Combination feeding - please help!

[Ellsiedodah]

Hi all

My LO has dropped to 2nd centile so health visitor recommended combination feeding. I'm fine with that as my baby (16 weeks old) is definitely too hungry on just my boobs (impatient for let downs which only come after around 20 minutes of him nibbling).

The problem I'm having is how much formula to give so that I don't overfeed him and how to do this so my milk supply doesn't entirely dry up.

So aptamil says a baby on straight formula should have x5 180 ml bottles. If my baby is gluggling at both sides of my boobs for 20 minutes and will return for 1 let down on one side, then how much do I follow up with?! I'm so clueless and don't seem to be able to read my baby's signs :( Yesterday, I thought he kept telling me he was still hungry so I kept giving him more of the bottles I'd prepared (each 150ml), but the feeds then just dragged on all day. He ended up straining loads and did 3 poos over the space of 2 hours. So I guess my questions and worries are:

What signs do I look for for tummy fullness - or should I just limit the amount no matter what his signs are?

Is it possible to do breast plus formula top up in a measured way - and how do I do it? He's 12 weeks for weight.

Or should I supplement a couple of feeds with a couple of bottles instead - and express when I miss the bf? What would my strategy be for expressing?

Is it possible his tummy is too small for 180ml at a time (therefore might I have to split this over more feeds in any case?)

MANY thanks for any advice you can give me - and please kindly don't respond if you want to tell me my breasts should be able to give him everything he needs... I'm a bit exhausted with that line.

Thanks all xx

...Oh and I should say I was bf-ing him every 2 hours at 3 months old and he still dropped the centile. Okay, so he may naturally be petite but I had been hoping to space feeds more not reduce time between them (with a view to getting his weight up) - hence the additional appeal of adding formula.

After a breast feed you can offer maybe an oz or two in a bottle as a top up, make more if needed. If you are wanting to replace a breastfeed I'd still only offer small amounts at first, probably 3oz at a time. Used paced bottle feeding and you'll soon get into the swing of how much they want to take.

Sorry I missed a good half of your post 12weeks is a notoriously fussy time. Baby will most likely want small amounts more often with volume gradually increasing. I would say it could be hard at this age especially to stretch the length between feeds.

Have you had breastfeeding support and has he been checked for tongue tie? Just seems odd that it takes so long for him to stimulate a let down.

I don't have any experience of top ups that I can share sorry! I'd probably go for offering 2oz after a feed as a starting point and see how that goes (if he's draining it every time/seems to still be hungry).

OP i think you need specialist breastfeeding support. Is there a local support group or could you contact someone properly qualified (not a health visitor or midwife).

There is no magic equation for how much formula a baby should drink to keep your supply up. I would offer a small amount of formula after each breast feed and take it from there - 2ozs to start with. Giving formula will make you produce less milk, that’s just the way it is, so you’ve got to work out what you want to achieve - giving full bottles to replace feeds will affect it more than top ups after each feed.

I’d second getting some proper bf support either a lactation specialist or a local support group with peer supporters. It is tough to keep going.