Triple Feeding

Crystal P.

Updated December 20, 2024 20:39

My doctor is concerned about my baby’s weight. I don’t want to quit breastfeeding, so he suggested triple feeding. Do you have any information about this?

Triple feeding is a lot of work, but with determination and consistency, moms can be successful. Triple feeding means that at every feeding, your baby is fed directly at the breast, receives a bottle of expressed breast milk (or formula), and mom hand expresses or pumps for the next feeding. This feeding plan should be used short-term to increase milk production, while closely monitoring your baby to ensure they are getting enough to eat.

Frequently Asked Questions:

Why is triple feeding recommended?
Should I breastfeed, bottle-feed, or pump first?
How can I maximize pumping sessions?
How can I get my baby back to breastfeeding exclusively?
How long is triple feeding needed?
What are some tips and time-savers to make it through this time?

Why is triple feeding recommended?

Doctors and lactation specialists recommend triple feeding when a baby isn’t getting enough to eat with direct breastfeeding alone. This can be due to poor feeding skills and/or milk supply concerns.

Poor Feeding Skills

Babies must latch deeply to transfer the necessary amount of milk for their growing needs. Anything that causes moms and babies to be separated, or unable to breastfeed soon after delivery, can lead to poor feeding skills. If a bottle was introduced and baby developed a preference, triple feeding may be recommended while they are learning to breastfeed.

Other factors that can lead to poor feeding skills include:

- Prematurity: Preemies (or NICU babies) who are just starting to practice breastfeeding may not be able to get enough calories at the breast. They may get most of their calories through a bottle, while mom is pumping to build her milk supply for when baby can fully feed at the breast.
  - Late-preterm babies (born between 34-36 weeks gestation), may not have developed the skills needed to transfer enough milk.
- Tongue or lip ties: Oral restrictions can cause poor feeding skills. A trained dentist, doctor, or lactation consultant can help determine if a tongue or lip tie is severe enough to cause milk transfer issues.

Low Milk Supply

There are several potential causes of low milk supply, and while working to increase supply, triple feeding may be recommended.

Perhaps the baby is emptying the breast well, but it’s not enough to meet their needs. Since supplementation is needed—which takes time away from breastfeeding—additional demand on the breasts, through pumping or hand expression, is necessary to stimulate more milk production.

We encourage working with a lactation consultant to address these issues. We have a breastfeeding specialist (RN, IBCLC) on our team who can help!

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Breast, bottle, or pump first?

You may need to experiment with the order of things and go with what works best for you and your baby. It may take time to determine how much to supplement. Work closely with your doctor to determine this, and communicate your observations so changes can be made as needed. Share your breastfeeding goals and your desire to breastfeed, instead of formula or bottle-feeding, with your doctor.

Option 1: Start with the breast, then supplement. Offering the breast first works for some babies and is recommended in most cases.

1. Breastfeed every 2-3 hours (8-12 times a day). Allow your baby to nurse until they stop actively sucking and swallowing, then switch breasts and repeat.
2. Pump for 15-20 minutes (contact the WIC office about borrowing a hospital-grade double electric breast pump). This milk can be used at the next feeding and can safely be kept at room temperature for up to four hours. Click here for more breast milk storage and handling guidelines.
3. Supplement with the amount suggested by your doctor, using the paced bottle-feeding method, a supplemental nursing system (SNS) or cup. Begin with breast milk, and if more is needed, offer formula afterward. Giving breast milk and formula separately reduces waste, in case your baby doesn’t finish the bottle.
4. To help build your milk supply and give your baby extra practice, you could offer your breast again at the end of the feeding session.

Option 2: Supplement first, then breastfeed. If your baby is overly hungry, offering just a little bit in a bottle can make for a more successful feeding session. Prioritizing calories over latching is recommended for preterm babies who need to reserve their energy, making Option 2 a better choice for them.

1. Supplement with a small amount. Don’t offer a full feeding of breast milk or formula in a bottle. Your baby may be more patient at the breast if their hunger is satisfied a bit first.
2. Offer the breast. Finishing at the breast can help your baby associate feeling full with breastfeeding, rather than bottle-feeding. Think of it as a 'dessert' to make breastfeeding especially satisfying.
3. Pump for 15-20 minutes for the next feeding.

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How can I make the most of my pumping sessions?

Triple feeding is exhausting, and it can feel like all you are doing is nursing, pumping, and preparing for the next round, with little break in between. Pumping effectively will maximize how much can be collected and save you precious time.

Make sure you are using a breast pump with a strong motor, and all parts are intact.
Get measured for breast pump flanges, as the proper fit is crucial for effective milk removal.
Pump consistently during each of the 8-12 breastfeeding sessions of the day. Effective pumping should not take longer than 15-20 minutes each time.
Make sure you are warm, comfortable, and relaxed—this encourages milk flow.
Learn the settings of your pump and utilize the “letdown mode,” if it’s available, until milk starts flowing.
Use a comfortable suction setting. It should be high enough to remove milk, but not so high that it causes pain.
Try hands-on pumping to maximize how much milk can be pumped and increase milk supply.
After milk flow stops, do some hand expression into the breast flange to collect more.

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My goal is to provide all feedings at the breast. How can I accomplish this?

There are several things you can do to help your baby learn to breastfeed effectively, which will increase your milk supply, so baby can get all they need from breastfeeding alone.

Paced feeding: Anytime your baby gets a bottle of breast milk or formula, use the paced bottle-feeding method to make a bottle-feeding session similar to breastfeeding, encouraging a smoother transition back to the breast.
Supplemental nursing system (SNS): This can be used while your baby is latched onto and suckling at the breast. While your baby gets milk from the breast, they also receive breast milk/formula from the SNS container through a small tube inserted into their mouth. Cup or syringe feeding can also replace a bottle and encourage your baby to get back to the breast. Work with a lactation consultant when using these alternative feeding methods.
Skin-to-skin contact: This encourages babies to latch, and it increases milk supply. Try the magic nursing position!
Take advantage of sleepy and drowsy times: Babies are often willing to latch during these times, especially if they aren’t overly hungry.
Breast compressions: These can keep your baby interested in the breast by increasing milk flow. This “hands-on” method can also increase milk supply!
Switch breasts multiple times during a feeding: When milk flow slows or your baby comes off the breast, switch.
Offer extra snacks: Nurse whenever your baby is willing, even if it’s in between feedings and not a full feeding.
Limit pacifier use: This prevents your baby from getting their sucking needs met this way.
Keep your baby close at night (in a safe sleeping space): Recognizing early hunger cues and having easy access to breastfeeding is beneficial.

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How long is triple feeding needed?

It’s important to have a plan to get out of triple feeding as soon as the process is started. Figuring out why triple feeding is needed in the first place is crucial, so those issues can be addressed and corrected.

Balancing Supplementation

Not supplementing enough means that your baby isn’t getting all they need to grow and thrive. Supplementing too much means that your baby is spending less time at the breast, which negatively impacts milk supply and keeps you on the triple feeding cycle.

Work alongside your doctor and lactation consultant to determine the right amount of supplementation, whether your baby is supplemented with breast milk or formula. Frequent weight checks and weighed feedings (weighing baby before and after nursing to see how much milk was transferred) can help. Contact the WIC office to schedule a weighed feeding and to get in-person breastfeeding help. Click here for the average intake for breastfed babies.

It is important to carefully reduce supplementation as your baby's skills at the breast improve and/or your milk supply increases. Remember to watch for signs that they are getting enough to eat.

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What are some tips and time-savers to make it through this time?

Hang in there, mama! This is an intense time, and your dedication to providing breast milk for your baby is admirable.

Ask for help. Have a support person take on the role of storing and handling the breast milk correctly and washing pump parts.
If you’re able, purchase additional pump parts (flanges and bottles) to minimize the need to wash them between each pumping session.
Use the milk from the previous pumping session for the current feeding session. Trying to pump and give freshly expressed milk at the same feeding can be stressful and lead to less output. Remember, breast milk can safely be at room temperature for up to 4 hours, so if used in that timeframe, it doesn’t need to be refrigerated.
Focus on your baby and yourself. Ask for help with other children and household duties.
If all the extra stimulation to the nipples is causing pain, soothe them by:
- Rubbing a few drops of breast milk on the nipples and air drying.
- Applying cool packs covered in a cloth after feedings.
- Going without a bra or wearing one that’s comfy but doesn’t rub.
- Using nipple cream designed for breastfeeding mothers. (Do not use lanolin products if you have a wool allergy.)
Set realistic goals and give yourself grace. If formula is needed, it’s okay! A happy, healthy baby is one of the best markers of success.

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Your breastfeeding peer counselor is available anytime to support you and can connect you with additional resources. Great job, and keep your head up during this challenging time.

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