Breastfeeding and top ups

Giving a “top up” with breastfeeding is giving extra milk to your baby, whether that is expressed breastmilk or formula. Breastfeeding with formula top ups is also known as mixed feeding. There are a few reasons mums need to or want to give top ups to their babies. The most common reasons are:

Worried their baby is not getting enough breastmilk – Many signs that make mums think this are misleading – check out this blog post for more info. 

Baby is not gaining enough weight – This usually means baby is not getting enough breastmilk.

They think extra milk will help baby sleep longer – This is a myth. Research shows that formula fed babies don’t sleep any longer than breastfed babies.

They want to share feeding with their partner – This works well for some families but can decrease your milk supply unless you express your milk when the other person is feeding your baby (supply = demand and if you skip a feed, your breasts get the message that they don’t need to be making milk and slow down production).

Do I need to give my baby top ups?

 If your baby is showing these signs, you do not need to give your baby top ups:

• Your baby is having at least 5 heavily wet nappies each day
• Your baby is doing 3 runny/soft poos each day (babies older than 6 weeks may do less, but they should still be runny/soft)
• Your baby is gaining enough weight
• Your baby is growing in length and head circumference
• Your baby is generally content (remember, all babies have fussy periods throughout the day)
•  Your baby is meeting all their developmental milestones

If you are noticing things that make you worry about your supply, bring your focus back to these reliable signs! Use this as your reassurance when you are doubting yourself.

If you have been told you need to give your baby top ups of extra milk (or you just want to), did you know there are options on what you can give? The World Health Organization (WHO) state the appropriate substitutes for breastmilk in order of benefit to your baby are:

1. Your own expressed breastmilk
2. Donor breastmilk from another breastfeeding mum (more info on this here)
3. Infant formula

If you’re able to express your breastmilk, this is the next best thing to your baby feeding directly at the breast. If this is not possible or more milk is needed, donor milk is the next best option and the next option after that is to give infant formula. You deserve to have all the information and make an informed choice when it comes to your baby’s care (and your own!) so if your healthcare practitioner is not telling you all your options, ask “what are my options?” or consider changing to another healthcare provider that does give you all the information.

How to give top ups

Cup feeding

Cup feeding can be used as early as newborn using a small cup like a medicine cup, moving on to bigger cups as the amounts your baby drinks increases after the first few weeks. To give your baby milk using an open cup, hold your baby in an upright position and hold the cup so that it rests on their bottom lip and reaches the corners of their mouth. Tip the cup so the milk reaches your baby’s lip. Do this very slowly so the milk doesn’t rush into your baby’s mouth and overwhelm them. Your baby will lap at the milk like a cat. It is important that you don’t pour the milk into your baby’s mouth, as this can cause them to choke. Your baby may pause now and then just as they do when feeding at the breast. Keep the cup in place and your baby will start drinking again when they’re ready.

Breastfeeding supplementer

(Also known as supplemental nursing system (SNS) and supply line)

A breastfeeding supplementer is a container with small tubes attached, one end of which is taped to the breast in line with the nipple. Your baby latches over the end of the tube when they latch on to the breast and they suck out the top up milk from the container at the same time as sucking milk from your breast.

Breastfeeding supplementers can be helpful when trying to boost supply, as the breasts get more stimulation and drained encouraging more milk to be made. They also help to avoid baby refusing the breast due to developing a preference for the bottle. See a breastfeeding supplementer in action here.

Bottle

If you do give top up milk using a bottle, paced bottle feeding can help to reduce the risk of overfeeding your baby, and your baby developing a bottle preference. Learn about paced bottle feeding here. 

Syringe

Usually a short-term way of feeding when only small amounts of top up milk are needed (e.g., when giving colostrum in the first few days of life). Expressed colostrum/milk or formula is drawn up into a syringe and very small amounts squirted into baby’s mouth between their gum and cheek. Be sure to only push a small amount of milk in at a time and let your baby swallow before pushing the next bit in. 

Spoon

Also a short term method for small amounts of milk. Expressed colostrum/breastmilk or formula can be poured carefully onto a spoon and rested on your baby’s bottom lip for them to lap at with their tongue, like when cup feeding. 

How much top up milk to give

This will depend on your individual situation. You may like to get some guidance from an International Board Certified Lactation Consultant (IBCLC) on this so you can make sure your baby gets what they need without overfeeding them.

It can help to watch your baby’s nappy output to know they’re getting enough milk. Your baby should be having at least 5 heavily wet nappies each day and doing 3 runny/soft poos each day (babies older than 6 weeks may do less, but they should still be runny/soft). If your baby has a lot more wet and dirty nappies than this, you may be able to try reducing the amount of milk in the top ups. If they are having less wet and dirty nappies, then you will need to give more top up milk to make sure your baby gets what they need to grow and develop.

The Top Up Trap

It is easy to overfeed a baby with a bottle because babies are born with a reflex that makes them suck whenever something touches the roof of their mouth. Because of this, they can gulp down a whole bottle even after a breastfeed making it look like they’re starving. The truth is, they can’t help but suck because of their built-in reflex, and then they can’t help but swallow, so they don’t choke on the milk in their mouth. If your baby has more top up milk than they actually need, they will likely go a lot longer before wanting another breastfeed, which can reduce your breastmilk supply (less milk drained from the breasts = milk production slowed down). This becomes a cycle that can be hard to get out of without support.

How to stop top ups

Stopping top ups can be a bit of a transition process depending on the situation. It’s important to make sure your baby is getting enough breastmilk from you before stopping top ups suddenly (you can find out how to check this here). You may need to reduce the top ups slowly while you work on building your supply to meet your baby’s needs. You may find it helpful to work with an IBCLC for support while you do this.