Booby Trap Series: If you need to supplement with formula, avoid these Booby Traps

This post is the 58th in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

Sometimes supplementing a breastfed baby is necessary in the early days and weeks after birth.*

When it is, it’s also necessary to protect breastfeeding.  So, how do you do that, and what are the Booby Traps to avoid along the way?

The Academy of Breastfeeding Medicine (ABM) lays out how to supplement while protecting and supporting breastfeeding in their supplementation protocol.  And some great advice is also contained in The Breastfeeding Mother’s Guide to Making More Milk and at Low Milk Supply.

Unfortunately, not all care moms get is consistent with their guidelines.  So, below are some Booby Traps to avoid if you need to supplement.  Do any of them sound familiar to you?

Booby Trap #1:  Not having an evaluation and plan to “fix” breastfeeding before starting supplementation.  The ABM recommends that supplementation begin in cases of dehydration when the condition “is not improved after skilled assessment and proper management of breastfeeding.” Being instructed to supplement when no one has helped you try to figure out and fix any breastfeeding problems is a Booby Trap.

Booby Trap #2:  Not being allowed to use your own milk as a supplement.  The ABM states, “expressed human milk is the first choice for supplemental feeding” when available.  But many mothers aren’t given the option of using their own milk.  Using pasteurized donor milk is not common practice for healthy, full term babies, but it remains “preferable to other supplements,” according to the ABM.

Booby Trap #3:  Being told to use a breastfeeding unfriendly feeding device.  Your providers can’t really be blamed for this one.  The Booby Trap here is that there is no consensus on which method is best.  The ABM states, “There is little evidence about the safety or efficacy of most alternative feeding methods and their effect on breastfeeding.  An optimal supplemental feeding device has not yet been identified, and may vary from one infant to another. No method is without potential risk or benefit.” A detailed discussion of the strengths and weaknesses of each is at Low Milk Supply.

Booby Trap #4:  Being instructed to use more formula than is necessary.  The ABM states, “As there is no definitive research available, the amount of supplement given should reflect the normal amounts of colostrum available, the size of the infant’s stomach (which changes over time), and the age and size of the infant.”  So being told to give your newborn baby “as much as she will take,” is probably not the right approach and will just result in some dirty laundry.  For older babies, a the ABM provides guidelines based on the available research.

Booby Trap #5:  Not getting support for maintaining and increasing milk supply (if necessary).  The ABM states, “If mother–baby separation is unavoidable, established milk supply is poor or questionable, or milk transfer is inadequate, the mother needs instruction and encouragement to pump or manually express her milk to stimulate production and provide expressed breastmilk as necessary for the infant.”  For older babies who are not gaining weight normally, mothers should receive breastfeeding support and a plan for increasing milk supply, if appropriate, and other recommendations for optimal feeding.

Booby Trap #6:  Not receiving a plan for weaning from formula supplements.  This issue is not addressed by the ABM protocol, but it’s a significant issue in the management of breastfeeding when supplementation is necessary.  Sometimes women are told to go “cold turkey” on formula supplements once a baby is gaining well, only to return to the office with an angry, hungry baby.  Sometimes they’re instructed to continue supplementing longer than is necessary.  A good resource for reducing formula supplements while ensuring normal growth is at

There are other Booby Traps specific to preterm babies.  One of the most obvious is not using donor breastmilk as the supplement.  More Booby Traps in the NICU are here.

Did you have to supplement?  Did you encounter any of these – or other – Booby Traps?  Did your providers help you do it in a way that protected breastfeeding? 

*Of course, the biggest Booby Trap is being given formula when it’s not necessary – a practice of 4 out of 5 hospitals.  See the ABM protocol on supplementation for guidelines indicating when it’s truly necessary.

Image credit:  Wikimedia Commons


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7 Comments | Last revised on 10/23/2012

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