How can I get her to eat more during the day

[ENMS]

DD is 23 weeks. We've had lots and lots of issues with breastfeeding since the beginning due to tongue tie, even after it was clipped she struggled to feed well. We've worked through it with many different specialists and now I'd say we're in a good place.  I have issues with milk production that is not stable - i either have lots of milk or not enough but I think this is under control now too.

The problem is that she still feeds every 3h during the night. For a while I maintained it because of the issues above we had weight gain issues so I was happy to feed her but now that we've reached a good place I would really need her to do longer stretche at night because I am exhausted.

She is an IS and her NF's are the same regardless of her routine.

I was worried she was snacking since we introduced a top up feed due to the longer A times but it seems like she can get to 3.5h without much of a problem between feeds during the day.

She often is not interested in a second breast but I offer it again after 15 minutes and often she takes it. She is supplemented by bottle with EBM when necessary but when my supply is good she usually refuses the bottle.

Her weight gain is good for her age now, 17 grams per day average for the past month.

I'm wondering if maybe her stomach is too small for her to take bigger feeds?  Any thoughts on how. I can get her to take more during the day? Should I reduce the feeds at night? I really feel like she is genuinely hungry at night but I know she could do longer stretches.

Here was yesterday:

Wu 7:05
E 7:35 (she was happily playing in her crib, very unusual usually she wakes starving)
E 9:15 top up
S 9:45-12:15
E 12:15
E 2:30 top up
S 3-4:50
E 4:55
E 7:10
E 7:20 top up bottle 2 oz
S 7:45-10:20
E 10:25
S 10:50-1:45
E 1:45
S 2:25-7 (that is one of the longest stretches she rarely goes that long)

The day before:

Wu 6:45
E 6:55
E 9:15 top up
S 9:20-9:55 (car nap)
E 10:35 one side only we were out
S 11:10-11:30
E 12:10
S 12:25-2:15
E 3:30 2 sides plus 2 oz bottle
S 5:20-5:40
E 7:20
S 7:45-11:00
E 11:00
S 11:20-2:15
E 2:15
S 2:45-6
E 6
S 6:25-8:30

ETA: i have a lot of milk at the moment so wondering if block feeding would help her get more of the fatty milk?

[ENMS]

Anyone? I was thinking of setting specific times to feed her and in between resettle her with PUPD. If I keep the 10-11 PM feed (it's the one she never misses) would it be fair to then hold off until 4-5AM before feeding her?

I'm guessing this may be the best way to reduce her calories at night and get her to take more during the day?

[*Ali*]

There is a huge growth spurt at 6mo when babies often wake more at night for feeds. I'd be tempted to wait until after that passes before looking at actively reducing NFs. Otherwise you could find you go through it all to get rid of a NF and then she starts waking for it again, genuinely hungry as a result of the GS.

2 NFs is pretty normal for this age. I'd concentrate on getting more in during the day before withholding at night. If offering the second breast 15 mins later works then I'd do that for every feed and even see if she will take the first breast again.

Have you tried breast compressions? That helps dislodge the fatty milk from the duct walls. Block feeding could help if you have over supply but as you say yours is unstable I'd be hesitant to try that as leaving one breast full sends the message to make less milk which you don't need.

[ENMS]

Thanks Ali, good point about the 6m GS I had not thought of that.

Yes, I do breast compressions at every feed.

I know 2 NF's are normal at this age, but is it really normal that she mostly feeds every 3h? It seems like a lot to me, I would expect her to do at least one 5-6 hour stretch at that age? I'm starting to Wonder if it is really hunger or something else, like a prop or something? She does fall right back asleep after her NF's (and probably 50% of the time she falls asleep while still at the breast but she wakes a little when I put her down.

[ENMS]

She had 3 feeds overnight - 10:30, 1:30, 5 AM.

She woke for the day at 8:30 and now she is feeding (9:30) and she is not taking a full feed, she is nibbling and obviously not hungry!

I'm starting to think I need to reduce the calories at night before she takes on more during the day?

[*Ali*]

Sorry for the delay in replying.

How are things now? Still the same?

[ENMS]

Hi there, yes pretty much the same.

The last 2-3 nights I have noticed she does not seem to take full feeds, despite waking up at the same times as usual (about every 3-4 hours). Then she is not that hungry in the morning. I have started offering only one side at her last NF around 5-6 ish but she still is not very hungry in the morning.

Last night she did much longer stretches than usual, she fed at 10PM and then at 3AM and that was it until 8AM. Even at 3AM, I noticed that she did not seem that hungry, she did not take a full feed and then in the morning she only took one side (she usually takes both sides).

Since this is still recent (up until a week ago she was taking full feeds) I think I will continue to Watch the next few nights and then possibly start reducing? She always takes a full feed at 10PM so I would keep that one intact and then start offering only one side and reduce the time every few days for the other NF's? Would that work? DS was bottle fed at that age so we gradually reduced the oz but I don't know if that can be done with breast feeding?

[ENMS]

Last night was:

10:30 both sides
2:00 one side because we both fell asleep so when I woke at 3 I just put her back down.
6:00 one side

[*Ali*]

Yes I would definitely start by reducing the amount taken at night by offering just one side is LO seems happy with that.