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I'm going to say again, I think the urate crystals are a big deal. I would try offering formula an ounce or so after each feed for a day or two. If she doesn't want to eat or she spits up a ton afterwards, then she likely doesn't need it. But I had this happen with my son, and he wasn't getting enough from me. He'd eat but he would get so tired he'd fall asleep. Then he'd wake up screaming and eat a little more, and the cycle would continue. We supplemented for a little bit and the urate crystals went away.

I'm going to suggest that if your LO is still having crystals in her urine and hasn't yet transitioned on to "normal" breastmilk poo then she perhaps isn't getting quite enough to eat.

I would eliminate any paci's or artificial nipples and aim to nurse at least twelve times in 24 hours, lots of skin to skin and keeping baby close should also help. You could also try breast compressions and making sure that your wee babe is actively sucking and swallowing while ate the breast. Hand expressing might also increase your pump yield.

Hang in there, Mama, you're doing great!

Our LO lost 12% birth weight and had trouble latching in the beginning so we supplemented formula at the advice of our pediatrician. I think it helped keep him from getting dehydrated but we used bottles and within a few days he was refusing to nurse at the breast. Not saying this will happen to you but just wanted to share my experience. It took me until 4-5 weeks and using nipple shields to get him back on the breast.

As for the crystals I would definitely keep an eye on them. Feel baby's mouth to see if it feels dry and feel her soft spot to see if it's sunken in. There are a few other signs of dehydration to keep an eye on as well so just Google them. Our LO was dehydrated only a little bit and bounced back quickly but I know a few people have ended up in the hospital if it goes on too long.

I would supplement if my child was not gaining appropriately. It is what it is, and I would absolutely follow the advice of the pediatrician.

I get what you're saying about establishing supply, and that's unfortunate that it may be affected in some way, but if my ped thought my lo was failing to thrive and had me jumping through hoops like that to help LO gain, I would take it VERY seriously.

I'd supplement and then swap in your pumped milk when you have enough.
BFing is so hard in those early days.
You're doing a great job!

It sounds like your supply is just fine so I personally wouldn't supplement right now. I definitely agree with your doctors assessment of feeding every 2 hours during the day and waking every 3 at night. When they're this young they don't really know to wake up in hunger yet. Also at this young age they are very sleepy and sleep a lot. You have to work to wake them up enough to nurse.

P.S. I supplemented regularly with my first because we needed to so I have no problems with doing so! It just doesn't sound like you need to.

I'm really glad to hear you're supplementing - I agree with the PP who said the urate crystals are concerning. With regards to early supplementing having a negative impact on your breastfeeding relationship, it seems like studies are showing that early supplementing is fine and won't prevent you from breastfeeding exclusively down the road. Emily Oster writes about this in Slate, citing two studies: http://www.slate.com/blogs/expecting_better/2013/09/13/when_to_give_your_newborn_baby_formula_the_first_big_decision_i_had_to_make.html

@buttermilk: I experienced a very similar scenario with my first. I had student nurses in the hospital who "checked" LO's latch, and said feeding 5 or so minutes per side each feed was "great". Fast forward to 2 days PP when I had my first actual nurse and she about lost her mind. She was livid that no one had actually helped me because LO was losing weight, wasn't latching well during feedings and I wasn't waking him often enough (because I didn't know I had to). She intervened with a crash course on latching, how often to feed, watching for swallowing etc... And as soon as I got on the more frequent feeding schedule, which was 2 hours during the day and 3 at night, he quickly gained the weight back and I never had supply issues after that.

I would give your new feeding plan some time to work before moving to supplementation, especially since you feel strongly about that. I am not one to care much one way or another regarding formula but I do think it will be easier to establish a strong bfing relationship if you don't supplement and at this point, her weight loss doesn't strike me as enough to panic just yet.

My suggestion is the same as others, wake to feed for at least a couple of weeks, skin to skin as much as you can, especially 100% during feedings since your body will respond better to feeling baby's warmth and let R stay on the breast as much as she wants. If she falls asleep there, leave your nipple in her mouth and enjoy the cuddles. She will instinctively suckle every few minutes which will continue to signal your body to keep making milk. You're doing great!!

First rule is to feed the baby. All the LCs I saw said that to me and they all encouraged me to supplement while working on my supply issues.

I agree that you should see an LC who will do a weighed feeding with you and see how much your LO actually transfers. That will really help you understand what is going on. But I do think in your situation I would supplement a little bit to make sure that your baby is gaining and healthy. As long as you are nursing every 2 hours and pumping until you are dry (I would recommend renting a hospital grade pump which will really suck out every last drop!) it shouldn't affect your supply.

I went through this struggle and I know how hard it is Remember that making sure your baby is healthy and thriving is your #1 job - not EBF!

@regberadaisy: that was so us in the hospital! We were feeding DD all my colostrum and she was screaming uncontrollably in the middle of the night (at about 22 hours old). One nurse brought us formula and DD pounded over 2 ounces! Clearly she was starving. It made me no longer buy the "colostrum is enough" and stomach the size of a pea/marble/whatever stuff.

@buttermilk: that's great news on the wet nappies! FWIW my little guy stopped pooping on a daily basis when he was six days old and still only goes twice a week at five months old!

@buttermilk: woo! Great job mama! Also, you two are gorgeous!

@buttermilk: Just reading this thread now, but happy to see she gained well!! Glad you don't have to worry anymore!

I went through the same thing with LO after he lost 1/2 lb the day after we went home. I was in tears when the dr. told me to supplement, and I did for 2 days until my milk came in.
Just want to say that supplementing with a bottle of formula did not hurt my breastfeeding relationship at all, and I really needn't had worried so much!

@buttermilk: Yay congrats! Great work, mama!

@buttermilk: Congratulations! Thats great! She just needed time!

Yes, # poo is all over the place. It can mean nothing and it could mean an issue. Biggest thing is to look at # of wet diapers! Also remember you can always "supplement" with a bit of pumped breastmilk if you are getting some of that.