Triple feeding when single feeding – with helper
Wake first baby if necessary and offer the breast with a deep latch. Watch for deep sucks and swallows. Use breast compressions to encourage baby to continue to feed and maximise milk transfer. Towards the end of the feed helper can begin rousing second baby. Once the baby has no more active feeding despite breast compressions, pass to helper to top up and offer breast to second baby. Top ups can be by paced bottle feeding, cup feeding or finger feeding with a syringe or feeding tube. If baby is very sleepy, finger feeding may be most effective. Again watch for deep sucks and swallows and use compressions. Once active feeding is no more, pass to helper to top up. Pump for 15-20 mins (with a hospital grade multi-user double pump if possible). Use this milk for the next top up. If volume is smaller than top up volume, donor milk or formula can be used. This whole feeding plan should be doable in an hour or a bit more.
*If there are no helpers available, it would likely be best to have the babies do both breastfeed and top up each before pumping after both. This will take longer.
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Triple feeding when tandem feeding – with helper
Latch both babies on with a deep latch. If babies are supported well, breast compressions should be possible to increase milk transfer, but can be more difficult when tandem feeding. Watch for deep sucks and swallows. Once there is no more active feeding, the helper can either tandem feed the top up. Or the helper and breastfeeding parent may take one baby each to top up, which can make pacing the bottle feed easier. Pump for 15-20 mins (with a hospital grade multi-user double pump if possible).
*If no helper then tandem feeding the top up will help make it more efficient. Pace the feed as best you can.
Top ups should be worked out using the 150ml/kg/day as a basis, divide by 8 for 3 hourly feeds, then half this volume if baby is transferring some milk. Use table below to assess and share this with the parent.
As babies begin to become more efficient on the breast we could offer the breast a second time for some feeds instead of topping up by another method.