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Personally, I would probably exclusively pump for as long as you felt able to, i.e. it was working for you and your family, especially with an older kid at home (and if that length of time ended up being just one more day, I'd feel ok about that, considering that she will already be getting breastmilk that you have frozen). I don't think that I would have the motivation to jump through all those hoops to get her back on the breast, and I say this as someone who nursed my first LO for 18 months.

You could also try it for a week--or some other length of time, and just commit to that time frame and re evaluate at that point. Either way, you are doing a great job and great to hear that she is home!

DS was a preemie with similar issues, but he was my first. I don't know what I would have done if it had been DD with trouble when I had a toddler at home. What helped us: zantac, baby wearing so baby could be held upright but I didn't have to stop what I was doing, sleeping and resting in a Rock N Play, gas drops. Here's another option: try feeding an ounce of pumped breastmilk, then the rest of the feed thickened formula. If she does fine with that, you can increase the amount of breastmilk until she doesn't need the thickener. That way she gets breastmilk but you can pump when it works for you. Then you can switch to nursing if you like. Or try alternating a nursing feed with a thickened feed. If it doesn't work for her reflux, reevaluate. She's past her due date now, so you might see a sudden change in her feeding ability.

Eh... If it isn't such a big deal to you personally I would just switch to formula. I mostly breastfed until LO was past 2 and I feel like it was overrated.

Do you still have the freezer stash or did you use it up? A friend of mine thickened her breast milk for her son with severe reflux. I can't remember what she used to thicken it, though. I would probably use up the freezer stash (thickening that, if possible), then go to either all formula or nurse with supplementing formula if you're not interested in pumping all the time. I think there's a prevalent attitude that formula supplementation is a death knell for nursing, but I combo fed my twins for the first year, then got them off formula at 13 months and onto whole milk, but continued to nurse. At almost 19 months we still have a wonderful nursing relationship. They got the benefits of breastmilk (I was encouraged to nurse through their first cold & flu season because of the benefit of my antibodies by our ped) but relied on formula to gain weight (they were born full term but small). If you're interested in talking more about my experience combo feeding just post to my wall and we can chat.

I'd try it? Your supply will be established in two more months and then you can maybe start to drop some pumps. You can supplement also if you arent producing enough. I switched from BF to exclusively pumping and I'm down to three pumps per day. Only the middle of the day pump is a drag. I liked breastfeeding but my anxiety was much lower knowing exactly how many ounces she is consuming.

ETA: I just read you have a two year old. That's a dynamic I can't speak to and I could easily guess why you feel overwhelmed. I would too.

I would EP a bit longer until it got to be a PITA then I would switch to formula feeding.

That's kind of what in doing with DD2, I'm EPing again but am prepared to stop at any time when it becomes overwhelming and switch to formula. So far it's going really well though. I EPed with DD1 and supplemented quite a bit with formula....she turned out great so I have a lot less guilt doing whatever is best/easiest for our family this time around.

I have two preemie babies and I think one might have reflux. I BF for a few weeks and supplemented with formula. I was barely pumping enough for one baby, let alone two. So formula was just there for us and they are on it 100% now. I didn't really have a connection to BFing and liked pumping better and spending time with my babies when I bottle feed. We are on two kinds of formula for preemies (neosure & Enfacare). Baby boy had some terrible gas issues on Neosure so the Dr suggested we switch to enfacare. It's going good so far.
As for pumping, I still feel guilty that I'm not pumping as much as I should. I should give them some more breast milk.

I know my situation is different from yours.

I would suggest seeing if you could add some powder formula to your BM. We fortified my BM with HMF or Neosure in the hospital and out so my BM would increase the calories to 24 cal. Regular BM is around 20 and the formula that we use is 22 cal. The babies have been gaining weight so that's why I feel like the formula is working. When I was BFing, they would nurse for 30 minutes but wake up an hour later hungry. I know they would get better getting the milk out over time but with twins it was just exhausting and feeding them formula got them to sleep longer. So as you can see I was conflicted with formula feeding and giving them BM via BFing or BM with fortifiers.

I was an EPer with N. I made it 8ish months. I found it easier and less stressful then BFing. I had a schedule and stuck to it. It was important to me for him to be EBF for at least 6 months. I got there and then I had a great freezer stash so he got breast milk and formula until a year.

E was a preemie and he was on the HMF along with breast milk for a bit. He began nursing like a champ around 8 weeks. Until then he nursed and would bottle feed. It was important to me that he got as much breast milk as I could provide him since he was a preemie. Once we overcame most of our hurdles he is still nursing at 21 months.

Obviously I am not in your shoes. If you aren't set on giving up try to just EP for now and later you can bring him back to the breast. Or formula feed totally. Whatever works best for you, your LO, and your family.

I have a reflux baby and from what I have read they can tend to do slightly better with breastfeeding as the milk digests quicker and spends less.time in their tummy which reduces spitting up. kellymom has some great articles about managing reflux which you might want to check out. That being said we has BF issues when my LO was a newborn so I was pumping around the clock and it was exhausting. I can totally understand if you want to switch to formula full or part time, a happy mama is the best choice for your baby and your toddler.

What @Annette said. My LO is 11 wks and not a preemie but had pretty severe reflux (hospitalized at 3 days old and multiple ER trips for possible aspiration and respiratory issues from the reflux).

We see a great pediatric GI every 2 wks who's very pro BF and imo was a lot more knowledgeable about the reflux than LO's ped who basically said what you were told, switch to AR formula or add cereal to pumped BM.

LO's GI says you can't mix cereal to thicken breastmilk, apparently it has something to do with the enzymes in BM, it doesn't break down properly. He has us use a thickener called Gelmix. It's the only thickener approved to use with BM. He strongly encouraged continuing to BF because breastmilk is easier to digest and breaks down faster than any formula. LO had (still has) issues with refluxing/vomiting 2 to 3 hours after feeds so this was important.

I went on an elimination diet and we switched up LO's meds so he's now able to be on straight BM without the thickener. We still have to do the holding upright, he still sleeps at a steep incline, etc.

But, he's my only baby. Dealing with your situation with a toddler.... that's tough! But maybe look into the Gelmix to mix with your BM.

I think I would. I went through some real hell breastfeeding and fantasized about going to formula. In the long run somehow I got through it and am so glad I did. I would do your best to make it work and that's all you can ask for!

I think I would definitely give it my best effort. My first was tiny (IUGR) and BF took a long time to establish pretty much for all the reasons you mentioned- the feeding and pumping etc. But in the end it was SO worth it. If it doesn't work out at least you know you gave it a good try. That's how I see it anyway.