The health visitor is now very concerned, I have until Thursday for him to
start gaining weight before she recommends we give him 1 bottle of formula
per day, I do not want to do this, but equally I do not want to harm his
long term development.

Ok. I think we really need to figure out what is going on here.

1. Is he wetting/dirtying diapers? When he nurses are you seeing milk in his
mouth? Do you hear him swallowing? Do you feel let-downs? Do your breasts feel
fullish before feedings and softer afterwards?
Does he seem content after her feeds?
If so, there is no reason to assume that your milk is inadequate, and no
reason, therefore, to assume that giving formula will solve the problem.
If there DOES appear to be a supply problem, and you've done all you can to
increase it, then some supplements may indeed be necessary. (But that does not
mean that you are a failure! It just means that you have a physical problem!)

2. I would be pursuing the blood in the nappy issue more agressively. Did the
pediatrician do any actual tests? A cathed urine sample? Blood in the urine can
be a sign of a wide range of problems, some minor, some serious; any of which
can affect a babies weight gain. If you can find and treat that problem, if
any, you may well solve the weight issue.

3. It is usually not advisable to weigh a baby before and after feeds (just
tends to stress out mom...) but if there a question about supply, this might be
a good step. You'll need a good, very accurate scale, but it will let you know
how much milk baby is actually getting at each feed. Can the HV or pediatrican
provide you with a scale?
Ample milk intake combined with poor weight gain would point to a physical
problem with the baby rather than a supply problem.

4. It's good that you are feeding more often, but I'd try feeding more often
still. You say you are feedng 'usually every 2 hours, at least every 3, except
for one longer sleep of 4-7 hours.' It's hard to estimate how many feeds that
is, but I'm guessing somewhere around 8? Which is still pretty low for a young
baby with weight gain issues. Try for every 2 hours during the day, and no more
than 4 at night. 7 hours is way too long for him to be going without eating.
(Can he sleep in your room, even if not in your bed? That will make night feeds
easier, and he may actually wake more often for night feeds if he senses your
presense/smells the milk.)

5. Have you tried pumping at all? (I don't remember from your earlier post.) I
don't
usually think it's such a hot idea, but,
especially if baby isn't interested in nursing as often as he should, pumping
may stimulate your supply, and if you do
end up having to give some supplements, you'll have some EBM on hand to offer
rather than formula.

6. Remember, remember, remember that
your milk will always be the best thing for your baby. Even if you end up
having to top it off with something else because the quantity isn't adquate,
the QUALITY is
exactly what your baby needs, and every drop of breastmilk you can give him
will benefit him, and give him something that no-one else can provide for him!

You're doing great!


Naomi
CAPPA Certified Lactation Educator

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reply.)