Triple Feeding

To triple feed means doing three things approximately every three hours. The whole process should take no more than 45 to 60 minutes. That way, you have time to rest before the next feeding.

Tip: Have your preferred supplement method ready before you begin so you can go from step 1 to 2 without pause.

Feed the baby directly from the breast.
• Place baby skin-to-skin and attempt to latch baby to the nipple. If baby does not latch within 10 minutes of trying, move to step 2.
• If baby does latch, observe the quality of their suck. A nutritive suck — jaw drops, slow rhythmic suck and swallow pattern — is effective feeding. When baby shows signs of tiring or uses a non-nutritive suck — a rapid, shallow suck — move to step 2.

2. Supplement with pumped milk, donor milk, or formula.
• Offer your preferred supplement, feeding a volume recommended by your lactation consultant (IBCLC) in conjunction with your pediatrician. Supplement volumes will change as the baby becomes effective at breastfeeding.
• You may supplement by spoon, cup or syringe/finger feeding for amounts less than 15 ml. 
• For amounts over 15 ml, use a slow-flow bottle or Supplementary Nursing System (SNS). SNS is only effective if the baby is latching well.

3. Pump both breasts.
• When both breast and supplemental feeding are complete, use a hospital-grade pump that lets you pump both breasts at once. Pump for 15-20 minutes.
• Use hands-on pumping techniques as you pump to stimulate milk flow. Keep pumping even if nothing comes out — it is breast stimulation on an empty breast that tells your body to make more milk. 
• Hand express for a few minutes after you have finished pumping to fully drain both breasts.
• Save any extra breastmilk for the next feed.

Triple feeding modifications.
Talk with your IBLC or qualified lactation professional about ways to modify the triple feeding technique to meet your family’s needs. Alternatives include:

• Finish at the breast. If latching is difficult, talk to your IBCLC about switching up the order of steps so you supplement first, breastfeed second, then pump.
• Part timer plan. You can use the triple feeding strategy only at certain feedings. For example, you may decide to skip the breast and simply pump and supplement at night.
• Parallel pumping. You can try feeding baby at one breast while pumping the other breast at the same time. You may enjoy checking off two triple feeding steps at once.