You may have been told that you should “top up” your baby with a bottle of formula after breastfeeding. It’s important to understand why.
This may be your experience: Breastfeeding seems to be going well but your baby feeds very often. You're worried you may not have enough milk. Someone suggests giving a bottle, just in case. However, you talk with a La Leche League Leader and learn that this is normal feeding behaviour for a newborn.
Or this may be your experience: Your baby is crying and you are crying. Everyone is hungry and nobody has slept well for a few days. You’re feeling overwhelmed. You see your healthcare provider who recommends temporary supplementation.
Common Reasons for Supplementation
- Baby not latching
- Slow growth or poor weight gain
- Low milk supply See Low Milk Production?
Sometimes supplementation is needed temporarily for a few days or a few weeks. Once milk production meets your baby’s needs, you can stop using donor milk or formula. When your baby is nursing effectively at breast, you can stop supplementing after feedings.
When temporary supplementation is needed, consider this plan:
Feed your baby
- If your baby is latching, feed frequently. Use switch nursing and breast compressions to keep your baby drinking. See Low Milk Production?
- Supplement with expressed milk, donor milk or formula, as needed.
- Consider using an alternative method of feeding. If your baby is latching, you could supplement with an at-breast supplementer. If your baby is not nursing, you might use a cup or finger feed with a tube or syringe.
- Bottles are not recommended. It can be difficult for babies to learn how to breastfeed while also using a bottle nipple. However, bottles may be the best choice for you, especially if you need to supplement long term. If you decide to use a bottle, consider the paced bottle feeding method. This method allows your baby to be more in control of the pace of the feeding. It slows down the flow of milk, allowing your baby to feed more slowly and take breaks. This helps to prevent overfeeding, which is common with bottle feeding.
Support your milk supply
- Express milk after breastfeeding.
- If your baby is not latching, pump at least 8 times in 24 hours.
- Consult your healthcare provider if you don’t notice an increase in milk production by day five.
- Discuss using a galactagogue (food, herb or drug that can increase milk production) with your healthcare provider. See Galactogogues.
Establish exclusive breastfeeding
- Hold your baby skin-to-skin often, especially in the laid-back position. This encourages your baby to latch. It also encourages your body to produce more milk.
- Give a little supplement before breastfeeding if your baby is very hungry.
- Know that feeding your baby and maintaining your milk supply are essential.
- Be patient about establishing full breastfeeding. It may need to wait. It may be challenging to do all three.
- Seek help if your baby is not latching, breastfeeding is painful or your baby falls asleep after a few sucks.
Reasons for Avoiding Bottles
- Newborns are still learning to breastfeed. They may have difficulty moving back and forth between breast and bottle. This may lead your baby to prefer the easier flow of the bottle and refuse the breast. This is more common if your baby is already having trouble latching.
- Sucking on a breast is different from sucking on a bottle nipple (regardless of the brand.) Sucking on a bottle nipple may encourage your baby to push the breast out and suck on your nipple. This leads to sore nipples and poor milk transfer from breast to baby. With a bottle the milk flow is immediate and requires little effort from your baby. At breast your baby needs to suck a couple of minutes to initiate the milk flow.
- If the milk flows too fast from a bottle nipple, your baby may bite down to slow the flow. This can result in your baby biting down on your nipple.
- When your baby is “topped up” with a feeding from a bottle rather than suckling at your breast, your body does not get the hormonal signals to make more milk. Your milk is produced on a demand and supply system. The more your baby nurses, or the more milk you express, the more milk your body makes.
- Top up bottles can undermine your trust in your own body’s ability to produce enough milk for your baby. The fact that your baby will take milk from a bottle does not mean that your baby is still hungry. Because of the fast flow, your baby has no choice but to swallow what is in his mouth. The more bottles given, the more your confidence is undermined.
Ways to Increase Your Milk Production
The primary way to increase milk production is to remove milk frequently from the breast. Milk removal tells your body to make more milk.
- Breastfeed early and often: This means putting your baby skin to skin as soon after birth as possible. It also means feeding 8-12 times a day including several night feedings.
- Hold your baby skin to skin often: Skin-to-skin care can calm a fussy baby and get them interested in feeding. It will also calm you.
- Ensure latch and sucking are effective: This may be your first time breastfeeding a baby. You may not be sure your baby is latching deeply enough. You may not be sure if your baby is getting enough milk. Consider talking with a La Leche League Canada (LLLC) Leader, attending an LLLC meeting, arranging a consultation with an IBCLC (International Board Certified Lactation Consultant) or getting a weight check at your baby’s healthcare provider.
- Feed when your baby shows signs of hunger: If your baby is showing signs of hunger, put her to breast. Don’t worry if she just fed 30 minutes ago.
- Switch nursing: Your baby may feed on one side and then start to fuss. Or your baby may stop sucking actively. If this happens, try burping and then offering the other side. You can switch back and forth several times. Each time you switch there is another letdown or milk ejection reflex.
- Breast compressions: When you notice that your baby is sucking, but not swallowing, you can help the milk flow by gently squeezing your breast. Place your fingers under your breast with your thumb on top, behind the areola (darker skin). Press gently until you notice your baby begin to swallow. Release when your baby stops drinking.
- Express milk: If your baby is not latching or is latching poorly, you will need to express your milk. You can use a breast pump or hand express. Express soon after nursing. Pump for 10 minutes or until milk no longer flows. Express your milk after as many feedings as possible throughout the day, ideally a minimum of eight times in 24 hours. To increase milk production, pumping frequency is more important than the total number of minutes spent pumping in a day. More often is better than more minutes. If you are supplementing, use your expressed milk first.
- Consider using a galactagogue: Galactogogues are substances that promote milk production. They may be foods, herbs, or medications. See Galactagogues for more information.
"Triple feeding” is the name given to the process of breastfeeding, pumping and topping up with bottles (either of breastmilk or formula). If you have been giving “top up” bottles for a few days or weeks, you still have the opportunity to work your way back to exclusive breastfeeding. You’ll want to slowly decrease the amount of supplement in each bottle or the number of bottles used in a day. Frequent weight checks are helpful to make sure your baby is continuing to grow. You will likely want to talk to an LLLC Leader or an International Board Certified Lactation Consultant (IBCLC) to create a plan. See Triple Feeding - What Next? for more information.
Remember, most breastfeeding challenges work themselves out by the time your baby has reached six weeks. This doesn’t mean you should just wait six weeks and everything will get better on its own. It might. Most mothers and parents find that getting the right support as soon as a problem arises works best. You may be able to turn things around in a few days with the right information. If the first person you talk to doesn’t seem helpful, keep going until you find someone who is a good fit for you and your baby.
It’s important to talk with someone who understands the normal course of breastfeeding and life with a newborn. This can make a huge difference both to your perception of what is going on and to the reality of your breastfeeding relationship. Call a La Leche League Leader or go to an LLLC meeting to get the support and information you need.
Updated December 2022