is it time to give him formula? and how do i go about it?

[Snowflower]

born 10-5 6lbs and 11 0z
now i have the dr's charts but do not know how to translate into oz...

10-10, 5 days old 6.43 lbs 9.95%
10-19, 14 days old 6.75 lbs 5.28%
11-23, 1mo 18days 8.18lbs 0.76%
12-02, 1mo 28days 8.62lbs 0.42%
12-12, 2mo 7days 9lbs 0.55%
12-27, 2mo 22days 9.56lbs 0.26%

So here I am. (nak) dr is insisting on supplementing. She keeps talking about 'catch up growth' and i don't know what it means. is he supposed to grow dbl time cuz he's so little?
i have seen a ibclc, his latch is good, he got about 2 1/2 oz at a early am app..so i'm on donperidome. been pumping a little. it hurts and i don't get much if any milk.
should i be super worried? i am a wreck. i have some formula, what now??? but i tried to give him some and he does not like it at all. he will take my bm in bottle tho.
this is my 2nd baby..first was slow to gain as well. not as bad tho. tia

[Megan73]

I'm so sorry you're going through this. I've BTDT and it sucks
I do think that it's time to supplement. What your doctor means about catch-up growth is that the longer he goes without gaining well the farther behind he gets and the more he would have to gain to be a reasonable weight for his age. But while your LO's weight gain is low, he IS gaining so it will probably just take a small amount of supplement to get him gaining well.
A couple of ideas...
Why is your pump hurting? If your flanges are too small it might cause pain and reduce your output by compressing the milk ducts. The 24 mm ones are standard but many women find the 27 mm ones more comfortable. You could also consider renting a hospital-grade pump.
How much domperidone are you taking? The standard starting dose is 90 mg a day, typically 3 10 mg pills, three times a day.
Have you checked out Human Milk for Human Babies or Eats on Feets for a milk donor? They're both on Facebook and I bet Portland would have lots of donors.
What I would do is start supplementing a small amount - talk to your doctor or LC but I'd guess half an ounce per feed - plus pumping after feeds and see where that gets you in a week. I would eliminate the bottles and cup, finger or syringe feed or use a supplemental nursing system like the Medela SNS or (better yet) the Lact-Aid.
What you want to do is play with the amount of supplement to get your LO gaining five to seven ounces a week - plus whatever catch up growth your doctor or LC think is appropriate. Renting a baby scale can really help ease your mind.
You may well find that with the dom and pumping you can eliminate the formula and just use BM then taper down on the pumping and supplementing. I was able to get to EBF with DS2 that way.
Edited by Megan73 - 1/1/12 at 7:30am

[Sukhada]

Just be sure when your doctor is looking at weight gain that he or she is looking at the growth charts for breastfeed babies because they tend to gain weight more slowly. You can have a baby that is both healthy and small. Having said that, we do supplement because we had a similar difficulty getting our little one to gain weight - in fact she lost a lot of weight after birth and then kind of plateaued and didn't gain any weight. It kind of broke my heart to give her formula, but I've come to accept it and believe that breastfeeding is not all or nothing. Any amount of breast milk that you're able to give your baby is amazing. Not to mention, the benefits that come from the act of nursing. I use a small feeding tube which I hold/attach to my breast. I put it on after she's finished her feed and still indicates to me that she is hungry. This way, she's still nursing so my breast is still being stimulated to produce more milk and we still maintain our breastfeeding relationship. I found that this was a good way for us to supplement. I also don't get much milk when I pump and I've heard that that is pretty normal. Pumping is not the same as having a baby breastfeed and so, while your baby may have no problem getting milk from your breast, the pump might. Pumping, like breastfeeding also takes some practice and getting used to. It took us two tries to find a formula that worried for our little one. While doctors often say they're all the same, in practice, I find that it's a bit of trial and error finding the one that works for you. We have also found that supplementing with formula seems to make our little one more gassy, even though we use a low lactose formula, so we've started her on probiotics.

[Megan73]

Originally Posted by Sukhada 

Just be sure when your doctor is looking at weight gain that he or she is looking at the growth charts for breastfeed babies because they tend to gain weight more slowly. You can have a baby that is both healthy and small. Having said that, we do supplement because we had a similar difficulty getting our little one to gain weight - in fact she lost a lot of weight after birth and then kind of plateaued and didn't gain any weight. It kind of broke my heart to give her formula, but I've come to accept it and believe that breastfeeding is not all or nothing. Any amount of breast milk that you're able to give your baby is amazing. Not to mention, the benefits that come from the act of nursing. I use a small feeding tube which I hold/attach to my breast. I put it on after she's finished her feed and still indicates to me that she is hungry. This way, she's still nursing so my breast is still being stimulated to produce more milk and we still maintain our breastfeeding relationship. I found that this was a good way for us to supplement. I also don't get much milk when I pump and I've heard that that is pretty normal. Pumping is not the same as having a baby breastfeed and so, while your baby may have no problem getting milk from your breast, the pump might. Pumping, like breastfeeding also takes some practice and getting used to. It took us two tries to find a formula that worried for our little one. While doctors often say they're all the same, in practice, I find that it's a bit of trial and error finding the one that works for you. We have also found that supplementing with formula seems to make our little one more gassy, even though we use a low lactose formula, so we've started her on probiotics.

Great post! I had to supplement both my babies with formula and an SNS and I agree with everything you write.
Two quibbles:
Breastfed babies tend to gain faster in the early months then level off while FF babies gain steadily. The problem with standard growth charts isn't during the newborn period it's when an older BF baby appears to fall percentiles when they're really growing fine.
Also, BM is packed with lactose - that's why formula is, too. It would be very rare for a baby to have trouble one of the components of lactose - it's called galactosemia and it would make them critically ill.

[Sukhada]

Originally Posted by Megan73 


Great post! I had to supplement both my babies with formula and an SNS and I agree with everything you write.
Two quibbles:
Breastfed babies tend to gain faster in the early months then level off while FF babies gain steadily. The problem with standard growth charts isn't during the newborn period it's when an older BF baby appears to fall percentiles when they're really growing fine.
Also, BM is packed with lactose - that's why formula is, too. It would be very rare for a baby to have trouble one of the components of lactose - it's called galactosemia and it would make them critically ill.

Thanks for clarifying these points Megan.

[Megan73]

Sorry to be such a nerd
Great to meet you on-line, Sukhada! It's OT for the OP but I'm always so happy to meet another SNS using mom online. DS1 was just like your LO. He needed about 8-10 oz of formula a day to gain well. I used a Lact-Aid, which is an awesome product for long-term supplementation if you haven't seen it. Happily I've been able to EBF DS2 after a bit of supplementing at the beginning.

[Sukhada]

It's nice to meet you too Megan! I've looked at the Lact-Aid and it looks like a good system. Currently, we're just using a laboratory cup (like the kind you use to collect urine) with a hole made in the cap for the feeding tube. I put the tube in while DD latches and then I tuck the cup into my nursing bra or on the couch arm (we have flat couch arms) and that seems to work. We started, like you, with 8-10 oz and now we're at 6 oz a day. My DD is 3 months now. I figure that we'll either continue to decrease the amount of formula or the LC said that we might continue until she starts solids. 

snowflower - you might want to check out this site http://www.breastfeedinginc.ca/ it's for the jack newman breastfeeding clinic, which is where i went when my DD wasn't gaining weight. they are very much in favor of supplementation, when needed, and have resources about how to do it.

[nikkijames]

I'm also not opposed to supplementation when needed, but also, how are baby's diapers? What is the output like? Is he meeting milestones and seeming content? Stuff like that is really important to take into consideration....

[Snowflower]

good amount of output. 4-6 wet./ day and is skipping a day or two on poopies, but will really explode when it's time. he is very active, alert, smiling and laughing.... just so itty bitty. he is content. i have to set alarms for every 2 hours to feed him cuz he won't complain until  later than that. 

[nikkijames]

I do think you want him to have at least 6 very wet diapers at this age....if you are often getting only 4 then yes I would supplement at this point...

[Megan73]

Originally Posted by Snowflower 

good amount of output. 4-6 wet./ day and is skipping a day or two on poopies, but will really explode when it's time. he is very active, alert, smiling and laughing.... just so itty bitty. he is content. i have to set alarms for every 2 hours to feed him cuz he won't complain until  later than that. 

How are you getting along,Snowflower? It's great that you're feeding him often - that's really important. Output is really only useful as a barometer of weight gain - the assumption being that kids who are getting enough milk to poo and pee appropriately MUST be gaining, too - but weight gain is really the gold standard. Have you been supplementing? Is he gaining?

[Snowflower]

He is gaining a little more :)  i have been supplementing some feelin better about stuff...thank you.

[Megan73]

Great news!