To supplement or not to supplement? Please read details!?

Question

I asked a question the other day about my 4 month old's size. She has always been on the small side, and as of her doctor's appointment yesterday, she is 11 lbs 9 oz and 23 inches long. She has only been gaining 1/2 an oz every day, and she's supposed to gain 1 whole oz. Her pediatrician told me that this is in the 6th percentile and that I need to start supplementing with formula...2 oz, 3 times a day, AFTER she nurses. (So far she has been exclusively breastfed.) He suspects I am simply not making enough milk. So I was totally bummed out by this news...I have nothing against formula, I was just so excited and proud when breastfeeding came so easy to both of us, and it's been an amazing experience. And now that I know she hasn't been gaining "enough" weight, I feel like I've failed her. So I immediately started trying to supplement like the doctor advised, but it's not working. She wants nothing to do with the bottle, and I know it's not nipple confusion or anything like that because she takes bottles of breastmilk for her Daddy and the babysitter several times a week while I am working...

Also, she NEVER fusses. And I'm not exaggerating. If she is still hungry after being nursed on one breast, she subtely lets me know (I can tell mostly by the way she grunts and her facial expressions) and I will just switch her to the other. I never unlatch her, I always wait until she pulls away herself. And even the doctor admitted that she looks perfectly healthy...she's proportionate and not skin and bones like you might expect an underweight baby to be.

So how long should I continue to try giving her the formula? Should I try things to boost my supply instead? (I know about Fenugreek, but that's about it...) Do you think it's possible that she will just always be smaller and that I shouldn't worry about it, since she's obviously not malnurished? What will happen at her next doctor's visit if I tell them I haven't been giving her the formula like they asked?

Answer 1

If she's fighting the formula and obviously doesnt like it then I personally wouldnt worry about supplementing.It's not like she's loosing weight. She is gaining even though it might not be a lot at least she's still gaining. She will just probably always be a smaller baby!

Also in a few more months she'll be starting solids ( i think you decided to wait til 6 months). When she starts those solids plus continuing nursing as she has been youll most likely see some pounds add on. I would just tell ur doctor that Ari doesnt fuss like shes still hungry, is a perfectly content baby, so u decided to continue on nursing as how you've been. Maybe after a few months of solids plus her breastmilk then I'd go back an evaulate how she's doing weight wise.



That's just me but I think it seems silly to try to force formula on her that she doesn't like when she IS gaining weight! All babies gain at different rates as you know b/c some babies gain like weeds while others like Ari are at their own pace.Also while most babies do double their birth weight by 4 months, they don't have to until 6 months usually!

Answer 2

Well she is definitely on the smaller side. Even by a breastfeeding growth chart she is still around the 10th percentile however if she was born small its not uncommon to stay small. Have you talked to a lactation consultant about it? That would be your best bet before trying formula. Find out what you can do to get your supply up. Very few people actually cannot produce enough. So I would get help before completely giving up on exclusively breastfeeding. I mean you also dont have much longer to go until you can start solids which will help too. My daugter is 4 months as well and only puts on about 4oz a week. She is 14lbs 5oz and 25 3/4 inches long however she was 8lbs 10oz at birth. She if formula fed and still only puts on 4oz so formula fed babies are not necessairly always bigger nor does formula always help with weight gain. Some babies are just light eaters. My doctor had me start solids early and that is helping her put on the weight so in another month or 2 when you start it should help a bit even if she is only taking a little. Until then talk to the LC. And remember your daughter is not underweight. In order for a baby to be in the 90th percentile someones baby needs to be in the 20th and the 15th and the 10th and the 6th. Nothing wrong with being tiny.

Answer 3

When Haley was born she had jaundice. They made me feed her every two hours and then supplement after her feeding with an ounce of formula. After 24 hours she had gained 6 oz. Maybe just giver her one ounce of formula three or four times a day for a week or so and see if you notice a difference in her growth. I know that Babies R Us sells infant scales. It's like $60, but sounds like it might be worth the investment to keep track of her growth.



Here is a growth chart calculator:



http://www.babycenter.com/baby-child-growth-percentile-calculator



Also, have you tried Fenugreek, I know you mentioned it above, but didn't say if you've tried it. I've actually just started taking it as now that I'm working I'm having to pump and not getting what I need per day to send with her to daycare. Also try pumping a lot more frequently right after feeds to help build your supply up a little more if you absolutely do not want to give her formula. I hope this works. I do understand how you feel. Don't give up hun. It will all work out.

Answer 4

I understand where you are coming from. My daughter was simply not getting enough milk from me. What I did and still do is pump and mix breast milk and formula. She never refuses the bottle when I do that. Straight formula after eating that sweet breast milk is a drastic change and that is probably why she is refusing. Right now I am taking Domperidone to boost my supply and it is working. I still supplement my daughter though. Visit this website and he will tell you lots of things to do to boost your supply. He is a pedi in Canada.



http://www.drjacknewman.com/



There is tons of things you can do to boost your supply and he will go over all of that. The natural things didn't work for me but everyone is different. Just don't give up or get yourself down about having to supplement. I know I did at first. You def don't want to be a sad momma LOL.



Hope I helped

Answer 5

I'd give yourself a week to try to boost your milk supply usuing Fenugreek, which you can buy in any organic market. Take the full dose (I think it's 3 pills a day) that really helped me work up my supply. Also, try pumping between the sessions when she feeds. That should bring in more milk as well. I'd do everything you can this next week to get her to feed more so you are making more and vice versa.



If she's still not gaining weight then I would really try giving her a bottle of formula before you put her down at night. The formula keeps their digestive systems a bit busier and might even allow her to sleep longer through the night. So, try that and see how she handles it and no matter what don't drive yourself nuts. You are doing what is right for your daughter and that's all that matters.

Answer 6

She might just be small.



The first thing I'd try is always offering her the second breast after she pulls away from the first. If she doesn't want it, she won't latch. But she might take some, and even if she doesn't take much, your breasts will be stimulated more.



If you weren't making enough milk and she wanted more, she'd be inconsolable and wanting to feed all the time . (Trust me. Been there.)



If she won't take formula, then tell the doc that you tried and she won't take formula, and also tell him about all the other things you've tried. But is she going up on the 6th centile? If so, she's probably completely normal, just small. The time to worry is if she's crossing over centile lines and getting further down the chart.



If you do want to supplement, them you may need to do it at other times so that someone else can give the bottles. It's common for a breastfed baby to refuse a bottle from mum - they want the breast!

Answer 7

I would not supplement. 1/2 oz a day is a perfectly fine amount of weight to put on. Unless she started losing weight, I would simply keep nursing.



My boys were supplemented in the NICU, and I didn't have much choice in the matter. Since my milk came in, they haven't had any more formula. Everyone tried to tell me that I'd have to supplement at some point since I have two, but i haven't. My doctor said that, too, but also said that he would only recommend it if they were losing weight or obviously weren't satisfied after nursing.



EDIT: It isn't about whether she is staying in the same place based on the charts.. It is whether or not she is losing *weight*. If she is not losing weight, she is doing fine.

You also have to remember, charts are based on the *average* person. Based on the BMI charts, I was always considered malnurished (until I had my twins, and I am now considered normal). But ask any of my doctors and they will tell you that I am perfectly healthy.

Answer 8

I love all the other answers so far, but just wanted to add my two cents:

It sounds like she is doing well and is just small. As previously noted, the growth charts are based on formula-fed babies and are often inaccurate for breastfed. Just keep feeding her on demand and try some of the tips to boost your supply. She is telling you that she doesn't want the formula, so just let her keep nursing! Sounds like you are doing a great job :)

Answer 9

I went through this as well and it was disasterous. If your baby is healthy and continuing to gain, she's fine. If you start to suppliment it WILL effect your production. She will stay full longer and not need to nurse which will cause your milk production to slow. Supply and demand.



She's just fine hun. I know it's hard not to worry but she's doing great.



Also, these charts are based on formula fed babies not breastfed babies. So if she were on formula, yes she would be considered small, but she's not. Formula fed babies tend to pack on weight faster. Look at it like this. If you were to eat only prepackaged foods, and a friend ate only fresh fruits, veggies and organic dairy, who would weigh more? It's the same thing with formula and breastmilk.



If you want to increase your supply (which im sure is fine) you can use a double electric breast pump. Pump on both sides at the same time, OR have her nurse on one side while you pump on the other (switching sides with each feeding). You can also take fenugreek (you'll know you're taking enough when you smell like maple syrup), blessed thistle or more milk plus.



Rest assured you're ing a great job. She's content and growing just like she should be :)

Answer 10

What chart did your doctor go by? Most growth charts are aimed at formula fed infants.



I personally wouldn't supplement with formula because as you're aware that _will_ make your supply go down.



Have you read; http://www.kellymom.com/bf/supply/low-supply.html for tips and whatnot about boosting supply?



My sister was always on the small side and she's now 12yo and very tall & skinny for her age (taller than me, and i'm 20, lol). So your daughter might just be on the small side, but she's certainly not unhealthy.

Answer 11

I would see a lactation consultant. I breastfed my daughter, but at 4 months she weighed 13 pounds.

However, I do want to say, that some breastfed babies are always smaller than formula-fed ones. Is your DR. looking at the breastfed baby growth charts? i always look at those, because formula charts are only for formula fed babies, and they tend to weigh more..



It could be a problem with the way the baby is latching on, so I do recommend seeing a lactation consultant.



ADD: here is a link to a breastfed baby girl growth chart.



http://www.kellymom.com/babyconcerns/growth/chart3.html