Breastfeeding and Supplementing

I have exclusively breastfed by almost 5 month old daughter, but in the past month or so my supply has been going down, as has her weight gain. I have already tried to bring my supply back and feel it is time to introduce some formula, as i am never very successful with pumping. At this point it is begining to appear that her weight is only holding steady, so we really want to increase her calories.

We have tried over the past week to give her a bottle, and she will have nothing to do with it. We have tried various bottles, teats and temperatures. My husband has tried feeding her as have I, seated away from us and towards, but she has no interest. She doesn't seem fussed by the taste, it really appears to be a case of not knowing what to do with it. Does anyone have any advice about offering a bottle way too late. I've thought about trying a sippy cup, but she seems so young. I have been given the green light by her ped to start solids but my older DD has excema and food alergies so we are hoping to wait until 6 months. Also, I don't feel my supply is even holding steady enough that she would be ok with BF and the amount of solids you offer in the early days of solids.

Any advice would be greatly appreciated.

Thank you!

<<I have exclusively breastfed by almost 5 month old daughter, but in the past month or so my supply has been going down, as has her weight gain. I have already tried to bring my supply back and feel it is time to introduce some formula, as I am never very successful with pumping.>>

Exactly how did you determine your supply is low?

If your using inability to pump much as an indicator your supply is low then could be mislead. Pumping is never an good indicator of how much milk a mom is making because breast pumps are not as efficient as an actual baby at the breast. For some women, they get little or nothing via the pump despite their baby having no issues sufficient milk directly at the breasts. 

The only accurate way to judge your milk supply is by how many wet and poopy diapers your baby is putting out and by whether he is gaining weight. Your baby should have at least 4-5 sopping wet diapers a day and a minimum of at least 1 poopy diaper every 7-10 days. 

This link has more info on determining if your older baby (6 weeks and old) is getting enough milk: http://www.kellymom.com/bf/supply/enoughmilk-older.html

<<At this point it is beginning to appear that her weight is only holding steady, so we really want to increase her calories.>>

Now an important thing to know about weight gain in breastfed babies is that it tends to slow down in the later months unlike formula fed baby which tend to grow at much more steady rate. Between 4- 5 months, the average weight gain is 4-5 ounces per week. Between 6 -12 months it slows down to 2-4 ounces per week. It important if you or your pediatrician is charting her weight gain history on growth chart to make sure it is one of the newer charts created by the WHO specifically for BF babies as the older.

Info on expected weight gain for older babies:
http://www.kellymom.com/babyconcerns/growth/weight-gain.html

A link to the WHO growth charts for breastfed babies with info on there proper usage:
http://www.kellymom.com/babyconcerns/growth/growthcharts.html

The following is to an infant growth calculator that can help you determine if the child is growing within a normal range:
http://www.kellymom.com/babyconcerns/growth/weight-gain-calculator.html

Now you say your child growth appears to be holding steady. Does that mean that she appears to have stop gaining weight is her weight gain simply much less then it was?

Can you tell us what her recent weight gain history has been?

Now one thing to keep in mind is that if your baby appears to be getting enough milk by all reliable signs but is just not gaining any weight then there are other possible causes besides low milk supply. One possible cause is an illness who's symptoms are not immediately obvious. I am aware of others moms who's babies stopped gaining weight for no obvious reason until it turned out there child had an illness that was causing their body to use extra calories to fight off the illness. In one case the mom's baby has a undetected case of pneumonia and once that was treated the baby started gaining weight again. Has your child has any illnesses recently or could she currently possible have a illness?

A final question, how may feeds is she getting per day?

Before you worry to much about introducing formula to get her to gain more weight, I would first make sure that your supply is low and that her weight gain is really below the average for BF babies her age. If you can get back to us regarding the above questions (those in red) then we can you determine if supplementing with formula is really necessary and how you might go about that.

Thank you for getting back to me.

Exactly how did you determine your supply is low?

Now you say your child growth appears to be holding steady. Does that mean that she appears to have stop gaining weight is her weight gain simply much less then it was? YesCan you tell us what her recent weight gain history has been? I have never pumped much so never use that as an indicator. I was looking at her weight, which basically leveled off. Each month until the 3-4th she was putting on about 900 grams/32 oz, but at her 4 month check up she had only put on 300 grams? 11 oz. Her wet diaper output hadn;t really changed, or the frequency of poop which is a few a day still, but the color of her poop had gone from orange to almost exclusively green, which I know can be a sign of an infection and she did have a cold for a few days in there. However, they weren't frothy (sorry for the details, I just know that typically the foremilk/hindmilk imbalance can cause frothy green poop). The pediatrician wasn't too concerned about the weight gain, but thoguht that her neding to feed every hour or so from 1am to 8am might be an indication that she wasn't getting enough. To be honest I had serious supply issues with my older daughter and bottle and breastfed her from the begining until she was 10 months when we went to bottle only. My goal was to nurse this baby for 4-6 months, and with an older child with Special needs, who needs a bit more from her mom than our current nursing schedule can offer, I'm okay with begining to suppliment and working towards weaning.

<<At this point it is beginning to appear that her weight is only holding steady, so we really want to increase her calories.>>
Last week she actually began to loose weight, however by the end of the week it had stabalized and has begun to slowly increase again. To do this has required going back to earlier feeding schedules. I feed on demand, but now I am offering even when she isn't really asking, but she is almost always happy to eat.

<<Now an important thing to know about weight gain in breastfed babies is that it tends to slow down in the later months unlike formula fed baby which tend to grow at much more steady rate. Between 4- 5 months, the average weight gain is 4-5 ounces per week. Between 6 -12 months it slows down to 2-4 ounces per week. It important if you or your pediatrician is charting her weight gain history on growth chart to make sure it is one of the newer charts created by the WHO specifically for BF babies as the older. >>

This makes it seem like the 11 oz isn't so bad, but is the quick drop from 31 to 11 a bad sign?


A final question, how may feeds is she getting per day? I demand feed so it is hard to tell, but I would say 7 during the day and then she basically cluster feeds from 1 or 2 in the morning until 8. Often it is dream feeding, but she is swollowing and gulping, and produces at least 2 fully wet diapers at night.

Thank you for all of your help!

To me it sounds like things are going ok.  The fact that she is wanting to nurse so much from 1-8am could be a developmental change, she's realizing that she is alone at night, or you said that she had been a bit sick so she may just be nursing for comfort b/c she doesn't feel well.

Are you having her weight taken at the dr office or by a LC?  Accurate weighing is key here, so a home scale won't cut it.   

My suggestion is to just nurse her on demand and have her weight checked again by her dr in a week or two to make sure her growth is ok.  If you want to start supplementing for ease due to your older child and concern we can certainly help you with that but don't jump to supplementation too quickly b/c it will effect your milk supply.

I also couldn't get my ds to take a bottle, he eventually took the born free bottles. 

Let us know where you want to go from here! 

Thank you to Chrissy for the great siggy!