Feeding FAQ: 6-9 months – Breast Feeding

How do I introduce the bottle to a dedicated breastfeeder?

My daughter Olivia is seven months and I would like to reduce breastfeeding and move to bottle feeding. Unfortunately the only advice in Gina’s book I didn’t listen to was to introduce a bottle early on in her life. Now Olivia will not take a bottle and I have to go back to work soon.
She is 20lbs and is a gorgeously contented baby. She follows the routine to the letter and I have no other problems with her (she is prone to constipation from time to time).
Thanks
Louise.

Getting an older baby to accept a bottle can be a difficult problem to crack. It would be a good idea to start weaning her on to a bottle when you have someone such as your husband or mother with you to help the process. Olivia associates you with breastfeeding so I suggest you let someone else try to give her a bottle first before you do it. Although you want to give up breastfeeding I would suggest you use expressed milk at first so Olivia is not given too many changes all at once. Ensure it is given when Olivia is really hungry and keep out of her eyesight and hearing. She may protest at first but with encouragement and a little perseverance you may be lucky and she will accept it. If she drinks several ounces, I would then offer her the breast to finish.

If Olivia appears to be able to handle this way of feeding without too much distress, I would begin to wean her off one feed at a time by offering more milk in the bottle each time and decreasing the breast feeding at the end. At her age, I presume she is only having 3 feeds a day, at 7am, 2/30pm and 6.30pm The best feed to drop first would be the 2.30pm. After 2-3 days, offer the whole feed in the bottle. Once she accepts that feed change on to formula.

Use the same method for the 7am followed by the 6.30pm. After a few days of Olivia accepting the bottle from someone else, try giving it to her yourself. Use a softish teat, such as those made by Tommee Tippee, who claim their “nubby” teat is the nearest thing to a breast. These teats will fit all wide-necked bottles.
Begin to offer her a cup with water at her lunchtime solids if you have not already done so.

As you are returning to work shortly this problem has to be solved. It may well mean a few days of a distressed baby but when she is really hungry, she will accept a bottle. There is a case study in The New Contented Baby Book on page 181 which would be worth reading.

Feeding FAQ: 4-6 months – Breast Feeding

Will it be possible to breast feed my 5 month baby after a 48hr break

I am having a MRI scan in three weeks. I have been told not to breast feed for 48hrs afterwards due to the contrast dyes used.
I used to give Sonny 1 bottle a night using expressed milk but haven’t done so for over a month. He has also taken formula on the odd occasion. He enjoys breastfeeding and I am worried how he will take the 48hr abstinence. I have a few frozen feeds of breast milk but not enough to last the whole 2 days. He now consumes all the milk I produce so I don’t think I could express and freeze more.
I want to carry on breastfeeding after the scan, and was hoping to do so fully. We are due to go away on holiday a week after the scan, and it would be easier if I did not have to take bottles with me.
If I introduce formula now in preparation, is my milk production likely to reduce so that I won’t be able to return to full breast feeding afterwards? Will expressing over the 48hr period be enough to maintain my milk production? I never seem to drain my breasts through expressing as Sonny does when feeding.
He has five feeds a day and is on day 16 of weaning.

In order to keep your supply going over the 48hrs begin to express now. Try for small amounts two hours after Sonny has fed from you and use it to boost the frozen supply. This will give you a slightly bigger supply which should help you cope with totally expressing for 48 hrs.
Would it be possible to rent a hospital type pump for the next month? They are the most efficient way of emptying a breast other than a baby.
Also reintroduce a bottle to Sonny now, as he could be reluctant to take it, having had a break of over a month. In order to keep your supply up, you will also need to express a full feed or as near as you are able, each time he has a bottle replacement in these next three weeks
It would be best to get him used to having one bottle a day by the time of your scan. Sometimes it is easier if someone other than yourself does this at first, especially if he shows signs of not wanting to feed from a bottle. By the time of your scan, Sonny should be more accepting towards a bottle and you will be able to give him some of the feeds for the following 2 days.
During the 48 hrs after the scan try to pump as near to his feed times as practical. Try not to be too concerned if you don’t get the amount he is taking at each feed. Keeping the breasts stimulated is the most important thing.
After the 48hr period is over, go back to full breast feeding but be prepared that you may have to offer a little formula for two or three days until your supply readjusts itself. Remember to rest as much as you can, and drink plenty of water between feeds to help you.
You will know if your supply is back to normal before going away. Why not pack some ready-to-feed formula and a few pre-sterilized bottles just in case there is a problem?

Feeding FAQ: 4-6 months – Breast Feeding

Can a low-weight 18 week baby’s sleep be helped by feeding?

We had our first baby, Evie, 18 weeks ago and generally she has settled into your routines, which we have been following since day one. She has always been small and has regularly gained only 4oz each week; she had 2 weeks where she gained 7oz and 1 week where she lost 1oz. Her birth weight was 7lb 1oz and she now weighs 12lb 1oz. I am breast-feeding, but my partner gives her formula at 10.30pm and again when she wakes in the night, around 5am (we introduced formula at 14 weeks). We do, however, have a few concerns. Firstly, she struggles between 4pm and 5pm, as she will not nap unless she is in the car. She is tired and fractious, and seems to want to sleep, but should we try to enforce a nap and, if so, how? Secondly, would you expect Evie to wake in the night because of her weight? As a result of her not yet going through the night, we don’t feel we can move forward on the split feed before her bath, cutting out the 10.30pm feed or starting her on solids.

Evie was a good weight at birth, but she has not been gaining the 6-8oz a week that is expected during the first few months. I believe that she is still waking in the night because she is genuinely hungry. I suspect that this is also the reason why she is not settling for the late afternoon nap. To avoid her getting so irritable late afternoon, I would suggest that you bring the 5pm feed forward to 4.30pm so that she can have a short nap at that time. You may find that bringing this feed forward has a knock-on effect and she becomes hungrier at 10pm; this is not a bad thing, because a bigger feed then may make her less likely to wake up hungry at 5am. You do not say if she is sleeping well at lunchtime; if not, I would suggest that you bring the 11am feed forward to 10.30am and give her a top-up breast-feed just before her lunchtime nap.

I would stick with a split feed at 4.30/5pm and 6.15pm until she is sleeping through the night regularly to nearer 7am. This could take a few weeks yet, as her weight is low for her age. The recommended age for introducing solids is now six months, although many health officials are saying that it is fine to wean a baby between four and six months if they are showing signs of needing to be weaned. Evie is not showing any of the signs and I would not advise that you wean her yet. I would, however, suggest that you try to increase the amount of milk she is drinking during the day, so that she may no longer need to wake up for a feed at 5am. Another way of increasing her milk intake is to wake her at 10pm for the feed and then keep her awake slightly longer in order to give her a top-up at around 11/11.15pm. This, of course, would mean that she is having three split feeds a day, but if it helps her to sleep longer in the night and improves her weight gain, I think it would be worth trying for a couple of weeks.

Feeding FAQ: 4-6 months – Breast Feeding

My 4 month baby is not interested in her milk by day, yet has begun to wake at night again

Amelia weighs 15lbs 7oz and has been following the 3-4 month routine. A week ago she began to take less milk at 2.15pm (when she is bottle fed), stopping after 3.5 or 4ozs. Even if I wait 20 minutes she will not take any more milk and push the bottle away. I expressed milk at 11am a couple of days ago (when I normally breast feed) and found I only had 4ozs of milk. I am worried that she is not getting enough milk by day which is causing her to wake in the night between 3-5am. I do not feed her in the night if she wakes, but she still doesn’t seem hungry at 7am. She is never really hungry at 7am even when she hasn’t woken early. She is usually happy to chat for 1/2 hourr until I get her. Should I be weaning her? What do I do about her decreased milk intake at 11am and 2.15pm?

There could be several reasons why Amelia has started to wake in the night. It might not only be her apparent disinterest in her milk by day.
Check she is not waking through being cold. Also, at this age many babies still have quite a pronounced Moro reflex. They still need to be tucked in well, even if using a sleeping bag which should be of the lowest tog rating (0.5 tog) and securing a thin cotton sheet with two rolled up towels either side between the cot mattress and the spars of the cot.
To eliminate the possibility of hunger in the night and also to help her intake over 24hrs, consider giving her a bottle of expressed milk or formula at 10pm. Keep her awake for at least an hour at this time to help her sleep nearer to 7am. Once she has begun to sleep through regularly, then you can begin to cut her time awake back to 30 minutes.
She is still quite young to be weaned yet, especially as the present guidelines suggest waiting until nearer 6mths. If you do decide to start soon, check with your health visitor first.
Try beginning her afternoon feed at 2.30 and see if she is hungrier by then. As this is her only bottle feed of the day, she may well be distracted from feeding, wanting to look around. Keep her in a quiet room and see if she is then more willing to take a little more feed.
The amount of milk you expressed is probably not a true indication of how much milk she is taking at 11am, as a baby is more effective at emptying a breast than a pump, especially if you only express when you are unavailable to feed her.

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:

BREAST BOTTLE
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.

Feeding FAQ: 3-4 months – Breast Feeding

What is the best way to drop feeds for my 3 month baby without becoming engorged?

I want to avoid painful, engorged breasts when I begin to stop breastfeeding, which I plan to do when Leo is around 4mths old (he is 3mths now).
With my first child it took a long 2 or 3 months to give up, as I tried to drop feeds and only express a little to give relief.
Leo has just started to go through the night and I am finding it painful just dropping this feed. I don’t want to start expressing milk in the night, but I am awake with pain in the right breast and under my arm. The right breast is producing a lot more milk than the left. I only express a tiny amount (60mls) from the right side, now only in the evening as Leo has formula at 10.30 (160mls). Lately I have felt I could/should express more than this, as I am going to bed with full breasts and know that will cause a problem in the night. I have not increased the amount I express at 10pm as I have been trying to drop this feed for 4 weeks. How can I stop feeding more easily? I don’t really like breastfeeding, and I sometimes feel it is getting in the way of enjoying time with my baby.

Unfortunately, when you do have a good supply of milk it can take quite a while to stop feeding altogether. If you try to speed things up too much, you could become engorged and a bout of mastitis could follow.
Now that Leo has dropped his middle of the night feed and you were already trying to drop the 10pm, you are in the situation of missing two feeds in a row which has caused your breasts to become engorged and painful.
Although it may feel like regressing, begin to express more at the 10pm feed. Bearing in mind that Leo is taking 160mls at this feed and that your breasts will go on making milk during the night, it is better to keep this expressing going whilst you also start cutting back on the day feeds.
Are you aware of lying on your right side at night? This can often have the effect of causing the milk to pool and become blocked in the ducts. If you are still wearing a maternity bra at night, make sure it fits properly and the seams are not digging into your sides as this also can cause blockages. If you do wake in pain, rotating your arm round in circles can help ease the blockage and therefore the pain. Be aware of any painful lumps forming; massage them downwards towards the nipple especially when feeding.
As you do have a good supply, it would best to begin to drop feeds slowly. Once you feel an improvement in the middle of the night begin to drop the 10.30am.
Rather than dropping the feed all at once begin to feed him for 5 minutes less each day and begin to top him up with formula. It could take your breasts at least seven days before they register that they no longer need to make milk for this feed.
On page 56-57 of The New Contented Baby you will find an explanation and chart, which helps you see how to drop feeds gradually. By the time that Leo is taking all formula feeds in the day you should be able to stop expressing at 10pm.
Although it takes time, it is better to drop feeds in this way when you have a good supply, as the outcome will be less pain and discomfort for you in the coming weeks.

Feeding FAQ: 3-4 months – Breast Feeding

My 3 month daughter’s weight gain is low, she feeds less, and does not like a bottle

My 3-month-old daughter has been on Gina’s schedule since 2 weeks. She is generally a contented baby and sleeps well. I have 2 problems: the first relates to her low weight gain at about 4.7oz per week. She rarely seems hungry – even after sleeping through from 11pm to 6.30am. Since 12 weeks, she’s beginning to take shorter feeds on the breast (10mins) rather than in the past when it was closer to 15-20mins. She often seems uncomfortable and fussy during the feed (after 5 minutes) I have tried splitting the feed as well as giving the breast 15-20mins later in order to increase her intake, but she is often reluctant and doesn’t take any or only a little more (5 minutes on breast). Since I’m breastfeeding, I don’t know how much she is taking but suspect it could be between 2-3oz (this is the amount I get after expressing one breast). At 5 feeds a day, this level of milk intake is very concerning! The second problem I’m facing is getting her to take the bottle; I have tried introducing it since the 3rd week. Initially she did not seem to know how to “suck” as the milk would just flow out of her mouth. Now she can take no more than 2oz of expressed milk per feed from it and I have to be out of sight. I am not sure if this is because she is not keen on the bottle (and she could have fed more on the breast), or if this is the amount she is really contented with. In any case, I am really worried about her daily intake which I am certain is too low.

After 3 months many breast-fed babies “speed up” considerably and spend far less time at the breast. But they also can be more easily distracted and more interested in looking around rather than feeding.

Try to feed your daughter in a quiet room with no external noise such as radios and lots of conversation. Her weight gain is low, but if steady, it may be down to her metabolism to gain less than the “average” baby. Have you discussed these concerns with your doctor or health visitor?

When you express, it is unlikely you will express as much as your daughter can extract from your breast. Although it appears a small amount, she is probably taking more than that at a feed. Ideally, at her weight she should be having about 5ozs at a feed and is probably taking nearer to 4ozs.

Making her feeds more spaced apart, as you already have been doing, is a good idea as you can see she is taking a little more. In the extra 5 minutes that she is feeding, she will be taking quite a bit more milk.

Getting her used to a bottle will take time. It is not at all unusual for a baby to take a bottle from someone other than the mother. She associates you with breast feeding so sees no need to feed from a bottle held by you. This will get better as she becomes more adept at sucking. Once she readily accepts a bottle from someone else, then you can begin to offer them yourself.

The movements needed to suck from a bottle are different from the breast where the baby “laps” at the milk. At present the Baby BFree bottles are the only ones where the action needed to obtain the milk is as close as possible to breast feeding. It maybe worth obtaining one and seeing if you have any more success. From your notes it seems she is on a 6-12mth teat which may be too fast for her. If she is being overwhelmed by too fast a flow, she may just give up taking a feed. As her stomach is being filled too fast, she is feeling full before she has taken enough. Try a slower flow and see if she is better able to cope with taking more. Splitting a bottle feed into two halves could also help. Give her 2-3 ozs and then a break of 20 minutes before offering the last 2 ozs. Letting her sit in her chair inbetween could help her feel more settled.

Feeding FAQ: 3-4 months – Breast Feeding

What can I do to get my milk supply back for my 3-month-old?

I think I am running out of milk. The past 2 nights at 10pm I have expressed and got less than 1 oz; I usually would get 4-9oz. I started to follow the increased supply routine yesterday; when I expressed at 2pm today I only managed barely 1oz, and when I had fed her she was still hungry. Initially I thought the problem was only there at the end of the day – until now. I have expressed since she was born so I know what to do and usually have no problems. My health visitor told me to just give formula but I don’t really want to; I am worried that if I give formula then my milk will dry up more and soon she will be formula fed. I don’t know what to do.

A supply dropping low does not mean the end of breastfeeding – even if you have to use a little formula whilst you get things back to normal.

The reasons why it happened could be many. If you are very tired or have had an upset over something, your milk supply will go down. The problem is that once you realise it is getting low, you worry about it more and more – which is not good for the supply. It is very dependant on hormones which can still be very much in control still, even three months after the birth.

Follow Gina’s increased supply plan, but don’t be surprised if it takes more than 24 hours to begin to notice a difference. It is more likely to be three or four days. Really resting between feeds and whilst your daughter sleeps is very important. So is eating and drinking well. Make sure you eat a proper breakfast, lunch and supper and also have a small healthy snack at the 10am feed and also have something at around 5pm. The long gap between lunch and supper is not good for breast-feeding women who need to keep their energy levels up throughout the day. In the first few days of the increased plan try to do the minimum needed in the house so you really are sitting or lying down for a lot of the time. What ever it takes to get your supply back on track, is the most important thing you can be doing in the next few days.

At three months after birth mothers often becomes a little run down. The euphoria and all the fuss surrounding a new birth have all died away and you are now very much on your own, as any help you had has probably finished by now. Although your daughter is sleeping through the night now, you have weeks of broken sleep to make up for. All this can lead to you being very tired and low. Also you probably feel that life is back to normal and are doing much more rushing around more now that your daughter is in a good routine.

Your problem is probably for a variety of reasons. When you express try to relax and do not worry that you will not be getting enough; if you become tense your supply will not flow so well. It is not always easy when faced with a setback such as this, but giving a small amount of formula to get you through the next few days is an option. Use it at the 10pm feed so, if your partner will do this feed, you are able to get to bed early. Any milk you expressed then can be used to top up with in the day. As soon as you notice an increase in your supply, replace any formula top ups you may have had to give, with expressed milk.

Feeding FAQ: 3-4 months – Breast Feeding

How can I get my 15-week-old baby to take more milk?

I am finding it difficult to get my daughter to feed more at each feed. She only drinks 2-3ozs at each feed, occasionally 4ozs if she really wants it.
Her weight gain is dropping slowly. At present she weights 12lbs 2oz.The health visitor has advised me to demand feed her for a couple of days, but it has been terrible. She is very agitated at each feed and takes her time. I never know if she is really hungry this way or just distressed. On the routine she fed every 3-4 hrs, but would only have a small amount. On demand feeding it is even worse as she sometimes only takes 1oz. This was supposed to increase her weight.
She does have a bit of a cold and cough at the moment and demand feeding has put her sleeping all over the place, making her grumpy.
In the past she had problems with colic and a little bit of reflux. How can I get her better settled and to take more milk?
The report which follows is not a reflection of every day as she has been catnapping with demand feeding.
6.15am 4oz, 9.00am 2oz, 10.45 3oz, 2.25pm 2.5oz, 4.00pm 2oz, 5.50pm 3oz, 6.40pm 1oz, 8.00pm 1oz, 12.05 6.5oz, giving a total of 25ozs.
She slept 12.50am- 6.00am, 6.50-8.20am, 11.30am-12.15pm, and settled at 8pm-9.20pm.

The problems that your daughter is having with only taking very small feeds and becoming distressed during them, needs to be assessed by a doctor. As she has had slight reflux problems in the past, the re-occurrence of “silent” reflux needs to be ruled out. The “silent” kind means that a baby may not bring back up its feed but still be experiencing discomfort whilst feeding and therefore becomes distressed, refusing to take in any more. Talk to your doctor and explain exactly how she behaves in her feeds.
As your daughter has a bit of a cold at the moment, she may be having difficulty in breathing whilst taking in a feed as her nasal passages are blocked. Using saline drops before a feed can help this problem. Take her to the doctor to have her checked over, as this could also be affecting her ability to drink properly.
Once you have discussed your concerns with the doctor and he is happy for you to get back into some kind of a routine, try “splitting” your daughters feeds. When she feeds on waking in the morning, let her have 2-3ozs and then have a break whilst you change her, and let her sit in her chair for 15-20mins before offering her another 2ozs. This may help her to increase her intake a little. If you give her this break at all her feeds, you may find, although rather time consuming, she will end up having taken more milk over 24 hours than she is doing at present.

Feeding FAQ: 3-4 months – Breast Feeding

When should I drop the 10.30pm feed for my 3.5 month baby?

I would like advice as to when it is appropriate to stop the 10.30pm feed. My daughter who is now 3.5 months old has slept through the night from 9 weeks of age and continues to do so. I find it difficult to know how much milk she gets at 10.30pm and what she still needs. I suspect she only receives a small feed at this time of only 50-100ml as when I express the other side (if she only feeds from one breast) then I only manage to express 40ml (with great difficulty). I have received very conflicting information on this issue and we have considered giving her an expressed bottle at this time just to see how much she gets. I am really quite confused.
My daughter is fully breastfed. She feeds at 7.15am 10-20 mins one side, occasionally both. 11am 10-25 mins breast or 200mls expressed, 2.30pm 10-25 mins breast or 200mls expressed, 6.15pm 15-35 mins breast, both sides or 200 mls expressed. 10.15pm 10-20 mins sometimes both sides. She weighs 15lbs 8ozs.
My daughter naps at 9-9.50am, 12-2.15pm and 3.45-4.30pm

Although you feel that your daughter is only taking a small feed at this time it is much better to keep the 10.30pm feed in place until she is established on solids. The reason Gina recommends this is because between the age of three and four months all babies go through a growth spurt and four feeds a day is rarely enough to meet their needs. You could certainly offer her an expressed feed to see how much she takes but although now it may be no more than 60-100mls, in a week’s time it may be much more. By dropping this 10.30pm feed too soon you may get into the situation of your daughter beginning to wake earlier in the morning because she is hungry. It is much better to keep it in place until you daughter has been weaned and is taking solids twice a day. Your baby will naturally begin to cut back on this feed and then it can be gradually dropped.
There is a case study in The Complete Sleep Guide p 92 which shows how things can go wrong if this feed is dropped too early.