How much top up to offer 5 week old mostly bf baby?

[Wildpoppy]

The baby lost 20% birthweight and didn't put back on until a month old. On pediatrician advice we've done formula top up though she takes the breast first each feed. I am finally confident I am producing enough milk - she is all milky when she pulls away and my breasts now leak etc. But sometimes she will feed for an hour and still be hungry.

We're offering 90ml top up about three-four times every 24hours, so not every feed. About one of these she doesn't finish it and about one she wants more afterwards.

Obv I don't know how much she gets from breast. And we are with HV help trying to get her back to exclusive bf. But in meantime are we offering too much top up? Or not enough? Or right amount? I just have no idea.

None, no top up. I get the impression bf was difficult but actually feeding bm on demand provides more calories than formula. HTH

If I remember correctly, a baby 1-6 months old will take an average of 750ml breastmilk a day. So 4x90ml top-ups is providing about half that intake.

Difficult to know if that's right amount though.

Do you know why your baby lost so much weight?

Go to bed and feed the baby, unrestricted feeding. Always bf on demand and your body will catch up.

I'd say that if you're happy with your supply, then don't give her the formula... she may be a bit fussy for a couple of days while your milk catches up with her demands, but if you offer top-ups, it never will catch up.

It's like this at every growth spurt anyway.

Good luck with it :)

I have to disagree thecaptaincroc - this is a little baby with weight issues taking a lot of it's nutrition from formula. Just stopping cold turkey could be dangerous.

We were v reluctant to use any formula but baby was poorly and in hospital several days post birth with suspected infection and other problems plus no interest in feeding and ultra sleepy. We eventually took pediatrician advice to top up and that kept her out of special care and tube feeding.

To start with I felt very guilty I couldn't provide for her fully. But actually I am providing - by providing formula I am keeping her healthy and helping her grow. Without it she would have got weaker and weaker and perhaps not have survived - after all mortality rate much lower now we have invented formula.

HV says not to do cold turkey. Nor can I feed her for the four hours in a row she'd happily feed for without top up. But I've read different things about whether babies will eat more than they need just becuase it's there and am just so confused about how much to offer.

Moon you must know more than I do then because I haven't seen the weight of the baby mentioned Just because a baby has lost 20% doesn't mean it is small. How heavy is the baby? Not that it matters because bf on demand will mean more calories than formula anyway.

But 4 hrly feeding is not normal for any baby Always on demand! Regardless of breast or formula! 2 hrly is more normal at least!

Losing 20% of birthweight is a huge amount though!

If the baby is feeding for hours without being satisfied, could there be a problem with the latch, or something like tongue-tie in the baby? Have you seen a breastfeeding counsellor?

If you are trying to go onto just breastfeeding I would start reducing each top up gradually so offer i dont know 10ml less each time hopefully that will gradually mean she increases what she is taking in breast milk and reduces the formula without any huge upsets? Unless there is any well known reason not to do it like this that i have missed!.

I wouldnt worry about whether you are CURRENTLY giving her the right amount - in my mind if shes happy with the amounts then it's the right amount.

Saw bf counsellor a few times. No tongue tie. After four weeks struggling we now have good latch. The whole bf thing is getting better each day. Now it's case of getting get to mainly or exclusively bf safely and working our how much top up to give in meantime.

I'd second Fernie's suggestion of gradually reducing the top-ups so your supply has a chance to catch up.

Well I still say just feed on demand and no top ups because while you give top ups your body will not make the difference. Or feed every 2 hrs for 3 days at least to boost supply.

If you are giving top ups always give them after bf's not before.

If she's now gaining weight there's no need for top upss - just feed her whenever she asks for as long as she likes. if you don't gove top ups your body will make more and more milk until the balance is properly established.

Could you express for some top-ups at least?

My Dd had 3 days in scbu, drip & tube fed and had feeding issues, losing 15% of her birth weight. We gave her top-ups by bottle after feeds of ebm then formula and first reduced how much was formula, and then cut the top ups down. We followed her lead in that if she had a good feed, came off herself and seemed satisfied we didn't top up, but if she was struggling and getting exhausted we topped up. At first she was too sleepy and not good enough at feeding to get enough calories just on the breast but she got better.

Be prepared to need to do long or cluster feeds and to need to express. If baby isn't exhausted then you both need the practice plus they're best at stimulating supply. But while topping up you'll need to express IME - not only do you want to keep your supply, you want to up it.