[indigo~]

Hi, I have had ongoing supply issues despite all efforts with expressing, motilium, fenugreek, nursing tea etc. I have also seen 3 different lactation consultants. With bubs now almost 15w old, the last LC said that my supply is probably as good as it's going to get.

I have given bub EBM (when available) and formula top ups in the past but phased them out and went a fortnight of no formula. Unfortunately bub did not put on sufficient weight at her fortnightly weigh. The MCHN recommended that I give her some formula top ups for the extra calories.

Just wondering how people know how much to give? She weighs 4.6kg (premmie so 8.5w corrected age). I usually only give one or two top ups a day; one in the afternoon when my supply drops and one in the evening if needed.

I base my decision on when it's needed when bub is sucking madly at my boob for ages but gets very frustrated and pulls off frequently and scrambles with her hands trying to drag the boob into her mouth, then cries and angles her head in for more. It appears to me that she's hungry and cranky she's not getting enough/any.

I usually make up just 60ml, mainly because it's a top up only after a BF and it's a multiple of 30ml (1 scoop to 30ml water) and she'll almost always take the lot.

My question is that i'm never sure if I'm either not giving her enough or giving her too much, making her uncomfortably full. She cries after the bottle whether I take it away early or let her finish the lot. I just can't seem to read her signs. And I would rather not over-stuff her as she has quite bad reflux (on maximum dose of losec).

Any suggestions? Thanks!

[neev]

I think it's 150mls per kilogram of body weight, per day for full bottle feeding but you should check this with MCHN.

I did combined feeding for the first month on all 3 babies due to supply problems. I only ever got 50mls combined per express (with motillium & fenugreek) so assumed that breastfeeding was supplying at least that amount (more efficient than expressing). I saw a lactation consultant for the 16 days that DD1 spent in special care nursery (6 weeks prem).

I used to add an extra scoop for the formula top-ups if they were finishing. DD2 had silent reflux and was on Losec and I gave 1/3 of a bottle, then a winding break etc. Bottle-feeding her sitting up (and for 20 mins afterwards) helped with reflux too.

DS had a formula top-up after every single breast feed (or EBM when there was some) as he was losing weight for nearly 2 weeks.

You're doing really well

[Jillian_10]

My son is not a terribly helpful example, as I don't think he was ever very effective at breast feeding, and he was very slow to gain weight.

He was born on his due date. 2 months later he was about 4.5kg (3.6 at birth). At that stage, I was breastfeeding him 4 times a day, 20 minutes each side, and 'topping up' with 120ml formula, with an additional bottle of 150ml formula in the early evening, sometimes one or even 2 other 120ml bottles.

I could never express properly, and had no idea what he was getting in breast milk, but at least he sat there placidly for 40 minutes.

I then spent 20 minutes wrestling with a screwing baby to get that much bottle into him. He needed it; his weight only just started picking up at that point ( he is a tall baby, looked like a skinned rabbit, ribs everywhere).

Anyway, I think he is unusual in how much formula he needed, but all the motillium, fenugreek, blessed thistle and lactation cookies in the world couldnt make him interested in eating.

[futureself]

Hi OP,
I've been giving top-ups for 5 weeks now and DS is nearly 14 weeks. The advice by the Paediatrician was the same regardless of whether I was going to use EBM or formula and was due to DS not putting on sufficient weight. Basically it was: 150ml per 1 kg of weight to get the total amount needed in 24 hours (720ml). Divide that by the number of BFs DS was having per day (8)and we got the 'average feed amount' (90ml). Half that was what the top-up should be (45ml). These 45ml Top ups had to happen after every feed except the middle of the night one which I know seems a lot (it did to me!) but the Paed said 1 or 2 a day wouldn't make a difference.
It worked and we're slowly dropping the number of top-ups per 24 hours now - down to 5 atm - but each is now 55 ml in line with his new weight.
Hope that helps

[kay11]

I combo fed for 6 months. I offered breast first and then topped up with formula until my baby was settled and happy. By 6 months, my baby was only feeding on the breast for a morning feed and was eating a good amount of solids. From memory the top ups were 60ml and became 90ml after a bit.

My baby got pretty chubby though so maybe it was a bit much (I topped her up after every feed so probably shouldn't have done as many). That said she's within normal height and weight as a preschooler and nobody gave me any grief for over feeding because my husband and I aren't overweight (and I stopped taking her to the MCHN and switched to my GP instead).

[Pup-pup]

I don't think I had supply issues, but early on with my DD1 I'd top up after a breastfeed, just of an evening. She'd take 30-60ml initially, but after a short time would completely refuse the top up, being full after the BF.

[axiomae]

Wow I came here looking for similar info! DD doesn't take much milk (I comp feed too) at night after her solids and I was a bit worried. Some quick calculations and she's probably alright, thanks to that maths, cheers ladies!

[AliC05]

Hi OP
Good on you for persevering with the breast feeding and comp feeding. I had to comp feed until DS was about 6 mo (when he was happy just with expressed breast milk, breast feeds and solids). I also had tried with motilium and fenugreek.

I also went with the 150mL of milk per kg per day (as per the local child and family health nurse) and would top up, up to 1/2 of his total feeds needs.
I, like you, went up in 30mL increments, I found that when he was finishing bottles of 30 and then 60 mL I would go up to the next amount, but would also try and balance it out with his weight gains.

I also tried weeks with only expressed breast milk but like your little one he wouldnt put on enought weight.

Its hard work - but I must say it was great once he was a bit older and we weren't having to worry about the comp feeding!!!

Robin Barkers baby love book also had amounts for formula feeding etc.

Edited due to my inability to type!!

This post has been edited by AliC05: 22/12/2012, 06:58 PM

[Pooks*potters]

OP, I had a similar issue in terms of supply, comp feeding, reflux and wondering what the hell to do.

I'll just tell you what helped me.

Firstly, the reflux. Great you're on the Losec, has it been for long? Have you tried a formula thickener? Might be worth talking over with a MCHN. I found it helped, although others have told me they saw no difference. I found with his reflux it made it so hard to know what was fussing from hunger, and what was fussing from pain. I found that giving DS a dummy after a bit, gave him a chance to have some "sucking" time, calm down and the saliva production is meant to be very soothing for reflux. Otherwise, I found he would pretty much demolish whatever amount I was giving him! He was (and is) one of the relux babies who find feeding very soothing on their tummies, and would take in as much as I offered, so the dummy was an important tool for us. Sometimes, in those early days, he would actually just fall asleep, so that was great. So can you ask about the dummies? While he was doing this, I'd hold him up on a tilt and gently stroke his back, and sing, and generally try to calm him (and get wind up). If I found he was getting antsy or sucking it very hungrily, I'd offer him a little more and depending on how he responded, allow him to finish. Have you looked at reflux.org? Some great tips there.

Secondly, and I am really not trying to put you off here because you are doing a stellar job, but I found that when I was comp feeding (he was younger, only 4 weeks, so not sure if it's relevant for you) DS developed a strong preference for the bottle. I believe that it was simply easier for him to get the milk in that was soothing his reflux. It's something to consider and I wonder if it would be worth seeing your LC to discuss. I actually got to the point where I was convinced he faffed around on the breast because he knew it would get him his EBM/formula. I would be wondering how the heck he was asking for more frim the bottle, and I think part of the answer was that he wasn't effectively feeding from my breast and was awaiting the top up as his "main meal". I was advised by an LC to express full time which was not something I felt able to do long term, so that was the end of it for us. However my DS was a lot younger (I think about 4 weeks at that stage) so I have no idea if that could be totally irrelevant for you. But as I say, might be worth asking.

Can I just say I know it's tough with reflux babies, you're doing a fantabulous job and I wish you all the best.

[chickenpants]

I am comp feeding my little dude too, and had problems with crying after feeds and reflux-type behaviour. It turned out that it was the formula we were using, once we changed that then he was absolutely fine and the issues went away.

He was on that S26 which left him grizzly and windy and sad - we found the Karicare regular formula works well with him, a lot of EBers swear by Bellamy's too.