Considering supplementing--talk me out of it?

[loraxc]

DS is 12 weeks and has/had a posterior tongue tie. He has just had it clipped but thus far has not "realized" this and is still sucking incorrectly. He has dropped from the 75th % to the 5th. I can live with this, as he is gaining a bit better now, albeit slowly. But I am starting to worry about his development. He is simply weak--he is actually very long, so his little limbs are long and skinny and he has "lollipop head." He has poor head control and cannot lift his head when on his stomach. More than that, though--my MIL is visiting, and with someone else here I realize that pretty much all DS does is nurse and sleep. (Nursing takes him 45 minutes at a time, usually, if not more, and he nurses every hour and a half or so when awake.) His active alert periods are very short. He just doesn't have the energy to do much other than get his calories in. I am not sure this is okay anymore now that he is 3 months. I feel like he should be learning more about the world and practicing more movement. Some part of me is feeling like we should supplement just to get him going longer between feeds and having more time when he is not at breast or sleeping. Am I off?

The problem isn't really that I have low supply, FTR--it's that he works too hard to get his milk. I don't pump very effectively or we could try more bottle feeding of EBM.

He has not had any formula thus far. His sister has allergies and asthma, though not food allergies. She was supplemented in the hospital. I would do almost anything to keep him from developing her health problems, and keep thinking "virgin gut, virgin gut..." But at the expense of his development?

[justthinkn]

Do you want to be talked out of it, or do you need reassurance that this is a decision you can make (either way), that you can trust your inner mom-sense? I cried for a week and did a lot of soul-searching before beginning to supplement because of supply problems - a different situation to be sure. But the process itself was so transformative, as I examined all the reasons I did and didn't want to supplement, and finally realized that only I was the expert on what my child needed and what was best for my family. (DD was borderline with my low supply, so both LC and ped said whether or not to supplement was up to me. I feel confident, though, that she would have eventually been FTT - there was no more improvement to be had with my supply.)

Anyway, you may have good reasons to want to supplement that override "virgin gut" (and probiotics helped me feel less worried about that loss). I think only you can know that. :

[alegna]

Things I would do *before* supplementing with formula, in no particular order:

work on pumping more/better- more pumping sessions, better pump, etc
add supplements to increase supply
breast compressions while nursing
supplement with pumped milk (not bottles- finger feeding, syringe feeding, cup feeding sns etc)
look for donor milk (see above for methods)
do a couple of days of -stay in bed and nurse like crazy
see an LC and/or SLP about training him to suck correctly

good luck!

-Angela

[ccohenou]

I won't try to talk you out of it...I think your instincts about his weakness and lethargy are right on. Do what he needs, hopefully in consultation with a knowledgeable HCP.

[Ruthla]

Honestly, with weakness and lethargy at 3mo, it sounds like he needs more milk than what he's able to get at the breast.

I'm not sure I'd go with a bottle or not- one the one hand, he's already old enough that bottlefeeding may not effect his desire to nurse, but on the other hand BF still isn't "well established" if he's not nursing efficiently. You could try using an SNS to get more milk into him more easily while he nurses, or use a syringe or a cup to get mroe milk into him before, after, or between nursing sessions.

Since you have an adequqte supply, the first thing I'd try is to pump after feedings, and then immediately feed him whatever you were able to pump. Even if you only get half an ounce per pumping session, that's half an ounce more than he's getting on his own.

If what you pump doesnt' seem adequate for the amount he needs to be supplemented, see if you can get ahold of any donor milk. If not, I'd go with a hypoallergenic formula.

[Chinese Pistache]

Originally Posted by ccohenou

I won't try to talk you out of it...I think your instincts about his weakness and lethargy are right on. Do what he needs, hopefully in consultation with a knowledgeable HCP.

I agree. Last week when my ds wasn't pooping or peeing and I realized my supply had dropped due to his not sucking properly, I had to supplement. I started crying at the grocery store in the formula aisle and then, I cried non-stop at home for a week. I hated giving it to him, but he was weak and my supply wasn't back up yet. I was pumping around the clock and taking supplements, at the same time, so fortunately, I only had to give about 6 ounces over 4 days, but it was very hard. I've nursed 3 other children into toddlerhood, so this is beyond frustrating.

We're still far from being out of the woods as far as nursing is concerned, but I feel really grateful that I had the option to give him formula at all. He's doing SO much better. He's strong, his color is good, he's got energy now. . . and frankly, that's what he needs to overcome his latch difficulties.

Follow your gut, mama.

[loraxc]

Thanks for the thoughts. I should add that...

--I am working with an LC and trying exercises to improve his suck. We may also start seeing an OT.
--I do do breast compressions, so much so that I am getting major tendonitis.
--I tried a makeshift SNS (syringe and tubing) and he could not get milk from it well--either he did not suck at all or it ran out of his mouth.
--I am taking tons of fenugreek. I have considered domperidone but am not sure if I would risk plugged ducts and mastitis, since my supply isn't really terrible, per se. He actually pees and poops fine, pretty much, indicating that he takes in a decent amount. The problem is excess energy use at the breast, we think.
--He takes bottles readily but I do fear that he might develop a preference. Maybe I should try cup-feeding, since SNS tubing did not work well. Would finger feeding work if that didn't?

I think what it is coming down is trying to weigh the developmental delay/weakness concerns vs. the virgin gut concerns.

[ccohenou]

Without being alarmist, in my mind the possible permanent neurological/cognitive effects of early malnutrition would outweigh allergy-related concerns. Would local milk-donors be an option for you, for a possible win-win? Have you heard about the Kassing method of bottlefeeding?

I wonder about whether it could be a chicken-and-egg problem...is it hypotonia causing feeding difficulties, or feeding difficulties causing hypotonia? Or an underlying problem causing both? What does the ped. say about his growth and overall health? Does the LC suggest supplementing?

[mirasmom]

I think your mommysense is right on- he needs more calories and one way or another you've got to get them to him. You can also syringe feed him an ounce or two - it wouldn't take much time. A little bit of formula isn't going to hurt him if he needs it developmentally and you might only need to do it for a short time until his suck is improved! Take care of your man, mama. Follow your instincts

[MonkeysRUs]

CST, and chiro would certainly be beneficial. Babies that have been tongue tied often need structural work to help overcome the adaptive behaviours they have learned which can prevent them from sucking properly once the tie is released.
If with the suck training and structural work, your baby still doesn't seem to be sucking properly, I would suggest having his tongue reassessed. Sometimes the doctor doesn't cut enough to actually release the tie, and it needs to be re-done.

As for supplementing, I would encourage you to trust your instincts. If your baby isn't getting enough milk at the breast or is burning too many calories while nursing due to difficulty extracting milk, it's going to affect his ability to learn to nurse effectively. I would suggest pumping after feeding and offering the EBM to top him up. It's time consuming, but it hopefully wouldn't be something you would have to keep up long term.

[loraxc]

Neither LC and ped (!) have suggested supplementing, although I think the ped will suggest it soon. She was hoping for massive immediate improvement after the tongue was clipped.

Question: if I do not want to bottle-feed, which method of supplementing (either EBM or formula) provides the *quickest* feed? Maybe cups?

I feel like donor milk should go to sick babies or moms who absolutely cannot BF. Mine isn't sick--just inefficient. And I CAN BF. In other words, I feel we don't "deserve" or qualify for donor milk. Is this a misguided sentiment?

[Ruthla]

Is the donor milk going to be "taken away" from a "needier" baby, or will you find a local mama to pump extra because she knows you need it, or who's willing to share a bit of her freezer stash? You're not going to need THAT MUCH donor milk- just enough to get him back on track and ready to nurse well.

Donor milk is "step 2" anyway. Step one is seeing how much you're able to pump on your own. Even if you're not the most efficient pumper in the world, if you're able to pump enough to meet his needs then you won't need a milk donor OR a can of formula.

[alegna]

Originally Posted by loraxc

I feel like donor milk should go to sick babies or moms who absolutely cannot BF. Mine isn't sick--just inefficient. And I CAN BF. In other words, I feel we don't "deserve" or qualify for donor milk. Is this a misguided sentiment?

I think it's misguided personally. If you're TRYING to pump and your baby still needs more milk than you can provide in order to thrive, I think you have every right to try to get donor milk. BUT, I think donor milk should be the standard first line supplement.

I'd try a private set-up first as mentioned. See if you have any friends or friends of friends who would pump for you.

good luck!

-Angela

[Pumpkin_Pie]

Not sure if this will help, but when I was pumping to donate, I would ALWAYS pump while DS was nursing on the other side. I found that I had massive letdowns that way as opposed to the trickle I would get otherwise. He is 13 months old now, and I never was good with the pump unless he was nursing away on the other side.

Just thinking that if you could get the milk out of the other side while he nurses, then he would still be getting nursing time in, and then you could possibly find a way to get the extra milk into him efficiently until he is strong enough and has a correct latch/suck.

[readytobedone]

are you using the best possible pump?

and have you visited a chiro? or craniosacral therapist?

i would do those things BUT i would probably supplement in the short run. his lethargy sounds immediately concerning to me. what does the doctor think?

[tbone_kneegrabber]

A woman I know, who had supply issues, hated the syringe and tube style of supplemental nurser, but when she got the Medela supplemental nurser she and her lo LOVED it. She said it was way eaiser for her and her lo to use.

Just another option instead of a cup or finger feed.

[Nan'sMom]

Quick email b/c making dinner but if you are thinking of doing bottles what we did for a while in the very early days was nurse for 10 min, give a certain amount by bottle, then nurse again. The LC recommended this to try to avoid bottle preference. Plus keep bottle near horizontal for slower flow and also make it take time to get started so more like waiting for let-down.

Not sure what to tell you. You've gotten some very good advice on this thread so not much else I can add except that small bit of additional ideas.

I'm wishing you lots of luck with all of it! You are working so hard and doing great things for your baby.

[justthinkn]

I agree that syringe and tube at the breast didn't work for us, while Medela SNS did! There's a cheapo trial version that they say to use for 24 hours, but I used for about 2 weeks before committing to the pricier one that I'm STILL using 9 months later

[MarcyC]

I would try breastmilk or formula in an SNS. If he's having a really hard time nursing you may need to offer bottles to make it easier for him. He needs calories in, and not burning too many.

[loraxc]

So tired. DS nursed pretty much nonstop from 3:30 am to 8 am this morning. My poor nipples were doing better, but now they're not. He seems so hungry.

Stupid formula is looking more appealing in these dark hours.

FTR, I don't have any local friends who are nursing whom I would feel comfortable asking for EBM. I am not sure what my options are if I want to pursue that in other ways.

Maybe I should order the dom.

ETA: I have considered CST or chiro. Frankly, though, I am not very convinced of the validity of these modalities for this problem, and we have spent so much $ on all this already that I hate to spend more on things I consider pretty much experimental.