17 week old 3 or 4 hour easy??

[Asha G]

Hi there I am really hoping someone can help me!! I think I have established a fairly good routine for my lo and my easy routine for the last 2/3 weeks has been:
E 8am (bf)-9am
A 9am
S 1030-12pm
E 12pm (bf)-1pm
A 1pm
S 330pm- 5pm
E 5pm(bf)-6pm
A 6pm
S 7/730-8/830pm
E 8/830pm (formula bottle)
S 9pm

The nap times vary, sometimes only an hour but sometimes 2 hours but this is roughly her routine.

My problem is that I just had her weighed and she didn't put on any weight at all in the last 4 weeks , just a few ounces so the health visitor has suggested I feed her more often so instead of 3 breast feeds Plus formula bottle I should Aim for 5/6 breast feeds plus formula at night (aswell as offering formula top ups after each bf).

So my question is how do I stick to the easy routine as at the moment I'm trying the 4hour easy. Also as she is 4 months old the nap guides suggest she needs Approx 2-3 hours twice a day but if she sleeps that long I cannot feed as often as I now need to .

I need to feed every 3 hours approx to get 5/6 feeds in during the day but not sure what to do with her naps now as she seems to have gotten used to her 3 naps a dAy at the moment??

Any help and Advice would be really much appreciAted as I felt I was starting to get there with a good routine and now I have to change again not to mention the anxiety of her not having put on weight in the last month 😢😢😢😢😢

Please help!!!!! 😁😁😁😁😁😁😁😁

[Asha G]

Hi there really need some advice on this so if someone could reply I would really appreciate it!! Thank you!!!! 

[jessmum46]

Hi, sorry you've not had any response yet.

Regarding the feeds could you perhaps offer her 'main' feeds four hourly but offer top-ups say 30mibs-1h later? Many breastfed babies can't actually manage 4h between feeds at this age so if she is hungry and showing cues earlier you should definitely feed her.  It may look more like EAEAS for a while but that's ok.

Also I notice you have sone very long A times - 2.5/3.5/2-2.5/then a tiny 30 mins? Is that right? It's ok if its working for you for now but it would be much more typical at this point to be having around 2h A time with two long naps and a catnap. Like I said, if you're both happy no need to change but be aware OT can accumulate x

[Asha G]

Hi there thank you so much for replying!! 
Yes I've been worried her a times are too long but she seems to be ok with it , I wait for her sleepy cues but sometimes she doesn't look tired at all. She does wake up at 4/5 am and fuss on and off til 7/8am when she usually wakes up.. Could this be a sign of the accumulated over tiredness?
I spoke to the hV again and we agreed that 4 breastfeeds followed by top up in the day and the one formula bottle at night would be enough so I'm now working on 3.5 easy:

7/730 wake up ( usually have to wake her)
730am bf plus up to 4 ounces top up
930am nap
11am bf + up to 4 ounces
1230pm /1pm nap
230pm bf plus up to 4 ounces
4/430pm nap
6pm bf plus up to 4 ounces
8 pm cat nap
9pm formula bottle
930pm sleep

Sometimes though she will sleep over 1.5 hours at nap time so end up having to wake her in order to keep feeding times but they do stil get pushed back by up to half an hour as I try to wake her slowly and then make sure she is fully awake before feeding. She doesn't really show hungry cues anymore which makes it harder for me and I end up relying more on the timings rather than her.
I read on the FAQ that sleep times for this age were either 2 x2-3 hour naps or 3 x1.5 hour naps plus catnap so I'm using the 3 naps a day as this seems to work for my lo.
I'm having her weighed again on Monday so that should help in terms of whether I can stick to this routine or whether I need to change it again
Should I be waking her up in the morning and at nap times though if she still sleeping??
Thank you again!!! 

[jessmum46]

Yes unsettled sleep in the early hours could well be OT, though sleep is always lighter at that part of the night.  Are you needing to settle her or does she manage it herself?

I'm not sure why you are aiming for such a long day?  If you are waking her at 7am to start the day I would make her 4/4.30pm nap a shorter one and go for a 7/7.30pm bedtime.  Two longer naps and a catnap is usual at this age, with around a 12h day x

[Asha G]

Sometimes she settles herself .. Usually by sucking her fingers but sometimes I need to pat her to calm her.
Well because I'm now trying to get more feeds in due to her low weight and feeding her every 3.5 hours I end up having to keep her up for longer in the day .. Not sure how to get the longer naps In Either due to the number of feeds I need to get in per day - but also not she would sleep for more than 1.5/2 hours at a time- how do I encourage her to take longer naps?
How does the 3.5 hour easy work with 2 naps and 1 catnap? I've been following one of the sample easy routines that has 3x 1.5 hour naps plus a catnap.. So not sure how to adjust!
A

[jessmum46]

You shouldn't need to keep her awake to feed her, that's just going to add overtiredness to your issues really 

Let's see if we could come up with a plan.....say with 2h A time:

WU & E 7
A 2h
S 9-10.30
E 10.30
A 2h
S 12.30-2
E 2
A 2h
S 4-5
E 5
A 1h30-2h (usually a bit shorter after a shorter nap)
E as part of BT routine
BT asleep for 6.30/7

Or if that's too many feeds too close together for her why not aim for four feeds in the day as per a 4h EASY plus a dreamfeed?

Bear in mind if you are continually offering formula top-ups your breast milk supply will diminish - it works on supply and demand.  That's fine if you are ok with a switch to formula longer-term but if you are wanting to continue to breastfeed the regular top-up plan with have a negative impact on that.  What are your thoughts?

[Asha G]

Thank you for such a quick reply!!
Ideally I wanted to. Carry on breast feeding but because she hadn't put on much weight the hV suggested the formula top ups after each fed as maybe she just not getting enough from me or not enough fatty milk... The routine below would be good until the afternoon but because she feeds for about an hour (approx 45 mins  bf and then 10/15 min bottle top up) I'd be worried that she wouldn't be hungry so soon after the 5 pm feed which is why I'd usually feed a bit later and also that way I can keep up with the extra feed that the hV told me to add intto her day
Should I wake her from her catnap in the afternoon then? As she wil sometimes sleep longer..
I just feel so confused about what to do 😞

[jessmum46]

I'm going to ask one of the BF mums to pop in to give you some extra thoughts .

Just regarding the weight - I know she didn't put on a huge amount in those four weeks but are there any other concerns?  She is eating/peeing/pooping ok?  Not a fussy eater?  Normal yellow poos?  Where is she centile-wise now compared with her birth centile?

[Asha G]

Ok great!
She was in the 0 percentile and had been following that curve but her last weight meant that she dropped below that percentile but she is a happy active baby - doesn't  cry that much and has had lots of wet nappies although she started pooping every 5/6 days in the last month but I asked the gp who said that was normal so no other concerns .
Getting her weighed again today so will know if it's just the amount of milk she is getting or if there are actually other issues.
Diesbt really fuss although had started to get more distracted while bf ..Looking away or sucking her fingers but thought the fingers maybe due to teething?

[jessmum46]

Sorry which percentile was it? 

It is normal for babies not to exactly follow a centile line, it's only really once they've crossed two centiles that you would start worrying  . I'm wondering if the top-ups really are necessary if all else is well?  With the best will in the world I think we would all agree here that HV advice is very variable and sometimes rather dubious and outdated (not true for all HVs - mine is actually brilliant ).  What's your gut instinct?

Feeding behaviour and distractedness sounds totally normal for four months

[weaver]

Hey hun, if you're concerned at all about your supply or her weight gain, the easiest way to deal with that is more frequent feeding you can totally work that around naps just by giving a main feed and adding in a snack during A time. That's what my two needed in that 4-6 mo period. I don't know if you're looking at the BW book but the BFing advise there is somewhat outdated and we like to think that Tracy would have updated it in the light of more recent research.

Bear in mind that babies grow at different rates and different times. They do not all do the same things

With all respect to your HV, the first thing a BFing mother needs to do if there are any concerns about supply or weight, is feed more. As PP says, formula may  reduce her intake of BM and undermine your supply.

[Asha G]

Hi both thanks so much for all the advice!
She is I. The 0.4th percentile and when she weighed week before last she had dropped below the curve so hV sId to increase bf plus offer formula top ups after each feed so we did that for a week with 4 bf plus formula tops and just formula at night ( we were already giving her just the bottle at night for her last feed). Then after 1 week she had put on almost a pound .
Because I was struggling to work the easy routine around all these feeds I've now started feeding a bottle in the morning And then pumping that morning supply and then I give 3 bf in the day and then formula bottle At night.
I just ft so confused about how to feed her more and still stick to the routine plus because she feeds for up to an hour on the breast I just felt I was feeding all the time.
When the hv Told me she hadn't put on weight I just felt so anxious and guilty and then my lo was drinking the top ups of formula I felt even worse because this whole time I thought she was getting enough as she never cried for more of fussed etc and then she was suddenly drinking g more even after an hour breastfeed.😞
I'm too scared now to stop the formula incase she not getting enough for me... Hav g pumped I think I have the quantity (after pumping got 120 mils) but not enough of the fat content - very thin layer of cream on the top 😞😞😞😞
Now I feel that I should just continue As I am and my routine looks like  this :

E 730Am bottle
A 830-9/930
S 9/930-11/1130
E11/-1130
A 11/1130-1230/1
S 1230/1-2/230
E 2/230
A 3/330-4/430
S4/430-5/530
E 6pm
A short activity time
A 8pm ish
9/930pm Dream feed with bottle

Is this ok? Also she doesn't Lways nap for 2 hours and is up with an hour .. Should I let her have activity time before her next feed or just feed her earlier and amend the routine as the day goes on?

[weaver]

Hun, bottles are very easy for babies to drink, they often will slurp them down easily. Doesn't really reflect anything about your milk. Also be aware that a baby is much much more efficient at getting milk from the breast than a pump is, so your baby will get more than the pump on the same period. The very best way to increase or improve your supply is to feed more, you will make more if you feed more. 

If she wasn't fussing or unhappy, if she was content in herself, that sounds like she was perfectly happy. Babies will not go hungry! They make very sure everyone around them knows if they are hungry.  Maybe she wasn't doing precisely what charts indicate she should but the charts are general blunt tools and cannot predict what every child will do.

It breaks my heart that this HV has made you feel anxious and like your milk isn't enough. I sincerely doubt that's true. By all means continue the top ups if you want to, but that is a bad route to continuing BFing.  If I were you, my aim would be to reduce and then stop topping up. It's your choice of course but topping up will reduce your supply, I suspect that if you follow this HVs advice you will end up topping up more and more, and reducing BFing. Again that's absolutely fine if that's that you want to do, but if you want to continue BFing, it's not the best way forward.

I wonder are there any BFing support groups near you? It might be good to go along for a chat with other local mamas.

[Asha G]

Well I'm
Only giving her the bottle at morning and night now and just the breast during the day with no extra formula top ups.
I'm just so worried that there isn't enough fatty milk and so if I go back to just breastfeeding she won't put in weight like before..
I will try finding some local groups too
Thank you so much for your help I really appreciTe it!!!