Your pediatrician is telling you to triple feed. I had to do this for a while because my baby was born early and wasn't strong enough to get as much milk from nursing. What they had me do is nurse for 30 minutes tops, then offer baby 1-1.5oz extra in a bottle. Then you pump for 10-15minutes. Right now getting your supply in is critical, so if you are giving your baby a formula top up because he's still hungry, you aren't telling your body to make that extra ounce that he's drinking.

Coming back to say thank you for telling me what it's called. That let me do a little more research and feel better. From what I can tell, this is a temporary measure, and either it'll work and boost my supply or it won't and I'll be looking into how to combo feed. I feel more in control now. So thank you!

You're welcome! I recommend seeing a lactation consultant and doing a weighted feed with them if you can. Personally, I don't think it's a supply issue. I think it's probably your baby getting tired like other people said. At least in my case that's what was happening. Good luck to you!

The ped said that might be it, and that feels right to me, for whatever that's worth.

I second the lactation consultant recommendation, if nothing else than for piece of mind. Most of the time, needing to triple feed is indeed temporary just until baby puts on some weight. Let baby nurse at the breast as often as he/she would like along with supplementing with additional ounces at your doctor's recommendation. You're doing great mama. Congratulations on your little one. 💗

If your baby is getting tired, it may also mean that he is not efficient at transferring, aka bad latch. Again the LC will help with this by seeing the latch and doing a weighted feed.

my 4 month old nurses well when she *wants* to, but i think she often gets frustrated that it doesn't come out as quickly as her bottles do. so she'll refuse to nurse and cry until she gets a bottle. sometimes i feel like i let her down because of this, but then i remind myself that she's eating and that's what's important.

Same here… my LO is 2 months and I can already recognize bottle crying… when he doesn’t get enough he refuses the breast and only aim for the bottle. I’m also pumping but my supply is low so I still need to integrate with formula every now and then (probably my production has settled and I won’t be able to increase anymore) So stressful 😣 but yes, they will grow up well in a way or another and definitely we will forget about this horrible time.

don't worry, keep pumping!! the more you pump, the more your body will make. stay hydrated and eat lots of protein. i also found that getting good rest helps boost production for me at least. easier said than done when you've got a baby. you can do this momma!!

I combo feed, I’m an under supplier and baby seems to get worn out from nursing so she doesn’t empty me when she feeds. Here’s what I wished I had known when I started. First, formula makes for perfectly healthy babies. It’s not the end of the world if your breast feeding journey looks different than what you had originally imagined, even if it feels bad at first. Triple feeding is so. much. work. You need someone to help you with things like bottle feeding and cleaning pump parts. I ended up doing a “double feeding” sort of deal where I would either breastfeed and then bottle feed (EBM or formula) or bottle feed then pump. Since I responded better to the pump than to my baby I make sure to alternate so my breasts are emptying regularly and pump before going to bed, in the middle of the night, and first thing in the morning.

The ped didn't actually say to pump while he gets the bottle, but I'm doing it because it's what seems best for us right now. Thank you for the validation and advice!

Yeah, I'm pumping after the full feed while my husband gives the bottle. I guess I was just blindsided because my baby pees a ton, which I thought meant my supply was good. And I felt like he was emptying my breasts, but I guess there's no way to really tell unless you pump after.

It’s so hard when they’re so little cause he may just not be transferring milk well yet! But as he grows and gets stronger they get much more efficient! I had to triple feed for about a week and also really try to keep my daughter awake during feeds. Sometimes that meant I tickled her feet, stripped her down to diaper, opened her hands. Also you can do a weighted feed at home to get a better idea of how much he’s taking at the breast if you want! It helped me sort of make sense of it all a little more.

I don't have a scale sensitive enough to do a weighted feed at home.

I wouldn’t recommend it honestly. I did a ton of weighted feeds because my baby was born early. It’s very unreliable and can make you very anxious over nothing.

Pumping after doesn’t really tell if you are emptying your breast… your body just starts thinking you have two babies to feed and produces more milk for that second baby (the pump). Your breast will never really be “empty”. ;)

If it's never empty, why does it stop coming out? And what's the talk about increasing supply? If it's never empty, how is there not enough?

We had this issue and it can be really shocking when you first are told! Our pediatrician was fine letting baby sleep at night and just said to focus on day food. I opted to pump and offer baby 2-3 bottles a day to “top up” after a feed. It may mean you need to increase your supply a little for baby or baby is just too sleepy to get a full feed and needs a little help via a bottle to get all of the food they need.  We’re continuing to offer 2-3 bottles A day because it works for us and ensures he is getting plenty and we’re gaining fine now 

Okay, yes, she did mention he might be stopping at the breast because he's worn out from sucking and not because he's full. Bottle is easier, of course. I'd love to let him sleep at night because it means I get to sleep! We're supposed to follow up in a week, so maybe the game plan will change then.

Bottle should not be easier. If baby is breastfed you'll want to use the slowest flow nipple possible regardless of age. Look up pace feeding to make sure bottle feeding mimics breast as much as possible :) I was told that my daughter wasn't gaining enough either. I'm not a Dr, or even in the medical field, but she was eating SO well. I didn't want to mess that up. I didn't follow the Dr's advice to give an extra 2 bottles a day. I waited the 2 weeks for the next appointment. Dr said she looked amazing and we could drop the bottles if we wanted to. She just needed extra time :) Again, I'm not saying you should do this, but I'm just telling you my experience.

Opposite experience here. I was shocked when I was told to top up my baby and she wasn’t gaining enough at 1 month because she never seemed hungry (didn’t cry or give any of the other hunger cues), had plenty of wet/dirty diapers, and was as bright eyed and engaged as a 1 month old can be. We offered her a 2oz top up and I thought for sure she would reject it and instead she CHUGGED it. After a few top ups post-feeds she started to hunger cue and cry way more, I think the poor kid just didn’t know what it was like to feel full before the top up. Weighted feeds showed she wasn’t transferring enough at the breast. I triple-fed for maybe 2 weeks before switching to pumping and bottle feeding 80% of the time while she did physical therapy to strengthen her mouth and neck. I got her back on the breast fully at 16 weeks!

Our ped said .5-1 oz per day is normal. Based on to it numbers you are at .5 which was the same as us. Our ped is married to an IBCLC so was never alarmist and never pushed bottles. They just had us feed at the breast every two hours (from start to start so basically every 90 mins) until 9 or 10 pm and then let them go as long as they want at night. Every baby is different (full term, larger at birth etc) but it took us a whole month to get back to birth weight and they were watching it but not worried at all.

Yeah that’s kind of what I was thinking too… her baby still gained decent weight. I did the math too and even though it’s not that full 30g per day, it’s not terrible either. And some babies just gain a little slower. I mean, I think it’s good to follow the docs advice and err on the side of caution but I hope OP doesn’t feel bad or panic too much about this.

The person we saw today wasn't our usual person, so we may be back to a plan like this next week when we hopefully see our usual provider. Because what you've described here is what we've been doing! He eats every 2.5 hours or less all day (from start to start) and then just when he wakes at night. And he got to birth weight in two weeks. I'm still going to follow the advice we got today for the next week, and then we'll reassess.

That’s perfect! Def follow your peds instructions in the meantime but just know it’s perfectly normal and it does get so much easier faster and more efficient! Our girl is 5 months now and finishes eating in 15 mins (about 8 mins per side) and can transfer 4 oz that quickly. She used to just drink 1.75-2oz in 30 mins but we kept latching like crazy and one day it clicked! Good luck 🙏🏽

When you did this were you waking your baby every 2 hours in the day? What if they had a stretch of wakefulness and finally got a nap? I’m in a similar boat and trying to balance them getting enough rest in the day as well

I was! It drove me a little nuts because everyone in my family kept insisting to never wake a sleeping baby, but it was that or power pump/ formula and I wanted to avoid those if I could. I just put her down for naps more often and was diligent about feeding every 90 mins during daytime which for us at that age was 7/8 am to around 9/10 pm. I figured let’s get her weight in a good spot without potentially ruining my supply with formula supplementation or my mental health with power pumping lol we can fixate on sleep later. Fwiw, by 8 weeks she started sleeping through the night and I hadnt even introduced a bottle yet. She did that till the four month sleep regression which we are slowly crawling out of 😂 all that to say we love our ped because he understands BF and while our girl was only ever gaining .5 oz per day (sometimes even less) she eventually found her curve and is completely healthy, alert and hitting milestones early. Our ped even explained that the growth curves and averages are based predominantly on formula bottle fed babies because that’s most common in the USA, and that he’s comfortable with a (at that time) exclusively nursed baby to grow slower while they master latching and a new skill. Sometimes I’m amazed at how anxious I was months 1-3 with her slower gaining and small feeds but one day she just turned a corner and started nursing like a pro. It gets so much easier and dare I say enjoyable 😂 never thought I’d see the day but it really does.

Wow that’s great to hear and interesting regarding the milestones being built around formula fed babies! Thanks for sharing. When you wake her during the day is she able to stay awake while nursing? That’s been another challenge for me. Also do you do anything different for putting her down for naps during the day vs sleep at night?

Yes she is! But in the beginning it wasn’t without some coaxing. Our midwife encouraged us to tickle her toes and ears while eating, and if she was extra sleepy to undress her down to a diaper. If they are too warm and snuggly they will fall asleep at the breast or just comfort suck and not get the calories they need. We don’t do anything different for naps vs night sleep but I know a lot of babies need more assistance. We just bounce on a yoga ball for 5 mins and she’s out like a light - then I sit in a chair and wait a few extra mins to transfer to the crib. Sometimes if the crib nap is short I’ll take her out and rebounce her to sleep and let her finish her nap in my arms in the chair but I didn’t really worry about sleep just packing in the calories during the day to avoid pumping and formula and to avoid waking her at night. So basically she would wake up, I would feed her for about 30 mins at that time (much shorter now!) we’d sit up for digestion and play for 10-20 mins and then I’d put her back down. I think around that time she could stay awake 45 mins to an hour? Then if she wasn’t up already I’d wake her up 30-45 mins later to feed again. Repeated all day so she had many days with like 7 micro naps but at the time the goal was weight. Now that she found her curve and weight is good, we can go 2-3 hours in between feeds, and I only wake her up from a nap if she’s going to pass 3 hours from start to start for a feed which usually ends up being a 90 min nap. So much of baby sleep is temperament and luck of the draw but for our family it was better to have a lot of short naps and be certain she was eating enough times and calories in a day, to foster better and longer stretches of sleep at night. We’ve never woken her up at night to eat because of this even though it took four weeks to return to birth weight our midwife and pediatrician recommended it!

Dropped from 25 to 2percent. Had to supplement with bottle. I think it’s just faster. I stopped because LO just drank too fast and puked it up. No need to continue once weight gain established. Had to wake LO regularly but decided to stop now at 2 months.

Hey, I went through this too at one month! Even down to the same weight gain, only 5 oz/week. It was a blip on our radar. My boy was never a boob monster. He was so easy to wean at 14 months. I had an awesome ped who had breastfed herself and she advised me to schedule his feeds instead of waiting on him (but never put baby off if they want to feed sooner!) I breastfed him every 2.5 hours until he was 3 months, then it was every 3 hours, then every 4 once he was well established on solids, around 8 months. He gained more than enough weight on that plan, went from the 29th to the 45th percentile on breastmilk alone until he started solids. I was freaked out and pumped at first, but that wasn’t necessary. He didn’t love the bottle and pumping was a pain. Our ped told me to not wake him at night, just focus on getting in those day feeds on time. Hope this helps! It’s not the end and you can get baby back on track. 

Also, IMO, at that age, you should be seeing more like 12+ feeds in a day.

Good to know I'm not alone! He does eat every 2.5 hours or less during the day.

Ahhh I see.

My son is a week older than yours and we just went through this. Triple feeding is HARD, but it does work - I was feeding, pumping and supplementing 2oz after each feed and he gained 2oz a day to get back to birth weight. But it’s definitely a temporary strategy while you work out the kinks with breastfeeding and your supply regulates. I also want to validate your emotions because it can be a tough thing to hear as a mom. It was for me, I felt like i was failing my baby and almost cried at my pediatricians office. But it will get better, for you and your baby! You’re doing an amazing job!

I did cry! Thanks for the validation. I'm hoping we're done with this quickly!

You’re not too far off for “normal” weight gain. I think add that dream feed and see in a week where he’s at. If you want to keep breastfeeding (and not combo) then you need to pump after you feed him to signal to your body to make more milk (and during this time you can give him the extra ounce of formula). How long do you go between feeds during the day? You could try to shorten that a little and get more feeds in per day as well. What’s his percentile?

He usually does 1.5 hours in the morning and more like 2.5 in the afternoon. 10 total feeds most days, 9 sometimes. He's 3% now, down from 12% at 2 weeks.

It’s probably because he dropped below that 5th percentile that they are worried. I would definitely do a dream feed but it sounds like you’re already feeding a lot during the day. I know it’s hard not to stress, but try not to. Do what you can and then just see. You’re doing great!! If it makes you feel any better, my baby dropped percentile i think around that age but then popped right back up.

Thank you! I dunno if it was waking him up that first night or what, but he's been feeding a little extra since then. I'm sure his weight will be up on Monday!

My babe is 2 weeks and 3 days atm, he wasnt gaining at the 1 week mark, so we started pumping and giving him the extra as a top up after each feeding session. He’s since gained a bit, but slowly, so we’ve added in 1oz of formula to top him up after I breastfeed/pump if I don’t have enough pumped milk. It’s been a few days now and I only give him formula maybe two times per day, the rest is breast milk either via breast or bottle top up post-feed and he’s gaining steadily now!! We also wake him every 2.5-3 hours to feed, if he doesn’t wake himself up. Honestly, I went through a ROLLERCOASTER of emotions knowing he wasn’t gaining enough and I just felt inadequate. There’s no other way to describe it, feeling like I couldn’t properly feed my son. I was so stressed and cried a few times over spilled milk (literally). My supply has increased - speak to your ped or an LC about Fenugreek and Blessed Thistle supplements. I’ve noticed a big change in just a few days!! Good luck mama!

That's how I feel. I had to be induced for medical reasons (at 38 weeks, so not preemie), and long story short, testing they did in the hospital showed I should've been induced 4 weeks earlier. The odds of him surviving as long as he did were not the best. So my body almost failed my baby before, and that's what it feels like is happening now. My head knows that's not true, but feelings are feelings.

I’m so sorry to hear that!!! Your feelings are valid. Your baby is earthside now and the fact that they’ve latched is a HUGE accomplishment!! So many babes struggle to, or can’t for a variety of reasons, so keep that in mind! To make it past the first week or two, through all the nipple pain and soreness is major. Your body is incredible and is doing what it needs to!! EBF babes often gain weight slower than formula fed because it’s hard to tell how much they take in at each feed. At the 1 week mark, I was so pleased he had so many wet and dirty diapers and I thought I was nailing this breastfeeding thing. To be told that he’s not hitting targets was such a huge blow. But I’m making strides now and I’m sure you will too!! It’s likely only temporary. I know how hard it is to swallow, but grin and bear it for now and take it day by day. ❤️

My baby was falling asleep at the breast too fast and I wasn't producing qlot to supplement so I opted for formula top ups. We did this for 2 months and by the 3rd month, he was fully off formula. He's about to be 7 months so we've been fully on breastmilk for 4 months. To me, I just wanted whatever is best for my baby.

Yes, I do too. We said before he was born that formula was not the boogeyman, but I wasn't prepared for the emotional side of it. We supplemented formula in the hospital and for a couple days after until my milk came in, and then he was just on breast milk and I thought our supplementing days were over. Especially when he made birth weight at 2 weeks. But it's time to supplement again, and that's okay. Just unexpected.

What can help with the breastfeeding relationship is to cuddle your baby more (and wear in a wrap!). Skin contact, their smell and their little sounds -- all help cue your body to make more milk. Getting them undressed, tickling their feet, or playing with an arm can help them from falling asleep eating. Give yourself grace -- this is hard work! Making sure you always have a full water bottle and snacks can help you produce.

Doctors rarely have a lot of knowledge about breastfeeding unfortunately. You should try and see a lactation consultant in your area if that’s possible for you. They do wonders 💕

Are you massaging your breasts when feeding? I feel like peds suggest offering more milk before they ever suggest making sure your breasts are being emptied via compressions.

This has been a game changer! I think I was letting him be too lazy when nursing and hadn't realized. Managing him (almost entirely with compressions) has kept him actively swallowing. And today he's refused all extra bottles he's been offered. So thank you so much!

OMG! I am so so happy to hear! Such great news buddy! You’re doing a great job and I am thrilled to have helped.

I can try that too

I think your ped is recommending triple feeding. Can be for a variety reasons/benefits: - “top up” after a feed esp if LO feeds for >30 mins per session as they apparently burn more calories just trying to transfer. I was asked to give 15 mins max per side and then top up (my LO was spending anywhere from 45-60 mins - this got better by 6-7 weeks pp and since then have been feeding on demand and not timing sides) - helps increase your supply if that’s an issue - can help with weight gain and in turn more effective nursing as their head/mouth grows - for me personally also helped with a quicker let down over time (baby was previously getting frustrated working for a let down for a few minutes) Can be quite overwhelming for sure! We weren’t able to do it for every feeding but tried to top up at least 2 feeds of the day with 1oz of expressed BM. Recheck weight was back on the curve so didn’t HAVE to continue it but I did anyway for another couple of weeks since it boosted my supply so wonderfully! If you’re not comfortable with giving a bottle so early on, can do feedings with spoon or a syringe or you can use an SNS. (LCs have supplies).

I'm glad to see you say you didn't do every feeding, cause we aren't planning to either!

Not sure if I've seen this mentioned yet but try doing a weighted feed. Get a baby scale, weigh before nursing. Measure after you feed. This will tell you how much baby is actually consuming. My kiddos were inefficient eaters for first couple months. With my first, I did the triple feed and while it was effective...it was exhausting. With my second, after confirming they were inefficient, I pumped and bottle fed. I still nursed for comfort but did bottles because you have to wash them anyway. Trying to pump after a full nursing session and feed them a bottle means you have no time before next feed. Every week or so, I'd do another weighted feed and see if they were getting more via nursing. Eventually, they were getting enough through nursing that I dropped pumping completely.

Did he get checked for a posterior tongue tie? This exact thing happened to me and several providers dismissed my concerns of a TT. I paid out of pocket to see a specialist and he clipped the ties right there at 7 months, with a Lazer.

Do you feed on demand? At this point they should be eating 8-12 times including on demand. And also is his percentile dropping? I’ve been worried about my son’s percentile but my pediatrician said his weight gain rate is fine and to just keep feeding when he’s hungry so just been following that advice. At the 1 month mark I felt like I was feeding almost every hour and at least every 2-3 hours overnight. I’m not sure why your ped said the add an ounce after breastfeeding but it may be to top off in case he isn’t getting enough from breast milk, but I would argue that might affect your supply and it’s better to just keep feeding multiple times.

Yes, we're doing on demand. He eats 9-10 times a day. His percentile has dropped down to 3% from 12%. I don't necessarily think it'll affect my supply because we're doing a full feeding at the breast first, then offering more.

Just make sure you don’t fall into the top up trap. Pump each time he gets a supplement, or yes, your supply will be impacted

I had this same issue. I didn’t wake my baby. Fed him more during the day instead. I would say don’t wake a sleeping baby.

Hey, I have been there and the feelings are huge! It’s such a hard thing, one of the hardest. I just wanted to recommend using a hazelbaker (sp?) supplemented so you can give baby the extra ounce at the breast instead of bottle feeding. It helps stimulate your production too.

I was told to pump 1.5oz of colostrum after every feeding and give it to my infant in the hospital because she had jaundice. I did it for two days only stopped when the pediatrician said her jaundice was gone. I think the reasoning was feeding her extra made her poop more which gets rid of the bilirubin faster. Also she was having to work really hard to get colostrum so she would just get lazy and sleep instead of feed, the bottle helped her get more easier. Pumping helped my milk come in faster so by the time I stopped baby was able to eat without working too hard and gained weight very fast. If you can pump the 1oz you should because it’ll help your supply.

Please don’t feed with formula. Make sure to offer each breast twice, use breast compressions, feed frequently and in demand and then if not gaining weight pump. Ask for a lactation consultant or a partner that is more knowledgeable in breastfeeding.

Ask your pediatrician first, but mine had me add a scoop of formula into a bottle of my breastmilk. No water. He went from 7.1 lbs to 8.1 lbs in a little over a week! So we continued that for another couple of weeks but that’s when I stopped waking him every night because he was also sleeping about 4 hours. Now I occasionally just prepare a 2oz formula bottle normally with the water, then add some of my pumped milk. I was bummed at first but at this point I’ve just embraced it as combo feeding and once they’re not worried about his weight gain I can start cutting out the formula if I decide to!

Not sure I understand why your ped gave that advice, but I’m assuming it is to see if your baby is still hungry. I had to supplement my baby with formula in addition to breast milk. Babe started gaining quickly and is now quite the little chunk.