Advice needed - bad night

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My LO is 4 1/2 weeks old. You may have seen from my previous posts that I have had to combination feed due to high initial weight loss and slow weight gain.

We made it back to birth weight by 3 1/2 weeks and have since gained a further 230g in four days. I was happy with this and so wanted to work towards Ebf again.

My initial regime was feed for 5-10 mins, top up with expressed breast milk/formula then express to help improve supply.

However now I'm wanting to get back to more bf I am feeding off both breasts until she comes off, then offering the third side and then offering top up.

Here's my problem. She seems top be possetting/ refluxing more and more after her
feeds. Last night she fed well on the breast and came off naturally. She fell asleep but I still offered formula top up, which she took half hearted, put her down then 5 mins later she woke in distress possetting but also rooting as if hungry. We then entered a cycle of trying to breast feed, offer top ups, wind and try to settle. The possetting/reflux appeared to worsen throughout this process. Eventually she slept on dh between 2 and 3:30. She woke when put in Moses basket so I bf her and she went to sleep from 4:30 till 8.

Is it possible that giving her that initial top up at 8pm after good bf made her too full, gave her reflux and started her on a cycle of suckling to sooth reflux but making it worse. Should I only give her the top up if she seems really hungry after a bf rather than giving it anyway. Just really worried about taking it away and her not gaining weight again.

Sorry this is very long. Hope it makes some sense!!

Hopefully someone will come along soon with more expertise, but I would be tempted, if she takes a full bf and seems content, to leave the top up. It may be that she had too much and therefore sicked up the unnecessary bit I guess?

I know that it's hard when you're dealing with a baby who has had v slow weight gain, but a few days will soon tell if this is the right approach I'm sure, and if you have a good, supportive HV/MW then they will surely help you assess your progress fairly.

Good luck!

Oh, one more question. Should I always offer the third side when bf or again just if DD still seems hungry?

I always kept offering until it was clear they didn't want anymore but I'm really not the best person to ask! I guess the difference with bf abnd ff is that with bf they can suckle without getting much whereas with ff they don't really need to do anything. So offering breast until baby says no quite clearly is not really going to do any harm at all I'd have thought. In fact, will do good in terms of supply.

Does sound like she didn't really need the formula topup, If she come's off is asleep then maybe try not waking her for the topup next time.

Even a full BF baby will take more from a bottle due to the faster flow from a bottle. So her actually taking any is no indiation that she needed anymore.

MigGril, yes that makes sense. I think perhaps she had a feed she didn't need and that started a bad cycle.

Never new feeding was going to be this hard. I come so close to quitting bf so many times now but I know I feel like I failed if I do. Just makes me want to cry.

Oh well let's see what tonight brings!

Sorry terrible English there, sleep deprivation is my only excuse!!