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Mostly BF newborn given formula top-ups and vomiting *update post 40*
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#1 Pooks Combusted

Posted 04 March 2012 - 07:21 PM

*Update post 40*

On advice of maternal health nurse and LC (I have seen a LC 3 times), I am persevering with BFing but am sometimes topping DS up with formula (my supply is affected by the use of the nipple shield, which is the only way I can BF due to flat nipples- which is also complicated further by the fact DS is a bit of a lazy feeder).

So, after an hour of feeding, I'm certain I'm completely drained, and DS is screaming for more food. First we try and make sure it really is hunger... after a while it becomes obvious that it is hunger, as he tries to get a good latch and BF from Daddy! Ok, time for a top up. He gulps it down like he's starving (maybe he is?) but then seems to vomit it all back up (probably isn't "all", but seems a lot). He never vomits breast milk...

Is this because the formula isn't agreeing with him? Because the bottle is too fast flowing? Because he's never that full with my breast milk, and vomiting excess is just normal newborn behaviour, but he never usually gets 'excess'? I have no idea. I'm pretty exhausted and can't think straight, and I can't seem to come across anything that gives me an answer on this one.

I see the LC again Tuesday, and will be trying to do something to boost my supply with her, just wondering if you can give me any insight before then as DP and I are finding the vomiting quite distressing (even though DS seems quite content and always stops screaming after the top up, and seems quite ok with the vomiting too). Thanks for any help.

Edited by pookems85, 06 March 2012 - 05:00 PM.


#2 katrina24

Posted 04 March 2012 - 07:30 PM

Hi, I just thought I'd put some ideas out there for you to discuss with your LC or GP.
1. Bub is drinking formula really fast because it is easy to suck compared to nipple and then an overflow vomit
2. Bub is a chucker and would chuck BM but isn't getting enough so only chucks the formula
3. Bub has a problem with formula. This seems less likely to me as it is immediate but I'm no expert so definitely follow up with LC or GP.
I would also look for other signs that the formula may be causing issues such as rash, terrible poos, etc.  My DD is allergic to milk and definitely vomits but it is always accompanied by other symptoms - this may not be the case in all kids though.
Good luck getting to the bottom of it.

#3 katrina24

Posted 04 March 2012 - 07:31 PM

Also, just check you have a slow flow teat.  If it is a slow flow perhaps discuss other options such as x cut with the LC.

#4 Pooks Combusted

Posted 04 March 2012 - 07:44 PM

Thank you so much, we're trying him on a few different bottles at the moment so I'll try to keep note of which ones are leading to the chucking in case it is related to the flow of the teat. I've taken down notes from your post to bring to LC appt. Thanks original.gif

#5 libbylu

Posted 04 March 2012 - 07:54 PM

Lots of babies 'posset' after every feed.  It is different from vomiting as it just kind of pops out, where vomiting involves stomach heaving.  It can look like a lot is coming out, but if you spill 20 ml of formula you will see it makes quite a mess.

#6 Hootabelles

Posted 04 March 2012 - 07:55 PM


I feed my bub a few bottles of formula when she was  3 months old but she would always throw up after..she also had eczema show up by the next day.  Unbeknown to me, until last week, I have found she is allergic to the cow protein that is also in formula.  She never took the bottle after those few times as obviously she knew it wasn't right..lucky for me I followed her que and continued with BF.

This is MY scenario and I am sharing in case your little one may be allergic or it isn't sitting right and you may need to change formula for one more sensitive to his tummy. I'm not a Dr but it may be something to look into with your GP.  Somethings not right if he is throwing up. It really is hard to find a formula that agrees with them as well.  Try Bellamy's as I have heard that is very close to the flavour of breast milk???  

Good luck

#7 Lucygoosey1

Posted 04 March 2012 - 08:05 PM

How much formula are you offering?   My paed recommended 30ml topup of formula following breastfeed.  My DD1 had this for a little while, but then stopped taking it at all (as she was satisfied with breastfeed alone).  We thought we'd follow the same idea with my DD2.  We only did this twice, as each time she guzzled the bottle like she was famished, then vomited it all back up!   It was just the desire to suck.  Could you  express to boost your supply??  Then you can top up with EBM.

#8 F.E.B.E

Posted 04 March 2012 - 08:08 PM

I had very similar breastfeeding issues with DS, so we also topped up on LC advice and yes he would spew it up at first. Giving small amounts in the bottle (30-60ml) is probably a good idea.

#9 QueenElsa

Posted 04 March 2012 - 08:17 PM

Hi Pookems,
I don't know which scenario, but just wanted to reassure you that my DDs have "vomited"/ possetted milk many times, sometimes quite large, distressing amounts. However they always seem happy afterwards and that's the important think. My babies stopped at 6 months. DD3 has done 2 big ones over the last few days.

Good luck.

#10 katrina24

Posted 04 March 2012 - 08:18 PM

Another idea of something to discuss with LC is positioning. Sometimes a different position for bottle feeding can help, maybe she could demonstrate some options for you.

#11 Delillah1

Posted 04 March 2012 - 08:29 PM

First of all, you're doing really well to be persisting with BF. I have flat nipples too and have fed my babies using a shield as well. It can be really challenging in the beginning but soon becomes second nature. In my experience my supply was not and is not (currently feeding 3rd baby at 14 weeks) affected by the shield. I am using the large size medela contact shield which has a semi circle type shape.
The first couple of weeks I was feeding constantly. Every 1.5 hrs around the clock. Have you tried topping up with  the other breast after a few minutes and then switching to the first breast again instead of formula? This can help increase your supply. Feeds would take me over an hour in the first 6 weeks so that is quite common. It is exhausting and never ending but persevere and at around 6-7 weeks you will breathe a sigh of relief and everything will become easier. I fed my first DD till she was 2.5 with the shield. I weaned my second baby form the shield at about 3 months when her mouth got bigger and she could latch on properly and she self weaned at 18 months. I tried with my first DD but was not confident enough without the shield to follow through. I had significant help from the Lactation consultants at The Mercy Hospital in Melbourne and took part in their day stay clinics at least 5 times with each DD. Now with my DS at 3.5 months I am almost able to go without the shield but notice that when he gets tired he seems to need it. So I am taking it slowly.

I just wanted to give you my story so that you don't believe the use of a shield will ruin your BF relationship or your supply. The frequency of feeding is just a normal part of establishing supply.
Regarding the vomiting, it could be that your baby cannot regulate the flow of milk from the bottle teat as well as he can from your breast and he is getting too much too quickly or that it doesn't agree with him the same way you BM does. I found that my DS would often still root around for more milk after an hour on one breast so I would put him onto the other where he would get instant gratification because the milk had built up while I was busy feeding on the other and he would get good mouthfuls of milk. If you keep switching when you feel he has drained one breast to the other you will build your supply and fill his tummy. Of course the ultimate test of this is how many wet/dirty nappies he produces. If you're using disposables you need 5 heavy wet nappies over the 24 hr period and at least one of those to be pooey.
Please ring the ABA helpline if you need help before you see your LC.
Good Luck! I hope this helps. Feel free to PM me if you want more info/support.

#12 Nobody Cool

Posted 04 March 2012 - 08:52 PM

Is your baby about three weeks old?

I think it is very possible that he is going through a growth spurt, hence the length and frequency of feeds.

The 3 week growth spurt I went through with DS was a total shocker and I almost cracked it and called DH to bring home some formula because we were both hysterical, he'd been feeding and screaming and fussing on and off the breast all day and I felt like I had nothing left to give. It was only thanks to Dr Google that I didn't and we got through it in a couple of days.

Feeding frenzies around growth spurt periods are normal BF baby behaviour and are their way of helping to increase our supply.

He was still feeding for an hour or so at a time at that stage - again, totally normal and they do get more efficient and faster as they get a bit older.

What makes you think you have low supply? Are you getting regular pale wet nappies? Is the baby bright eyed and alert for the most part, even if unsettled for periods of time. Fussiness and unsettled behaviour is really common up to the 6-8 week mark and not necessarily related to feeding.

Like a PP I have flat nipples and we fed for 14 months (off one boob for most of it!) with a nipple shield and no impact on supply.

Hope things pick up for you - those first couple of months are bloody tough.

Edited by Shady Lane, 04 March 2012 - 08:55 PM.


#13 --binda--

Posted 04 March 2012 - 08:58 PM

I would toss the bottles, and just keep putting him to the breast, that is the only way that it will boost your supply.

#14 cinnabubble

Posted 04 March 2012 - 09:03 PM

Could he have reflux and be wanting to feed more to soothe his stomach, rather than because your supply is insufficient?

#15 Tesseract

Posted 04 March 2012 - 09:09 PM

You are doing really well, those first weeks are so hard. I had a rough start to breastfeeding as well, in fact I didn't feel like things clicked until about 8 weeks, and then not fully until 12 weeks when it got so much better. Hang in there!

The others have given you good advice and it's great that you're seeing an LC. You can also call the ABA anytime if you just want to chat to someone who understands.

I was feeding EBM at the start as I was pumping to up my supply and because she wouldn't latch. The thing I discovered with the bottle feeding was that it was a lot better to offer it in 20-30 ml lots. So I would breastfeed (if I could get her on), then give 20-30 mls, then put her back to the breast. This way it kept her motivated to drink from the breast. Also, it is very difficult for a newborn to regulate the flow of milk from a bottle, so while they may be gulping it down like they're starving, it can actually be that the milk keeps flowing and they have no option but to keep swallowing. So when you bottle feed take the bottle out of the baby's mouth the second you sense they may want a break, or even just every 10 ml or so. This way they have a chance to turn their head away when you offer it again.

Also, DD threw up after every feed for the first 4 months (and this was on EBM and also breastfeeds). Because she wasn't bothered by it and her weight gain was fine they just said she was a chucky baby and not to worry.

All the best xx

#16 F.E.B.E

Posted 04 March 2012 - 09:13 PM

I found that fenugreek supplements and pumping after each feed helped my supply a bit. Has your  baby also been checked for poor suck reflex? That's what my DS had, which no amount of putting to the breast helped (if you get it diagnosed quickly there are some things that can be done however).

A GP visit might be useful if you have any concerns about your baby's health, including weigh gain, reflux etc.

#17 ms flib

Posted 04 March 2012 - 09:14 PM

Definitely check that you have newborn teats. They have a slower flow - really important!

Good luck!

#18 lucky 2

Posted 04 March 2012 - 09:20 PM

It's great you are having a review with the LC soon.
When you give the top up, use ebm is possible or formula, how much do you usually give?
Regarding bottle/teat type, I'm wondering if the Medela Calma bottle may be of help for your baby, the milk only flows when baby sucks so it will not overwhelm and bub can set the pace.
Another thing to consider is a Supply line, especially if it is only a few times a day. The SL can be a bit fiddly but it is a top up that is given at the breast rather than in a bottle.
You may have already discussed these things with your LC though, its not for everyone.
All the best.

#19 lucky 2

Posted 04 March 2012 - 09:25 PM

QUOTE
I would toss the bottles, and just keep putting him to the breast, that is the only way that it will boost your supply.

It may not be safe for this particular baby not to have top ups.
This new mum is going on the advice of a MCHN and LC who know the situation well (sb LC 3 times).
I would not be suggesting she goes against professional advice for safety reasons.

#20 squirt081

Posted 04 March 2012 - 09:35 PM


QUOTE
I would toss the bottles, and just keep putting him to the breast, that is the only way that it will boost your supply.


QUOTE
It may not be safe for this particular baby not to have top ups.
This new mum is going on the advice of a MCHN and LC who know the situation well (sb LC 3 times).
I would not be suggesting she goes against professional advice for safety reasons.


Agree

OP when I moved my DD to formula she was on S-26 gold and vomited that. I found that she has problems with the gold formulas.

When DS went to formula I found he had the same problem but he had stomach pains instead of vomiting

Edited by squirt081, 04 March 2012 - 09:37 PM.


#21 ~A Poetic Winter~

Posted 04 March 2012 - 09:38 PM

QUOTE (--binda-- @ 04/03/2012, 09:58 PM) <{POST_SNAPBACK}>
I would toss the bottles, and just keep putting him to the breast, that is the only way that it will boost your supply.


rolleyes.gif  helpful! The OP explained why he is on top ups, plus a hungry newborn that isn't being satisfied is not a pleasant little person to have in your house.

OP my DS was what my MCHN called a 'happy chucker' after every feed something would come back up, either a little or a lot it ranged. He was on the slowest teat and also on their recommendation we gave thickner to help keep it down too original.gif

ETA: I wouldn't give thickner unless advised, just giving you my story on how we helped with the chucking up

Edited by twoformee, 04 March 2012 - 09:40 PM.


#22 EJ75

Posted 04 March 2012 - 09:40 PM

Hi OP

Just a thought but are you using the "Gold" formulas?  Eg S26 Gold or the Karicare equivilant?  My DS2 would always bring up the occasional formula feed. I found that the original stock standard formulas agreed with his little tummy more than the "Gold" ones.  It was like they were too rich for him iykwim.

Not sure if this helps but maybe something to ask your LC.

Good luck

ETA - snap squirt081

Edited by EJ75, 04 March 2012 - 09:43 PM.


#23 sarkazm76

Posted 04 March 2012 - 09:45 PM

My DS used to want to feed constantly - I believe he would have stayed on the boob all day if he could.  it was so draining and made me paranoid I had low supply as even after 1.5 hours he would come off an cry like he was starving sad.gif  So distressing.  We had a rough start as it was and then when finally I thought we were good he got more and more unsettled.  He would vomit all the time - everytime you picked him up practically.  One day he threw up ON my breasts.  With all the help we had sought and all the people we had seen.... no one suggested reflux but that did turn out to be it.
All the best to get some answers.  Just ask about this as a possibility with your LC original.gif  If it is reflux do not give bubs Mylanta if suggested by your Dr... it contains aluminium which is not a naturally occuring mineral for the human body.  Our Gp put DS on it but we saw a Paed who said not to.  He's been on Losec for about 9 months and we're weaning him off it right now.  We tried once before but he wasn't ready.


#24 Princess.cranky.pants

Posted 04 March 2012 - 10:04 PM

My first thought was he doesn't need all the formula and is posseting the excess. How much formula is he having?

A baby is not necessary hungry even if they appear to be looking for food. The rooting reflex is instinctual. If you hold a baby in the breastfeeding position they can start looking for food but not necessarily be hungry.

Also he might be comfort sucking if he is feeding for an hour. He might be getting upset because he is still wanting that comfort sucking (reflux?). Will he take a dummy?

What bottle/teat combo are you using? Some newborn teats are faster than others and breastfeed babies generally need a really slow flow teat.

#25 Lokum

Posted 04 March 2012 - 10:26 PM

Hey Pookems, glad you're hanging in there.

In the mix with everyone else's ideas and suggestions:

1. Is it possible that what looks like an OK latch with the shield is really not getting enough nipple, deep enough down his mouth? (This was our problem, and cause DS to look like a lazy feeder. Really he would latch, but when he tried to suck he'd lose the nipple, so he'd stop. Feeding took forever, and he wasn't actually feeding/sucking enough, so I wasn't getting enough stimulation to keep up supply. Two different LCs looked, checked, and said we had a good latch - but you can't really tell from the outside with flat nipples how much they're being drawn down the shield.)

1 a) When you're using the shield, and he pulls off, is your nipple sucked down into the teat part of the shield, like a beanie pulled down over your ears? Or is it just perched on your nipple like a beret or a straw hat? If the shield just slides off, I'd say he's not really latching well, despite appearances. A good latch using a shield should mean you get a certain amount of suction like well-fitting goggles on your face, so you can wave your boob around a bit and the shield won't fall off easily.

2. I would agree that it's not likely to be the shield which is affecting supply, but rather that he's not doing strong, consistent sucking. Same as I suggested before, I'd work on pumping a lot and trying to give him as much EBM as you can. See if he chucks after a bottle of say 120ml of EBM (in 30 ml lots with little breaks in between.)

3. Rooting and squawking and screaming could be tiredness from the ordeal of another unsatisfying BF experience. He's not necessarily hungry for the formula... You could build up enough for a decent feed (120-150ml) of EBM, and then when he's hungry, start the feed. He'll take it easily because bottles are easy. He won't be tired out. Then see if he chucks (in which case he might just be a chucker), or is still not satisfied, or goes to sleep happily. It could be that the BF itself makes him tired, hungry and cranky (which is probably what it's doing to you!!). Of course, building up 150ml of EBM is easier said than done.

4. Reflux. The screaming and mad sucking, followed by chucking, screaming, sucking etc does sound a bit like pain. But I think everyone jumps to that a bit fast - I'd consider other things first.

5. In our experience, it was important for DS to have 6 or 7 short practices at BF every day. After 3 weeks he did get the hang of latching with the shield, despite flat nipples. However, it was also very important for him to get 8 full, proper feeds per day, so after a few minutes BF practice at each feed, I focussed more on pumping, keeping up supply, and getting EBM into him. We were lucky, and it did work out despite ultra flat nipples, small sleepy baby, poor sucker, etc.

GOOD LUCK! You're doing really well! Mostly BF is excellent too.




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