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Thread: Supply and feeding at night only

  1. #1
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    Default Supply and feeding at night only

    Hi all, for medical reasons I've had to put my 6mo on high-cal formula during daylight hours, but want to continue feeding at night as long as possible. I'm pumping at the moment to maintain my supply, but am wondering what would happen if I stopped pumping? Would my supply maintain as far as night feedings? Or diminish altogether?

  2. #2

    Default Re: Supply and feeding at night only

    I'm afraid it's hard to say-anytime milk is not being removed with the frequency that a breastfed baby would normally be doing, milk production will go down. There are other issues to consider at well-if not pumping for long hours would possibly lead to engorgement, plugs or mastitis for you, or bottle flow or nipple "confusion" leading to breast refusal in baby.

    On the other hand, assuming milk production was well established in the first place, and your baby continues to want to nurse frequently at night, you might do fine partially nursing, at least for a while. I guess I would liken your situation to a mom who is working separated from baby and for some reason cannot pump at work but baby nurses at night. Yes, milk production will diminish, but not as quickly as if baby was not nursing at all.

    Has the reason your baby needs to be exclusively fed high calorie formula "during daylight hours" rather then nursed at all during that time been explained to you to your satisfaction? Usually when a baby requires supplemental feedings, (and some do) supplements can be given in such a way that they do not interfere so much with normal nursing.
    Last edited by @llli*lllmeg; August 10th, 2013 at 03:05 PM.

  3. #3
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    Default Re: Supply and feeding at night only

    Hi, thanks for your reply. Yes, I'm satisfied that the high-cal formula is the way to go for the moment. Baby's weight had started to drop, and we had made several attempts to get it back up using methods other than totally swapping bottles for BFing. When her weight continued to go south it became clear that at least for the time being she needs the more calorie-dense formula amd we need to monitor how much she is taking in. It appears she's a poor feeder, perhaps due to tongue tie which was not caught until now. I will be exploring whether fortified BM might be an option once we get an established pattern of weight gain. For my own peace of mind I will probably be sticking to bottles for the foreseeable future so I can closely monitor her intake.

    Her night-nursing is still a strong habit and one I encourage, so I suppose I'll keep pumping as long as I can so we can keep that going. I'm not too worried about nipple confusion as she clearly hates bottles after lights-out, all she wants is her mama!

  4. #4
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    Default Re: Supply and feeding at night only

    Mama, is her weight actually dropping, or is she continuing to grow but just at a slower pace? The reason I ask is that many breastfed babies begin to drop percentiles around the 4-6 month mark. It's generally a normal consequence of the baby putting more calories into action (reaching, rolling, kicking, standing, crawling, etc.) and allocating fewer to fat. A lot of pediatricians do not realize that this is a normal pattern for breastfed babies, and when a baby- for example- declines from the 50th %ile to the 25th %ile they go into panic mode and prescribe formula. I'm not saying that is what has happened with your baby- obviously I don't know! But if that sounds possible, then maybe we should talk more about what's normal for breastfeeding and when formula is an appropriate response to an issue with weight gain.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  5. #5

    Default Re: Supply and feeding at night only

    If you have not seen an IBCLC yet, or not one that you felt was helpful, I would suggest exploring that possibility again. If a baby is not able to get enough milk, then it is important from a medical standpoint is to fix that issue, if possible, while supplementing if/as needed.

    description of typical lactation consultation- http://cwgenna.com/lconsult.html

  6. #6
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    Default Re: Supply and feeding at night only

    She's been losing weight, and quite possibly for longer than we've been aware of it. I'm not one to panic about dropping percentiles, but she's actually fallen off the chart from 75 at birth to 50 at three months to well below 3 now. We've been dealing with this for the past month, and it's even involved an admission to the local children's hospital where they ruled out a medical cause for it. While there, I was pumping to confirm my own supply, and was feeding her high-cal formula to see if she was able to gain weight. My supply was fine, and she was able to gain weight on the formula. But as soon as we left hospital and I embarked on a feeding plan of BFing, solids, and formula supplementation, she started dropping again. I think it was too much, too soon for her. I'm not able to get her to take a bottle unless I totally withhold breastfeeds, so trying to mix the two by day wasn't working. The solids will need to come at her own pace, so I'm not wanting to rely on them to get her weight up. Thus, formula it is. I'm not particularly happy about it, and I was really really broken up that I would be giving up breastfeeding. But then I realised that as long as we have our night feeds, she'll still get some of the benefits of breast milk, and we'll get to maintain our breastfeeding bond.

    Seeing how she feeds on bottles has actually been a bit illuminating to how she was breastfeeding. The amount of time it takes her to take in 80ml is way longer than she'd usually spend at the breast. I think that for whatever reason (possibly tongue-tie, as previously mentioned) she wasn't able to extract as much as she needed, and she's learned to like the feeling of being less full. So getting an adequate volume into her is a challenge. An average day of bottles sees her consuming about 360ml between 7am and 7pm. Thankfully, that's enough for her to gain on for the moment, if she's consuming the high-cal formula. My hope is that she'll learn to enjoy feeling more full, will take more volume, which will allow me to change the contents of her bottle to breast milk.

  7. #7
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    Default Re: Supply and feeding at night only

    lllmeg - I actually was able to see a lactation consultant, and she was the one who diagnosed the tongue-tie. However, after discussing it at length with her, I decided not to have it fixed - for the moment at least. The lactation consultant pointed out that while fixing tongue-tie in the early days is a miracle cure, it may well not be for a baby of 6 months. Also, it could put her off her feeds for a few days, which would be quite bad for her at the moment as she needs to feed every day to put on weight. I think the bigger problem is that she learned to go on smaller feeds, so even if we fixed the problem and allowed her to get more at the breast, she would probably choose not to take it at this point.

  8. #8
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    Default Re: Supply and feeding at night only

    Quote Originally Posted by @llli*babyracoon View Post
    While there, I was pumping to confirm my own supply, and was feeding her high-cal formula to see if she was able to gain weight. My supply was fine, and she was able to gain weight on the formula.
    This is a little perplexing. Supply is fine but baby's not eating enough... Usually when baby isn't eating well, supply tanks. Did the docs explore the reflux angle? Sometimes babies who have bad reflux learn to avoid using their digestive system- it just hurts too much.

    One thing you might want to discuss with your baby's doctors would be adding calories to your own milk, delivered via bottle. To my knowledge there are 2 ways to do this: one, make "double cream" bottles by allowing a bottle of pumped milk to settle and then pouring the cream off into a second bottle, which is then fed to the baby, and two, by adding something called human milk fortifier to expressed milk, which is an approach often used with premature babies.

    Is the high-cal formula also hypoallergenic? Allergies sometimes cause slow weight gain, and I think allergies/intolerances can also cause reflux to worsen, which might be an angle to consider here.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  9. #9
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    Default Re: Supply and feeding at night only

    Yes, one pertinent thing I didn't mention was that when we became aware of this, I started taking a galactologue which I think accounts for the fact that my supply was adequate while pumping in hospital, despite my baby evidently not taking enough in while breastfeeding. I continue to take it so as to keep my supply up as I'm still not sure where we'll be in, say, a month's time as far as a feeding plan.

    The docs did day it could be silent reflux, and she's on an antacid to account for this. The only way to confirm if it's silent reflux would involve putting her under general anaesthetic and do a scope, which was deemed too invasive. I'm not all that convinced it's silent reflux, as I did not notice a change in her feeding, but we're sticking with the antacid for the time being.

    I don't think the formula is hypoallergenic, but the docs did not seem to think this was an allergy/intolerance issue. Regardless, I certainly will be exploring the possibility of giving her my own fortified milk, as I would much prefer it, as would she I imagine (the formula does not taste nearly as nice!).

  10. #10

    Default Re: Supply and feeding at night only

    Sounds good. Unfortunately what we see a lot is mother's being told to supplement with formula instead of mama's milk, when the option the mom would prefer (and usually makes more sense from a health & wellness standpoint for many reasons) is to increase the amount of mama milk into baby however that can be done, (fixing latch or sucking issues, increasing mom's production, encouraging baby to nurse more often or longer each session, maybe with breast compressions, and, if needed, supplementing with bottles of expressed milk,) while supplementing with formula above that only if and as needed.

    This is due to the mistaken belief that poor gain, when breastfeeding related, has to do with the quality rather than the quantity of mothers milk into baby.

    btw, I totally agree about the solids- relying on solids is not typically a smart way to get a baby’s caloric intake up at this age. I would think solids being kept at a bare minimum for a bit makes the most sense as, calorically, breastmilk and formula are both so superior to almost any food a baby is likely to eat. Kellymom.com has a nice article comparing caloie and fat content, solids to breastmilk and breastmilk to formula.

    I also agree that the evidence does not suggest that frenotomy is a miracle cure. Suck training and/or exercises post frenotomy of some type is often also needed esp. if the frenotomy is done later. But this does not mean it is appropriate to rule out frenotomy. If your baby’s tt were not causing serious breastfeeding issues, then there would be no reason to treat it. But the suspicion is that it has caused serious breastfeeding issues, in that it is suspected of causing baby to not be able to get enough milk and for your production to be harmed. I have no idea if that means a frenotomy at this point is appropriate or not, but if you did want to research tt further I can suggest some links.

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