I'm Told that my Breastfed Baby Needs to be Supplemented.... What Should I Do?

Being told that your breastfed baby needs to be supplemented can feel extremely overwhelming and can often feel like quite a blow to the self-esteem.  You might be concerned about your milk supply and if your baby will prefer the bottle to your breast. You may feel confused as to why your baby isn’t gaining the appropriate amount of weight while breastfeeding.  

So, let’s talk about the reasons why a baby might need to be supplemented and how to do this without sabotaging your milk supply and your breastfeeding relationship.

What is a supplement?

A supplement is anything in addition to what your baby receives from your breast while breastfeeding.  Babies can be supplemented with: 

Mom’s own pumped milk (if baby is not removing her milk well enough)

Donor milk (from a milk bank or from another breastfeeding/pumping parent)

Formula

How do I know if my baby truly needs supplemental feedings?

Babies are expected to gain a certain amount of weight based on their age.  So, if a baby is NOT gaining that expected amount, additional supplementation is often recommended.  Here are the weight gain expectations for the first year of baby’s life:

Initial weight loss in the first few days of life - no more than 10% of baby’s birth weight

2 weeks - baby should be back to birth weight (or very close, if he/she lost more than 10% in the first 2 weeks

2 weeks - 4 months - baby should gain about 7 ounces per week

4 months - 6 months - baby should gain about 4-5 ounces per week

6 months - 1 year - baby should gain about 2-4 ounces per week

Why might a baby need to be supplemented?

There are many common reasons why a baby might need supplemental feedings.  

Some common medical issues that can arise shortly after birth that may lead to supplements are prematurity, low birth weight, poor feeding, low blood sugar levels (hypoglycemia), elevated bilirubin levels (jaundice), dehydration, excessive weight loss or poor weight gain.  After those first few weeks, some common reasons for supplementation are baby not removing milk well while breastfeeding (due to tongue tie, reflux, very long feeding sessions) and a low milk supply. In all of these cases, the first step is to ensure that baby is breastfeeding effectively.  Next we want to assess mom’s milk supply to make sure that she is producing enough milk for her baby. Sometimes all it takes are a few modifications to the baby’s feeding routine to help baby start to gain weight. Other times it requires a lactation consultation (done by an IBCLC) to assess baby’s feeding and mom’s milk supply for the cause for baby’s low weight gain.

What if I can't express enough milk for my baby?

First you’ll want to make sure that you have everything you need to express your milk.  If using an electric pump, make sure the pump flanges fit correctly and that you are pumping for about 15 minutes after breastfeeding.  Some moms let down for the pump easily. Others find that they prefer a hand pump or hand expression. You will want to find what works best for you.

In those first few days after birth (when milk production has not quite yet surged), it can be a bit challenging to express a measurable amount of milk.  In this case, sometimes baby might need to be supplemented by donor milk or formula.

Once your mature milk is in (after those first few days), you might want to meet with an IBCLC to put together a breastfeeding/pumping plan to see if you are able to express enough milk for your baby, as well as increase your milk supply, if necessary.  If you are not yet able to express enough milk for your baby’s supplemental feedings, donor milk or formula would be recommended.  

Do I have to use a bottle when giving my baby supplemental feedings?

Not at all!  There are several ways to supplement a baby.  Each way has its pros/cons and will be determined by what works best for you and your baby.

Cup feeding is great for older babies, as well as some younger babies who will not take a bottle

Finger feeding is great for the first few weeks of life, as the flow is slow and your finger can help organize your baby’s sucking rhythm.

Supplemental nursing systems (SNS) allow your baby to be supplemented at the breast so that he/she still thinks everything is coming from you!  The SNS has a tube that slips into your baby’s mouth, at the breast, to provide the supplement at the same time baby is breastfeeding. This works best when baby is latching/breastfeeding well and mom is trying to increase her milk supply.

Bottles are definitely an option, as well.  You will want to offer a bottle in a baby-led (paced) manner so that your baby doesn’t begin to prefer the ease and flow of the bottle, compared to your breast.

Will my baby ever be able to fully breastfeed after supplements?

Generally, the answer to this is YES!  Most reasons for supplementation are short-term problems that are resolved relatively quickly with good treatment.  Premature babies grow and get stronger, and typically get better at breastfeeding around their due dates or shortly after.  A baby who is having difficulty with breastfeeding immediately after birth will often be ready for breastfeeding within a few days after birth.  If breastfeeding challenges linger for more than a few days, an IBCLC can help identify the reasons and set you on a path for reducing and hopefully eliminating supplementation as soon as possible. In the meantime, expressing your milk in addition to breastfeeding will help maintain and build your milk supply as challenges resolve.  

When can I stop supplementing?

Part 2 will discuss how you’ll know it's time to wean from supplements and helpful tips for doing so. 

For more information about supplementation reasons, methods, and choices, check out these The Boob Group podcast episodes: 

Exclusive Breastfeeding and Early Supplementation 

Breastfeeding the Jaundiced Baby

When Breastfeeding Doesn’t Go As Planned 

Low Milk Supply: Donor Milk, Milk Banks, and Formula

Partial Breastfeeding: When Supplements are Needed

Supplement Options: Donor Breastmilk, Milk Banks, and Formula

This past week, we released one of my most favorite episodes on The Boob Group: Low Milk Supply: Donor Milk, Milk Banks, and Formula.  I had the esteemed pleasure of interviewing Amber McCann, an International Board Certified Lactation Consultant, fierce supporter of all things mothering, and dear friend.  I wanted to know what options were out there for mothers who needed to supplement their babies, as well as the pros and cons of each.

I pulled out the most salient points for this blog article, but you can click here to listen to the Boob Group episode in its entirety: Low Milk Supply: Donor Milk, Milk Banks, and Formula.

What are your options if you need to supplement your baby?

When feeding an infant, the World Health Organization lists a hierarchy:

• Milk taken directly from the mother’s breast
• Expressed milk from baby’s mother
• Expressed milk from another mother (wet nurse, donor milk, milk from a milk bank, etc.)
• Breastmilk substitute (formula)

Is it safe to offer your baby another woman’s breastmilk?

Making the decision as to what to feed your baby should never be taken lightly.  It is important when one is considering offering donor breastmilk to their baby to balance the risks and benefits.  You should always consider asking the potential donor mom for a copy of her prenatal blood work to check for sexually transmitted diseases and other potential pathogens.  It is also important to ask questions about lifestyle choices, such as alcohol use, smoking, diet, medication use, etc.  Eats on Feets has a Resource Guide with great lists of questions for both the donor and recipient of expressed breastmilk, as well as an extensive list of health considerations.

What are the main benefits of using donor milk?

• It’s breastmilk!  It has everything your baby needs, nutritionally and immunologically.
• It has every benefit that a mother’s own milk would have.

What concerns may arise when using donor milk?

• A number of pathogens enter into human milk if a mother is infected, however few diseases can be transmitted through human milk, itself. 
• The main diseases that cause concerns are HTLV, HIV, and CMV.  CMV is typically only a challenge for premature infants.  Fortunately, HTLV can be deactivated by freezing and HIV by flash heating.

Where can a mother find someone to donate milk?

• Start with your own social group.  If you have friends or friend of friends who are breastfeeding, there is always a chance that they or someone they know has an excess supply in their freezer or would be willing to pump for you, if they knew there was a need.  All you have to do is ask!
• Informal milk groups, such as Eats on Feets and Human Milk for Human Babies
• Milk Banks

What are milk banks?

Milk banks are non-profit organizations where breastfeeding moms can donate breastmilk, should they fit the milk bank’s criteria.  The Human Milk Banking Association of North America requires that their donors be in good health, not regularly on most medications or herbal supplements, willing to undergo additional blood testing, and be willing to donate at least 100 oz.  Donated human milk is pasteurized and then either sold to hospitals to feed critically ill babies or to families who purchase directly from the milk bank. 

How should I choose between donor milk, milk from a milk bank, or formula?

This is such a hard decision and definitely not one to take lightly!  What is most important is to look at your needs, your baby’s needs, what you feel most comfortable supplementing with, and what’s the best choice for your family.  So, sit down, research all of your options, and choose with your heart and knowledge. 

As a follow up to this article, several moms submitted stories about their experiences using donor milk or donating to a friend or milk bank.  Stay tuned, as we share them during the rest of the week!

If you have a story about using donor milk or donating breastmilk to a friend or milk bank, and you want to share it with our readers, please email it to me at robinkaplan@sdbfc.com.

Did you have to supplement your baby with donor milk, milk from a milk bank, or formula? 

How did you choose which supplement to use?

Update on 2013-01-24 15:36 by Robin

Here's your Call to Action:

Too many breastfeeding mothers have no idea that human milk sharing is an option and we want to change that!

If you are a breastfeeding mother and have used donor milk or have donated your own milk, we would love to hear your story!  Other breastfeeding moms need your support!  Just knowing that someone else out there went through a similar experience.... well, that can make all of the difference in how a mother views her own breastfeeding experience!  Your stories are beyond powerful!  They need to be heard!

If you would like to have your stories posted on our website, as well as The Boob Group's website, please send your story to robinkaplan@sdbfc.com.  

We will begin posting your stories as soon as we receive them!