What is the best way to wean this baby from supplements after
breastfeeding? We are going to do a test weight today to see how much
baby is really getting at the breast. I would like to be able to advise
this mother on an exact amount she needs to be topping off with after
the breastfeeding, if it is even necessary. Eventually, I would like to
see her breastfeed, on demand, without the supplement. I will be
following up with her after she has gone home.

Thanks for any input,
Brenda Phipps, BS, IBCLC

Since this baby is taking 50 ml after each breastfeeding I suspect that her
intake at breast might be poor. You will definitely have more information after
you do a test wt. To over- simplify, the best way to wean this baby from
supplementation is to increase intake at the breast. It sounds like this mother
has an adequate milk supply since she is pumping after breastfeeding and
supplementing with her own milk. I find with premies, positioning is all important. I
tell moms that term babies will often reposition themselves to effect milk
transfer, but that a premie is not strong enough to do this and that she will
have to do it totally for the baby. I teach them that it is important to get a
good, deep asymetric latch and to really tuck the chin. The simple maneuver of
pulling that chin in tighter often results in a "flutter" suck turning into a
nutritive suck. I also have mom use compression to enhance flow and, of
course, make sure the shield is on correctly.  We're trying a little experiment in
our NICU.  When a baby is able to get at least 1/2 of a feeding from breast we
don't top him off but put him back to breast when showing feeding cues. After
6 hours we do top the baby off by bottle or gavage to make up for missed
intake. We're just now trying it on our first baby. I'll let you know how it works.
This is an ex 25 weeker, now past term, poor feeder overall, severe reflux
(what we call in the NICU the whole 9 yards). Mom is desperate to breastfeed and
has a good supply. Baby has been going to breast for weeks but is
inconsistent. I'm crossing my fingers. For a healthy 35 weeker a little cue based feeding
without top off as long as you are doing test wts. and don't let the baby
lose wt. should be fine.  If this baby does need supplementation, don't do it
after every feeding unless he is getting very little from the breast. I do find
that most of these babies breastfeed really well as they reach almost term and
break that 6 lb. barrier, as long as you can keep them doing some feeding at
breast until that time.

Kathy Boggs, RN, IBCLC

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