Help - how to offer formula to my 5-month exclusively breastfed son

Laura - posted on 06/25/2012

My thought is that he has just likely settled into his own growth curve. Breastfed babies often gain weight really rapidly in the first months and then slow down. I'll bet your doctor is using conventional growth charts and not one for breastfed babies. If you are feeding on demand, he is producing wet diapers and meeting all his milestones and he is still gaining, even if just a little, then I would be hesitant to add formula into the equation.

My sister is going through something very, very similar and luckily her doctor is not worried and asked her NOT to add formula or start solids early.

Here is a good link and you can plot his growth and maybe that will ease your mind.

http://kellymom.com/health/growth/growth...

Hugs.

Catherine - posted on 06/25/2012

I have 4 girls, and the second one has always been a lot lower for her weight than her height (at her 4 yr old check, she had shot up to 90th percentile for height but just about dropped off the bottom on the weight). She is now 10 yrs old, very active, bright and still painfully thin even though the amount of carbs & protein she can put away puts many an adult to shame, and has done since she was about 2 yrs.
We don't really know where this gene came from.
I absolutely agree with former posts saying that if he's sleeping well, and developing well, then the doctor can take a chill pill.
The 'experts' have to protect themselves as much as anything & this is not always actually in the best interests of baby or mum.
The advice I got from an experienced nurse at above-mentioned 4yr old check, was that if they are having a massive length/height growth spurt, some kids just don't put any weight on because their body is a little busy. Baby's and kids apparently usually grow first in head circumference, then on down the body. With our 'skinny' girl, it's the other way around; her legs grow first, then the rest, then later she puts on a little weight, then just as you think she no longer quite looks like an Ethiopian human aid advertisement, her legs start again....

Margarita - posted on 06/24/2012

I am reminded of a friend of mine who's daughters were both in the upper percentiles at birth (I think they were both 8.5 or 9 lbs) but while the first one grew quite steadily and is still in the upper numbers by height (not so much by weight anymore), her second didn't gain quite as quickly and the doctors were concerned it was "failure to thrive" - meaning she wasn't growing and may not be getting the nutrients she needed. Fast forward twelve years, and baby number two is still skinny as a rail and not particularly tall, but it's not from lack of nutrients! LOL. She eats everything in sight and is quite healthy and athletic, just small. Mom was never particularly tall, and dad was never particularly heavy, those are just the traits she inherited from each.

My own daughter was always in the lower numbers, and at her two year checkup, the doctor was concerned she was behind her own growth curve and had me come back in 3 months rather than 6 to have her height checked again (she would have just had me keep an eye, but as it was summer, it's a lot harder to see growth spurts in shorts than long pants). She'd grown some more, still less than in the past, but doc wasn't too concerned. Then at her three year check-up, the nurse actually measured her twice because she couldn't believe how much she'd grown all of a sudden! Basically, as Sally pointed out, children don't grow in a straight line, they grow in spits and spurts. One day they will be tiny, then grow on you overnight, then seemingly not change for a while, then grow on you again, usually right after you bought them clothes that will no longer fit. LOL =)

Anywhoo, on to the actual advice part. If, and only if, you want to introduce formula, I would do it after a feeding and only if your breasts are empty and baby still seems hungry. You mentioned, that your baby sometimes turns away, which usually means he's full, so he may just not be doing much growing now, but may be ready to do it again later. Have you introduced a bottle at all? Tommee Tiptee (sp?) makes some bottles that are supposed to mimic the breast, including stretching and contracting). I believe Evenflo also makes some bottles called Breastflow that are supposed to be closer in shape, etc., to the breast. We did just fine with Dr. Brown bottles, but for a brief moment it looked she might change her mind and not like them anymore. Mostly they were with milk I expressed, but occasionally they were with formula if the breast milk hadn't thawed. I do understand your concern. According to my mom, I lost interest in the breast once I got the bottle, but it had more to do with the fact that milk flows faster from a bottle than the breast and I was apparently more interested in other things!

I would go ahead and do the tests. You will either find out that there is a problem and be able to correct it early, or most likely, you will get some peace of mind. Heck, your doctor might find out that the blood counts are nice and high and that he's doing just fine. As for increasing your production via nutrition, what you need is not necessarily more fluids, but more protein and fat. Remember that you need more calories to feed a baby than you need to make one. I was actually drinking whole milk for the first 18 months just to keep weight on. Don't force yourself to eat if you're not hungry, but do try to make sure you get plenty of nutrition when you do eat. Also, make sure you get plenty of rest (not easy when you have a baby and are worried, but it's quite helpful in keeping you healthy and in your milk production). I also agree that a lactation consultant would be very helpful in increasing milk production.

Good luck ;)

Maren - posted on 06/24/2012

Sometimes I believe doctors rely too much on the weight and and not enough on everything else (and for a new mom it can be tramatizing). My sister went through the exact same thing with her oldest. The dr was not happy with weight gain, and had her start using formula around 4 months, and by 6 months she was no longer bfing, and now at 7 she is still extremly thin. Genetics also has a lot to do with it. If you his father or anyone in your family is naturally very thin that can have a lot to do with why he is so thin. To me he shounds like a very happy, very healthy 5 month old.
As he is 5 months old it is ok to even start solids, rice cereal, infant oatmeal, and even pureed fruits and vegies (avacados are an excelent sorce of fat). I would rather go that route as he will still want to bf with those as apposed to formula.
But before starting formula I would deffinatly talk to other drs or like some other moms have said lactation consulants.
Best of luck to you.

Sally - posted on 06/19/2012

Growth charts were invented in the 1950's when it was a point of pride to have the fattest baby possible by stuffing any pureed anything you could get down their throat as often as possible. Some new ones for healthy breastfed babies have been made since then, but very few doctors even realize they exist and so don't have them.
Because breastfed children are getting the nutrition they need instead of being forced to overeat and because breast milk is so much healthier than formula, many breastfed babies will measure "small" on the charts. Nurse him when he wants instead of on a schedule and as long as you get enough wet diapers and he is acting happy and healthy, don't worry about it. Giving him formula is the fastest way to screw up your milk supply and is not nearly as good for him as your milk is.
Also babies don't grow on a nice smooth curve like the charts show. They'll hang out for a while, then get fat overnight, then hang out for a while, then get tall overnight, and repeat. They also don't always have their growth spurts at times that are convenient for the doctor to measure. My older daughter scared her doctor by being at the same percentile for two years then dropping 20 points between checkups. She had a growth spurt the next week and was suddenly right back where she "belonged"
Good luck

Celeste - posted on 06/18/2012

I'm in the US so I'm going to convert this into pounds LOL

"My son has a birth weight of 3860 grams and a birth length of 52cm. A really big boy. At day 3, he reached his lowest weight of 3570 grams. At 2 months, he was 5760 grams and 60cm. At 4 months, 5910 grams and 67cm. It was at this time I begun to worry about his weight. "

birth: 3860 g=8.5 lbs 52 cm= 20.4"

lowest weight: 3570 g =7.8 lbs

2 months: 5760 g = 12.6 lb

4 months: 5910 g = 13.02 lbs

You need to look at the overall picture and from my calculations, his weight gain is GREAT!! You want about 1 lb per month from the LOWEST weight, which is 3570 g (7.8 lbs) At 4 months, he's almost doubled his weight! I don't think you need to worry about his weight gain at all.

"To ascertain how much he ate per feeding, I weighted him before and after the feeding at the doctor’s office. He gained a weight of about 100 grams after the feeding. Since he got a little distracted and often looked around when we were out and I breastfed him, I thought this milk intake was normal. Based on the fact, I guess the problem here is because I fed him for a short time so he could not eat the more nourishing hindmilk"

Since milk intake varies througout the day, it's kind of hard to ascertain with one feeding how much he's gaining.


As far as hindmilk. The more "emptier" your breasts are, the fattier your milk is. And this is why it's important to nurse on demand and not on a schedule (routine is OK though). It doesn't turn to hindmilk at a certain amount of time. Here's more info about hindmilk/foremilk:
http://kellymom.com/bf/got-milk/basics/f...

Honestly, I don't think there's a problem here. Your baby seemed to gain weight pretty rapidly at the beginning and he's beginning to slow down which is pretty typical.

But, if you want him to get tested, maybe that will give you some peace of mind..

Maggie - posted on 06/17/2012

Thanks so much for your advice!

My son has a birth weight of 3860 grams and a birth length of 52cm. A really big boy. At day 3, he reached his lowest weight of 3570 grams. At 2 months, he was 5760 grams and 60cm. At 4 months, 5910 grams and 67cm. It was at this time I begun to worry about his weight.

To ascertain how much he ate per feeding, I weighted him before and after the feeding at the doctor’s office. He gained a weight of about 100 grams after the feeding. Since he got a little distracted and often looked around when we were out and I breastfed him, I thought this milk intake was normal. Based on the fact, I guess the problem here is because I fed him for a short time so he could not eat the more nourishing hindmilk. Then I increased the feeding times and fed him 7-8 times per day. For each feeding, I let the baby suck the first side for about 25-30 minutes, then 10 more minutes for the other side, then 3-5 more minutes again for the first side. Sometimes the baby pushed my nipple out before the feeding ended. Sometimes the time for one side was up and he did not push out, I had to pull my nipple out(if i did not, he may suck for an hour).

Just as I mentioned before, one month passed, at 5 months, he was 6065 grams and 70cm. Only gained a weight of 150 grams from 4 month to 5 month after I made so many efforts. It seems that he does grow, but only in length, not in weight. According to his growth chart, He was in the 95% percentile for height but only 5% for weight.

If he has a good sleeping and is well fed, he is very active. When he is awake, he kicks his legs, waves his arms. At 25 days old, he could lift his head up at tummy position. At 4 and a half months, he could roll over from tummy to back and vice versa. He used to poop 1-2 times per day. Occasionally once for around 3 days.

Before he was 2 months, I fed him on demand. From 2 months, I tried to set up a routine for the baby. Regularly, I fed him 6-7 times per day. Besides these regular feeding times, if he showed signs of hunger(when he was fussy but showed no signs of sleepiness and could not be calmed down by hugging, I assumed he was hungry), I would feed him.

I really don’t know why he could not gain much weight for the past 3 months. The doctor suggested that if he still could not gain much weight after offering formula, I should take him to have a blood test and urine test to make sure he does not have anemia or have an infection, both of which may have an effect on his weight. I readlly don't now what to do

Dove - posted on 06/17/2012

He gained as much in one month as he did in two, so you are heading in the right direction. I, personally, feel that adding any formula will just sabotage your breastfeeding efforts.

Celeste - posted on 06/17/2012

I agree with Amy, I'd find an IBCLC because she'd be more knowledgeable about breastfeeding..

A couple of questions:
-Can we get a weight history? Starting from the *LOWEST* weight as it's normal to lose weight at birth..
-Are you breastfeeding on demand or on a schedule? Are you letting baby decide when he's finished or are you taking him off at a set time?
-Is baby meeting milestones? Active? Happy?
-Was he sick in the past?
-Is he tongue tied?


I honestly don't think it's your supply because your baby has plenty of diapers. I don't think that formula is the answer. Find a LLL or an IBCLC in your area.

Formula is not more flavored, and many babies will reject formula after being on breastmilk (breastmilk is more sweet).

Tina - posted on 06/17/2012

I would get your breast milk tested to see what your fat content is before doing anything. Also, if you supplement with formula, keep pumping because you never know if that will cause issues, too. Try block feeding. You offer one breast, then offer that breast a second or third time, as well. This makes them get more hind milk which is the fat that they need to poop and grow. (Is he pooping good?) You might just have a lot of foremilk (wetting diapers). Keep nursing and check your milk. Then you can make an informed decision. If you start supplementing, feed him formula and then pump that session and freeze it.

Amy - posted on 06/17/2012

Before offering formula I would reach out to a lactation consultant to ensure your son has a good latch, most will weigh the baby before and after a feeding to see how many ounces they are taking in. Since your son has plenty of wet diapers and you don't say anything about being fussy or lethargic it's possible that he's just a smaller guy, you don't say exactly how much he weighs only that he hasn't gained much in the past two months.

I'll be honest with you most moms who breastfeed find it difficult to introduce formula because it's not as sweet as breastmilk. If you are going do offer it I'd offer it only after you have breastfed and never use formula as replacement to a feed or else you will see a dip in your supply. I worked full time so my daughter had to take bottles I found Playtex Ventaire wide nipple bottles worked best for us. We never switched off of the 0-6 nipples on them, that way she had to work just as hard at the bottle as she did actually breastfeeding. She's now 2 years old and has just about self weaned except for one feeding.