Pediatrician recommends supplementing - should I?

Hello all!
I'm sure this has been brought up many times before, but I was hoping
for some advice. First some background: my baby girl is 5 weeks old
and was 5lb 11oz at birth (not preemie -- 39 weeks gestation, just
small, but perfectly healthy). We had a HORRIBLE time breastfeeding
the first couple of weeks, and she dropped down to 5 lbs. Since then,
she has gained consistently at the rate of 1/2 oz per day (which is on
the very bottom of the "acceptable" range according to the
pediatrician). He wants me to try supplementing with formula. I want
to avoid that at all costs. What would you all do? Thanks for any
advice!

LubsyB wrote:
Hello all!
I'm sure this has been brought up many times before, but I was hoping
for some advice. First some background: my baby girl is 5 weeks old
and was 5lb 11oz at birth (not preemie -- 39 weeks gestation, just
small, but perfectly healthy). We had a HORRIBLE time breastfeeding
the first couple of weeks, and she dropped down to 5 lbs. Since then,
she has gained consistently at the rate of 1/2 oz per day (which is on
the very bottom of the "acceptable" range according to the
pediatrician). He wants me to try supplementing with formula. I want
to avoid that at all costs. What would you all do? Thanks for any
advice!

Usually, supplementing is shooting yourself in the foot. The more you
supplement, the less she'll nurse,the less you produce, the more you
have to supplement. I'd think - and I'm not a pedi - as long as she is
gaining weight she's ok. btw, dropping weight in the first weeks is
normal. We were a special situation (DD was IV fed for a week, tube fed
for the second week), but she didn't regain her birthweight until 3 wks
old, and gained very slowly once I started Breastfeeding directly (the
tube feeds were EBM). The nurses at the NICU were harassing me a bit
about the slow weight gain and insisting they at least tube-feed (ie
force feed) to make up the difference. Fortunately the neonatalogist
sided with the LC and me and insisted we keep on BF. Now, by 3 weeks
she *was* gaining reasonable amounts and doing well, your situation
does sound a bit different.

I gather BF is going well now? How long does she feed on each side? DO
you let her nurse until she's done on each side or do you switch sides
after a certain number of minutes? Could it be she's not nursing long
enough and only getting foremilk rather than hindmilk? DD only nursed
on one side per session, and in that first week I'd have to encourage
her to nurse more, even though the nurses also said I should switch
sides after X# minutes.

Have you pumped? You can consider pumping after each feed, then give
her that via syringe or bottle (if BF is well established now). That
way your supply isn't adversely affected, but you're topping her off
for awhile and see if that makes a difference (I also did that with DD
for the first week or so).

LubsyB wrote:
Hello all!
I'm sure this has been brought up many times before, but I was hoping
for some advice. First some background: my baby girl is 5 weeks old
and was 5lb 11oz at birth (not preemie -- 39 weeks gestation, just
small, but perfectly healthy). We had a HORRIBLE time breastfeeding
the first couple of weeks, and she dropped down to 5 lbs. Since then,
she has gained consistently at the rate of 1/2 oz per day (which is on
the very bottom of the "acceptable" range according to the
pediatrician). He wants me to try supplementing with formula. I want
to avoid that at all costs. What would you all do? Thanks for any
advice!

I had a baby who consistently gained at the very bottom of the
acceptable range and chose not supplement. He is now a normal 5 year
old. Since your baby is gaining within the normal range, you don't
have an immediate emergency and don't "have" to supplement right now.
However, you probably would be happier to have her gaining faster.
Since she is within the normal range you have time to try various
methods to increase her weight gain without supplementing. If her
weight gain drops and you do need to supplement, you may be able to
pump and use you own milk, avoiding bottles and formula.

What is her nursing pattern like? Is she getting at least 10-12
nursings in 24 hours? Is she a fast feeder, slow feeder, sleepy feeder
etc?

Do you feel like she is running out of milk and would take more if it
were available?

She could still need work on her latch. You may want to get that
checked. If her latch is OK, switch nursing, back and forth from side
to side each time she slows down can help her get more milk and
increase your supply. Breast compression (squeezing your breast) when
she slows down can help too. You may want to try herbs or Mother's
Milk tea. Kellymom has good information on herbs.
http://kellymom.com/herbal/milksupply/index.html

Does she seem to fill up quickly and not want more? Does she have lots
of gas?

She could be filling up with air. More frequent burping and/or
symethicone drops might help?

--Betsy

LubsyB wrote:

Hello all!
I'm sure this has been brought up many times before, but I was hoping
for some advice. First some background: my baby girl is 5 weeks old
and was 5lb 11oz at birth (not preemie -- 39 weeks gestation, just
small, but perfectly healthy). We had a HORRIBLE time breastfeeding
the first couple of weeks, and she dropped down to 5 lbs. Since then,
she has gained consistently at the rate of 1/2 oz per day (which is on
the very bottom of the "acceptable" range according to the
pediatrician). He wants me to try supplementing with formula. I want
to avoid that at all costs. What would you all do? Thanks for any
advice!

Don't supplement. Just nurse until baby is full
or asleep. Don't time the session, just nurse.

-- Anita --

LubsyB wrote:
Hello all!
I'm sure this has been brought up many times before, but I was hoping
for some advice. First some background: my baby girl is 5 weeks old
and was 5lb 11oz at birth (not preemie -- 39 weeks gestation, just
small, but perfectly healthy). We had a HORRIBLE time breastfeeding
the first couple of weeks, and she dropped down to 5 lbs. Since then,
she has gained consistently at the rate of 1/2 oz per day (which is on
the very bottom of the "acceptable" range according to the
pediatrician). He wants me to try supplementing with formula. I want
to avoid that at all costs. What would you all do? Thanks for any
advice!

Up to a ten percent drop in weight at first is considered normal, so
that would be about 9 oz. for a 5 lb. 11 oz. baby. She lost just *two*
ounces more than that ... not such a hideous thing. (Two of my three
babies lost more than 10% without having any problem, but they were
biggish babies to begin with, plus they lost most of the weight almost
immediately, and I think their birthweights may have been inflated due
to retained water from my being on an IV for a long time before they
were born.) Yes, half an ounce a day is at the bottom of the range, but
heck, she's not a large person, and she *is* into the normal range
despite your rough start. I don't see a reason to panic yet, if she's
acting normal, pooping and peeing well, and all that. What's her
feeding behavior like -- is she nursing for decent lengths of time,
latching well, not going too long between feeds? I wouldn't be
surprised if she started gaining a bit faster soon.

Some people do breast compression to try to get more hindmilk into the
baby. Maybe someone who knows more about it can post.

--Helen S.

I'm sure this has been brought up many times before, but I was hoping
for some advice. First some background: my baby girl is 5 weeks old
and was 5lb 11oz at birth (not preemie -- 39 weeks gestation, just
small, but perfectly healthy). We had a HORRIBLE time breastfeeding
the first couple of weeks, and she dropped down to 5 lbs. Since then,
she has gained consistently at the rate of 1/2 oz per day (which is on
the very bottom of the "acceptable" range according to the
pediatrician). He wants me to try supplementing with formula. I want
to avoid that at all costs. What would you all do? Thanks for any
advice!

sorry, it's at the bottom of acceptable, not below the acceptable range, so
exactly why does he want you to supplement with formula? Even if it was
below the acceptable range the first solution would not be to supplement
(unless it was an urgent health issue), I'd recommend a visit to a lacation
consultant, just to check your latch and everything is ok. Given she was
small, that's probably just her constitution so she's not going to be
putting on as much, that amount is going to be a similar percentage of her
body weight gained than a larger baby that gains an ounce, her stomach is
going to be smaller, so in some ways her acceptable range should be adjusted
and she's probably middle of that range.

Cheers

Anne

Hello,

Helen S. mentioned trying breast compressions. These can be very
effective for "supplementing" baby with your milk as she breastfeeds.
Assuming she is nursing well now, and you are not in pain when she
sucks; all you do is move your hand back towards your chest (not
towards her mouth). You compress the breast while the baby is actively
sucking, then relax when she pauses. There is a good description of
breast compressions on Jack Newman's section of
Breastfeedingonline.com. What you are are doing is simply moving more
milk towards the baby than she can get herself with each suck. It's a
very simple, efficient way to "supplement."

Good luck,
Rachel

On Jan 3, 8:56 am, "LubsyB" wrote:
Hello all!
I'm sure this has been brought up many times before, but I was hoping
for some advice. First some background: my baby girl is 5 weeks old
and was 5lb 11oz at birth (not preemie -- 39 weeks gestation, just
small, but perfectly healthy). We had a HORRIBLE time breastfeeding
the first couple of weeks, and she dropped down to 5 lbs. Since then,
she has gained consistently at the rate of 1/2 oz per day (which is on
the very bottom of the "acceptable" range according to the
pediatrician). He wants me to try supplementing with formula. I want
to avoid that at all costs. What would you all do? Thanks for any
advice!

"LubsyB" wrote in message
oups.com...
Hello all!
I'm sure this has been brought up many times before, but I was hoping
for some advice. First some background: my baby girl is 5 weeks old
and was 5lb 11oz at birth (not preemie -- 39 weeks gestation, just
small, but perfectly healthy). We had a HORRIBLE time breastfeeding
the first couple of weeks, and she dropped down to 5 lbs. Since then,
she has gained consistently at the rate of 1/2 oz per day (which is on
the very bottom of the "acceptable" range according to the
pediatrician). He wants me to try supplementing with formula. I want
to avoid that at all costs. What would you all do? Thanks for any
advice!

Hmm. Do you feel like she is weak or lazy? One of mine was weak and lazy
and while my supply was fine, he wasn't very good at getting full until he
was a little stronger. If she is strong, alert, active, healthy looking,
plenty of diapers, etc she's probably just small. I could tell my weaker
baby wasn't getting as much, but then I had nursed two previously and he is
a twin so I had another stronger baby to compare to in real time

If you think she may need to get a little stronger she is old enough to
introduce a bottle. If you decide to go that route, my advice would be to
pump some milk...nurse her until she is full, and then have someone else
give her a couple ounces from a bottle. I'd do that maybe twice a day.
Pump while someone else gives her the bottle. You aren't likely to get much
milk then but don't worry about that, it is just to signal your body. You
may need to pump each morning to get those ounces. If she refuses the milk,
she is getting full at the breast. If she is drinking it down just continue
on like that for a couple weeks and she'll slowly get stronger and better at
the breast. Cut out the one bottle, and then cut out the next a few days
later.

I was able to eliminate all the bottles and he was/is fine.


--
Nikki, mama to
Hunter 4/99
Luke 4/01
Brock 4/06
Ben 4/06

Hmm. Do you feel like she is weak or lazy? One of mine was weak and lazy
and while my supply was fine, he wasn't very good at getting full until he
was a little stronger. If she is strong, alert, active, healthy looking,
plenty of diapers, etc she's probably just small. I could tell my weaker
baby wasn't getting as much, but then I had nursed two previously and he
is a twin so I had another stronger baby to compare to in real time

If you do feel this is the problem for your baby then the last thing you
want to do is introduce a bottle, babies like this are much more suspetible
to developing problems with switching between breast and bottle. I've also
had a baby with a weak suck, but I didn't notice as he was my first, we
didn't really have a problem until I introduced first a pacifier, then a
bottle, after that it took weeks of pumping after every single feed and even
then we didn't quite make it through without some supplementation, though
those were more related to my health issues than the early problems. Breast
compression is a very good way to assist a baby with a weaker suck, use your
thumb and forefinger, thumb on top of the breast, cupping it an massage down
towards the nipple, you can actually apply quite a lot of pressure, the aim
is to get to the deep tissues and really make sure that the breast is
emptied during a feed.

Anne

Thanks for all the advice! In answer to some of your questions,
breastfeeding is going much better now (I've had my mom, who
successfully bf'd 3 babies, sit with me many times to watch her latch,
etc.), and I let Sara feed on each side until she gets too sleepy
(10-15 mins per side). If she still acts hungry, I let her go back on
the first breast for a few more minues.

I also have been pumping some, and offering her that after a couple of
feedings a day, and she always takes 1-2 more oz when I offer, so that
makes me think she leaves hungry sometimes -- even after 45 minutes.
One thing of note is that she doesn't eat 10-12 times a day, maybe more
like 8. She typically sleeps for 2-3 hours every time before waking up
to eat. Her diapers are definitely good, and she has long alert
periods where she's perfectly content, so it's not like she's crying
all the time or anything.