Triple Feedings

Sometimes the normal course of breastfeeding is interrupted or derailed and you may need to jump start your milk supply or help it get back on track. Triple feedings are a way to quickly get back to exclusive breastfeeding or to start breastfeeding exclusively for the first time while ensuring your baby is getting enough to eat.¹ 

1. Breastfeed for 20-­30 minutes 
   • Use breast compression to increase flow if your baby starts to fall asleep at the breast. To compress your breast, after you begin feeding, place your index finger under the breast and your thumb on the top of the breast. Apply gentle pressure to the breast inward, pressing your finger and thumb toward each other and then toward your chest wall. Milk should start to flow quicker keeping your baby interested in continued latch and sucking.
   • Switch breasts as necessary when breast compression no longer results in more sucking/swallowing bursts.
2. Supplement the baby with the amount of expressed breast milk recommended by your pediatrician or IBCLC for about 10 minutes.
   • If you don’t have enough expressed breast milk, use donor milk or formula to get to the recommended amount.
   • Try using a feeding method that is not a bottle such as a cup, spoon, finger feeding syringe, or supplemental nursing system (SNS). If you don’t have access or cannot use these tools, it’s OK to use a bottle.
   • Try to encourage your baby to fall asleep and lay your baby down or have another adult hold the baby so it is easier for you to do step 3 without a delay.
3. Pump both breasts for about 15 minutes.
   • Use hands-­on pumping techniques which will remove more milk, thus stimulating the breasts to produce more. For hands-on pumping, massage both breasts from the outer edges toward the nipple with a light touch. Then put your pump on and do breast compressions as described above (section 1). Make sure you don’t get too close to the flange or areola when you are touching your breasts because you risk breaking the flange seal.
   • Store your expressed breast milk covered on the counter at room temperature (up to four hours) or in the refrigerator to use for the next feeding cycle.

• Triple feeding is generally helpful when trying to improve milk supply or baby’s interest in latching. If you start to see improvement in these areas you can cut back or stop. Triple feeding should not be used as a tool for more than three days.
• Try not to take a break between steps 1 and 2 or steps 2 and 3. Break after the third step. 
• The whole triple feeding cycle should take no more than 40-­60 minutes per feeding.
• The start of each triple feeding should be two hours after you started the last feeding.
• Complete 8 total feedings during the day time of each day. If starting every two hours, you would complete 16 hours of triple feeding cycles per day.
• Take a break from triple feeding cycles at night. When you go to bed at night, wake up after 3 hours and either direct breastfeed or pump and give baby a bottle. 

• Use this chart to track breastfeeding and supplement sessions. 
• Use this chart to track wet and dirty diapers. Note that a baby who receives formula supplements may produce fewer poops that may be darker in color from breastfed poops.
• Follow­ up with the provider who shared the triple feeding schedule with you, usually your pediatrician or IBCLC, to ensure that baby’s growth stays on track as you work on increasing your milk supply and transition to exclusive breastfeeding. 

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1. https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/10-breastfeeding-the-late-pre-term-infant-protocol-english.pdf 
2. https://www.lowmilksupply.org/ (Making More Milk: A Nursing Mother’s Guide to Milk Production, 2nd Edition)
3. https://nancymohrbacher.com/products/hardcover-breastfeeding-answers-second-edition-2020 (Breastfeeding Answers: A Guide for Helping Families, 2nd Edition)