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

Gerber to the Rescue (Or So They Want You To Think)

We’ve all been there. 

You’ve been home with your new baby for a few days/weeks.  It’s 2am and you’re tired and overwhelmed.  You’ve never felt such bone-aching exhaustion.  All you want to do is crawl in bed and sleep uninterrupted.  Just for a few hours…. even ONE hour.  But your baby is crying and won’t stop.  You’ve tried everything – a fresh diaper, breastfeeding, you’ve shushed, swaddled and swung to the point of fatigue.  And the baby won’t stop crying.  You’ve woken your partner, called your mom or sister and none of the advice is helping.  You’re worried that you’re doing something wrong or that you’re doing nothing right, that something is wrong with your little one, that you’re not making enough milk.  You’d try almost anything at this moment to soothe your baby’s distress.

It’s exactly this vulnerability that formula companies prey upon when they make commercials like the one below:

The commercial for Gerber claims that the specially-created formula is effective in calming ‘excessive crying and colic.’  Nothing is more upsetting to a mother than the sound of her baby crying – we are biologically designed to physiologically respond to our own children’s sounds of distress, to do whatever we can to stop the baby from crying.  Gerber is just PRAYING that a frustrated and exhausted mother will see this commercial and think that this new formula the answer to her struggles.  Some moms may decide to introduce the formula to an exclusively breastfed baby, initiating the slippery slope of decreased supply and increasing ‘need’ for supplementation - just what formula companies are hoping for.

What Gerber fails to mention in the commercial is that the probiotic they have included (L. reuteri) has been studied and shown to exist in breast milk.  Or that breast milk also has all the calories, protein, fat, carbohydrates and vitamins that your baby needs – AS WELL as antibacterial, antiviral, and antimicrobial factors specifically formulated to protect your baby.  That breast milk contains all the probiotics AND prebiotics your baby may need.  Or that human milk changes in composition as the baby grows, continually providing a unique superfood specific to YOUR baby. 

Gerber also doesn’t explain to the new mom why her baby may be crying.  The first three months of a baby’s life is often called the “fourth trimester” and should be treated as such.  Just days ago, your baby was safely tucked in your womb, with constant warmth and soothing sounds and movements.  Upon birth, the baby is thrust into his new environment, which is often cold and bright and always unfamiliar.  Gerber doesn’t share the statistic that babies who are worn 3 or more hours a day cry 50% less than babies who aren’t.  Gerber doesn’t remind the new mom that her 2-week old baby may be experiencing a growth spurtand the constant nursing and fussiness is a normal part of this, that the baby is doing all he needs to boost mom’s milk supply as he grows big and strong.  Gerber doesn’t educate the mom on what she can add to or remove common allergenic or inflammatory foods (such as gluten, dairy, and soy) from her own diet to help soothe a colicky baby. (Check out our Boob Group podcast episode: GERD, Reflux and the Breastfed Baby for an explanation on symptoms, causes, and remedies for GERD, reflux, and colic.)

There are many reasons for a crying and colicky baby, and a number of solutions.  One action that is never the answer is replacing any amount of breast milk with an artificial milk.  Shame on Gerber for suggesting to an unsure and overwhelmed mother that her breast milk is lacking in something that could soothe her crying baby!

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! 

Does A Free Can of Formula Really Benefit Anyone?

Just last week, the American Academy of Pediatrics approved a resolution that advised pediatricians not to provide formula company gift bags, coupons, and industry-authored handouts to the parents of newborns and infants in office and clinic settings.

In their rationale, they explained that: Research has demonstrated that the free distribution of commercial materials, such as formula samples, diaper bags, formula coupons, or other gifts via commercial infant formula marketing implicitly endorses formula feeding and creates the impression that clinicians favor formula feeding over breastfeeding, and research demonstrates that this activity decreases exclusivity and duration of breastfeeding.

Enfamil bag with free formulaSo, how does this really affect both breastfeeding moms and formula-feeding moms? 

Does a can of free formula really benefit anyone?

To answer this question, I had to combine my Lactation Consultant (IBCLC) training with my mom-who-had-to-use-formula opinion.  After much thought, my answer was a wholehearted NO!  I absolutely believe that free formula at the pediatrician office does not truly benefit either the breastfeeding mom nor the formula-feeding mom.

And here is why….

1. As newly breastfeeding moms, we are constantly self-doubting our supplies and our capabilities to fully nourish our babies.  I mean, without a scale, we really don't have an accurate way of knowing how much our babies are taking from the breast.  When we receive a free can of formula from our pediatrician, it is as if that highly respected person in our community somewhat doubts our capabilities as well.  If this statement was untrue, then why do we have so many mothers in the United States who are not meeting their personal breastfeeding goals, even at three months postpartum?  

This thought was further substantiated when I brought up this AAP resolution during my most recent recording of The Boob Group radio show on Saturday.  The three panelists (breastfeeding mothers) said that they had never considered using formula until the free sample was staring them in the face during a growth spurt or during a particularly long cluster feeding session.  While all three moms decided not to use it, they claimed that it definitely was a consideration during these times when they were questioning whether their babies were getting everything they needed from their breasts.  Fortunately they were surrounded by breastfeeding-supportive friends and family to substantiate that they were doing a fantastic job at breastfeeding.

2. The Affordable Care Act, which will come into full effect on August 1, 2012, is requesting that American insurance companies cover lactation support (provided by an IBCLC).  What does this mean for the new mom?  This means that the Unites States government feels that breastfeeding is so important that it wants you to get all of the assistance you need to make it work, and will cover it under your insurance plan.  If struggling moms can have access to the breastfeeding help they need, then free formula is not super necessary at the pediatrician’s office

3. Formula marketing in breastfeeding pamphlets is not inadvertent.  The purpose is to advertise their formula products.  When pediatricians use breastfeeding pamphlets from breastfeeding-supportivecompanies, THEY are advertising that they are fully invested and supportive of breastfeeding and will do everything they can to help a mom meet her personal breastfeeding goals. Free pamphlets written on a formula company’s letterhead sends quite the opposite message. 

4. If formula is medically necessary (such as when a mom’s supply is not fully meeting her baby’s nutritional need and she doesn’t have donor milk), and free formula is not an option, then pediatricians may now be more willing to refer this mother to an IBCLC.  Without free formula, the parents are now fully responsible to go to the store, purchase the formula, and follow the pediatrician’s recommendations.  Instead, if these parents are under the care of an IBCLC, the baby will be fully monitored and the parents will be carefully instructed on how to use the formula AND protect the mother’s milk supply.  Also, the IBCLC will hopefully be able to identify the root of the breastfeeding challenge, rather than placing a Band-Aid (formula-supplementation without protecting mom’s milk supply) on the situation. 

5. If formula is needed or desired, it is readily available pretty much all hours day and night.  Lack of a free formula sample is not going to hinder a formula-feeding mom’s access to feeding her baby.   

6. If a mother chooses to formula feed her baby, then she is already purchasing formula from a store or online anyway.  The free container from the pediatrician is not going to make a substantial reduction in her formula budget, so it doesn’t really help her out either.

7. Check out when this policy is actually put into practice!  In 2009, the California WIC agency changed its formula-giving policy so that there was no routine issuance of formula in the first 30 days for breastfeeding infants and individual assessments of mother and baby were conducted for breastfeeding concerns and problems immediately postpartum and at the first postpartum visit.  Within 6 months after implementation of these changes, the rates of food packages for fully breastfeeding infants increased by a very impressive 86 percent. (WIC Works: Policy Changes Raise Breastfeeding Rates)

So, what do you think? 

I know, I know… Whoopi is definitely not going to LOVE this policy.  

This is the deal, though.... This resolution is not about discriminating against formula-feeding moms.  It is about removing a sabotaging element from breastfeeding mothers' lives.   Banning free formula and formula marketing in pediatricians' offices may truly help a few moms find the support they need to meet, and surpass, their personal breastfeeding goals.