The Premier Pediatrics Bridge Feed

This is a program designed to help new parents use formula or pumped milk in addition to breastfeeding during the early days of their baby’s life before their milk  comes in.  Ultimately, the goal is to provide enough nutrition to satisfy your baby without diminishing the drive to breastfeed.  We break the day into 8 three hour sections. Keep in mind that most babies will feed every 2-3 hours, for an average of 8-12 feedings per day, so this schedule is flexible.  During each section, the first hour is when the majority of the feeding happens.  During the next two hours, we implement a strategy to “comfort first and feed second”.

Hour One:

Try to achieve active feeding  for 20 minutes per breast.  This means that your baby is sucking with effort as opposed to a fluttering motion with a shallow latch.  If your baby falls asleep on the breast, take him off for a couple of minutes and attempt to arouse him gently. Some techniques include rubbing his back, tickling the toes/cheeks, or getting him undressed. Once he is more awake, you can attempt to relatch.  Add each of these active feeding spurts together until you achieve 20 minutes per breast.  At the end of the hour (or 40 minutes if you have an active feeder), provide 15-30 milliliters of formula or pumped milk. Be sure to “pace” the feed, allow for a burping break every 10-15 milliliters and watch for hunger cues before offering more. If you feel like you had a tremendous feed and your baby looks comfortable, forego the supplementation. 

Hour Two:

If your baby fusses and looks like he is rooting, try non-nutritive soothing techniques such as swaddling or putting a finger in the mouth.  If none of these techniques work, provide 15 milliliters of formula or pumped milk.

Hour Three:

If your baby fusses and looks like he is rooting, try non-nutritive soothing techniques such as swaddling or putting a finger in the mouth.  If none of these techniques work,  start the next three hour block earlier at “Hour One”.  For example, if your baby does not calm with non-nutritive soothing techniques at 2 ½ hours, start the next 3 hour block at this point.  Also, if your baby sleeps for 4 hours without stirring, you can start the next 3 hour block after 4 hours.  Just make sure that you have achieved at least 8 feeds in a 24 hour period.  

This plan is not meant to stress you out.  Please read the following points that may clarify some of the questions or apprehensions you might be feeling.

  • Always talk to your partner or call us if you are stressed out by this plan or the process of feeding, we will get you to your ultimate goal as a team.
  • This is not a prescription but rather a guideline.  All babies are different.  Some will feed every three hours while others will feed more sporadically.  
  • If you have breast pain or 20 minutes per breast feels like an eternity, do not feel obliged to stick to 20 minutes per side.  Do what feels manageable. Many babies will feed for less than 20 minutes per side, and this is absolutely OK. The key is to keep active breastfeeding to a maximum of 20 min per side each feeding session to avoid nipple trauma and over fatigue for both mother and baby.
  • If you are giving greater than 45 milliliters of supplementation per block, give us a call.   
  • Remember that one day is not necessarily representative of the next.  You and your baby are learning a skill together and as you get practice, it will improve.
  • This strategy is particularly effective during the first week.  Usually your milk comes in around day 4 or 5 and you will see the amount of supplementation you use decrease.
  • Pumping after breastfeeding may help stimulate milk production.  However, this is not absolutely necessary, especially if the baby is actively latched 15-20 min per side during feeds. If you feel like your baby is not latching adequately or your breasts continue to feel full after a feed, you can pump for 10-15 minutes directly after breastfeeding. Ideally, your partner would provide bottle supplementation during this time. If the addition of pumping is too overwhelming, do not push yourself to add this step. Rest, in addition to hydration and a healthy diet, are also extremely important factors in milk production.
  • Remember that even if you do not see milk, the colostrum you are producing is a power packed liquid and is the perfect source of nutrition for your newborn at this stage.   
  • We have excellent lactation specialists. Please reach out at any point and we will get you in touch with our network of breastfeeding experts. 

 You got this!  Good luck!

The Doctors of Premier Pediatrics