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Should you top up with formula?

The top-up trap

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To top-up with formula or not?

As a breastfeeding mama I’m sure by now you’ve wondered – “is my baby getting enough?” and “should I top him/her up with a bottle?” It is not uncommon to feel this way, particularly if you had a premature baby who needed early feeding support or if you have a history of low supply.

In the first four weeks of your baby’s life, your body responds to the number of times your baby breastfeeds, aiming to provide a supply that matches demand. Following these 4-6 weeks, your body establishes this supply-demand pattern, and your breastmilk production every 24 hours remains reasonably stable.

By introducing top-up bottles of formula, you are effectively telling your body whatever milk bub removed at the breastfeed was enough and no need to produce more. This begins a vicious cycle, as this will decrease your supply over time which in turn, requires more and more supplemental feeds.

Signs your baby is receiving enough breastmilk:

  • Gulping and swallowing while breastfeeding
  • Producing frequent wet nappies daily
  • Baby settles following feeds
  • Gaining weight as to be expected for age

With regards to baby’s weight, it is important to remember, your baby will lose up to 10% of their birth weight in the first week following birth. After 4-5 days, they should begin regaining weight until they are back to birth weight by 10-14 days of age. Following this, they should continue to gain weight, not lose.

If you do not notice any of the above and you are concerned, here are a few solutions to improve your breastfeeds first, instead of just topping up with formula:

  • Check your baby’s attachment – ensure they are productive and suck/swallows evident.
  • Demand feeding – Instead of implementing a feeding schedule, allow your baby to breastfeed whenever they demand.
  • Avoid dummies – these may hide feeding cues essential to demand feeding.

Whilst breastfeeding is not an exact science, and in the early days there is often trial and error – once your supply settles and baby’s weight stabilises, there is much improvement.

Written by Keryn Thompson, RM & IBCLC (L-301766)

References

Dattilo, A., Carvalho, R., Feferbaum, R., Forsyth, S. and Zhao, A., 2020. Hidden Realities of Infant Feeding: Systematic Review of Qualitative Findings from Parents. Behavioral Sciences, 10(5), p.83.

McInnes, R. and Chambers, J., 2008. Supporting breastfeeding mothers: qualitative synthesis. Journal of Advanced Nursing, 62(4), pp.407-427.

Newby, R., Brodribb, W., Ware, R. and Davies, P., 2015. Internet Use by First-Time Mothers for Infant Feeding Support. Journal of Human Lactation, 31(3), pp.416-424.

Smith, H. and Becker, G., 2016. Early additional food and fluids for healthy breastfed full-term infants. Cochrane Database of Systematic Reviews,.

Wennberg, A., Jonsson, S., Zadik Janke, J. and Hörnsten, Å., 2017. Online Perceptions of Mothers About Breastfeeding and Introducing Formula: Qualitative Study. JMIR Public Health and Surveillance, 3(4), p.e88.

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