WWYD RE Health Visitor

meritaten

I breastfed all three of my kids, but, I am the first to say I am no expert. I did find however, that they tended to want more feeds per day (and night!) than my friends formula fed babies. for the first six to eight weeks I would be feeding on average every two - three hours - or virtually non stop some days!

I don't think I would be panicking yet! its early days, but I would increase the frequency and perhaps the length of feeds. as another poster pointed out its the hindmilk which is the richest. also they are quite right that babies can feed in their sleep. when they finish a feed I find they open their mouths to 'break the seal'.
and before long you will be feeding them in your sleep! though I would keep quiet about that as some on here would be horrified as it means 'co-sleeping'.

aridjis

they are trying to recruit health visitors, I think.

http://www.nhscareers.nhs.uk/explore-by-career/nursing/careers-in-nursing/health-visiting/skills,-qualifications-and-training/

Apparently the training is 'at degree level' and you have to qualify as a nurse or midwife first.

Alchemilla

I would suggest seeing a breastfeeding counsellor. Having been in a similar position, the b/f counsellor was the only person to be of help. Has baby been checked for tongue tie?
Good luck and congratulations on your new arrival.

freddie2

"The growth charts in the little red books they give you, I am lead to believe, are based on bottle fed babies, not breast fed babies, so it doesn't really apply for your baby. Perhaps you could google this yourself and check if I am correct. "

Not true. For the past 4 years WHO growth charts have been used which are based on the optimal growth of breast fed babies.

DevilsAdvocate1

Toto wrote: »

How is this helpful to the OP? I'm sure there are some bad health visitors as there are bad people in every profession. But, as you have not seen the baby in question how is it helpful to sow the seed that this health visitor is 'a childless Hitler lording it over new mums?'


It could be possible that there is a reason why this baby hasn't gained weight, just as it is possible that it is nothing sinister. The only appropriate advice I can give is to seek a second opinion and to keep a close eye on the baby. I would get the baby weighed regularly and watch for any signs of ill health or change in behaviour (crying more often, sleeping and difficult to rouse, not waking for feeds).


I think it would have been a poor health visitor who didn't express her concerns or advise on an action plan, I also think she should be commended for seeking the opinion of the paediatrician. She is only doing that for the benefit of the baby. Had she of ignored her concerns and done nothing she would be quite rightly called incompetent had there turned out to be an underlying reason for the baby's lack of weight gain. It seems a case of damned if you do and damned if you don't.

The advice the health visitor has given regarding top ups shows that they health visitor is not knowledgeable regarding breastfeeding. In my area health visitors are allowed to specialise in one of three areas. If their specialism is not breastfeeding then they have very little training in supporting it. My health visitor decided to specialise in post natal depression and gave very poor advice regarding breastfeeding. She put me under huge pressure to switch to bottles.

The way breastfeeding works is that when the breast is empty the body gets the message that the milk is needed and makes more. If you introduce top ups via a bottle the milk will stay in the breast for longer (because the bottle had been used rather than the breast). The body gets the message that the milk is not being used and so slows down milk production. Introducing top ups, especially when it is done after every feed, has the effect of making the baby feed from the breast less often. The milk stays there for longer and milk production slows down.

This can very quickly (in just a week in some cases) lead to low of amounts of milk being produced and mum finds herself fully bottlefeeding. Great if this is what she wanted to do, very upsetting if its not what she intended.

To increase milk supply she could put the baby to the breast more frequently. There is also some evidence that feeding the baby in the middle of the night at least once can boost milk supply.

Of course her baby may just be one who gains weight slowly. My own children all gained weight slowly and with baby 2 and 3 I did not get them weighed as I found the whole process too upsetting. I knew they were getting enough as the were happy and alert. Also, the had no signs of dehydration. A dry mouth and sunken fontenelle are signs of dehydration.

Also, were different scales used during the weigh ins as this can have an effect. With DS1 they weighed him before and after a feed and he was 2oz less after he had fed, despite no wet or dirty nappies. This told me something was wrong with their scales!

lao_cat

DevilsAdvocate1 wrote: »

The advice the health visitor has given regarding top ups shows that they health visitor is not knowledgeable regarding breastfeeding. In my area health visitors are allowed to specialise in one of three areas. If their specialism is not breastfeeding then they have very little training in supporting it. My health visitor decided to specialise in post natal depression and gave very poor advice regarding breastfeeding. She put me under huge pressure to switch to bottles.

The way breastfeeding works is that when the breast is empty the body gets the message that the milk is needed and makes more. If you introduce top ups via a bottle the milk will stay in the breast for longer (because the bottle had been used rather than the breast). The body gets the message that the milk is not being used and so slows down milk production. Introducing top ups, especially when it is done after every feed, has the effect of making the baby feed from the breast less often. The milk stays there for longer and milk production slows down.

This can very quickly (in just a week in some cases) lead to low of amounts of milk being produced and mum finds herself fully bottlefeeding. Great if this is what she wanted to do, very upsetting if its not what she intended.

To increase milk supply she could put the baby to the breast more frequently. There is also some evidence that feeding the baby in the middle of the night at least once can boost milk supply.

Of course her baby may just be one who gains weight slowly. My own children all gained weight slowly and with baby 2 and 3 I did not get them weighed as I found the whole process too upsetting. I knew they were getting enough as the were happy and alert. Also, the had no signs of dehydration. A dry mouth and sunken fontenelle are signs of dehydration.

Also, were different scales used during the weigh ins as this can have an effect. With DS1 they weighed him before and after a feed and he was 2oz less after he had fed, despite no wet or dirty nappies. This told me something was wrong with their scales!

I think to be fair to the HV her interests are in helping the child to gain weight. Yes some babies gain slowly but a 0 gain in 3 weeks is cause for concern. I had weight gain issues with ds, and we did do top-ups. A mix of formula and ebm, i prob only gave him max 150ml of formula a day and I slowly reduced it over 2 weeks. It did not damage my supply and it helped get ds weight back to where it needed to be. There is a difference between topping up and supplementing. Replacing a whole feed with a bottle of formula has a much greater impact on supply.

Saffagal

My LO took just over 5 weeks to regain her birth weight, and since then there have been periods where she has gained almost nothing and then a period (2 - 3 weeks) where she has suddenly gained loads. I found the periods when she noticeably grew in length she gained less weight. Breastfed babies don't always gain weight predictably and remember weight is only one indicator of a healthy baby and shouldn't be looked at in isolation: are they alert, awake, content between feeds? Are there regular wet and dirty nappies? Is baby meeting milestones?

Toto

DevilsAdvocate1 wrote: »

The advice the health visitor has given regarding top ups shows that they health visitor is not knowledgeable regarding breastfeeding. In my area health visitors are allowed to specialise in one of three areas. If their specialism is not breastfeeding then they have very little training in supporting it. My health visitor decided to specialise in post natal depression and gave very poor advice regarding breastfeeding. She put me under huge pressure to switch to bottles.

The way breastfeeding works is that when the breast is empty the body gets the message that the milk is needed and makes more. If you introduce top ups via a bottle the milk will stay in the breast for longer (because the bottle had been used rather than the breast). The body gets the message that the milk is not being used and so slows down milk production. Introducing top ups, especially when it is done after every feed, has the effect of making the baby feed from the breast less often. The milk stays there for longer and milk production slows down.

This can very quickly (in just a week in some cases) lead to low of amounts of milk being produced and mum finds herself fully bottlefeeding. Great if this is what she wanted to do, very upsetting if its not what she intended.

To increase milk supply she could put the baby to the breast more frequently. There is also some evidence that feeding the baby in the middle of the night at least once can boost milk supply.

Of course her baby may just be one who gains weight slowly. My own children all gained weight slowly and with baby 2 and 3 I did not get them weighed as I found the whole process too upsetting. I knew they were getting enough as the were happy and alert. Also, the had no signs of dehydration. A dry mouth and sunken fontenelle are signs of dehydration.

Also, were different scales used during the weigh ins as this can have an effect. With DS1 they weighed him before and after a feed and he was 2oz less after he had fed, despite no wet or dirty nappies. This told me something was wrong with their scales!

There is no need to introduce formula, you can add a top up by expressing which is what I would advise. By expressing the milk production should increase even if mum isn't able to gain much via the pump to begin with. I would advise her to pump at night when the prolactin levels are highest. However, topping up isn't the only way to change things, increasing the quantity of feeds by not allowing baby to go 6 hours between feeds especially at night and ensuring baby is getting a good lengthy quality of feed is also something to try.

DevilsAdvocate1

lao_cat wrote: »

I think to be fair to the HV her interests are in helping the child to gain weight. Yes some babies gain slowly but a 0 gain in 3 weeks is cause for concern. I had weight gain issues with ds, and we did do top-ups. A mix of formula and ebm, i prob only gave him max 150ml of formula a day and I slowly reduced it over 2 weeks. It did not damage my supply and it helped get ds weight back to where it needed to be. There is a difference between topping up and supplementing. Replacing a whole feed with a bottle of formula has a much greater impact on supply.

As far as I'm aware, the evidence is that replacing one regular feed with formula has much less impact that giving an extra bit of formula at the end of a feed.

Expressing is such a faff and many people will get next to nothing out. You can't compare what you get out when you express with what the baby gets out as the baby is more efficient than a hard pump.

Increasing feeds is much less of a faff, though it can sometimes be difficult to get the baby to keep suckling. There are techniques such as breast compression which help get more milk into the baby. Also, changing the nappy mid feed can help too.

Many breastfed babies don't regain their birth weight until the 3 week mark.

Christmasfairy

My youngest was a very poor feeder, I was advised to bottle feed her every 2 hours whether she was crying for food or not. It made no odds, she was always small and put on weight very very slowly. She never took more than 3oz at a time and by 10months was off milk completely ( although I added to to her food).

My point is, my HV had me terrified, appts with peds, gps,feeding specialists, nothing made any difference and I spent the first year of my DDs life counting every oz and weighing her every 2 days. Our gp finally said, stop worrying, let her eat what she will and we will keep an eye on her.

She's 4 now and eats like a sparrow still, but she's healthy and happy, I just wish I had taken my HV advice with a pinch of salt and trusted my instincts a bit more