Top-Ups - When, What, How and How Much to give!

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Following our last episode talking about combi-feeding with Lucy Ruddle, we discuss top-ups; how they're used, how they should be used, and alternative strategies that can be used to limit or reduce their use. The NICE faltering growth guideline is the starting point, while it does detail everything that needs to be done, it remains open to interpretation over the level of breastfeeding assessment needed, and quickly moves on to talk of setting goals/review dates without specifying which actions can help establish and continue breastfeeding. To try and fill this gap, Jenny uses her IBCLC knowledge to talk through strategies used in practice which can be adopted by HV’s/HCP’s and how there are many more ways to do top ups than just using a bottle. To help avoid all babies of any age or size being told to have 40mls top-ups (the figure that most often seems to be plucked from the air without an evidence base), we explain how to calculate a top up using weight and weight loss. The NICE Faltering growth guideline https://www.nice.org.uk/guidance/qs197 Finger feeding: https://breastfeeding.support/what-is-finger-feeding/ Breast compressions: https://breastfeeding.support/what-is-breast-compression/ Paced bottle feeding: https://breastfeeding.support/tips-to-bottle-feed-a-breastfed-baby/ Book recommendation: Making more milk by Lisa Marasco & Diana West https://www.amazon.co.uk/Making-More-Milk-Breastfeeding-Increasing-ebook/dp/B07SQS22LC/ref=sr_1_1?dchild=1&keywords=making+more+milk&qid=1625065400&sr=8-1