Human Milk Fortifier

[SpringCrane]

My healthy, full-term 4 month old is low weight. I've posted about it before. He had a check up today, and he's 95th percentile for length and 5th for weight. He's been staying on his curve since his initial drop at 8 weeks, though his weight gain is low and slow. He refuses to nurse, my supply is low, and he's dairy sensitive. He's bottle-fed a combo of pumped milk and nutramigen. He doesn't love the formula, and my supply is low, so despite it all, his fluid intake is low. The pediatric nutritionist suggested adding human milk fortifier to increase his caloric intake. I had never heard of this, so I looked it up today. It states it's only for preemies and/or baby's under 8 lbs. Little guy is 13 lbs.

Anyone use this before? Does this sound right?

His long and skinny frame is to be expected based on our family, but he is gaining less per day than they'd like. They aren't super concerned, but his ped has been in contact with the nutritionist and GI specialists, so she's definitely not completely comfortable with status quo.

The nutritionist also suggested concentrating his formula a bit more or adding a small amount of coconut oil. And his ped said she'd think about offering solids sooner than 6 months as an option, too.

 

[Left wonderin]

My LO is 5 months and only coming up on 12 lbs is also an enf baby . No one has raised any concern with me

 

[loeylo]

Yeah, Gracie only weighed 16lbs at 8 months and she was on the 50th centile!

 

[SpringCrane]

Is it a boy/girl difference?

 

[loeylo]

Is it a boy/girl difference?

I honestly don't think there would be that much of a difference, I'll go check her red book.

 

[Left wonderin]

Not sure my LO was 6.5 lbs born .she still fits in 0-3 month clothes . She is tiny

 

[Left wonderin]

Can I ask how you know your supply is low ?

 

[loeylo]

Gracie weighed 12lb9oz at 16 weeks, which is on the 25th centile. I have ripped the boy pages out (for some reason!)

Gracie is also tall and thin, she is between the 75th and 91st centile for height but she was between the 2nd and 9th at her 6 week check. Her weight has always fluctuated between the 25th and 50th.

 

[loeylo]

Also, Gracie is CMPA and is purely on nutramigen.

 

[SpringCrane]

Can I ask how you know your supply is low ?

I just don't get much when I pump. I'm sure it'd be fine if I was nursing, but I get a max of 15 oz total breastmilk in a day. I pump 4-5 times per day.

 

[Left wonderin]

I get zero if I pump !!! Pumping just doesn't work for me . It is not an indication of supply as babies usea totally different method than a pump to extract the milk. With my first LO I gave up bf at around 4 months thinking I had low supply for the following reasons

1. Got little to nothing when I pumped
2. My boobs never felt full any more
3. Couldn't feel a let down anymore
4. LO fussed at the boob and wouldn't eat

This time round the same happened and I thought oh no here we go again. Turns out my supply is just fine . Pumps don't work for everyone , around 3-4 months your body regulates the amount of milk required so no more leaking , spaying , heavy boobs and forceful letdowns, I worked through the " the world is much more interesting / the milk not coming quickly enough for me phase with this LO and we are now out the otherwise of it .

I've given upon pumping all together as it frustrates me and I end up wanting to tear my hair out ! I am no expert but have read ALOT and been to alot of BF support groups . I would suggest maybe trying to let your boy feed more often ( even 3-5 mins at a time ) as his will increase any supply way better than pumping . Pumping actually will reduce your supply as its not as efficient as babies I also made the mistake of thinking because LO only ate for max 4 mins at a go there was no milk left so she stopped and was not full. Not the case at all turns out a baby is soo efficient at getting milk out form 3 moths old 3-5 mins feeding constitutes a full feed . My poor LO was persecuted with me constantly trying to latch her on again !! No wonder she screamed !! For me I thought the feed should be 20 mins ..

Now she feed 3-5 mins with lots of switches betweens boobs maybe every 2-3 hours

 

[Left wonderin]

Hope some of that is helpful . If not just disregard x

 

[SpringCrane]

Hope some of that is helpful . If not just disregard x

Thank you Unfortunately, the little guy flat out refuses to latch, so I'm only able to give him what I can pump. I've seen several LCs, a pediatric nutritionist, and GI specialists, and they all agree his latch is fine (back when he would), no tongue/lip tie, etc. My first was a very quick eater, and I had the same thoughts as you, thinking he wasn't eating long enough, but we figured each other out and he breastfed for 18 months. This guy though, once I introduced the bottle to supplement his intake at the initial sign of slow weight gain, he's refused to nurse unless VERY sleepy... So almost exclusively during the night, if he does.

I was mostly asking for advice about the human milk fortifier as that seems to be what the ped wants to try next, but it's $100+ for the smallest case I can find! I'm fine with it if he takes it and it works, but we've already thrown money away trying other things, and I had never heard of it, so I was looking for any experiences with it. But, I do appreciate the advice and kind words regardless :-D

 

[Lil mole]

How sensitive to milk is your little guy? If he reacted to your breast milk it is likely he is quite sensitive. Are you dairy free now? Could you try an amino acid based formula (neocate) as the nutramigen does still contain cows milk protein, very broken down, but it is likely to still be a problem for a baby that reacts through breast milk. Poor weight gain is a symptom of cows milk allergy.
If you only found the milk sensitivity through formula top ups then please disregard the above.

Re the fortifier can you quizz the paed about it? If they are suggesting it they should first answer your questions about. Hopefully they are fully aware of the guidance on its use and suggested it because they think it may work for your baby x

 

[MindUtopia]

My understanding is that you're right, human milk fortifier is only for very small babies and preemies right after birth when they need to put on weight or put back on weight that was lost when there is a concern about failure to thrive. I've never heard it recommended in older babies, but I would probably ask some more questions and get some evidence of its use in older babies and see how they would suggest you use it.

I probably wouldn't concentrate the formula as they are usually electrolyte balanced to be digestible and support baby's natural electrolyte balance. I think they can sometimes become dehydrated or get too much salts if you play around with the mix of formula to water. I know you aren't supposed to do it with normal formula and I would imagine the dairy-free versions are no different. No idea about the coconut oil, but I would probably want to talk to a ped about that first, rather than just trust the nutritionist.

Does he tend to take breastmilk better or formula better? I would actually wonder if there is a way you could encourage the consumption of the one he prefers. I had an awful time with pumping as well and my body didn't respond when to the pump, so didn't get much (though 15 oz sounds amazing! I never got that much in a day, so you should be really happy with that). If you want to keep pumping and he'll drink more BM than formula, could you try something to boost the amount you can pump. There are some good websites about how to exclusively pump and boost supply (things I wish I had known when I was trying to do it!). Maybe changing around your pumping schedule, adding fenugreek, or prescription meds to boost milk production.

In my case, the thing that worked was to stop pumping and focus only on formula. That was really when her weight finally came up and stablised. I'm not sure why or what happened, but something we were doing just wasn't right until then, which was around 3 months. That may not be what feels comfortable for you though.

 

[noon_child]

I agree that a baby who is sensitive to the dairy in breastmilk could still be sensitive to the dairy in Nutramigen. I don't know the cost of a totally dairy free formula in the US but compared to the fortifier it might be worth a try? Keep in mind though that dairy free formulas are often Soy based and babies with CMPI are often intolerant of Soy too.

Have you tried power pumping?