Triple Feeding - What Next?

Deal with Pain
If your nipples are damaged and sore, it is important to deal with the pain by finding the cause.

Common causes include:

• a shallow latch
  ~A baby with a shallow, painful latch is not able to remove milk effectively from the breast.
  ~See Positioning and Latching for more information on achieving an effective and comfortable latch.
  ~Or contact a La Leche League Leader or International Board Certified Lactation Consultant (IBCLC) for support.
• pumping issues - These may include:
  ~a poorly fitted pump flange;
  ~pump vacuum setting is too high; or,
  ~not lubricating the flange before pumping.
  ~See Pump Fit Matters for more about pumps and comfort.
• See Nipple Pain for more information and other possible causes.

Tips for transitioning to feeding exclusively at the breast

Offer any supplement in a way that protects breastfeeding

• Option 1 - Paced bottle feeding:
  ~allows your baby to be more in control of the feeding;
  ~slows down the flow of milk, so your baby can feed slower and take breaks.
  ~helps prevent overfeeding, which is common with bottle feeding.
  ~helps prevent your baby from expecting a fast, steady flow of milk from your breast.
• Option 2 - Cup, spoon or syringe:
  ~Transitioning from a bottle to cup feeding may be helpful.
  ~Using a different feeding method may prevent your baby from being frustrated or confused by the change from your soft breast and nipple to a stiff, firm bottle nipple.
  ~For more information see Cup Feeding 1-2-3.
• Option 3: At-breast supplementer system:
  ~Supplementing at the breast means your baby spends more time at the breast, which helps to increase your milk production.
• For additional information see How to Protect Breastfeeding While Supplementing.

Reduce supplementation gradually

• As your baby increases the amount of feeding at the breast, gradually reduce the amount of expressed milk or formula you give to your baby. This way you will see gradual progress to your endpoint of exclusive breastfeeding!
• Consult your healthcare provider or an International Board Certified Lactation Consultant (IBCLC) on how much to reduce the volume of expressed milk or formula you give per day.
• Once your baby is nursing well, your plan may include
  ~Reducing the amount of supplement in the supplementary feeds by 8-15 ml (¼-½ oz) each day or two once your baby is breastfeeding well. This will result in a total reduction of approximately 30-180 ml (2-6 oz) of supplement each day or two.
  ~Removing the supplement for one feeding in 24 hours (for example, if a baby has been getting 4 feedings by bottle over 24 hours, drop down to 3 feedings by bottle over 24 hours). You can drop one bottle feed every few days (or more frequently), if your baby continues to be satisfied after feedings at the breast.
• Watch that wet diapers and bowel movements are sufficient and remain consistent. See Poops and Pees.
• Continue to have your baby weighed regularly by your healthcare provider.
• If you are pumping more milk than your baby needs you may be at risk for inflammation of the breast (mastitis). If you think you might be over pumping, a gradual reduction in how often you pump and/or how long you pump helps to prevent oversupply and decrease the risk of mastitis. See Oversupply and Forceful Letdown and Mastitis - A Matter of Inflammation.