Breastfeed with formula top up...

Long story short. 3week old, still 200g less than birth weight. Paed. advised to continue breast but reduce feed to 10 min per breast - 8 feeds a day - and give formula top up. (advised that 90% of feed occurs in that 10 min, and predominantly expending energy after that initial 10 minutes on each breast)

So far have given 3 bf plus form. top ups and 1 pure f. feed overnight, result has been vomiting after every feed....never vomited previously..only possetted sp?

Top ups have been various amounts, tried and tested -
80ml 70ml 50ml and overnight bottle feed was 70ml total - same amount we used to give overnight of EBM.

Has anyone else been in this situation??? What is YOUR advice.

We have had many well meaning suggestions, and support saying we're doing great, we need facts and from someone who's experienced this PLEASE! :pray:

On average babies feed 8-12 times in a day, so i would offer feeds more often before adding formula. Paeds are not always the best people to get advise on breastfeeding, do you have a LC (either privately or through the hospital) you can talk to?

They are pretty big top ups. And the vomitting shows that bub is not handling it.

When my bub was not gaining weight, i would just offer her the breast whenever she woke. SOmetimes she only had a little drink, other times it was more, but it was giving her more overall without overloading her tummy.

You can always ring the ABA on 1800 686 2 686 to get support or advice.

Hi there

You have to do what is right for your bub, but we also were told the 10 minute thing, but others also told us that babies can take up to 40 mins per boob to feed ... so we let DS feed for as long as he needed to.

Sometimes feeds would take 60 minutes, sometimes 90, always had to wake him up constantly!! Tickles, unwrapping, nappy change in the middle, etc, but we just let him take as much time as he needed.

We made sure it wasn't tongue tie, we made sure he was attaching ok, and we otherwise just got comfy, whacked on a DVD (quietly, so he wasn't distracted!) and let him take his time.

I also expressed as much as possible (electric pump) so that when he needed a bit extra (and when I went back to work) DS could get boob juice. Now, that's a heck of a lot of work and IS NOT for everyone, but it worked for us and I was pleased with our decision. But I had a lot of support - at home DH would do almost all the cleaning and preparing or the pump and equipment, the freezing and labelling, and most days all I litterally had to pop it on and do it. At work it was trickier, but I have a supportive workplace, and just work a little extra to make up the time.

And as DS got older, he got quicker. By maybe 4-5 months old, he probably was only 8-10 minutes a side :)

I got through all of West Wing, Gilmore Girls, Friends and Press Gang, but I also managed to exclusively breastfeed/EBM feed until only a 10 days shy of 6 months.

But make sure that whatever you decide is in the best interests of your LO and something that is manageable and maintainable for your family.

There are lots of good options here - don't let yourself be judged or bullied into one particular one :hug:

Sorry to hear you are having troubles airline.

I'd say also the problem could be she is taking in too much. I'd say try less more often. Also I know alot of the girls in my bb group had trouble with different formula brands and had to try a few to find the best suited to their Bub.

I also found my LC's were a god send. Great to debrief and give you difference ideas of things to try.

Hi Airline
Have you spoken with a lactation consultant at all for advice? The low weight gain must be a worry for you :hug: But I'm sure you can get on top of this.
As the others have said, 10 minutes is still a very short time for most little bubs to finish feeding. You could try giving 20 minutes per side, then if your baby is still interested, go back to the first side again (so it might be 60 minutes all up (or less if baby comes off themselves) but 3 boobs). And 10-12 feeds would be quite normal at this age - the best way to increase milk supply is to feed more. Sometimes when babies are little they'll feed for aaaages, but actually might get more milk with more frequent, shorter feeds. But I'd go for the 20 minute method, rather than only 10 at this age.
What have the weight gains been like? How many wet & dirty nappies are you getting?

As for topups, I'd say 70ml is a whole feed, rather than a topup, and that would probably explain the vomitting. Babies have a hard time regulating the flow from a bottle and will often drink all even when they don't really need it.

All the best

You've been given some great advice here Airline.

Your paed isn't really the best person to be advising you on breastfeeding. In the early days babies definitely need to be feeding more than 8 times a day. I'd offer breast before formula and see how you go. I also found that my little one would feed for around 20 minutes each side - she'd get very cranky if I took her off earlier than that :D

:hug: :hug: The early days are tough :hug:

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10-12 feeds would be quite normal at this age - the best way to increase milk supply is to feed more. Sometimes when babies are little they'll feed for aaaages, but actually might get more milk with more frequent, shorter feeds

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How many wet & dirty nappies are you getting?

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super points!!

Ok. It sounds like your Paediatrician has assessed bub's weight needs to increase. My DD1 had also not regained her birthweight by 3 weeks, was dehydrated and needed formula topups due to a simple case of physiological low supply on my behalf. That may not be the case with you though, so you might want to seek advice from a lactation consultant in conjunction with your Paed. Your Paed sounds like they are wanting to get Bubs weight up fast and is probably concerned that breastfeeding is using up calories if they're limiting the feed times, but 10minutes in total does sounds a little too short, did they mean 10min per side? Did he use any means to try and ascertain how much breastmilk bub is currently getting from you? I am totally understanding needing to give formula in this situation, but if Breastfeeding is important to you, get advice now on this as your Paed is there for bub, but a LC knows more about boobs, so both can work together KWIM.

Did you mean that bub has been keeping down a bottle of EBM no worries of the same amount of formula? And that now bub vomits the same amount given at the same time of formula? If so, I would suggest it may be an issue with bub adjusting/not tolerating the formula. If you have been giving EBM, does that mean expressing the top-ups might be an option for you and using the EBM instead of Formula, because that would be an ideal solution both for increasing weight and for keeping your supply up?.

Other than that, it may be bub is drinking too much as Mad B said, they can just drink and drink with a bottle and especially if their little tummies are not used to taking that much and haven't stretched, they will bring it back up. I suggest (if you still feel you want to go with the topping up method) you cut back 10ml at a time until the large possets stop. Or that bub is taking in too much wind (as they can gulp more with the bottle) and is bringing all the milk back up on top of a burp (have had that happen more than once here), if that sounds like it could be the case, make sure you're using the slowest flow teat possible, and maybe even angle bub up so bottle isn't rushing in, it can help to prevent bottle preference sometimes too if you still want to breastfeed.

Just throwing some suggestions your way, hoping not confusing you. Ring your Paed if the large possets continue as it could be indicative of something else, like reflux etc that might have to do with bubs weight too. Hope this helps!

thank you everyone for your comments. although i read them all or DH did to me,first opportunity to reply. not all of you read my information correctly, i did specify that paed. said 10min on each breast prior to top up, but sas, thank you yours was the most helpful as you had same situation after 3 weeks. this is not to say i appreciate all comments, but like every thread, some more valid to my questions (dictated by DH as my head is in pieces with sleep deprivation etc)

decision was made...some points were not mentioned in the first post...ie I had spoken to ABA already,and they were happy with no. of feeds, amount expressed EBM, etc. but now that friends and family showed concern about lack of birthweight after 6 weeks and paed.s advice didn't work, we had to make a decision.

just for info purposes, after he fed from each breast and had only 20ml of a different formula...he was content waiting for his bath ... then he puked everywhere, DH on nightshift again, and bub pood constantly for about 2 minutes, runny mr. whippy just kept coming and then peed himself. all this has started with the intro of formula. so in tears phoned DH said decision made, he's going to be purely bf, i will top up with EBM,i will call aba again and get advice, i'll take fenugreek to increase milk supply as it's natural and lc advised that at chemist as an option..maxilon does not agree with my tummy and is another 'chemical' i don't want to take.

so this weekend it's a feed every 3 hours as per the normal day schedule and same at night, with any top ups in arvo/night when milk supply is less and 30 ml of EBM will be given, and better burping, and hope that the self settling he's learned from the 'save our sleep' book routine continues. it's taking longer, but as long as it works whether it's 2min or 20 min he's not vomiting, thus not losing weight, topping up with my milk not formula he has to be gaining weight and strength. he has plenty of wet nappies...used to count don't now. not always really heavy but blue line, needs to be changed for comfort.

if he does not gain weight (we will weigh him same chemist same scales next week a few times) then we need to revisit agian. ABA said you can fortify EBM, and she gave me her no. to let her know how he does, she's in mel and works at hospital so said she'd look into it. tried to hire/buy baby scales but noone has them although everyone thinks everyone else has them. always the weekend!!

sorry it's badly punctuated and spelled but rushing in case he wakes. typing with a wheat pack strapped under arms onto boobs as this helps let down apparently.
thank you again, our i've not really posted on many other forums other than LTTC...Hi weemans mum!

Hi back!
I'm glad you've come to a decision about the feeds.
I had the weight gain problems too and just took him to the health clinic twice a week to use their scales.
Once he started gaining we could cut out the ebm and all seems good.
FX you get there too, expressing is a pain if your b-feeding as well but still better than comp feeding for me.
GL!

Firstly have I been there - yes.
It took DD1 a month to get back to her birthweight of 2350grams (BUT she was a 7 weeks early)
I took her home just shy of two weeks of age, the first week at home she lost 10 grams, we were trying the "routine" thing, it did not work.

We went to demand feeding and toped up with EBM if she was still looking for food, not after every feed, moreso late in the day when my supply was getting lower, and held off on getting some type of routine until she was a bit older. Following that she had a good gain and hit her birthweight at one month of age.

I was on Motilium (ignore as you don't want to add another chemical), added in Blessed Thistle, drinking Aktavite. I would give lactation cookies a shot.

So my recommendations from Experience is to kick the routine for a few weeks, just feed on demand and see what happens, don't worry about the Formula, the reason bub's is not coping at the moment is it is M is trying to learn how to absorb a whole new type of food.

DD1 was a horribly slow feeder, 1 1/2 hours then I would settle then express, clean and be bascially back at square one again.

DD2 all demand fed, and haven't cared about routine what so ever and she has set her own routine :)

So there is my story from my Experience. HTH's

I got my scales from EBAY and still use them now. When you weigh ensure it is the same time of the day, after x many feeds, nude etc.

Hun, it is great that you have been able to take in all the information and find the bits that will help you the most. In the early days there is so much to take in and it is really hard when you are not getting enough sleep :hug:

I think you have made a really good decision to stop the formula for now. If it is not agreeing with his tummy - which is what it sounds like - then it can make it even harder for him to put on weight. If the weight gain continues to be an issue, it might be worth seeing if eliminating dairy from your diet for a little while helps as it is possible that he has an intolerance to cows' milk protein (which he will mostly likely grow out of before he's 1 if this is the case). I wouldn't worry about this yet though, just something to file away for later.

Is the 3 hour feeding schedule a suggestion of the paediatrician too, or is that because of Save our Sleep? Many mums find it hard to maintain breastfeeding following Tizzie Hall's routines as they don't take into account normal baby behaviour and needs, nor the need for mums to feed regularly (more often than every 3 hours in many cases) in order to establish and maintain their milk supply. The mums I know who have had babies with low weight gains, have found that feeding more frequently is the best way to speed the gains up. You might find it interesting (I did!) to know that the latest research shows that the fat content of the milk (and also the content of live cells) is highest about 30 minutes after a feed. This suggests that a top up at the breast about half an hour after a feed would be the best way to help a baby gain weight.

I also agree with the previous posters that 20 minutes on one breast at each feed would help more than 10 minutes on each side. Switching sides half way through a feed used to be recommended before research showed that the fat sticks to the ducts and only comes out in the milk as the breast empties. So switching sides before a breast is emptied means the baby gets lots of more watery milk and not much of the fattier milk that fills them up and helps them grow and put on weight.

GL with getting that weight gain going hun - you are doing so well. Let us know how it goes.

Hi Airline, Sorry to hear you're having such a rough trot with weight gain. I just wanted to let you know that my Paed told me to 'demand feed' - which he meant when I demanded it, not the baby, and never less than 3 hourly. I'm so glad I was too tired to remember what he'd said & did proper demand feeding. I remember feeding 20mins or more each side many times. You might be interested to know that feeding within an hour of when the feed started (so a 'top up') is still classed as part of that original feed. I read that out of a book after a couple of weeks of feeling guilty for topping Jack up a couple of times a day, thinking I was doing it wrong. Really, it's baby's way of a) getting the fatty goodness they need, and b) building up production in your boobs.

As for anything else, I think Manta Ray has said it all. And if you have a niggling feeling that Save Our Sleep isn't working for you or your baby, there are other ways out there that might suit you AND baby better.

Good luck with your little boy.

Hi Airline,
Sounds like you have made a great decision, I hope that it works for you and your bub.

I thought I might offer you a few things i know.
*The more feeds a baby has, the more breastmilk that is made, breastfeeding produces breastmilk :-D
* The first feed off a breast is called their foremilk, this is a sugery - watery type milk that gives them a burst of energy
* the second half (Not necessarily half) of a feed is called hindmilk - this is 'fatter' and will fill them up more.

So with that being said, sometimes it is more helpful for the baby to feed as long as they like, so they are getting all that fatty Hindmilk to bulk them up.

I hope things settle down for you and your little bubba starts putting on the pounds :-D Take care.

luv MN :-)

Thank you again. Need to point out my typo. Not 6 weeks old 4 weeks on Tue. Now feeding and therefore waking him at night and thus waking him every 3 hours or if he wakes early. 20 min each breast, top up with ebm in evening. Last night dhgave him ebm the full feed he has always had since week 1 of 70 ml. Will post tom .handful....... .

Hi Airline, sorry, I saw this earlier but haven't had a chance to reply!

With DS2, we were down to -15% birth weight at day 3 so were put on formula. I got in a private LC and she's helped immensely. This is what she has me doing:

1. Offer boobs 20 mins on each side
2. Top up with EBM then formula (at that age it was 90ml total)
3. Express 10 mins on each side. (I would express while DH fed DS2) - this would keep feeds down to 60mins

While expressing, I would have wheat-pack on each boob to warm it up, and would massage the boob by hand to get the ducts happy.

I would take
1. Motillium (I understand you don't want to do this) - 8 tabs / day
2. 1500 mg Fenugreek
3. 800mg blessed thistle.
4. 6-8 lactation cookies / day
5. 1 no-alcohol beer (cooper's) from the supermarket / day

There is a combined herbal medication called "breastfeeding gold" which is a combination of fenugreek / blessed thistle, I only take 10/day of that instead of 15/fenugreek / 8 blessed thistle.

Drink *lots* and *lots* of water. My LC said that if you can *just* smell the fenugreek on your body, then you've gotten the dose right. I can smell it in my pee (maple syrup smell!)

When doing the top-up, we were told to sit him up and to use a long teat. We were also given exercises for around his mouth to build strength and let him know a feed is coming.
Our LC also said that babie's digest food in 90mins, so if they want a feed at the 2.5hours mark, then that's fine. We were feeding him no more than 3-hourly (from start of feed to start of feed) to get the weight up. So we were waking him up for the feeds. It's interesting to know that the best way to see if your bub is feeding enough is to watch their movement - lots of sleeping with no alert periods isn't good, so as long as your bub has alert periods, then it's likely to be getting enough.

All the best in your journey!

Good for you Airline and DH - sounds like you have a plan (and a supportive DH which helps exponentially). Yeah, it really sounds like a cows milk allergy/intolerance with the formula poor little thing, hopefully what you're doing will do the trick with the EBM, it's all a learning process, all you can do is try different things, some things will work and some things won't. It's all part of the process and hopefully you'll see some steady gains soon. All the best.

I ended up doing similar to what Kazbah has advised, however Fenugreek made me vomit. In fact one evening, I still had a bladder infection, some kind of constipation, and the Fenugreek altogether, and we had to visit the hospital as no medical centres were open, I was in agony.

With comp feeding I generally do breasts 20 mins at least one side, then if he is fussing, I do a bit of EBM or formula then back on the other side or just whichever works at the time to feed him.

Unfortunately I am not in a really good feeding routine, as between the emergency caesar, separation from my partner and all the appointments you have after giving birth, I have just been a little bit ad hoc some days. So sometimes I have been just BF at a cafe and more relaxed than at home! Other times we've been out and I had to FF for that feed. Or some nights I might have FF at 2am and then expressed.

I am using NAN-HA and Pidgeon bottles. Pidgeon somehow fit the Medela Swing pump too. I use a Avent microwave steriliser from the op shop but you could use a vegie steamer.

:( sorry that it's going so rough for you ... big hugs ...

I hope you get into a routine that works for you both

The other tips I have found are to use Pigeon bottles, and also use a wide neck bottle and a slow flowing or newborn teat.

I was told the 10 min 90% thing in the OP on about day 8 by a visiting midwife.... Said they'd seen something at a conference.... It's crap, well it was for me! When I was taking him off and swapping sides after such a short time all bubs was getting was fast flowing watery skim milk x2. This quenches the thirst and stops the crying but lead to poor weight gain and colic.

I saw a LC who said to keep him on 1 side till he had completely drained it. This could take sometimes up to 45 min in the early days (probably cos the 10 min feeding crap had mucked up the balance of my supply so much). I noticed after 10-15min he'd almost look asleep and finished, but if I pulled back a bit gently or stroked or tickled him, he'd have a few more sucks. This is the time when they are getting the fatty hind milk, I could feel my boobs tingle with it as let down. I'd feed him till the nipple fell out of his mouth as he was so drowzy and what my mum would call 'milk drunk.' (which is what the fatty hind milk does to them, they look and act 'drunk').

Jake had lost more than 15% in 3 days and I was advised formula top ups because he was only gaining 60g in like 5 days. THEN I changed from the ' must give each side, 10min' philosophy to the ' drain each boob' philosophy, and he shot up 260g in 6 days, and has continued this growth rate ever since!

Also, LC said when you keep them on the 1st side till they are milk drunk, then burp them, change them, offer other side. Sometimes they won't take it, and that's ok, I would then express a little from other side, just for some relief. Also I demand fed him but also was careful to make it 3-4hrly. Jake has never slept for 4-5 hrs between feeds like I hear other newborns can do, he likes his milk too much (and he poos a lot!)

Hope some of that helps!


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Thanks BBB I have done that in the early days. I think you had an emergency caesar too?

Sometimes I would swap sides, but only after 20 minutes. So here is a list of what we did, some of which you would know already but I am just adding to the info on this thread as there's not much about comping out there.

Had emergency caesar (literally arrived by ambulance and bubs was footling breech)
Put him on as much as I could, not much help from staff.
They took him to nurses station for the first two nights, brought him back for feeds, but I threw up on him etc.
Gave top ups but they wouldn't always give them to me.
Staff seemed annoyed that I had done the ABA class.
Nurse who discharged me at 7.30am, wrote that I hadn't attended their "breastfeeding session"! and went on and on about Mastitis as well as sending us home, I was in my pyjamas!
Went home, tried to BF exclusively.
Put him on the boob a lot.
We realised he sucks like a Dyson, so no prob there.
I can't remember when but we saw an LC as an outpatient at the RBWH.
One night though, I had had him on for hours and hours, and he was starving, and we rang the ABA and she said to go and get some formula at 3am, and so we ended up taking a risk and feeding him some kind of diluted Carnation milk (my Mum was a Mothercraft nurse many, many years ago).


By I think it was the Sunday after coming home, to my parents, had the midwife refer us to Royal Children's re failure to thrive and red umbi. They gave me a bit of counselling, Motilium, and said 20 minutes and then top up.
So in that time I had loads of conflicting advice, the worst from some of the midwives. Also I was annoyed I was not referred to an LC as an inpatient.

However as outpatients we have been treated like royalty with home visits!
Also due to having the catheter in for an extra day, I had a bladder infection and so I was on antibiotics for ages, from the caesar and then from that.
I tried Fenugreek but it made me throw up. What happened one night was I was constipated, nauseous from the Fenugreek and obviously I still had the bladder infection, so I was in agony, it was the Queen's birthday holiday so we went back in again, ended up in Obstetric Review lol, and it was just the bladder infection.

So in that time my parents were helping me with expressing and comping, he had three people looking after his feeds, but overnight just myself. The baby's father just was not there for us, and I broke it off with him (stress), bizarrely despite claiming to support BF he has still harassed me at times while feeding! Also we've had to go shopping and move back here (more stress).

Now it's just me and bubs on my own, I am managing as I live in a small unit, but a couple of days here I have tried to exclusively BF all day, and by midnight, I have had to end up giving him a bottle, with my eyes closed and him lying on the bed next to me.

Comping can be done, but you have to manage it so your health isn't compromised either.

So BBB, basically sadly I did have him on one side at times but it just didn't happen for us enough.

Whenever it was that I saw the LC as an outpatient (might have been at one week old) my milk literally came in that day, so we did a feed in front of her which was fine. The main tip she gave was to push my breast forward with the side of my arm, and to hold my breast for him at times.

fennel tea also can help - and tastes pretty great!

also, I used to make fenugreek tea with fennel in it, 'cause it masked the fenugreek flavour pretty well.

and you can get capsules with fenugreek, so you can just shoot them :)

I had an emergency csection too at 38 weeks but I had a spinal, I think you had a general? So your recovery was worse I think, plus I didn't have a foot kick through my lady parts!!!

You are doing so well by persisting and seeking help. The other thing I forgot to say is I used to have to express the first 20ml of watery milk so baby could latch on.

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Yes it was, also they attempted an epidural, I don't know how far it got but I had a bit of a bruise on my back.

Thanks BBB. Finally managed to express 40ml last night, after having bubs on briefly.

Thats good hun x

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Jim's so funny he knows the bottle and the boob. If I sit him up in the bottle feeding position he will make a certain O shape with his mouth, ready for the bottle. Sometimes he will refuse the bottle, and he wants the boob though, and so then he will make his way to my left side, and look at my boob and open his mouth in a different way.