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Breastfeeding
yvdukana
member
Weight Gain, Jaundice, and Supplementing
yvdukana
member
Hoping someone here could give me some advice. My son is 12 days old and has been EBF, he was 6lbs 15oz at birth. We met with a LC after getting off to a rough BFing start after my milk came in. Now he's latching on well and eating every 2 hours or so, usually just off one side, but he's a lazy eater and can spend anywhere from 15-45 on one breast. He barely ever lets go himself, he usually falls asleep, stops sucking and I unlatch him. He had some jaundice at 2 days old when we left the hospital, bili level was 8 and he was down to 6lbs 9oz. We went to the pedi at 4 days old and he was still 6lbs 9oz and his bili was up to 15. The pedi wanted me to supplement formula in a syringe, but my milk had just come in, so she agreed to just let me keep feeding him and wait it out.
At 10 days we went to a BFing drop in group run by my LC and we did a weighed feed, he took one side for 35 mins and got in 32 cc and then took the other side for 25 mins and got in another 32 cc. The LC was happy with this and said 15 cc on each side would have been good. Fast forward to yesterday at his 11 day pedi appt and he was only up to 6lbs 11oz and is still a little yellow. The pedi says he's not gaining enough weight and that the jaundice should be gone and is insistent I supplement 10 cc formula through the syringe at every other feed. I don't think I have a supply problem, he has at least 6 wet and 5-7 dirty diapers a day. He seems content and alert when he's awake except for a fussy period usually during the evening.
I'm so at a loss what to do. Should I supplement him like the pedi says? Or is he doing okay with being EBF? Supplement with pumped BM? The pedi claimed he NEEDED the formula because there could be some enzyme with the bili that the BM can't break down, and that the formula will flush it. I just don't want to supplement formula, even a small amount and have it affect my supply or our BFing relationship. Anyone experience anything like this? What did you do? I plan to call my LC tonight and ask her opinion, just because I feel the pedi's answer to everything is formula.
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Re: Weight Gain, Jaundice, and Supplementing
It is false that formula is needed to flush bilirubin out; I'm sorry that your pedi seems less knowledgable about breastfeeding and so quick to turn to formula.
What is true is that he needs lots of breast milk to flush it out. I would also make sure he gets some sunlight as that will also help (even just sitting with him by a sunny window as much as you can). My guess is that he does need to up his intake a bit - but that doesn't mean you have a supply problem but rather a demand one (that he is being a "lazy" nurser).
On the weight gain...it's not a problem in and of itself that he hasn't hit birth weight yet. 2 weeks is still within the range of normal. Since he is jaundiced, that is likely contributing to his laziness (although 45 minutes is a very very typical length of time for a newborn to nurse). It's not at all unusual for a newborn to hang out at the breast on and off for hours, particularly in the evenings. Get comfy and nurse, nurse, nurse!!
I would make sure he is nursing at least every 2 hours during the day and every 3 at night (so if you start nursing at 8, you will start again at 10 even if he nurses for 90 minutes). That means waking him to nurse, even at night.
If he has only nurse 15 minutes and falls asleep, I would try to wake him (this isn't a magic number but chances are if he doesn't nurse for long he is falling asleep and could eat more). Newborns are very sleepy and even more so with the jaundice. Try tickling his feet, blowing on his cheek, stripping him to his diaper, etc.
I wouldn't worry about your supply so much as just getting him to nurse more. Once the jaundice clears and he passes birthweight he won't be so sleepy at the breast and you won't have to work at it so much.
Breastfeeding Counselor with Breastfeeding USA
Babywearing Guide ** Newborn Carriers
Cloth Diaper Guide
Safe Bed Sharing Info
Be careful just "choosing your own adventure" as far as what advice you take from your doctor and what advice you dismiss. High bilirubin can, and does, cause irreversable brain damage. So, that is why your doctor is taking it very seriously. If you don't feel like you can trust your doctor to put your child's needs first and come up with a plan to prevent brain damage, then you should probably find another physician first (and then ask that physician your questions).
Lactation consultants are great--but they don't really have the medical training necessary to treat jaundice and ensure that your baby flushes the bilirubin fast enough to prevent brain injury.
Either call your physician back and outline your concerns and have him talk you through WHY he asked you to do what he did, or find a new doc. But don't take this lightly and just think that this is simply a breastfeeding/formula feeding issue. Your baby's health really is at stake when it comes to clearing bilirubin from their body after birth.
That said, you need to get that baby eating as much and as long as possible, whether you feed breastmilk or formula. Try lots of skin to skin, flicking their feet a bit when they fall asleep, talking to them to keep them awake, changing positions often, etc.
Also, just FYI, there is actually a form of jaundice called "breast milk jaundice" that occurs in 2% of all babies.
If jaundice occurs or lasts past the first week of life in an otherwise healthy and thriving breast-fed infant, the condition may be called "breast milk jaundice." It is probably caused by factors in the breast milk that block certain proteins in the liver that break down bilirubin.
https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001990/
We are not doctors on this board, but to say that your pediatrician doesn't know what he is talking about is ridiculous. Your doctor specifically said to try formula becuase he is concerned about "breast milk jaundice," which is only cured by giving the baby formula for a short period of time until the jaundice is cleared, at which point you can resume breastfeeding.
Please talk to your pediatrician about your concerns.
Thank you for the info. I looked into breastmilk jaundice, but that isn't what she said he had since this was present since birth. His bilirubin is decreasing and she said he was looking better, it was just that it was "still there" and the slower weight gain that concerned her. I don't care for this pedi, she's the partner of the one we interviewed and picked, and I do feel she disregards my questions and jumps straight to formula as the answer. I have no problem supplementing the formula if he truly does need it, I'm not willing to compromise his health for the sake of BFing, I just want to make sure it is what's best, and like I said, she doesn't answer my questions and blew me off when I ask. She still hadn't called back with the latest bili draw even though I called at 9:30 am and was told I'd get a call back as soon as it comes in, it's now 3:45 pm and I'm sure it's in by now. I've made sure our next appt is with the doctor we chose.
That is great. Glad that you are continuing to follow up and that the next appointment will be a more substantive one with the doctor of your choosing.
Hope it goes well, and just in my experience among my group of real-life friends, early supplementing absolutely did not impair my friends' breastfeeding relationships unless they weren't that committed to it in the first place. As long as you pump everytime you offer a supplemental formula bottle (if you find out you have to go down that path), you won't lose your supply!
Just to follow up on what sooner posted re:breastmilk jaundice -
My guy was slightly jaundiced from birth and it was something my pedi wanted to keep an eye on because of breastmilk jaundice, so just because your LO was jaundiced at birth, doesn't mean that it's not still a concern.
Billi counts for jaundiced babies peak around 10 days, so if it continues to rise after that it could be breastmilk jaundice (is what he explained to me). He's super pro-breastfeeding, and the jaundice was slight in our case, so he encouraged lots of breastfeeding and keeping an eye out till the 1 month appointment (we saw him at 3 days, 1 week, and 2 weeks) before supplementing. And he noted that if we had to supplement, it would just be until the jaundice cleared up.
"Breastmilk jaundice" is rarely a serious condition as bili levels rarely go into the danger zone - certainly worth monitoring but the use of formula is not indicated unless bili levels get too high (and in this case they are not).
The majority of the time the answer is more nursing. Given that your LO does have slow weight gain, he is probably not getting enough milk. So the answer is to nurse more and both the jaundice and the weight gain concerns will go away.
Breastfeeding Counselor with Breastfeeding USA
Babywearing Guide ** Newborn Carriers
Cloth Diaper Guide
Safe Bed Sharing Info
The pedi called just before closing time, his bili is down to 11. So it is decreasing, though apparently still elevated for his age. She called it breastmilk jaundice, yet from what I have read and what some of you are saying, shouldn't his level be increasing with the breastmilk if it were BM jaundice? When I asked, she yet again said the treatment is to supplement with 10 ml formula through a syringe every other feed. I prodded further and she finally said she's recommending the formula not only due to the jaundice, because she would normally "just keep an eye on it," since it's decreasing, but in combination with the slow gain she wants me to supplement.
She also noticed our next appt is with our pedi and said "oh we prefer you stay with one doctor," I promptly responded that we would be, we're staying with the one we chose originally, she's much more BFing friendly, BF her own 2 children, and always answers all questions. I don't think there's a need to supplement now based on this info and the suggestions you ladies gave me. Am I wrong?
Breastfeeding Counselor with Breastfeeding USA
Babywearing Guide ** Newborn Carriers
Cloth Diaper Guide
Safe Bed Sharing Info