Reasons to Supplement, Reasons Given to Supplement, But No Real Need, Choices in Offering Supplements, Weaning From Supplements

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 individual circumstances.

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

*breast refusal

*separation of mother and baby (employment for example)

*adoption

*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 when
breastfeeding, and for which there is no safe alternative

Reasons given to mothers to supplement, but usually NOT needed:

*Jaundice

*help to sleep longer or through the night

*topping off a feeding to ensure baby "gets enough" milk

*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

If 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 period.

Understanding how the breast works, and what's normal in the breastfeeding relationship, may help prevent unnecessary supplementation.

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 breast.

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 (as mentioned):

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 more.

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 the bottles.

Sources for above info include but are not limited to:
WHO Baby-Friendly Hospital Guidelines; Breastfeeding Answer Book, LLL, Breastfeeding and Human Lactation, Riordan & Auerbach