Getting from combo feeding to EBF - which of the following options should I try?

[wonderingstranger]

So, my baby boy is 5 weeks old, is combo fed and he’s gaining weight exponentially. I think the weight gain IS from combo feeding and I need to change something. He’s 11.3 lbs at 5 weeks and still gaining rapidly. My pediatrist told me he measures almost as a 2 month old. Our current feeding is breast on demand + top up 5 times a day with 120 ml formula. (I estimate he eats more than 200 ml per session) I pump too and make about 90-100 ml per day from 3-5 sessions (I get between 15-40 ml per session of pumping) I want to EBF, but I find it hard to find information on how to get from combo feeding to EBF. I even had sessions with an LC.

I came across on some ideas/options:

A. Take the plunge and EBF and stop formula. (Problem with this is that I have a very high demand baby that gets frustrated at the breast if milk doesn’t come out and screams - that’s why I top with formula. I first BF before formula always - sometimes even for an hour)

B. Limit time at the breast for 10-15 min each side and Pump, pump and pump. (that way, I have some control on how much baby is eating and up my supply from pumping. Baby also doesn’t get tired from BF as much - I read that after 45 min of breastfeeding baby consumes more calories than he takes in - so maybe he is hungrier when I offer the bottle?) also, pump when? After BF or at 1-2 h after BF?

C. Gradually up my supply by both BF and pumping and gradually lower my formula amount. (Thing is, I don’t know if baby will accept to eat less formula as he got used to this quantity…also, baby might be overfed with this option too)

D. Just relax and not overthink or do anything…accept I have a lower supply and continue with what I have and not worry about baby being overfed or growing above 90 percentile (maybe that’s what he is and needs to eat)

E. Other?(suggestions)

It’s just that this is stressing me out and I feel like I fail the baby regarding feeding. Thank you!

 

[skelendke]

@wonderingstranger When we have a baby who is combo fed, as much as you noted, we don't just cut that out because it is unlikely your body would be just able to switch up the production on the spot.

Are you working with an IBCLC? This is still in the breastmilk supply building window that naturally happens so it is impossible to tell if you will be able to EBF based on this post - often the formula top up trap can be a factor which when we adjust that, goes away, sometimes there are other factors that can impact supply and formula will be needed.

Are you pacing the bottles? Often babies are being overfed on bottles when they are not setting the pace - not saying this is happening, just very common to see when we watch the bottles.

Paced bottle feeding video

We don't time babies on the breast - we watch what they are doing and do feeding management based on transfer - so that we know baby is drinking - 45+ minutes on the breast would have lot of non-nutritive suckling there and often doing rapid switch nursing/breast compression can help.

Videos on transfer - good drinking vs nibbling

If you want to see how much formula your baby needs the go-to is using an SNS for two weeks - this does a few things, gets your breasts stimulated by baby (much better than a pump), gets babies nursing and they can tell us when they are finished and the formula ensures that they are not going hungry; and at the end of the two weeks you know how much formula is needed or when it is needed.

SNS info and videos - trick to learn, we have a learning day first

It would go like this days 1-3 latch breast one, use compressions when the flow slows down, switch sides when the compression stop helping, add SNS with formula to finish; days 4-7 latch breast one and two with breast compressions, switch back to breast one add SNS with formula to finish; days 8-11 breast one, two, three all with compressions, breast four SNS with formula to finish.

We do not track the amount of formula being used until days 12-14 when we track when the baby is still showing cues and needing the SNS added and how much total formula they are taking - from there is a new plan based on this info.

Breast compressions info and videos

Next best would be naked bottle feeding - so latch baby breast one, with compressions, breast two with compression 1/2 bottle paced; change diaper. Then breast one, with compressions, breast two with compressions - check for cues to see if baby is still hungry offer bottle (paced); slowly changing to breast one, two, three then 1/4 bottle, diapers, breast one, two bottle, every few days - this should not extend nursing times because you are watching transfer and baby is drinking the whole time and gives your body the opportunity to make more milk if we do it slowly.

In a perfect world all off the breast feeding is done with open cups - because babies set the pace ... but this is messy to learn, a lot of people are not comfortable with this option in the western world but it is very complimentary to nursing.

Hope that helps! Cheers!

 

[wonderingstranger]

@skelendke Thank you for this throughou response. I do work with a LC, but I think I need to search for another LC for a second opinion. The consultation I received was to pump in between feedings, at 1.5 hours after BF…and to continue what I am doing now. It did improve things, but really slowly and my baby is still gaining weight at a fast rate which I attribute to combo feeding because I am not sure how much baby is taking on the breast, but he does seem very hungry and gulping 4 oz bottles after BF. And oddly enough, showing hunger cues even after that 4 oz bottle sometimes (angry cry, hands in mouth, searching for breasts with his mouth when carried etc.)

I do slow paced bottle feeding, yes…per my LC recommendation.

I just tried an SNS last night with my LC, but baby’s hunger cues and quantities eaten were the same. I do think SNS helps with my breasts being stimulated to produce more milk.

I will study and try the method you suggested…I’ll try it.

I had colostrum for almost 2 weeks PP or transition milk and it was very little. I was induced, but ended up with a C-section. My baby boy’s appetite was great from the beginning as he was born at 41 weeks and had a lot of vitality. So, there was a mismatch between what my breasts could offer and his appetite. He never showed satiation cues only at my breast, no matter how much he sucked on it. It could have been a case of inefficient latch or the fact that he was sleepier due to mild jaundice. So, I decided to supply with formula since he was screaming of hunger. Wished I worked with an LC from the beginning.

And now I struggle with my supply still (even though it’s better and better day by day) and want to work towards EBF as much as I can.

 

[skelendke]

@wonderingstranger Normally with pumping it is within 30 minutes of nursing, so that when baby comes again there is faster letdowns/plus any milk being stored so a bit surprised to see wait 1.5 hours as the recommendation - babies will often nurse every 1.5-2 hours so that is why we try and do it as close to when they come off the breast as possible.

When we see gulping as a description of a bottles - that usually tells us that there is things that we can work with there - slower flowing nipples, every 3-5 mouthfuls removing the bottle for a larger pause, every 1/3 of the bottle burps and switching hands we feed them with/switching the sides of the body the baby is on, and really watching their hunger/full cues. This typically means different amounts each bottle as the amount from the breast should be fluctuating as your prolactin cycle changes throughout the day.

SNS is one of those things that we are not going to see a lot of change until we get to adding it on the third/fourth breast, usually, for intake of formula - in fact in the first days of using it we often see formula go up a bit and then as the body makes more milk it tapers off and then the last few days of that we really get a bigger picture of what is going on with supply. The reason that we push back which breast we add it every three days is to give your body a chance to make more milk.

There is never any issue with feeding babies a supplement - we need to ensure their basic needs are being met while working on what is happening with the supply and any IBCLC should be recommending supplements if baby needs them (formula or donor milk) so you would have had them telling you to give that to the baby even if you called on day one - you are doing a great job and if you can see improvement I have no doubt you will continue to do so!

There are herbs/foods/medications even that can help with supply - be sure to as your LC for their recommendations as they are based on your personal medical history and breast exams.

If baby isn't latching efficiently or maintaining the latch, there are lots of things that can help there as well (positioning, bodywork, releases).

The Concorde hold is a latch that works well with babies with latching issues.

List of herbs/foods articles

Take care!

 

[mamba]

@wonderingstranger I’m also 5 weeks and noticed my supply is growing with my also very large 5week old. I freaked out the other day because she has started eating SO much. So I pumped and used stored milk for 12 hours just to be sure she was getting enough. Girl, she was getting 5oz every 2-3 hours .. my supply increased over a matter of 24hrs. It may not be the same for you, but know your baby is also going to get more efficient at eating so they will chug more in shorter periods. Mine is eating a lot faster and getting just as much, and eating close together (cluster feeding).

 

[wonderingstranger]

@mamba I do hope that is the case for me also…I did notice an increase in my supply for the past few days, I hope I am right.

 

[mamba]

@wonderingstranger Baby will get fussy at the boob if they don’t get enough, rooting for more after latching for a period of time

 

[selam]

@wonderingstranger Gradually!! I did accomplish this but it’s hard and you’re halfway there!
Gradually lower the amount of formula and increase number of pumps. If the baby is still hungry give him more!
Option B is how you accomplish it!! Lol