Many care providers advise a new mom to supplement with formula when a feeding-related challenge, i.e., increasing jaundice, arises. We are not saying that you should not use formula, or that you should feel guilty if you do. We do want you to be armed with the facts so that you can make an educated and empowered decision about supplementing and understand its impact on breastfeeding and reaching your goal.
1. It’s often not necessary.
Yes, there are instances in which your baby might need to be supplemented. And there are even rare cases when they might need a special infant formula. Some of those we note below. However, if breastfeeding is managed properly, there are only a few situations in which a baby needs more milk than its mother can provide — in fact less than 5% of women are not wired to make enough milk– there are even fewer circumstances in which breastfeeding should be discontinued completely. And if a supplement is needed, WHO advises that infant formula be given only as a last resort to your baby, recommending that babies be fed, in order of preference:
- at the breast;
- via pumped or hand expressed breastmilk, using a cup, spoon, or oral infant feeding tube, i.e. NOT by a bottle with an artificial nipple, as this causes breastfeeding problems;
- with pasteurized, screened, donor milk from one of the several human milk banks in the USA (yes, really and it’s safe–see the Human Milk Banking Association, www.hmbana.org); and, lastly, with infant formula. (World Health Organization (WHO), 2003).
A good question to ask prenatally is whether your hospital stashes frozen, donated, screened and pasteurized human milk, and if not, consider switching to one that does!
2. It can lead to more problems.
Supplementing during the first few days and/or taking the baby off the breast – even briefly—can be a slippery slope leading to breastfeeding problems and failure, often causing more problems than it attempts to solve. Firstly, it can wreck your confidence in your body’s and little babe’s ability to breastfeed without the help of artificial milk. Basically, being told that formula is needed can be the equivalent of being told that you or your milk are just not enough for your baby. Many mothers lose their confidence right then and there — especially first-time mothers — and never fully get it back. They wind up doubting their ability to satisfy their babies in general and give up nursing prematurely. There are many reliable studies which prove that giving even one bottle of formula in the early days of life (Hall et al, 2002; Hornell et al, 2001) and taking home a “free” diaper bag with formula samples (Rosenberg et al, 2008), will have the effect of shortening the overall duration that that mother breastfeeds.
Secondly, supplementing with formula can compromise your milk supply. Your breasts need the constant stimulation of your infant’s suckling to bring on a full and perfect milk supply. Adding formula to your baby’s diet will mean less breastfeeding, which means you may produce less milk.
Thirdly, supplementing through a bottle can teach baby some ugly latching habits! Breastfeeding is instinctive, but there is a learning curve involved – usually about 4-6 weeks. (See our section: The Learning Curve) Most babies need to practice milking the breast for a few days to master the skill of suckling. Milking a breast is nothing like sucking on an artificial (bottle) nipple. Many newborns who receive early bottles will quickly develop a preference for the faster flow of a bottle and become accustomed to sucking that way. When it’s time to get your baby back on the breast, you may have a hard time with getting the baby to be patient at the breast and/or with sore nipples from your baby’s new “bottle” latch.
3. It can undo some of breastfeeding’s benefits.
While giving your baby a little formula will certainly not ruin him, it may completely change – for many weeks or more — the healthy balance of beneficial gut flora that breastfeeding achieves in your baby. The healthy bacteria and infection-fighters contained in your colostrum and milk are responsible for jump-starting your baby’s immune system and protecting him from common infections like strep, staph, e.coli, rotovirus, etc. (Hanson, 2004). This doesn’t mean you should panic, or feel guilty, if you have had to supplement or your baby has been given formula against your wishes . . . sometimes with all the booby traps, supplementation is necessary. It does give you extra motivation to get the excellent help you need (see the resources below) so you can get your baby on the breastfeeding track again, if possible. If you have a professionally diagnosed (by an IBCLC) case of low milk supply and will need to continue supplementing, it gives you extra motivation to ask for better access to donor milk, and safer, better standards for infant formula–formula still gets recalled from time to time, and supplementing and formula-feeding moms need better information on safe and proper preparation. Lastly, it gives all of us motivation to fight the barriers that cause moms to have unnecessary difficulty breastfeeding!
© 2008 Best for Babes, LLC, All Rights Reserved.
The American Academy of Pediatrics (www.aap.org) has also issued new guidelines for managing jaundice, accessible on their website.
To locate a highly trained feeding expert (lactation consultant) near you: www.ilca.org
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Cox SG. Expressing and storing colostrum antenatally for use in the newborn period. Breastfeeding Review 2006; 14:11-16
Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics. 2003 112:607-19.
Gartner LM, Herschel M. Jaundice and breastfeeding. Pediatr Clin North Am. 2001 Apr;48(2):389-99.
Hall RT, Mercer AM, Teasley SL, McPherson DM, Simon SD, Santos SR, Meyers BM, Hipsh NE. A breast-feeding assessment score to evaluate the risk for cessation of breast-feeding by 7 to 10 days of age. J Pediatr. 2002 Nov;141(5):659-64.
Hanson LA. Immunobiology of human milk: How breastfeeding protects babies. Amarillo, TX: Pharmasoft Publishing, 2004
Hoover K. Supplementation of the newborn by spoon in the first 24 hours. J Human Lactation 1998; 14:245
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Lepercq J, Coste J, Theau A, Dubois-Laforgue D, Timsit J. Factors associated with preterm delivery in women with type 1 diabetes: a cohort study. Diabetes Care. 2004 Dec;27(12):2824-8.
MacMahon JR, Stevenson DK, Oski FA. Physiologic jaundice. In: Taeusch HW, Ballard RA, eds. Avery’s Diseases of the Newborn. 7th ed. Philadelphia, PA: WB Saunders; 1998
Meier PP, Furman LM, Degenhardt M. Increased lactation risk for late preterm infants and mothers: evidence and management strategies to protect breastfeeding. J Midwifery Women’s health 2007; 52:579-587
Rosenberg KD, Eastham CA, Kasehagen LJ, Sandoval AP. Marketing infant formula through hospitals: the impact of commercial hospital discharge packs on breastfeeding. Am J Public Health. 2008;98:290-5.
Sarici SU, Serdar MA, Korkmaz A, et al. Incidence, course, and prediction of hyperbilirubinemia in near-term and term newborns. Pediatrics 2004; 113:775-780
Smith LJ. Impact of birthing practices on the breastfeeding dyad. J Midwifery Womens Health. 2007 Nov-Dec;52(6):621-30.
Subcommittee on Hyperbilirubinemia. Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation Pediatrics, Jul 2004; 114: 297 – 316
Watchko JF, Maisela MJ. Jaundice in low birthweight infants: pathobiology and outcome. Arch Dis Child Fetal Neonatal Ed 2003; 88:F455-458
World Health Organization. Global strategy for infant and young child feeding. Geneva, 2003 http://www.who.int/nutrition/publications/infantfeeding/en/index.html
The information in this document is in no way intended to diagnose or treat any medical condition and is not a substitute for an in-person evaluation by a qualified, independent Internationally Board Certified Lactation Consultant (IBCLC) or your breastfeeding-friendly pediatrician.