UPON LEAVING THE HOSPITAL
Upon hospital discharge, you might be given a “back up plan” to triple feed as needed, until the weight check in 1-2 days. If you have risk factors for low milk supply , this is especially important. If your milk doesn’t clearly come in as soon as expected or milk removal is a problem (latch pain or refusal), triple feeding gets your baby fed and avoids excess weight loss. Pumping or hand expressing colostrum helps bring your milk in if your baby isn't removing milk well.DAY 3 to 6 ish
Cluster feeding is expected as your baby nurses frequently to stimulate your milk to come in. As milk volumes increase as expected, feedings space out to every 2-3 hours, although it's still normal for your baby to occasionally nurse hourly. But, if hourly feedings persist for more than a day or so, your milk may be late or your baby isn’t removing it well. A weight check should already be scheduled, but until then, consider triple feeding.THE 2 nd WEEK
Even if all is well, I typically recommend a weight check around 7-10 days to make sure your milk supply is increasing adequately. This is especially important if this is your breast's first time to prove themselves, or if there are risk factors for low milk supply.It's also very important to get this weight check if your baby was born a couple weeks or more before your due date. Some smaller babies gain well in the first few days when the volume of milk they need is very small. During the second week, they need to remove more than double this volume, and they may not have the stamina to do it.
Click here to read about breastfeeding preterm babies.
If weight gain is indaequate, triple feeding can “buy some time” as milk supply catches up, and/or “buy time” while your baby practices latching and gets stronger to remove milk better. In this case, you will need to offer the supplement even if your baby comes off the breast sound asleep, as some babies may not actually ask for more milk. If he allows the feeding device into his mouth and then swallows, he has room for more, so keep going. The sooner his weight catches up, he’ll do better over-all.
OVER THE LONG HAUL
If your baby isn’t gaining enough weight to follow the growth curve, the situation needs sorted out. Sometimes parents don’t realize their baby isn’t gaining as expected. Well baby check-ups are done at 2 weeks, and then 1,2,4,6,9 and 12 months to make sure your baby’s growth and development are appropriate.You may be shocked at what the scale says because you didn’t notice that your baby looks “skinny.” Looking back, you may realize he's either been acting quite lazy or low energy, or perhaps he’s been irritable and wanting to nurse more frequently, especially at night. This can happen during growth spurts, but feeding frequency should return to typical within a day or two. If not, just get a weight check to be sure.
Click here to read more about how babies behave if they're not getting enough.
A healthcare provider will interpret the growth curve together with your baby’s over health status. If there are concerns, triple feeding will assess your milk supply and assess your baby’s ability to remove milk. Since you'll offer supplemental breastmilk, donor milk or formula, this plan will prove that your baby can gain weight simply by consuming more calories. This is an easy way to rule out concerning medical causes of poor weight gain. In the process, your milk supply will hopefully recover, if supply was part of the problem.
While breastfeeding, you cannot measure how much your baby drinks, unless you are also pumping at least some of the time, and can thus measure volumes at different points in the day. Even so, it helps to know that from about 1-6 months, most babies need about 2-5oz every 2-3 hours during the day and sleep longer stretches at night. This will total about 24-32oz per day. After 6 months, milk intake can decrease to about 24oz per day, because solid foods will provide additional calcium, protein, iron and vitamin A.
Click here to read more about expected volumes of milk intake.
Kay Anderson MD, IBCLC
5/23