Navigating Triple Feeding: A Comprehensive Guide

Triple feeding is a widely adopted feeding strategy designed to address specific breastfeeding challenges that newborns might face, such as insufficient weight gain or latching difficulties. This comprehensive approach involves three main steps: breastfeeding, pumping breast milk, and offering supplementation. The primary objectives of triple feeding are to ensure the baby meets their nutritional needs, establish a full milk supply, and address breastfeeding difficulties, all with the overarching goal of achieving long-term breastfeeding success.

How to Triple Feed:

Direct Breastfeeding:

• Initiate each feeding session by offering the breast to your newborn as they display hunger cues—clenched fists, tongue/mouth movements, rooting, and hands to mouth. Aim for approximately every 2-3 hours, totaling 8-12 sessions in 24 hours.
• Professionals may differ in their opinions on the optimal duration of nursing during triple feeding. Typically, it is recommended to nurse while still observing swallows or for no more than 30 minutes in total. However, individual circumstances vary, and it's advisable to discuss this with your lactation provider for personalized guidance.

Expressing Breastmilk:

• Post breastfeeding, use a breast pump or hand express additional breast milk. Since breast milk production is based on supply and demand, pumping is crucial when providing supplementation to achieve a full milk supply.
• There are various methods to express milk, including using a double electric pump, a manual pump, or hand expression. Collaborate with a lactation provider to determine the most suitable method for you, ensuring a proper fitting flange and optimal pump settings for comfort and efficiency.
• The duration of pumping varies for individuals, with a typical pump cycle lasting 30 minutes. Adjust according to your milk flow.

Supplementing:

• Adhere to guidelines from your pediatrician and lactation provider regarding the quantity for supplementation, usually ranging between 10 and 30 mLs. Begin with a lesser quantity and offer more based on the baby's cues.
• Prioritize the use of available breast milk for supplementation, resorting to formula only when the quantity of breast milk is insufficient. Engage in discussions with your lactation provider and pediatrician for guidance.
• There are various methods for supplementing during triple feeding. Collaborate with your lactation provider and pediatrician to determine the most effective form for you and your baby.

1. Bottle: Use a slow flow bottle and pace feed your infant—holding the bottle more horizontally to naturally slow the flow and allow baby to pace themselves.
2. Syringe: Place the tip of the syringe in baby’s mouth, allowing them to close their lips around it and slowly release the liquid. Alternatively, you can use a syringe and adapter in the corner of baby’s mouth while they are direct breastfeeding.
3. Cup Feeding: using a shallow cup, hold it to baby’s lips, gently tipping the cup and allowing baby to lap in the liquid.
4. Supplemental Nursing System: A SNS is where a tubing that is connected to a bottle of breastmilk or formula is taped to the parent’s breast to allow baby to latch to the breast and feed while also receiving supplemental nutrition through the tube.
5. Finger Feeding: similar to the syringe and SNS system, a small tube that has access to breastmilk or formula from a bottle or syringe is taped to your finger. You will then allow baby to suck on your finger, where they will be able to pull in the breastmilk or formula.

While triple feeding can be an effective strategy, it presents its own set of challenges, both physically demanding and emotionally taxing for parents. Drawing on my experience as a lactation counselor, feeding therapist, and a mom who has undergone triple feeding, here are some tips to make the process more manageable:

Work with a Lactation Provider: Engage with a lactation provider throughout the entire process to monitor progress and guide the cessation of triple feeding. This ensures any potential feeding issues are appropriately addressed.

Rely on Support: Enlist your partner to assist in triple feeding, providing supplementation, managing pump parts, handling milk storage, and offering emotional support.

Prepare Breast Milk in Advance: Set yourself up with breast milk on hand for each feed to streamline the process.

• Pump once prior to starting triple feeding. This way, you will then have that breastmilk for the first triple feeding session ready to go and you will simply save what you pump for the next triple feeding session and so on.
• Collect extra milk using an alternative method before a triple feeding session. Using a suction breast pump or breast collector on the opposite side while nursing can be a way to collect extra milk. You can then use this for the first triple feeding session and save what you pump for the next one and so on.
• Use formula for the first triple feeding session. If you offer formula supplementation for that first triple feeding session, you will then have what you pump for the next one and so on.

The duration of triple feeding varies for each baby and parent, often considered a temporary strategy to address specific challenges during the newborn stage. Consulting with a pediatrician or a lactation provider is crucial to determine when you can gradually reduce or eliminate the need for triple feeding as your baby grows, gains weight, and becomes more adept at breastfeeding.

While challenging, triple feeding can be a helpful tool to meet your breastfeeding goals. Seek support from those close to you and your healthcare providers to make it as streamlined, stress-free, and successful as possible. Remember, you are not alone in this journey, and the right support can make all the difference.