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

Breastfeeding Your Baby with Jaundice

Written by Danielle Blair, IBCLC

The term jaundice gets used a lot regarding babies.  It can have many different meanings depending on the context.  From the Mayo Clinic website:

“Infant jaundice is a yellow discoloration in a newborn baby's skin and eyes. Infant jaundice occurs because the baby's blood contains an excess of bilirubin, a yellow-colored pigment of red blood cells.”

Types of Jaundice 

Baby's livers are immature, and they may not break down the bilirubin efficiently after birth.  Some amount of jaundice is considered normal for healthy babies.  We expect the bilirubin levels to rise slowly in the first several days after birth before peaking and then decreasing.  This type of jaundice is called “physiologic jaundice” and typically requires no treatment other than good feeding management.  Physiologic jaundice can be intensified in breastfed babies by mild dehydration that often occurs before milk volumes increase, which then can lead to “breastfeeding jaundice”.  In the case of physiologic or breastfeeding jaundice, the baby's skin may appear slightly yellow, often just on the face or torso.  A second peak of jaundice known as “breast milk jaundice” may occur during the second week of life.

In some cases, bilirubin levels rise very rapidly in the first 24 hours after birth.  This is not considered normal and can be a sign of infection or improper liver function, and merits immediate evaluation by a doctor.  Babies born before 38 weeks gestation, babies with bruising from delivery, babies with different blood types than their mothers (also known as ABO incompatibility), and breastfed babies are at increased risk of clinical jaundice.

Test for Jaundice

Bilirubin levels are determined by blood testing.  The levels that are considered normal depend on the baby's relative risk of jaundice and the number of hours since birth.  For example, a premature baby will be considered clinically jaundiced and require treatment at a lower bilirubin level than a full-term baby.

Treatments for Jaundice

If bilirubin levels rise very quickly after delivery, a baby may be monitored closely for good feeding, and may need treatment such as phototherapy (often called “bili lights”) or assistance with feeding to ensure that the baby takes in enough fluids to flush out the bilirubin.  A baby with very high bilirubin levels will likely have very yellow or orange colored skin from head to toe.  He may be very sleepy and feed poorly.  In rare cases, prolonged high bilirubin levels can cause brain damage.  This is why some cases of jaundice may require treatment.  

If your baby has elevated bilirubin levels, you may be encouraged to breastfeed more frequently, to use breast compressions to help baby take in more milk, or to offer some expressed breastmilk in addition to breastfeeding.  

For the baby who is not feeding well or is very sleepy, expressing milk and feeding in another way, such as by spoon, dropper, tube/syringe, or bottle, may be a temporary solution to help baby take enough milk volume to prevent severe jaundice.  Offering expressed milk in addition to breastfeeding can also help keep bilirubin levels under control in high-risk babies.

If better feeding management does not work, your baby may need phototherapy to help break down excess bilirubin in the bloodstream.  A “bili blanket” is a pad with UV lights that is wrapped around the baby, allowing baby to stay with mom and continue breastfeeding.  “Triple lights” are arranged in an isolette to allow as much of baby's body as possible to be exposed to the UV lights to bring down elevated bilirubin levels as quickly as possible.  For triple lights, a baby will typically be admitted to a NICU or special care nursery.

Sometime supplementation with formula is necessary to keep a jaundiced baby well-hydrated and to help treat the jaundice.  Formula should only be used if an insufficient volume of breastmilk is available.

Also, don't forget to check out our Boob Group podcast episode, Breastfeeding the Jaundiced Baby

Breastfeeding Misconceptions: Does Baby Weight Loss Mean Mom Doesn’t Have Enough Milk?

How many times have you heard a so-called ‘fact’ from a family member, friend, healthcare professional, or online resource that has your ‘mama-radar’ going off at warp speed?  Maybe something just doesn’t sound right.  Maybe it goes against all of your mama-bear instincts.  Maybe it is completely contradictory to what you heard the previous day.  Well, it’s time to start busting those myths and misconceptions! 

Today, we start our new series called Breastfeeding Misconceptions. 

Every month we will be BUSTING common breastfeeding myths and misconceptions, hopefully making your breastfeeding experience that much easier!

Myth #1: If your baby loses weight in the first week, it means your milk supply is low. 

Not true!

 

All babies lose weight after birth:

A newborn baby takes in approximately 5-7ml of colostrum per feeding in the first 24 hours.  Babies are burning more calories than that as they attempt to breastfeed and expel that sticky, gooey meconium.  Nature has provided the perfect amount of colostrum in those first few days to nourish your baby and while the quantity is small, the quality is jam-packed with every calorie, immunological property, protein, vitamin, and laxative that your newborn needs to poop and pee.  Babies are expected to lose weight in those first few days.  That doesn’t mean that mom’s supply is low.

Babies typically lose weight until mom’s ‘fuller milk’ comes in:

The amount of colostrum continues to grow as your milk transitions to ‘fuller milk’, which comes in around 2-5 days (depending on baby’s access to breast, effective sucking, birth interventions, etc.)  Typical colostrum amounts are about 5-7 ml per feeding in first 24 hours, 7-15ml per feeding from 24-48 hours, and 22-27ml per feeding from 48-72 hours.  Your baby will most likely lose weight until your ‘fuller milk’ comes in, but that doesn’t necessarily mean that you don’t have enough milk.  What parents want to look for is that their baby is peeing and pooping (at least 1 of each per day of life) and baby’s weight loss plateaus once mom’s fuller milk has come in. 

Here’s a great graphic of a baby’s stomach from Babies First Lactation and Education

Delayed milk supply doesn’t equal low milk supply:

There are several situations where a mother is at a higher risk for a delayed milk supply.  As mentioned in this Best for Babes article, there are a number of factors that increase a mother’s risk for delayed milk supply.  Some are beyond our control (or difficult to control): diabetes, obesity, thyroid problems, hypertension, PCOS, preterm birth, and anemia.  There are also factors related to birth that can influence when a mother’s fuller supply comes in: cesarean birth, receiving lots of IV fluids, prolonged pushing stage, stress, cascade of interventions, hemorrhaging, mother-baby separation, just to name a few.  If you are at a higher risk for having a delayed milk supply, it can be very helpful to speak with a lactation consultant within the first 24 hours after your baby is born.  She can teach you ways to hand express and pump to help speed up the process of your fuller milk coming in, thereby DECREASING your risk for a low milk supply.

Lots of fluid during labor can cause greater weight loss in babies:

Studies have shown that mothers who have long periods of birth interventions (epidural, Pitocin, eventual emergency cesarean, etc.), tend to have more fluids during labor, thereby inflating baby’s birth weight and causing a large drop in baby’s weight in the first 24 hours.   In those first 24 hours, we are looking for 1 pee and 1 stool (as a minimum.)  For those babies that pee and stool multiple times in the first 24 hours, their weight loss is going to be greater, but that is not an indicator that mom’s supply is low. It just means they had a lot of fluids to expel after birth.  Here are a few articles that explain this phenomenon. Dr. Jen: Newborn Weight and The Boob Group: Birth Interventions and Their Impact on Breastfeeding.  

Baby may lose weight (or gain weight really slowly) because they are having a difficult time transferring mom’s milk:

There are many reasons why a baby might lose weight, sometimes continuing past the first week of life, even when mom has a full supply.  Some of these include: engorgement (causing baby to have difficulties latching on), tongue-tie or lip tie, baby is recuperating after a difficult labor, baby is jaundiced, premature baby, etc.  Again, when baby is losing weight due to these situations, it doesn’t always mean that mom’s supply is low. If her baby is having a difficult time transferring milk, then she should definitely meet with a lactation consultant to make sure she is doing everything she can to protect her milk supply until her baby can start to efficiently transfer milk from her breast.

Supplementation doesn’t equal formula:

If your milk supply is delayed, if your baby has elevated bilirubin, if your baby has lost more than 10% of his/her birth weight, that doesn’t automatically equal FORMULA supplementation.  Mom may actually have enough of her own milk to supplement her baby with until baby’s weight is back on track.  All she has to do is hand express or pump and see what extra she has.  If mom doesn’t have enough of her own milk to supplement, then the hand expression or pumping (in addition to breastfeeding) will help to bring in her milk supply more fully.  In the meantime, moms have other options.  A mom can use milk bank breast milk or donor milk, if she prefers.  For terrific information about milk banks, check out Human Milk Banking Association of North America and for milk sharing, check out Eats on Feets.  The most important take away of this all…. When supplementation is necessary, it is imperative for a mom to increase her breast stimulation to help bring in her supply more fully.  When her baby is getting a supplementation from another source, it is saying to mom’s body that she doesn’t have to make that amount of milk, which is totally not the case.  The sooner mom’s fuller milk comes in, the sooner supplementation can decrease, so spend the extra time and effort… it will be worth it in the end.

Important note: When you might become concerned about your milk supply

While all of the above statements should illustrate why a mother should not be told that she has a low milk supply early on, there are some situations that might indicate that mom has a low milk supply (either temporarily or more long term.)  If you are experiencing any of these situations, please connect with an IBCLC as soon as possible, as sometimes this can be a very temporary situation, as long as measures are taken quickly to protect mom’s milk supply.  Here are some indicators that mom’s supply might be low:

• Breasts did not grow and/or areola didn’t get darker during pregnancy

• Breasts don’t feel heavier or fuller by 5-7 days postpartum

• Fuller milk hasn’t ‘come in’ by 5-7 days postpartum

• Baby is continuing to need supplementation to gain weight and mom is not making enough to supplement with her own milk

• Mom has insufficient glandular tissue