Looking for some advice/guidance on combo feeding. DS2 is 2.5 weeks old and not gaining enough weight so our pedi wants us to supplement. I am fine with using formula as I have a 2 year old so I don't really have the time to BF/pump/bottle feed every feeding.
I am mentally struggling with his lack of weight gain because I struggled to BF DS1 and mentally tortured myself over it. I promised myself I wouldn't do that this time. However, didn't expect to run into the weight gain issue so soon. My first LO struggled with weight gain, and we supplemented him with formula, but not until he was 8 weeks old. All that to say, I am considering combo feeding to take a little bit of the stress/pressure off of myself, while still giving him the benefits of breastmilk. He is nursing pretty well, and has a decent latch despite being a sleepy nurser. He nurses regularly, normally every 2-3 hours and seems full/content after eating, but only gained 1oz in a week. We go for another weight check tomorrow, but I feel like I need to figure this out and make sure he is getting enough.
cantaloupe / 6131 posts
We added a bottle of formula to the mix at 3 weeks for the same reason. DH would give formula at that last feeding before we went to bed at 10 or 11pm and I would pump a good long while so I could be comfortable. That would usually be close to what we needed for the first morning bottle that DH would give around 7am, but if not I would top it off with formula. I would nurse and be up with DS during the night, so I would pump first thing while DH gave the morning bottle and try to get a little sleep. That morning pump would give me enough for another feeding, which I would put aside for later in the day.
My son was a complete narcoleptic at the boob and even with ice packs we couldn't keep him awake. Then he'd be screaming 20 minutes later because he was hungry. It was a vicious cycle coupled with colic and reflux.
I think having bottles mixed in with nursing helped him learn to take full feedings, because he didn't fall asleep quite so easily with a bottle. That helped him take bigger feedings and probably stretched his tummy out a bit. Anyways, feeding him every 3 hours and tracking his ounces helped me worry less and he immediately started gaining. DS spit up a lot with reflux too so if I didn't have formula, I wouldn't have been able to get him those extra ounces.
nectarine / 2987 posts
We combo fed our preemie until he weaned onto just nursing, so maybe not the same end goal as you, but still combo feeding for weight gain! We tried a few things. One system was that after he nursed we offered one or two ounces of formula and once a day at bedtime I pumped while he just had a big bottle of his (fortified) formula and I put that pumped milk in the freezer.
persimmon / 1367 posts
I combo fed LO starting around 6 weeks, as I knew I wouldn't be able to pump when I went back to work at 12 weeks. We didn't do it for weight gain, so we just started gradually substituting nursing session with one formula bottle. For us, it worked out incredibly well. By 12 weeks, LO was getting bottles between 8am-6pm, and breastfeeding the rest of the time. We were able to keep our breastfeeding relationship going until she self weaned at 13mos. I looked at it as LO getting the best of all worlds:the all good stuff in breastmilk and the calorie density of formula.
Best of luck to you!!
persimmon / 1367 posts
Just want to add, combo feeding was such a stress reliever too, anyone could feed her, and there were so many options for getting her fed!
apricot / 324 posts
@gingerbebe: my little guy was born 2.5 weeks early so I wonder if some of his sleepiness is due to that. And he does the same thing. Falls asleep and seems do ten then sometimes wakes up a short time later rooting and acting hungry. It's so frustrating! It's good to know your son started gaining right away, I'm hopeful for the same.
@Rocker2014: thank you for your response! That sounds like an ideal schedule. I work PT and have to go back when DS is 8 weeks old, and pumping is going to be a huge obstacle so if I can avoid having to do it, that would be great. Did you have any supply issues with just nursing at night? By 13 months when were you nursing? Before bed and first thing?
honeydew / 7230 posts
I combo-fed my twins from day 4 on. If your goal is to breastfeed long term, I would plan to always offer the breast first and then offer a bottle of formula (or pumped milk?) after. That way you're consistently sending the message to your body to keep making milk. Or, if you offer a full bottle of formula, try to pump. That'd send the same signal to your body, of course. If you want to get all the way over to formula eventually, that's obviously way less important. I wanted to keep nursing, though, so I always nursed first, then offered a bottle, until they were maybe 6 months or so? Then my supply seemed to be more established, so I was less concerned about it plummeting if I skipped a nursing session while we were out of the house or something. We started with 1 oz bottles of formula after nursing and gradually increased that. My twins were tiny and weren't gaining, so we actually had them on high calorie formula. We did paced feedings to keep the bottles slow and always used preemie nipples so they really had to work to take the bottle. I think that helped keep them from developing bottle preference. I also nursed on demand whenever they wanted, day or night, until very recently (they are 22 months now) which I think helped with preferring breastfeeding, too.
persimmon / 1367 posts
@CRGmama: I never had any issues with supply, though I know it can be an issue for some people. I worked closely with a lactation consultant on a plan to gradually substitute one feeding during the day with a bottle. I started with a midday feeding, and never dropped more than 1 per week. It was about a 6 week process, and I also made sure I continued to drink tons of water, eat lactation friendly foods, etc. Even after I returned to work I made sure that I kept the same schedule on weekends, so my body didn't get confused.
I nursed all feeds between 6pm and 8am until LO started solids around 6 -7 months, when I switched to bedtime/overnight/morning breastfeeding only. We kept going with that until her first birthday, when we got rid of the morning nursing session (she wasn't interested, preferred her banana!).
I always encourage others to try combo feeding if EBF doesn't seem like it will work, we had such a great experience with it!
apricot / 324 posts
@gingerbebe: can you tell me more about reflux? I'm starting to suspect that may be a player in our game over here.
pear / 1521 posts
@CRGmama: I don't have personal experience with this but I think it'll be hard to keep up your supply if you drop all the daytime feeds when you go back to work. Your supply isn't fully established until around 12 weeks so if you do hope to be able to transition to just nursing when you're home/not pumping then I'd try to pump at least for your first few weeks back at work. I know easier said than done!
Even if you end up switching entirely to formula you are doing a great job! I remember my daughter's GI dr telling us that BFing, while awesome, kind of follows the law of diminishing returns so the benefits they get out of it over formula are less and less over time. So even if it doesn't work out long term your DS is still getting great benefits from it Right Now and that's what matters most!
cantaloupe / 6131 posts
@CRGmama: Sorry, this is going to be a novel.
My son had both colic and reflux, so it may not be totally the same, but basically from the minute he was born, he screamed like he was on fire. (He was born 1 weeks early at 39 weeks, but was also smaller - 6lbs 15oz at birth - so I wonder if that had anything to do with his issues as well). He also had pretty bad jaundice and spent 5 days in NICU.
The only time he wasn't screaming was when he was eating (but he would only nurse for like 5 seconds before passing out for 20 minutes, and then wake up screaming). If we gave him 1-2 ounce formula top offs, he'd eat but then within minutes start screaming and arching. We suspected gas because he was hiccuping and his belly felt hard (they don't start figuring out how to fart for a few weeks), so we were diligently burping, bicycling his legs, and giving him gripe water and all that, but he would just be really unhappy when you'd think he would sleepy and satisfied from getting a full meal. I noticed he would make gagging and gasping sounds, like he was trying to keep something down, and sometimes would puke.
No one was sleeping, he was crying for most of his waking hours (which was a lot - I don't think he slept more than a combined 6-8 hours a day in 20-30 minute spurts), my supply sucked, and we had to go in for weight checks every other day and he was losing or barely maintaining.
At 3 weeks, I suspected silent reflux. Its where don't spit up that much because they are holding it in. Silent reflux sucks the acid is burning them twice - once on the way up, and once on the way down when they swallow it back. Regular reflux they just puke and its out one-way.
I went in to talk to the pediatrician and she suggested we try Zantac and to formally put formula supplementation in the mix. My doctor also suggested I eliminate major food groups (dairy, soy, caffeine) to see if it helped. We got Dr. Brown's bottles on their slowest flow and started with Gerber Good Start Gentle because its the most broken down. He took that formula just fine and between that and pumped bottles of breastmilk in addition to nursing, his weight was finally starting to come up. But because of the colic, he was still screaming a lot, and the larger feedings (instead of the mini snacks he'd been having before) meant more spit ups and probably more burning. Overall, he was better than weeks 0-3, but we started adding gas drops to every single bottle and to his mouth at every nursing session. We started holding him upright for 20 minutes after each feeding and continued to sleep him in the RNP. He still didn't sleep more than 30-40 minutes at a stretch, but he was at least gaining.
By 6 weeks, I felt like maybe we were doing better (except for his 4-5 hour witching hour scream sessions from 9pm-2am) but by week 8 it was clear something was wrong again, because he was back to screaming most of the day and puking. I had some friends who had gone through reflux and they told me Zantac often stopped working and to push for stronger meds. My doctor sorta fought me on this and just adjusted the dosage of Zantac and asked me to cut more things from my diet.
But things just got worse - the pukes when they happened were getting huge and at 10 weeks, DS went 10 days where he literally didn't sleep for more than 20 minutes at a time. He was otherwise whimpering and screaming all day long. I demanded Prevacid, I went on a total elimination diet, and my doctor asked me to put DS on hypoallergenic formula for 2 weeks to see if it helped.
So we did 2 weeks on Nutramigen, while I lived on rice and chicken and pump/froze my milk. After a few rough days adjusting to Prevacid, DS got a LOT better. He FINALLY started sleeping like a newborn (we were finally getting 2 hour stretches of sleep!) and wasn't upset all the time.
By 12 weeks, his colic peaked, his meds had finally stabilized, and we started reintroducing breastmilk, 1 bottle per day, to see how he tolerated it. He seemed fine, so we went back to Gerber Gentle (Nutramigen is expensive!) We started getting a 4 hour stretch for that first block of sleep in the evenings and I transitioned more towards exclusive pumping. We still nursed at night and for comfort, but it was just easier for me to keep track of his intake with bottles.
By 4 months, we introduced rice cereal and oatmeal to help the reflux, he was still on his breastmilk + 1 bottle of formula schedule, and he finally STTN! We were able to start weaning him off meds at 5 months. He was off them completely by 5.5 months old and by 6 months I was able to eat normally without creating any issues for him.
At that point, I started changing his formula to ones that weren't as broken down to step up his lactose tolerance. We went from Gerber Gentle, to Similac Sensitive, to Honest regular dairy formula. We weaned totally to formula by 9 months and he was on Honest until he turned 12 months. He had a bad reaction to whole cow's milk, so on the advice of our pediatrician, we did 1 month on toddler formula to give his gut a little more time to adjust, and then tried milk and it went fine. He's been on exclusively WCM since 13 months and has had no issues with dairy or anything else.
eggplant / 11861 posts
DS is 11 days old and is not into nursing at all
I keep offering but it is a struggle!
I pump as much as I can but get 2-3 oz a session he can eat 3 oz no prob from a bottle
I had to give formula last night as he was hungry and I only could pump 2oz
I feel like I am.OK giving himhim formula if need be
But I am. trying head hard to get BF going but it's just not enough