Weaning From Top-Ups to Exclusively Breastfeeding

A mother asks, ‘My son is 4 weeks old and has been breastfed and also ‘topped up’ with formula since he was a week old. He is now almost a kilo above his birth weight and appears very healthy, so I would like to breast feed exclusively. Is it possible to wean him off the formula?’

You are doing a great job persevering with breastfeeding and yes, it is possible to wean your baby off the formula now that he is thriving. This will help to increase your milk supply, setting you up to breastfeed exclusively and it will avoid early weaning.

As long as you are offering formula your breasts aren’t getting signals to make the entire amount of milk your baby needs and there is also the risk that your baby will start to find bottle-feeding easier due to the different sucking action required, so will take more milk from bottles and less from the breast. Babies who do this often seem to wean quite suddenly, even though the weaning process has been happening all along as they have been drinking more and more formula. This can be devastating to mothers who want to continue breastfeeding.

Seeking support

It’s always important to trouble-shoot reasons for a low milk supply if this is a factor that led you to offer top-ups. For mums wanting to ditch top-ups, it is important to check with your health carers that your baby is thriving, and to get personalised guidance from an IBCLC Lactation consultant who can take a history of your health (in case health issues such as PCOS  or insufficient glandular tissue(IGT) are influencing your milk supply), your baby’s health history and to observe your baby feeding and do an oral assessment to make sure your baby is feeding effectively. She will be able to address feeding issues and refer you to further specialist care if this is necessary.

Tips for giving top-ups

If you are offering top-ups from a bottle, try finishing your baby’s feed at the breast. This way, your baby associates his full tummy with mummy and the breast, rather than the bottle of milk. You will also feel much better about this – mothers who offer the breast after bottle top-ups say they enjoy nursing their calm, relaxed baby, instead of feeling inadequate because their unsettled baby gulped down a bottle of milk. Also, as your baby nurses at the breast, even if he isn’t sucking vigorously, this gives your breasts an extra boost of stimulation by encouraging milk drainage and enhancing the release of milk making hormones.

Alternatives to bottles

Instead of using a bottle for ‘top-ups’ you could consider using a Nursing Supplementer – a device to contain the extra milk with a fine tube you place next to your nipple so your baby is receiving all of his feeds directly at your breast, rather than from a bottle. This extra contact and sucking at the breast will also help to stimulate your milk supply.

Eliminating ‘top-ups’

To eliminate ‘top ups,’ you can gradually decrease the amount in each bottle - for instance, whatever amount  of supplement your baby is having over a 24 hr period, you can try decreasing this overall amount by 30 mls (in 24 hrs), this may mean decreasing each top-up by 5 to 10 mls.  You can go with this decreased amount for three days as you monitor your baby. If your baby is still having good output - at least 5 heavy wet nappies a day- and weight gains are steady, you can  decrease another 30 mls over a 24 hour period for the next three days and so on, as long as your baby's output and weight is steady.

As you decrease the amount of supplement your baby may need to be fed more frequently for a few days, until your supply catches up with his needs.

Depending how much supplement your baby is having (and with support from a health professional such as an IBCLC  Lactation Consultant or your  Child Health Nurse), another option is to go more ‘cold turkey’ (check with your health carer before you do this). Plan a few days at home - stock up the fridge with nutritious food and drink for yourself and focus on resting skin to skin with your baby and breastfeeding. Fill your feeding basket with nourishing snacks and drinks, then relax and breastfeed your baby as long as he wants and snuggle him skin to skin between feeds so you can observe and respond to his earliest hunger cues – Netflix and chill has a whole new meaning for mums boosting their milk supply!

Allowing unlimited and frequent access to the breast will help with breast emptying and stimulate your body to increase milk production. Skin to skin contact will enhance the hormones that help boost your supply too. However, please observe your baby closely and seek help if you are concerned – if he isn’t having enough wet nappies or is unsettled and seems hungry (see this checklist to help work out if your baby is getting enough milk), remember your first priority is always  ‘feed the baby’.

Will expressing help?

If you have been offering quite a bit of formula, another suggestion is to express breast milk between feeds (this will stimulate your supply) so that top-ups are expressed breast milk rather than formula. This way, you can gradually offer more breast milk and reduce the formula as your supply increases.

Of course, while this is helpful to increase your supply and to eliminate the use of formula, it can be quite time consuming and stressful and still doesn’t eliminate the bottle if you are using one. So, if you have a willing baby who sucks effectively, it is far easier to simply put him to the breast more often – at least for part of the day, then gradually increase this top-up free period.

Is baby still hungry?

As formula takes longer to digest and tends to ‘zonk’ babies, your baby may seem a bit unsettled after feeds and he will want to feed more frequently for a few days as you reduce formula feeds. It’s normal for exclusively breastfed babies to need between eight and twelve feeds a day – that’s every two to three hours and often a period of cluster feeding as well.

If your baby seems unsettled after feeds, you could try to distract him by taking him for a walk in a sling or get your partner to walk him (there won’t be a milky smell to remind him about feeding more). Of course, if your baby is upset and hungry (keep an eye on his nappies –he needs to have at least 5 heavy wet nappies a day), take a step back, make changes more gradually and consult an IBCLC lactation consultant for guidance. Remember, the first rule is always ‘feed the baby.’