Any advice on how to cut down formula top ups?

[Gahrattwice]

Strap in for a massive essay:

I have a six week old baby. She lost a lot of weight on day nine and we got sent to a&e and put on bottle top ups of 60ml after every breastfeed, so eight per day usually. Which I now realise was a full feed.

Weight gain now good and I have been trying to reduce the formula and get back to EBF. I have sought help and advice from various sources (been to all the groups, called all the helplines) on how best to do this, how much to reduce by, but have been given conflicting info. I have very slowly reduced to around 350ml of formula per day over four approx 90ml feeds, plus anything I have managed to express. But baby is constantly hungry, never seems satisfied. Even when I have broken and given 125 ml in desperation she roots around for more. I'm not sure I'm doing the right thing in trying to get back to EBF when she is so unsatisfied all the time. Last few days since TT snip have been the worst, constantly rooting and crying if not attached to my boob for hours on end, but is angry and frustrated when on the boob too, I'm guessing because she prefers the bottle now.

She is still putting on weight of around 25g per day on average, and has plenty of wet nappies. Only poos every couple of days but they are massive! Tongue tie was cut couple of days ago. I am trying to express as often as I can, but she won't be put down so is hard, and I am really struggling to cope. She hardly sleeps so neither am I!

Has anyone else had success with going back to EBF from formula? I have been trying so so hard with it but am on the verge of giving up, which is making me feel like shit. I don't even know why, there's nothing wrong with formula, and I wasn't that bothered about breastfeeding when I was pregnant!

I had similar issues with my 1 year old. To be honest, I just ignored them mostly. I gave her about 2 botttles a day. And just put her on the breast all the time. Baby is probably cluster feeding. Eventually I just gave her one bottle in the evening. Before just stopping all together. Baby needs to feed to up your supply. If you want to ebf, you just need to put up with the constant feeding. My baby was attached to my boob the majority of every day until she was at least 3 months. It's hard going. But worth it if it's what you want to do. Now at 14 months we are still going.

That hospital's advice was terrible - I would complain, my HV said to top up no more than 20ml after each feed to see what effect that had.

The thing is if she's had that much formula you are not currently going to have the supply - the only way to build your supply is to feed feed feed - even when you feel totally empty. I would recommend a feed then cut your top up by half. Give it 30 mins then BF again, don't top up, bf again after 30 mins, and another and another. Basically you never went through the 'all day breastfeeding' that many newborns do so you're going to have to do it now if you want to rebuild your supply. Can you commit up to a week to chilling out skin to skin on the sofa and just letting her feed as much as possible?

My lactation consultant had me pump after every feeding. I was then able to use that milk in an SNS at the next feeding. It was time consuming, but it kept baby used to the breast and kept my supply up. Your supply will only be as high as demand.

I never managed to get off the breast, express, formula regime and switched to formula and it made a massive difference to my baby to us all. But, more positively, I know far more people that managed to continue breastfeeding after dropping top-ups. Quite a few moved to one bottle at night rather than top-ups after every feed and quite a few were successful in dropping formula top-ups completely- some with very little effort.

You’ll get a sense of whether you’re baby is getting on ok with breastfeeding with wet nappies etc (as others have said cluster feeding is very normal). The difference I saw between friends that were managing well with breastfeeding with some top-ups versus my situation (not successful breastfeeding and more dependent on the formula) was that my baby would become very listless. She only had the energy for a little bit of screaming when she was hungry and then we’d have a bad feed and she’d get sleepy and give up until we could get the expressed milk (which started to dry up) or the formula into her and she’d pick up again.

It’s so hard isn’t it OP? You should feel very proud of yourself and your hard work whatever you decide to do going forward.

I always tell my antenatal classes that there are no right/wrong answers with infant feeding as long as baby is putting on weight and well (which your little one clearly is). It’s about the bigger picture, your overall aims, mental health, needs as a family etc. There is no place for guilt, everyone wants their baby to thrive and do well in my experience and BF is definitely something which is MUCH easier for some then others.

I mix fed last time by choice but it was

posted too soon!

mainly baby feeding on the breast with some formula top ups when baby seemed to need it. This time however DS2 will not latch (turns out being a midwife and knowing theoretically how it all works isn’t enough to compel baby into line so i’m embarked on a pumping adventure which is frankly a lot of stress and hassle I don’t need. Getting tiny amounts (30ml or less after a long session. It takes time and energy away which i’m starting to consider the point of especially as I feel guilty for not giving toddler DS1 more. My current goal is to give baby as much BM as I can for as long as I can face the pump. Personally I’m not bothered about EBF as I would be too heartbroken by a baby that was hungry or unsatisfied - but aware that may be an emotional response. I love the ‘milk drunk’ face and murmuring of a full baby and it’s one of the things I look forward to the most in the early days - especially when tired and stressed.

I would have a think about why you personally want to EBF and what you feel you would benefit or lose from allowing baby as much too up as they want (whilst absolutely trying to give them as much BM as possible)

Try not to get too hung up on the different advice you were given - the hospital was telling you the best way to get baby to a safe weight quickly whilst the lactation people will be telling you the best way to get the baby onto EBF. Neither of them were wrong, just slightly different focuses.

Mrscog - you can’t know that the hospital’s advice was terrible unless you have full access the the babies weight loss, blood sugar results, presentation (I.e. responsiveness, alertness, nappies, feeding hx etc) on admission to hospital.

Is there a reason why you want to EBF?

I had this issue with my DD - she lost too much weight, my milk was delayed (hence weight loss) so had to top up with formula. She also had a tongue tie (cut then regrew & cut again) & silent reflux. Through it all I combi or mixed fed. I actually found it took the pressure off me as I really struggled to provide enough milk for her & couldn't pump much either. It allowed me the space for my boobs to refill & have my DH the chance to feed & bond. I actually breastfed her till she self-weaned at around 21mths.
We've done the same thing with DS who is 8mths now; although he hasn't had the same health issues as DD, I decided EBF was just too much pressure on me so we've combi-fed him since birth. He breastfeeds throughout the day, has one bottle of formula at bedtime (which DH does) & then is breastfed in the night if he wakes (down to once a night now).
It also means DS can go away from me for the day - essential as I'm back at work in March & he'll be at nursery & with his grandparents whilst I'm at work for 3 days.

You've done amazing to get where you are & it certainly sounds like your little one is cluster feeding to boost your supply so things will improve, but I just wanted to say it is possible to combi feed successfully too.

I'm ebf my 4 week old but use nipple shields with a big nipple because he fights the boob otherwise. Have you tried that? He was premature so had a bottle to start with so I wonder if that's why he will only use the shield. It's an Avent one if you are interested. We also used a bottle for expressed milk to top him up and we're advised to use a bottle that's hard for him to suck so he prefers the breast. It's a Lovi one but I'm.in Poland and don't know if you can get the brand in UK. I also used a lactation supplement called Femilactor you mix it with milk twice a day but again I don't know if it's available in UK. Drink lots and lots of water and if you can try and sleep, I know it's hard! But my supply drops dramatically when I don't get any sleep at all. Can your partner/husband do a bottle feed while you get some rest? If not you can try to sleep propped up with her on your shoulder. This is how we sleep at night because he won't go down on his own. It's the only way I get any rest. Good luck, I know it's hard I'm still struggling now and wonder how anyone ever makes it look so effortless!

Amazing, so much support and lovely kind words (I'm ignoring the less kind ones). Is really reassuring to hear others stories from poeple that have gone through similar, it has made me feel much less alone.

I think the idea of spacing the bottles out rather than reducing makes sense to me, I might try that...

Eastendqueen - yes you're right in terms of what was initially needed for the first 24 hours, but for someone who wanted to breastfeed, because it works on a supply and demand basis, the focus should have been very quickly trying to increase BM supply and reduce top ups - certainly not discharge someone who wanted to BF basically formula feeding to full amounts.

I have no problem with formula and I think that people who want to FF should be respected, but I know so many people who WANTED to BF whose journey was either made so much harder or ruined by health professionals who don't fully understand the delicate supply and demand - mine nearly was, it was only because I accessed a 2nd opinion that mine wasn't ruined either.

Mrs - that's what i'm cross about, no one said anything about the impact of top ups on my supply, or how I could make sure I could continue breastfeeding. I know it was important to make sure there was no more weight loss, but no efforts were made to determine what caused it. I was told there was no tongue tie and just to top up. When in fact there was quite a significant tongue tie.

Like I said, I am more angry at myself, I should have realised.

No don’t be silly when you have a baby you rely on the professionals to help and guide you. It sounds like they should have taken you and baby in for a couple of days and got you to feed on both sides and then express and give the expressed milk as top ups rather than formula. They would be clinically observing baby closely of course. Then weighed baby again after 24/48hours and then reassessed as this isn’t unusual in new babies.

I exclusively breast fed but had to go into hospital with my 2nd because of jaundice, she didn’t poop for a few days (I knew everything is ok as She was passing gas and has a soft abdomen). They spent the entire time trying to get me to express and give top ups. I refused because I knew she was feeding ok.

I was treated awfully because I went against them, woken up if I had forgotten to record a feed, encouraged to express even though her jaundice was improving and she pooped nuclear after 2 days in hospital when I went to get some edible lunch. They kept me in hospital longer than they had to it was just awful. I left exclusively breast feeding and continued for over 2 years. A 1st time mom would have folded with out a doubt.

I’m sorry that was an essay but what I would advice is to see if there is a breastfeeding cafe in your area they are usually brilliant they are staffed by fully trained healthcare professionals who are breastfeeding experts.

You can normally get baby weighed there as well and you will get sensible advice. It also means you can step away from the baby weigh in clinics at the GP’s.😊

Do what is right for you and your family a happy baby means a happy Mommy and as a consequence a happy Daddy.

You've got a triple whammy of 6 week growth spurt, tt snip and trying to reduce formula. Sit on the sofa or bed all weekend, feed, feed, feed some more. Reduce bottles by an oz, couple of days another oz, couple of days another till they are gone. It'll be a tough week but stick in

Just a few extra things:

1. A poster above said that mixed feeding allowed her breasts to refill. This is a mistake: full-feeling breasts aren't necessary to feed your baby and will be inhibiting your supply. Empty breasts (frequent feeding) are the way to increase your supply (only weighed against feeding being tiring for your baby)
2. Read the KellyMom pages. Fantastic site : Kelly Mom page on increasing supply
3. Agree with pp about loads of water, warm food and lots of rest. You need the ingredients and energy to make the milk.
4. Definitely get some breastfeeding help to make sure your baby is latching correctly. I paid for one (found on the internet) and it felt like a worthwhile outlay. Breastfeeding cafes are also meant to be good - and free - but I found it really hard to get out places at a set time in the early weeks!
5. I was getting very little milk pumping, and it was taking up a lot of my time and energy, so I just stopped doing that. (and remember I did manage to switch to ebf). It isn't what gets recommended, but I made the call that the pros of stimulating my milk were more than offset by the stress and tiredness (which limit milk production). I'm not saying to stop pumping, just to trust yourself to make the right choices for you.
6. A pp mentioned a few days of skin-to-skin. My lactation consultant suggested the same, and one of my lovely memories of that time was a day when I stayed in bed with DD all day, and we just cuddled skin-to-skin and fed. Did absolutely nothing else. It felt impossibly decadent - somehow I felt that by 5 weeks I should be up and doing things. Which with hindsight, was a crazy way to think! Your baby is still practically new born (I know it doesn't feel it!). Relax, stay in bed with a huge jug of water and some snacks beside you, a meal in the fridge ready to heat up for lunch made by your DP, and do nothing but cuddle and feed all day.

Thanks Nord! I have already cut back on the expressing, it is just too stressful to try and find the opportunity to do it.

I really am not sleeping very much at all, not too much I can do about that sadly, but I can definitely eat more and better, it keeps getting to 3pm and all I've eaten is biscuits .

I have done a skin to skin day in bed, keep meaning to do more (like today) and failing. Will try for one tomorrow!

Had another day of literally non stop breastfeeding today, her dad has taken her out for a couple of hours to give me a break before more of the same tonight. I can't believe how long she is going without sleeping. Hopefully is increasing my supply lots.

Personally I’d drop the pumping and just have her on the breast all the time until your supply hits her demand with formula top ups only when you can’t take any more and she is still hungry. Pumping plus ff and bf is hideous. If your baby is now feeding from you ok, she will be much more efficient at stimulating supply and extracting milk than pumping (which can be useful to maintain supply if a baby is struggling to latch or stay awake during feeds, etc). I’m not an expert though, just someone who has been through this.

This. I’d clear a week and do nothing but sit and bf so your supply can catch up. She will be seeming unsatisfied because she needs to suck to increase supply.

Get your box sets lined up, plently of drinks and snacks, and sit on the sofa all day feeding.

Fwiw, my baby did the same and i had completely different advice. I was told not to top up if possible because a) i needed to stimulate supply and b) top ups can mask underlying issues by temporarily boosting weight gain. I was told to do the above, feed as much as possible.

Pumping i hate. It’s a pita and it’s time your baby could be feeding, stimulating supply.

Your baby shouldn’t be hungry. EBF is obviously not working well. Just accept it and use formula. I have no idea why women whip themselves into a frenzy about breast feedyifbita not working. Whether it be shredded nipples, lack of milk supply, depression, bad latch etc. Your baby will be just as healthy in formula. She has had the most important part which is the colostrum.

I had a little premature baby and had to work really hard with mixed feeding to get over jaundice and avoid him losing weight.
I thought he was hungry all the time but now, at 5 months, I think he just wanted the breast because they are programmed to at first.
My midwife said that if his poos were yellow and not green he was fine.
Don’t know if that’s true but he is fine — he’s huge now.

Nothinglefttochoose that is terrible advice - breastfeeding is a skill and for those that WANT to do it, there are all sorts of techniques and things to improve it. Butt out and for me breastfeeding was a biological yearning - I couldn't have not done it, it wasn't me whipping myself into a frenzy. And no, formula doesn't lead to 'just as healthy' babies. Some babies will be just as healthy, some will be less healthy.

Your baby shouldn’t be hungry. EBF is obviously not working well. Just accept it and use formula

Have you breastfed?

Bf babies aren’t necessarily “always hungry”. It may be a growth spurt and the need to suck to stimulate supply.

I had a baby who liked to feed a lot. It was comfort, the way she fed, lots of things. I bf successfully for 2 year, despite people like you telling me she “must be hungry” should be sleeping though, and trying to tell me i should switch to formula.

Bf babies are different to formula fed. Their behaviours and feeding routine can be very different. Which is why many people with no bf experience automatically assume it’s not working. Which is why bf rates are low.

A baby who has been topped up so extensively will need to feed a lot to catch up supply. It does not mean she is starving or bf is not working.

I have told the private lactation consultant I saw, my midwife, my health visitor, and the la leche league adviser, that she is constantly hungry, and none of them seem concerned. Urgh, I dunno, I just want her to be happy.

A baby building supply will seem constantly hungry until you’ve sacrificed unto a week feeding hourly if that’s what it needs. Have you done this? It’s fine not to and mix feed, but if you want to BF that’s what it takes when you have supply issues.

It’s fine to do whatever option and you should do what makes you happiest as long as you are getting regular wet/dry nappies and some weight gain.

You almost certainly don’t yet have enough milk due to topping up, you definitely can build the supply if you want to but it will take effort.

Whatever you do it’s fine. My DS1 fed 2 hourly for 18 weeks and fed for 45 mins each time. So out of each 2 hour block of time he fed for 45mins then was settled for about an hour. If she won’t settle at all i’d Do a small top up after 45 mins. Frequent small top ups are much better for supply than replacing whole feeds.

Mrscog - I have been feeding her nearly non stop for three days! Had the odd two hour stretch when asleep/someone has taken her to give me a break. I haven't had her off the boob for more than ten minutes for the last seven hours apart from an hour nap. Have just given her 30 ml of EBM, she was frantically rooting for more so have now also given 90ml formula. She wolfed it down.

Am really hoping the non stop feeding is helping my supply

It sounds like she's trying to increase your supply, good girl! I got by without going to top-ups so I can't help on volumes to switch, but had one thought. Are you eating and drinking enough yourself? My supply really struggled when I briefly tried to diet. Granola on the other hand - well, oats are great for supply, I have shitloads of milk when I have granola for breakfast. Also fenugreek works for some, but really really don't touch it if you take levothyroxine.