What pump do you have? How are you getting on with it? Is it worth considering an alternative?

I had the same thing but DD was younger when they insisted I add in small amounts of formula at every feed as pumping didn't get much out.

She took to it wonderfully however despite doing paced feeding with the bottle then she developed a preference so had to give up breastfeeding at 3 months where she just refused to latch on.

Bit sad about it to be honest and might have done it differently if I had not needed to go back to work when she was 4 months so she would have been on the bottle anyway.

I'd keep EBF but I'd never suggest anyone else do. I really dislike washing up and the faff of bottles. I've given up dairy to help my 6 month DD, have you been asked to do the same?

What you're considering doing is called triple feeding and it sounds joyless and time consuming, look after yourself firstly.

You're doing great, it's not easy

I was in this position 8 months ago. DS wasn't gaining weight, and every person who looked at him just said "stick him on formula". Only problem was, DS refused a bottle of formula completely. I tried different ones, even soya ones, and different bottles but he just wouldn't drink it.

The dietician was still trying to push it so I went to the health visitor who suggested a breastfeed every two hours. That almost killed me and didn't help at all.

Then weaning started early at the paediatrician's suggestion and was awful. DS hates it and clearly wasn't ready. So after that, I ignored all the shitty "advice" I was being given and took things at DS's pace. He starting solids when he was ready and still refused bottles or formula in anything.

He's 1 in ten days time and finally, 3 weeks ago, got above the 0.4 centipede line. He's looking much chubbier, still breastfeeding happily and honestly I'm so glad I took his lead. He still refuses formula completely (I try a bottle every few weeks just to prove it to the dietician who still insists formula is best) and happily eats all food I've tried so far. Ultimately, breastmilk is best and as much as everyone was worrying about DS he is healthy and I didn't force him onto formula.

I also found expressing hindered things, as pumps aren't as effective as baby. I'd ditch the pump and just feed from the breast. I know all the weight issues seem scary but I'm so glad I relaxed and let DS do it how he wanted. I also don't feel guilty giving him a chocolate muffin for breakfast!

Personally I would add a formula feed or two (which I did) and it soon became apparent that I just couldn't satisfy her through bf alone. I managed both for 2 months and eventually stopped bf 2weeks ago. She's steady on the 9th centile now and 6months.

I couldn't express enough, would take over an hour to get 3oz/90 ml from both 😩

I did find it took her a couple of weeks to settle on the formula, it made her extra windy and a bit colic, I switched from sma to hipp which is organic and 'gentle' on the tummy (and cheaper!) which she then settled on immediately.

Most important thing to me is a fed baby, however you choose to do that to support their early development is up to you, you know baby best. Advice from drs and health visitors in my area was so contradictory, everyone had different opinions so I just tried a few things out myself.

If you add in formula and don’t express then your body won’t know to make the amount baby needs. Is he well and alert and meeting milestones other than weight?
I’d continue EBF for now and ask that the weighing and monitoring lessens if possible.

Can you get a supplemental feeding system?

You can feed formula and breastmilk at the same time whilst still stimulating your breasts to keep producing milk. It’s such a good invention!

www.medela.co.uk/breastfeeding/products/feeding/supplemental-nursing-system

Sorry saw this in active. What has caused the concern in terms of weight? Is he below the centiles or has he dropped centiles? What build are you and your partner and what were you like as children?

Sorry for the questions but my first was 50th at birth and 1 year later (stopped bf at 10 months), she was on the 9th and she remained there until puberty. But the first few months when she was ebf, she only put on 3-4oz a week. She just stopped feeding when she was full.

Have you seen an IBCLC? a lactation consultant? Midwives and paediatricians aren't quite the same.

Who ruled out tongue or lip ties?

Knowing what I know now, I would top up with formula, probably the ready-made bottles if you can afford as they are much less hassle. I did the whole pumping for 12 weeks thing and then pumping every night for weeks after and going back I wouldn't do it again. Breastfeeding is great but pumping is the fucking pits and if my DD was getting mostly breast milk then I would be happy with some formula. It's not toxic, and on a diet of mainly breast milk she will be getting all the benefits anyway. She's 10mo old now and we are mixed feeding - she feeds from me overnight and maybe once during the day and then gets a cup or two of formula with her meals, and the difference it has made to my free time and just mentally knowing I no longer have to pump is great.

Also at 4mo your supply is quite well established now, and in a couple of months when baby starts solids it will naturally start to decrease anyway after the first couple of months, so I wouldn't be too concerned about supply. At four weeks, yes, but not four months. As long as you keep feeding on demand, your supply will be where it needs to be.

As CMPA is a strong possibility I’d try going dairy free (you!) before I tried (cows’ milk based) formula.

I had exactly the same thing.

Perfectly heathy baby. At about 4 months dropped from above the 25th to the 0.4th centile.

I was given tips on milk production- eating well, feeding more etc, but it was never suggested I express or top up.

In fact I was told expressing instead of feeding can be detrimental to milk production as your body responds far more to a baby than a pump. I was also told that giving formula would likely improve weight in the short term, but that it may mask any genuine illness.

So i was told to keep bf. And given a referral to paeds. Baby had a blood test to rule out liver, kidney, metabolic, infection etc. Saw paeds who took one look at her, did all the measurements and declared her completely healthy. Said some babies “catch down” and find their own centile a bit later, and that she was meeting milestones and nothing to be alarmed about.

The one question they asked was “if it wasn’t for the number on the scales would you be worried?”.

No. The only reason we were there was because of the scale.

We started weaning at 5.5 m and she started gaining a bit- if you look at her weight chart now it’s a series of “steps”- gained for a few weeks, stabilised, gained, stabilised etc.

She’s still on the small side but very healthy. Started walking at 8 months which didn’t help with the weight gain!

So it’s up to you. I was fairly confident there was nothing wrong, but understand the worry as in those early days weight seems such a big deal and all anybody worries about.

For mu second i didn’t get her weighed. No problems!

Oh I didn't notice the CMPA thing. Yes I think you should explore that first as formula won't make that any better and possibly worse. My friend's son had very poor weight gain and it was CMPA. He didn't actually start gaining well until he started solids, even with her going dairy-free and topping up with dairy-free formula.

Maybe a formula feed before bed would help with sleep? Nothing wrong with mixed feeding provided the bf side of things takes priority and doesn't decrease because of the formula.

If he has a possible CMPA then formula is the worst thing to give him. As you are producing 2 whole bottles of expressed milk, which is a lot, that means your supply is good. Try adding a pumping session in the mornings when breastmilk production is higher and see what happens.

I’m new to this so apologies just trying to work out how to use this. Thank you for all of your replies, plenty to think about.

He had tongue tie which was snipped when he was just over 6 weeks old (he was already dropping on the growth chart). About a month ago he dropped the 2 centiles required to see a paediatrician. (Both of us are fairly small people in terms of weight and height).

I’ve tried cutting out dairy for a few weeks and didn’t make any difference but maybe it wasn’t long enough. I would like the paediatrician to do a test for this but I understand they aren’t very reliable. I also argued that giving him formula top ups would make it much worse if he did indeed have CMPA.

It’s been a long journey, we’ve seen multiple health visitors, a doctor, attended lots of breast feeding cafes, I’ve called the breast feeding helpline a few times too. We’ve also been in touch with and met up with an infant feeding coordinator. I just feel pretty exhausted and very worried about DS but only because of the weight issue. I realise the rash and dry skin can also be sensitivities to all sorts of things.

Thank you again for all of your help, I will speak to DH with all of these replies and see what we’ll do next.