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my LO is now 86 days old and has been exclusively breastfed. He just had his check up today and now measures as follows:

height: 59cm. 57.5cm two weeks ago. weight: 5.15 kg (with clothing on, suppose he would be just a little bit below 5kg without clothing). his weight was 4.74 two weeks ago. HC: 40cm.

The doctor plotted this against a chart and we found that he is now just above the 3rd percentile... A good side is that he has been reaching development milestones faster than supposed to. He is pooing and peeing a lot though he sleeps an average of 11-13 hours total a single day.

My wife has been very eager to breastfeed him exclusively. But, when the doctor suggested we supplement with formula, she is pretty upset now. She had a lactation consultant come in to check breastfeeding. The consultant diagnosed the baby as having a tongue-tie, so we had that cut a month ago. But still not a significant improvement observed.

With these in mind, should we really supplement with formula?

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    Welcome to Parenting.SE! I personally deeply sympathize with how hard it is to be told that breastfeeding is not going well; it's easy to feel like a failure. (Been there, done that, the kid is now 11 years old!) However, I feel like your Question is sort of seeking a "second opinion" than what the doctor said, and that is something that we can't really provide for you over the internet. – Acire Aug 18 '15 at 1:09
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    The rule of thumb / trick with reading the percentiles is not where your baby currently is, but to plot baby's growth in it. If it is roughly parallel to the lines, everything is fine because the growth rate is ok. (Some bumps and dents are normal.) My son was always over 97% for growth, yet below average in weight, daughter is a 50%-girl. But if you notice a deviation it's time to pay attention. If you can't bump up milk supply it's not a shame to supplement with formula, it might even reduce stress for the mother. Don't let the "breast vs. bottle" flamewars on the web get at you! – Stephie Aug 18 '15 at 6:11
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    Have you tried topping up with expressed breast milk? As a long term solution this may be difficult to manage but it can give you an idea if the baby is still hungry after breastfeeding and if bottle feeding helps him to get more milk (your wife would need to express milk when she hasn't just fed the baby and store it). Attempting to express milk after breastfeeding could also help to boost her milk supply if the baby doesn't latch well to improve the supply by himself – MiniMum Aug 19 '15 at 13:51
  • Dolfromspace, to get this discussion on a more solid foundation: Would you mind to share the older weight/growth data with us? You probably had previous checkups, right? Or, even simpler, tell us whether the growth rates (length and weight) are off or consistent. – Stephie Aug 19 '15 at 18:18
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If you need a second opinion, please get one from another doctor (preferably as soon as possible so that your baby can get the necessary nutrition without delay.) However, since you asked:

Yes, you should supplement his feeding with bottles. There's no shame whatsoever in doing this for any reason, let alone to help your baby grow. To continue exclusively breastfeeding is to continue letting the baby go hungry.

As @Erica said, it's hard for some people who want to do everything the "natural way" to add supplement feedings. But the baby's health is at stake here, not the feelings of adults. A lactation consultant is not going to make your wife suddenly make more milk (sorry, but it won't happen), and it certainly won't make her feel good about herself unless the consultant determines that your wife has done everything she possibly could have done, and it's time to add supplement.

All the benefits of breastfeeding will continue as she continues to primarily breastfeed. Plus, you can help feed the baby as a dad by giving him a bottle as well.

Some of the the potential myths you will hear should not sway you both. They may include:

  • milk production will go down
  • the baby will get lazy and will prefer the bottle
  • you will cause nipple confusion
  • formula will cause digestion problems, constipation or allergies
  • bottle feeding can cause (insert worst fear here: dental troubles/ear infections/deformed facial features/other)

If you ate only organic food grown on your own property but you had a drought, would you still insist on eating only what you grew despite being hungry most of the time, or would you add other organically grown food to your diet?

It's no different for your baby. This needs to be approached only from the baby's best interests. Your doctor has given you advice. If you don't trust your doctor, get a second opinion. But don't let some random stranger on the internet who doesn't have your precious baby's best interests in mind talk you out of it.

I've taken care of hundreds of babies as well as my own. My first required supplemental feedings, and I nursed him until I became pregnant with the second (for reasons I won't go into.) I never saw nipple confusion in a full-term, non-adopted baby.

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    +1. My wife and I had to start supplementing our 12-week old last week. I wish I had seen a post like this when we were struggling with the decision. I will say, however, that her digestion has seen a big change. Instead of 1-2 poopy diapers per day, we've been seeing one every 2 days or so. – Jeffrey Blake Aug 18 '15 at 5:16
  • @JeffreyBlake - Congrats on your new baby! I agree, frequency of pooping will change some, but nothing is written in stone. My first (breast and bottle) pooped several times/day. My last (breast only) pooped - I kid you not - once every week for a few months (he was receiving medical attention.) YMMV, as they say today. :-) – anongoodnurse Aug 18 '15 at 5:30
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    This answer matches our experience - this still gives the benefits of breastfeeding and it gives mum a bit more resting time to improve the quality of her milk, which is important too - if it's just colostrum rather than hindmilk then you're not feeding your baby, it's the equivalent of drinks. Even in countries with high levels of breastfeeding, many of them count breastfeeding supplemented by formula to still be breastfeeding. – James Snell Aug 18 '15 at 19:20
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    This is a very good answer that clears up some of my deepest frustration. I love the analogy. Thanks for the advice, anongoodnurse. – dolfromspace Aug 19 '15 at 21:43
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First, the formula has the same amount of calories than the breast milk, and the composition in proteins, fat and amino acids its practically the same. The formula it's more difficult to digest than the breast milk.

Your baby it is very young, I recommend you to breastfeed him/her when he/she wants to, not in a schedule, that helps a lot.

And if you want to supplement, first nurse the baby, then give a bottle of formula. My two kids gain a little weight some months, but my oldest girl it's now a really REALLY tall girl (she looks like a 8 yo, but she's only 5yo).

EDIT: if the baby is active and achieving milestones, it's a healthy baby. My two kids are very skinny, but healthy. And exclusively breastfeed both of them.

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I also sympathise with your wife's situation. My answer will be based on my personal experience with my two girls, but also on discussions in help groups and research on the matter.

My first daughter would also not meet her wight growth milestones. She was always feeding and still not getting much weight, but met her other milestones a lot sooner.

I have been told growth does not come linear with babies, the either gain weight, or height, or milestones. Do you or your wife know about growth spurts? The occur with babies regularily, at 10 days, 6 weeks, 3 months, 6 months, 8-10 months, 12 months, 18 months.... and do go on, even when they're not babies anymore. Those are periods of frequent feedings, especially when breastfed, and the mother usually feels she does not have enough milk. That is because lactation is based on a supply and demand system. That means, if the baby needs more milk, he will want to feed more often, and the supply will adapt and the mother will have more milk. Supplementing with formula destabilizes this process, and the formula meal the baby gets will not be demanded from the mother and thus not be produced. Then, lactation decreases.

This is the theory. In my experience, lazy feeders like my first daughter do not manage to increase demand, and I would nurse her for hours at the 3mo growth spurt. That one was our greatest breastfeeding milestone together, and it lasted for a whole month. My second daughter was a bit better at it and I didn't feel this growth spurt as that bad. Also, from the 2-3 help groups I've been on, I noticed a trend at 3 months. Almost all mothers feel like they don't have enough milk, and all at 3 months. So it's always this growth spurt that's the hardest to overcome.

I agree with @anongoodnurse on the point that you should supplement IF the baby is hungry. And I agree that nipple confusion never happened to us, but my girls always preferred the breast, I couldn't even get them to use a pacifier... and i tried. BUT I haven't read from your question that the baby is going hungry, only that he is not meeting weight milestones. Which could be for various reasons, and not because of insufficient milk supply.

You and only you see your baby and know if he is healthy and happy. If he is, and only points on a chart are your concern, then I really advise to at least wait out the 3 months growth spurt. Afterwards breastfeeding does get easier!

LATER EDIT
Here is a little guide to checking if a baby is getting enough breastmilk. It's on the site of La Leche League organisation. http://www.llli.org/faq/enough.html

This is from the breastfeeding clinic of Dr. Jack Newman's http://www.breastfeedinginc.ca/content.php?pagename=doc-IMB

I stand by my statement that the baby gaining weight and the baby being hungry are two different situations. And only the parents can asses that. Is he hungry? Ok, try supplementing if raising the milk supply fails. But why not try that first?

I like Stephie's comment, it would have been a good answer... Growth is not a point in a chart but a progression, and that is important to monitor.

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    "I have been told growth does not come linear with babies, the either gain weight, or height, or milestones." This (and other aspects of your answer) would be better if supported with a study/research. Growth curves and milestones are two different aspects of development. It's not one or the other in spurts."...then I really advise to at least wait out the 3 months growth spurt." This baby is 86 days old. If a baby has a growth spurt coming, then they especially need the nutrition at that time. -1 from me. – anongoodnurse Aug 18 '15 at 19:14
  • @anongoodnurse I like how you keep implying that breastmilk is not nutrition and that they are keeping the baby hungry. Increasing the milk supply should be the first step, but that is easier said than done, and most are just afraid. Because of people like you that are condemning mothers for 'letting the baby go hungry'. I stand by my statement: keeping the baby hungry and him not gaining weight by formula standards are two completely different things! – Ioana O Aug 19 '15 at 9:52
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    Sorry, Ioana O, that comment made me downvote your post. There is a difference between a "temporarily low milksupply" and a baby not growing well. Yes, there are doctors who like to "interfere", but there are also thousands of very responsible doctors out there who have the baby's well-being in mind. And if a child's growth rate is dropping, that is a cause of concern. Supplementing formula may be a solution or there may be other causes. And so that you can esitmate where I'm from: I BF both my children well beyond the 2-year mark. I am a staunch supporter of BF, but within reason. – Stephie Aug 19 '15 at 10:35
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    "You and only you see your baby and know if he is healthy and happy" -- I would not be so quick to dismiss the advice of a pediatrician, but instead would recommend a second (medical professional!) opinion for a more complete evaluation. Parents are the "front lines" but they need support of experts. I like some parts of your answer, but others don't feel very supportive of a mother who may need to supplement with formula. – Acire Aug 19 '15 at 11:43
  • That's no problem, I see we come with different cultural backgrounds and I am not getting my point across. Kids grow fine on formula too, but the mother will always feel guilty, because she tried hard and didn't succeed. That is where I wanted to help. – Ioana O Aug 19 '15 at 14:14

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