How Do I Wean from Supplementing my Breastfed Baby?

This is Part Two in our supplementation series.  Don’t miss Part One: I’m Told that my Breastfed Baby Needs to be Supplemented…. What Should I Do?

One of the most challenging aspects of supplementing your breastfed baby is knowing when and how you can reduce or completely stop that supplementation.  You will want to work with your pediatrician and an IBCLC to help fine tune this process for you and your baby, but here are some general guidelines.

The reason you were supplementing may determine when you can stop

Early supplementation in the first few days after your baby was born may have been recommended to help resolve a temporary medical situation, such as jaundice, hypoglycemia, or excessive weight loss.  Typically, once your milk supply has fully ‘come in’ and baby is gaining well, supplementation can stop. Longer-term supplementation, such as for a premature baby, baby with feeding challenges, or a breastfeeding parent working to increase milk supply, will likely require a longer weaning process.  In both cases, though, watching the baby for signs of effective breastfeeding will be an important part of baby's care.  

How do I know if my baby is breastfeeding well?

There are quite a few ways we can tell that a baby is breastfeeding well

• Baby actively feeds for 20-40 minutes, seems satisfied after eating, and can go about 2-3 hours between most feedings

• Breastfeeding is comfortable and your breasts feel softer after your baby has fed

• Diaper count - Babies in the first few weeks to months should pee/poop at least 5 times a day.  As babies mature, so do their digestive systems. After the first few months, babies often continue to pee at least 5 times daily, but poop frequency may drop to 1-2 times daily

• When you weigh your baby before and after a breastfeeding session (like with a gram-sensitive scale at a breastfeeding consultation or support group), your baby is taking in an appropriate amount for his/her age and weight.

• Weight gain - Baby is gaining the appropriate amount of weight based on his/her age  
  

What is the best way to wean from supplementing my breastfed baby?

As your baby begins to breastfeed more effectively and transfer more milk from you while breastfeeding, you might also notice that your baby begins to refuse supplements (or just takes less) after breastfeeding.  If your baby is gaining weight well, then you might consider offering less of a ‘top off’ after breastfeeding and see if your baby continues to gain weight well. If your baby is gaining more weight than expected for his/her age, this is also a reason to pull back on supplementation.

To wean from supplementing your baby, you will want to either reduce the amount of supplementation after each breastfeeding session or cut back on how often you supplement during the day.  Try this reduced supplement amount for a few days and see if your baby still seems satisfied after eating throughout the day and night, as well as check your baby’s weight to make sure he/she gained enough over that time period.  If weight gain is still more than needed/expected and your baby seems satisfied after eating, continue to pull back on the amount of supplement per day until you reach a point where you have either cut supplementing completely or dropped down to your baby’s sweet spot.

While reducing the supplementation amount, this also means that you might be able to cut back on the number of times you pump per day, which is what every parent wants to hear, right?  A lactation consultant can definitely guide you on this process so that your milk supply isn’t lowered with this decrease in pumping frequency.

What if I am unable to wean from supplementing my baby?

There are some situations when a breastfeeding parent may not have a full milk supply and will need to supplement long term.  Working with a lactation consultant can be very valuable during this process to help maximize your milk supply potential, as well as discuss options for long-term supplementation.  

It is incredibly important for any parent needing to provide long-term supplementation to understand that EVERY drop of breastmilk you produce for your child is valuable.  You are creating a perfect food for your child, as well as providing amazing immunity-boosting benefits that only YOU can create. Your milk was meant for your baby and breastfeeding does not have to be all or nothing.  While it can feel absolutely heartbreaking to hear that exclusive breastfeeding may not be a possibility, I’d like to share a beautifully written breastfeeding memoir on our website.  The author, Aran, brilliantly coins a new term, ‘Inclusive breastfeeding’, which helps put all of this breastfeeding and supplementation into perspective.

 So, what additional questions do you have about weaning your breastfed baby from supplements?  Feel free to add a comment here and we will gladly offer advice!

And, if you need some guidance on how to navigate your supplementation journey, book an appointment with us, as we would love to help!

To book an appointment at the San Diego Breastfeeding Center, click here!

If you don’t live in San Diego and would like to book a virtual consultation, email Robin at robinkaplan@sdbfc.com

If you are looking for a lactation consultant in your area, click here for ILCA’s Find a Lactation Consultant Directory

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