Feeding FAQ: 4-6 months – Breast Feeding

My 4.5 month son seems to still need large top-ups after breast feeds

As I had some problems with my latch-on in the early weeks of breastfeeding, my son had some problems gaining weight. As a result, we put him on formula top-ups twice a day to ensure he was getting enough to eat and to take some pressure off me. As he has grown, so has the amount of formula he can consume. Now I am worried that he is eating too much even though he is not gaining weight excessively. My friends are amazed when I tell them that Miles is capable of drinking nearly 240 ml of formula after a breast feed (although I have been limiting him to 210ml because I am worried).
I have just started on CLB and Miles has adapted well to the structured day. He is going down well most times, although he is still waking during the lunchtime nap. He slept from 11.45pm to 7am for the first time yesterday. The CLB requires breastfeeding from both breasts at each feed. I have never done this before, so I am worried that by introducing it now, will mean that I do not have enough supply for his age and weight. Also, what should happen to his formula feeds? At the moment I am doing a combined feed twice a day.
In addition, my son is now very distracted at the breast, pulling off and looking around after a few minutes, even though I feed him quietly in the nursery. The advantage of the formula is, that he always drinks everything in the bottle, getting upset if I try and take it away. He is totally focused when he has a bottle feed even if he has just come off a very distracted breast feed.
At present he weighs 6.4 kilos. He is 4.5mths old. He takes a breast feed of both sides at 7am, 2.30pm and 10.30pm. At these feeds he takes one side for 25 minutes and the 2nd side for 10mins. At 10am he has one side for 25mins then a 180ml top up of SMA using an Avent bottle and a no2 teat. At 6.15pm he takes 25mins from one side and 210mls. At 10.30pm he takes both sides and sometimes a top up of 60mls.

Using a mixture of formula feeding and breast is totally possible but some babies do realise that milk is more easily obtained from a bottle as it requires less work. The action of taking milk from a breast is slightly different and requires a baby to “lap” with his tongue rather than suck with his lips. Below is a summary of the differerences:

Mouth wide open Mouth only slightly open
Whole jaw involved in sucking Jaw quite still
Lips fairly still Lips do most of the work
Tongue moves to release milk Tongue relatively still
Delay before letdown No waiting, milk flows immediately
Requires effort Relatively easy

Changing to a bottle which “mimics” breastfeeding could help your son. “Baby B Free” bottles (previously called Dr Brown) do this. The baby needs to use his tongue more than his lips to obtain the milk. At present it seems he is not taking a full feed each time he has feeds from the breast only. Your supply is not always meeting his demands and so he makes up when offered the bottle which is easier to take. At his weight he needs about 990mls-1.05 litres a day which would make each feed about 180-210mls.
Along with using a different bottle, try the plan for an increased milk supply on p 52 of The New Contented Little Baby Book. Once you know that your supply is meeting his needs at each feed, you can begin to cut down on the amount of formula he receives as a top-up.
You could also replace one feed, possibly the 10pm, with formula so you could have a good rest at night. Once you have begun the increased supply plan, use the expressed milk you have to top him up with during the day.
You may decide you wish to continue with a mixture of breast and formula-feeding but possibly would find it easier and better for your supply to follow the increased milk supply guide. This would help you keep a good supply going and also ensure that your son still takes the right amount at each feed whether from the breast or formula.