The Breastfed Baby
Reasons to Supplement, Reasons
Given to Supplement, But No Real Need, Choices
in Offering Supplements, Weaning
It is rare for the healthy, full term newborn to
need to a supplement. The AAP
policy for breastfeeding mothers on "routine supplementation"
states: (#4 in policy statement):
"No supplements (water, glucose water,
formula, and so forth) should be given to breastfeeding newborns
unless a medical indication exists.92-95 With sound breastfeeding
knowledge and practices, supplements rarely are needed. Supplements
and pacifiers should be avoided whenever possible and, if used
at all, only after breastfeeding is well established.93-98 "
Most mothers do not - or should not - need to worry
about supplementing their babies, but occasionally the need
arises to offer the baby a supplemental feeding. Most experts
agree that the best supplement is mother's own milk. Only rarely
would infant formula be needed over a mother's own milk. If a mother
is concerned about the possible
need to supplement her baby, or if her pediatrician or health
care provider suggests that she supplement, she should contact a
board certified lactation consultant immediately, to help in deciding
what type of supplement is best, if considering
infant formula, what she needs to know before use, and which
method of supplementing would be appropriate for the mother's
NOTE: In the
event of a serious health concern, supplementation should begin
immediately to avoid possible serious health consequences to the
health of the baby. A board certified lactation consultant can help
support mother and provide appropriate and accurate information
regarding necessary supplementation.
Reasons to supplement may include:
*more than 10% weight loss in newborn infant
*no weight gain, or slow weight gain in infant
*serious illness in mother or baby
*physical problems with mother or baby
*separation of mother and baby (employment for example)
*very low birth weight;
*severe dysmaturity with potential severe hypoglycaemia;
*infants with inborn errors of metabolism
*critically dehydrated infants;
*infants whose mothers are taking medication which is contraindicated
breastfeeding, and for which there is no safe alternative
Reasons given to mothers to supplement, but usually
*help to sleep longer or through the night
*topping off a feeding to ensure baby "gets
*getting baby "used to" taking formula
"in case it is ever needed"
*inaccurate info that Breastmilk is "not enough"
nutritionally (i.e. the older breastfed baby)
Choices in Offering Supplements
the need arises to supplement, there are many ways in which
the supplement can be offered. The supplement can be given by cup,
syringe or dropper, finger
feeding, a nursing
supplementer, and of course by bottle.
Mother may want to consider the age of the baby, and the circumstances,
before deciding which method might be best for her and her baby.
How much to supplement can be determined by calculating
how much milk baby needs to take in for age and weight in a 24 hr
the breast works, and what's
normal in the breastfeeding relationship, may help prevent unnecessary
Supplementing can be a very slippery slope. Weaning
from supplements can be an almost overwhelming prospect for a mother.
It is important to remember that if the
supplements have been used daily and for an extended period (not
an occasional supplement) weaning from away from them should be
a gradual process.
Weaning from Supplements
An excellent method for weaning from supplements
is shared here by Kathy
S. Kuhn RN BSN IBCLC and lactation consultant for Parentsplace.com
(understand this is only an example and you should be closely
followed by your pediatrician and hopefully an experienced LC too):
The first thing I would recommend is that
if you have been using infant formula, you start to pump to try
to make as much of the supplement breastmilk as possible. Get an
electric RENTAL pump with a double kit to maximize your pumping.
Every ounce of formula you give the baby is teaching
your breasts not to make that amount of breast milk. If you give
10oz a day of formula your breasts will make 10oz less than your
baby needs, unless you are pumping 10oz. (and of course if you
were pumping 10oz you would be giving that instead of the formula)
The breasts know how much to make by how much is taken out of
The supplements should not be dropped suddenly since that would
put baby at risk for not gaining and would not give your breasts
a chance to make up the difference. But if your baby is bf well
what you need to do to increase the supply is slowly reduce the
supplements. Here's the method I use with moms in similar situations
Start recording the amounts you give via the bottle and total
it each day so you know how many ounces per 24 hours you give
via the bottle, record how much is ebm and how much is formula.
Also, record the wet and soiled diapers. As you increase the breastmilk
and reduce the formula your baby will probably start to poop more
since breastmilk will loosen the stools.
After you have an idea how much he gets each day via bottle start
to systematically reduce that amount, starting with reducing the
formula first(reduce the ebm via bottle last). So, for example:
if baby gets 10oz of formula and 4 oz of ebm per 24 hours via
the bottle his 24 hours total is 14oz of supplement. You should
of course continue to put him to the breast as much as possible
during this process, at least 8 times in 24 hours.
On day 1 to 3 give him only 13oz via the bottles in 24
hours, give whatever you have of ebm and make up the difference
with formula..so it might be 4oz of ebm and 9oz of formula. Don't
give more keep putting him back to the breast if he needs to eat
If his diaper count does not reduce from what it has been, on
days 4-6 give him only 12 oz of milk in bottles per 24
hours. Say you have 5oz ebm and 7oz of formula each day.
Again if the diaper count stays the same or more drop more from
the daily 24 hour total of bottled milk, and you can start to
increase the rate if it is going well for example to 10oz on days
6-7, maybe 6oz would be ebm and 4oz of formula.
Continue to reduce the daily total in the bottles by about 1-2
ounces every 1-3 days as long as the diaper count is good. When
reducing the 24 hour total you can reduce the amount in each bottle
or reduce the number of bottles or a combination of both...the
important factor is reducing the 24 hour total.
When you get to the point that it is only ebm in the bottles you
can drop the bottles much faster. This is a flexible process,
you can reduce the amounts in the bottles faster if it is going
well and the diaper count and weights are good or reduce more
slowly if it seems as though the diapers are dropping and the
weights are not as they should be. But you must keep good records
so you know where you are in the process.
You should also get the baby weighed AT
LEAST every week or more frequently as the ped recommends
until the transition to the breast is complete and then one more
weight check one week after the baby is totally on the breast.
That way you will be reassured the baby is "getting enough"
through this process and have the confidence to keep reducing
Sources for above info include but are not limited
WHO Baby-Friendly Hospital Guidelines; Breastfeeding
Answer Book, LLL, Breastfeeding and Human Lactation, Riordan & Auerbach