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