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Feed The Baby: When Supplementing Saves Breastfeeding

Most mothers make plenty of milk for their babies — nature designed breastfeeding to be a very hearty system. But by virtue of the work I do, I see my fair share of low milk supply cases (I see the babies who are having issues with breastfeeding!).

Many of the mothers I see are very committed to full breastfeeding, as well they should be! They want their baby to receive 100% breastmilk at the breast (no bottles or other devices). This is the goal, of course. The problem comes when a baby is not growing healthfully this way.

Now, it’s normal for all babies to lose a bit of weight in the first few days after birth. But by 3-4 days after birth, a mother’s milk should become more abundant (“come in”), and a newborn should start to gain, rather than lose weight. Most of us agree that it can sometimes take up to two weeks for a baby to get back to his or her birthweight. I like to see it moving in that direction by the end of the first week, but sometimes moms and babies need those first two weeks to work out kinks and get on track.

Lately, I am seeing doctors and other helpers let a baby stay underweight quite a bit even after those two weeks, often hardly gaining any weight for the first month. How is this possible? Well, I think many of these helpers are trying to protect the breastfeeding relationship. Supplementing with formula, for example, can quickly wreck a mother’s milk supply. They believe that all a mother has to do is breastfeed more often to increase her supply and fatten up the baby. This is usually the best way to increase milk supply, but if this strategy isn’t working by two weeks, or three weeks, or four weeks, something needs to be done!

Besides the obvious fact of “This baby is starving, please feed it!” it is super important to understand that a hungry, underfed baby will not breastfeed well. A low-weight baby will often conserve his or her energy and be sleepy or lethargic at the breast. Breastfeeding is hard work: you want a strong, energetic baby at your breast! Underfed babies are also often irritable, with tight, clenched bodies and mouths (also not good for breastfeeding). As IBCLC veteran, Linda Smith says, the first rule of solving breastfeeding problems is “Feed the Baby!”

If you need to supplement, there are many ways to make it work. The first, best choice is to pump your own milk and feed it to your baby.  This not only ensures that your baby gets the healthiest food possible, but also helps increase your milk supply.  If you aren’t able to pump enough milk, the next best choice is breastmilk from a donor (see resource list below). But if you have exhausted all your resources, you can give your baby a conservative amount of formula for a limited amount of time.  Think of it as medicine to help your baby breastfeed. And there are several breastfeeding-friendly methods of feeding the baby the supplement, with or without bottles. See an IBCLC for help figuring out the best method for you and your baby.  And if you aren’t able to pump enough of your own milk for your baby, an IBCLC can help you maximize your output.

Speaking of IBCLC’s, if your baby isn’t beginning to gain back his or her weight in the first week or two of life, please see an IBCLC right away! Breastfed babies are meant to gain oodles of weight in the first few weeks. If your baby isn’t, something is amiss. Besides latching issues and infrequent breastfeeding, common causes include tongue tie and certain hormonal imbalances in moms. Check out this website for more causes, and possible solutions. It is important to be assessed and advised by an IBCLC because milk supply issues are often nuanced and complex.

But the good thing is that most of these problems are solvable, and the earlier they are addressed the better. Go with your instincts: if your breastfeeding helper doesn’t seem to be addressing your issues knowledgeably or kindly, find someone else. And if you need to supplement your low-weight baby, don’t despair. Within a few days of supplementing, you will usually find (depending on the cause of the low supply) that your baby perks up and nurses more efficiently, thereby increasing your supply and making breastfeeding a more manageable and enjoyable experience. Under good guidance, supplementation usually doesn’t last forever, but when used properly, it can really save the day!

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More Resources

Low milk supply causes and treatments

http://www.second9months.com/low-milk-supply-tricky-to-treat/

http://kellymom.com/bf/got-milk/supply-worries/low-supply/

http://www.lowmilksupply.org/

http://www.phdinparenting.com/blog/2013/8/19/breastfeeding-and-low-supply-common-and-surprising-causes-an.html

Milk Sharing/Donor Milk Resources

http://hm4hb.net/

https://www.hmbana.org/

Supplementing and Weaning from Supplements

http://kellymom.com/bf/pumpingmoms/feeding-tools/bottle-feeding/

http://www.lowmilksupply.org/abs.shtml

http://www.lowmilksupply.org/finishatthebreast.shtml

http://kellymom.com/bf/got-milk/basics/decrease-formula/

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20 thoughts on “Feed The Baby: When Supplementing Saves Breastfeeding”

  • I had to supplement the first week because I had an emergency c-section due to pre-eclampsia. My son was hungry and I didn’t even have colostrum yet, so the hospital staff gave me a syringe with a tube to tape to my nipple. It helped so much and he was completely breastfed after that, and he nursed until he was over 5 years old 😉

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  • As I read this I’m nursing my 5 month old using the SNS (supplemental nursing system) with formula. This is # 4. I have low fat milk and have had to supplement all of my kids. This is the only one that hasn’t had a bottle yet.

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  • My third baby is now 11 months old and we started out with me staying another 6 nights at another hospital. We survived me pumping and sending milk home with daddy those nights. My second daughter was failure to thrive and we worked around the clock with nursing (each side twice) and then pumping and offering what I pumped every three hours around the clock. It was scary, but having had done it the first time with an over supply, I knew that wasn’t the problem… and sure enough, once she/ WE figured out how to nurse properly, she started to gain weight. She’s now entering kindergarten as a lean and muscular girl!

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  • I had to supplement for the first couple of weeks when my daughter was born. I had pre-eclampsia and peripartum cardiomyopathy. Between the c-section delaying my milk coming in and the lasix reducing my supply, supplementing was a must. Luckily it all worked out. I am now off the lasix, my daughter is 6 months old, and sheis exclusively breastfeeding.

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  • I couldn’t breastfeed, but the midwives I knew at this one dojo I used to be a member of insisted that I keep trying. Never worked out their guilt trips never did. We had no bank near us nor knew of any wet nurses. I’m thankful we at least have formula for the women and trans men who can’t breastfeed, but their babies can still get something nutritious.

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  • I still supplement about a bottle of formula a day (or sometimes not at all) for a host of reasons that stemmed from a tongue/lip tie. I try to look for the silver lining. Usually my husband will feed my baby her bottle at the end of the night so that I get a nice break. Considering I wanted to give up many times that first two months or so, I feel glad that at worse my baby gets a bottle a day.

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  • At the “taking care of a newborn” class we took in the spring of 2013, I asked the two nurses leading the class about this because I’d just read some studies that showed supplementing like this could help moms breastfeed longer. They both said No! That’s not true! etc. and reiterated the either-or argument. I was really saddened, and I was completely open to supplementing, knowing the facts. Those nurses were supposed to be lactation consultants!

    I had an unplanned csection and after the first two days we were about to supplement, then my son and I figured out the breastfeeding and he started to gain weight. But I was not opposed to formula and knew if I needed it I would use it.

    I wish more new moms had the confidence to do what is right for their babies without feeling like they need to be 100% anything – you can be a good mom without being adamant about any one practice. Two mom friends whose kids are both about the same age as mine were practically apologetic to me about supplementing with formula, and all I could say was “don’t explain anything to me! You’re keeping your kid healthy!”

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  • Hi had to supplement because my son lost a lot of weight and was not gaining enough with just my breast milk. I am fine giving him extra calories of formula as long as he is gaining weight and is healthy. i want to do what is best for my child and if that is supplementing then I will do it. I

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  • Thank you for this post! I was diagnosed with delayed lactogenesis and poor hormonal response since birth when my little guy was born 6+ weeks early. He didn’t have the energy to breastfeed all day and wasn’t gaining weight. I never had any indication that my milk was “coming in” and he had his very first positive post breastfeeding weight at 8 weeks! Needless to say, we needed to feed my baby and that’s what we did! I pumped 10 times a day to get 5-6 ounces and then supplemented with formula. Today he is a healthy 8 month old who loves to nurse! He gets every drop of breastmilk I can provide (which is about 5-6 ounces in 6 pumpings a day) and formula helps me feed him.

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  • Thank you for the interesting article. I do find this a tricky subject to navigate. While there are of course some babies who really do need supplementing/ formula feeding, I don’t think it’s quite accurate to say simply that “a conservative amount of formula for a limited amount of time will be ok”. Yes, in terms of impacting milk supply, it possibly will be. And if you have tried everything else and decide it’s something you want to do (or you have to do), I’m not going to judge you in any way shape or form and will support you with every ounce of my being. But I do feel that too many mothers are still told that formula is the same as breastmilk and not informed of the risks, whether that be allergic response or whatever. I work in a London borough in the UK where most mothers I see in the first two weeks have been encouraged to supplement with formula, usually completely unnecessarily. They are told they “have to” and “a little won’t matter”. It is a daily battle trying to a) encourage health professionals to support breastfeeding and b) empower mothers to demand this support. We have had some babies (a handful) slow to regain birthweight, who have had intensive support with expressing and feeding breastmilk, improving feeding at the breast, and who have all been closely monitored and supported to eventually get on track. They aren’t all slow, sleepy feeders or reluctant to open their mouths; in none of these situations has their been a longer-term impact or any health issues. It is sadly too easy for someone to tell you to give formula; far, far harder to really support you if you want to avoid it. I do worry that the message that a bit of formula won’t do any harm will get taken by some as a blanket response to poor breastfeeding and take us backwards in the attempt to normalise and support breastfeeding, rather than taking us forward 🙁

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    • Thank you for your thoughtful response. I, too, find it to be a tricky issue, and perhaps I didn’t make It clear enough just how much of a last resort formula should be (I may go back and edit, actually!). I do understand the risks of formula to the virgin gut of the newborn, as well as possible allergic reactions (and setting baby up for allergies later in life). All that said, I see lots of moms whose babies are severely underweight and it’s scary! They are usually 2-4 weeks old, and are either still losing weight or barely back to birthweight. Some of these moms are already pumping (maybe not as efficiently or as often as they should be), and donor milk is not available. Maybe in a few days time, their supply will increase or they will be able to get some breastmilk from a donor, but in some cases, the baby can’t wait. And a healthy baby will not only be a better nurser, but will give the mother a bit of relief so she can do what she needs to do to increase her supply and make breastfeeding work. And of course there are the mothers who will never be able to have a full supply, and formula saves their breastfeeding relationship. Anyway, I agree that there is a potential for my article to be misunderstood, and I have tried my best to make it clear that moms who are struggling with this issue should be seen by an IBCLC, as these cases and complex and there isn’t one answer for all moms and babies. But I do share your concerns and I thank you for your feedback!

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  • I had a breast reduction surgery when I was 18 years old. 8 years later, my midwives told me that I would likely not exclusively breastfeed because the surgery typically damages too much tissue.

    We didn’t have much of a plan in place as I was pretty determined to breastfeed. When my daughter was born, she was on the lower side of a healthy birth weight, she had the cord wrapped around her neck and she wasn’t breathing well. They immediately took her away from me for the next 2 hours. By the time that she was returned to me, she was very lethargic and it was difficult to get her to latch for more then 1 or 2 minutes at a time.

    By day 3, she had lost 11% of her body weight and was still jaundiced. At that time my midwife recommended supplementing with formula. It was what I had been dreading. My body could not give my baby what she needed. I alone could not sustain her and keep her alive. Of course, my baby’s needs will always come before my own, so we began supplementing.

    I would struggle to wake her up enough to nurse her for a few minutes, then I would pump, feed her the pumped milk out of a shot glass (so as not to cause nipple confusion), then top her up with formula out of the shot glass as well. After 24 hours, she had gained over 9 ounces.

    After 48 hours, she was an entirely different baby. She was eager at the breast, demanding to be fed, for 20-30 minutes at a time! I continued to pump, slowly pumping from 1/2 ounce to 2 ounces. The first time I pumped 3 ounces after a feed I cried. Before I knew it, she was refusing the formula top up. With the help of our midwives and IBCLC, we were exclusively breastfeeding!

    Without supplementation, my child would have been very hurt or worse! I am so happy that it helped us on our breastfeeding journey! She is now a very healthy and happy 11 month old and is loving solid food with no sign of stopping nursing any time in the very near future.

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  • This is exactly what is happening to me and my second baby! I exclusively breastfed my first with not too much trouble apart from the fact he was constantly at the breast the first 2/3 months.
    My second is now 2 months and was gaining very little weight although he was also very very often breastfeeding (but obviously not efficiently!). We just had to stay 2 nights in hospital because he got diarrhea and they wanted to monitor him to make sure he didn’t dehydrate. Although I had given him supplements of formula almost from his first week I was trying to give as little as possible to not “mess up my supply”. Obviously when in hospital they told me we would have to boost him with a lot more formula I broke down in tears thinking it was the end of that for us. I obviously pumped as much as I could while I was there and now that we’re back home and my baby is already looking more healthy and round I realize how important this supplementing can be. He actually seems to nurse more efficiently now because he’s not so tired ALL the time (exactly like you say in your article). I wish I had read this before (and listened to my mum) instead of all the articles saying to NEVER supplement a breastfed baby if you want it to work. In our case, it might actually work thanks to supplementing…!!!

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    • Hi! I’m so glad you’re feeding him and that he’s feeling better. Definitely pump and try to feed him your pumped milk as much as you can (obviously superior to formula and keeps up your supply). Just do your best. A fed baby most important. BUT I would recommend trying to figure out why he’s not getting enough at the breast. I highly recommend a meeting with an IBCLC. xoxo

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