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!