Dropping top ups
By Jennifer Clark, IBCLC. Revised May 2022
Top ups of expressed milk or formula for your baby may have started for a number of reasons after birth. This could be due to baby being preterm, separated from mother, low bloods sugars, tongue tie, weight issues, jaundice or illness. Once any of these things have resolved you may want to look more towards exclusive breastfeeding. Ensure you have had feeding checked by an IBCLC or breastfeeding counsellor and that baby is transferring a good amount of milk during feeds. See our piece on positioning and attachment for help
Ensure you have a good milk supply.
If you’re exclusively breastfeeding and giving expressed breastmilk as a top up and your baby is doing well then get feeding assessed and top ups can be dropped steadily. The main thing here is that your baby can remove all the milk needed from the breast so breast compressions may help. If baby was needing these top ups due to, for example, a tongue tie that has now been released, drop these slowly and monitor wet and dirty nappies and get baby weighed.
If your baby is having formula top ups it is important that you give your milk supply a boost to ensure you’re making enough milk to meet baby’s needs. The best way to do this before dropping top ups of formula is to express to mimic baby’s feeds. See ‘expressing to build milk supply’ for further information. The more frequently your breasts are stimulated whether with feeding baby or pumping the more milk you will make. At night the milk making hormone prolactin is at its highest, therefore, feeding at night is key to building your milk supply
It is always advised that any top ups are dropped slowly, especially if your baby is on volumes >30mls at most feeds. If your baby’s weight gain has consistently been steady and they’re well drop the volumes slowly. Your baby may do this themselves as they start to feed more efficiently and are more alert and awake. If your baby is on volumes of >30mls drop the volumes by about 10mls a feed and monitor. For example, if you’re currently breastfeeding 8-10 times in 24 hours and then giving your baby 50mls of formula after every feed reduce this to 40mls while doing breast compressions and adding in expressing sessions. If baby is settled and wet and dirty nappies are regular (5+ wet nappies and >2 yellow stools in 24 hours) and weight gain continues to be steady (30g/day) then you can drop this by another 10mls every 3-4 days. Once you are under top ups of 30mls and nappies, weight and baby is settled you can think about dropping to 3-4 top ups a day as opposed to after every feed. When you do this you may find that baby has a period of cluster feeding. Ensure you have drinks, snacks and support around during this time to ease this! Periods of cluster feeding will help give your milk supply a good boost to catchup with your babies’ milk needs.
Tick list for dropping top ups:
As IBCLCs we recommend this method of weaning off top ups as it allows milk supply to catch up and baby to learn to take more milk from the breast in a gentle manner.
Baby is back to or over birthweight (and gaining well >30g a day) and your IBCLC/midwife/HV has suggested that you can start dropping top ups.
Ensure baby is having at least 5 heavy wet nappies and regular dirty nappies (if under 6 weeks at least 2 good size bowel movements a day, if over 6 weeks this may be less).
If using formula for top ups get a good breast pump and express regularly to help boost supply. You are able to then replace some of this formula with expressed milk as you slowly reduce.
Drop top ups slowly, ideally by 10mls a feed at a time then check nappies and weight are still ok. For example, if you are topping up by 60mls after feeding on both breasts, drop this to 50mls and then try to add expressing sessions to help boost supply. Slowly drop the volume every 3-4 days depending on how baby copes. Weigh baby every week to monitor their gain while dropping top ups.
Pictures - First picture shows topping up baby at the breast with a peridontal syringe. Second picture shows expressed breast milk in a breast pump