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Common Problems: Early Supplementing

Many ill-educated care providers immediately advise a new mom to supplement with formula when a feeding-related challenge (e.g. jaundice, nipple pain, insufficient weight gain, etc.) arises, without having consulted first with a feeding expert, or IBCLC.   Let’s be clear:  Rule #1 is FEED THE BABY–and sometimes, especially if problems have snowballed without being properly managed–supplementing is necessary .  So we are not saying that you shouldn’t 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.

Three Must-Know Facts on Supplementing with Formula:

1.  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 (Parry et al, 2013, 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.

2.  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 — there are even fewer circumstances in which breastfeeding should be discontinued completely.  And if a supplement is needed, the World Health Organization advises that infant formula be given only as a last resort to your baby, recommending that  babies be fed, in order of preference:

  1. at the breast;
  2. 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 can cause breastfeeding problems;
  3. 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)
  4. 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!

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, especially considering all the booby traps, supplementation is necessary!  We believe that ALL mothers do the best they can, given their particular situation and circumstances and that the focus needs to be on putting more pressure on the booby traps, not moms!    The silver lining:  If you were booby-trapped into supplementing early, it may strengthen your resolve to get the excellent help you need (see the resources below) so you can get your baby on the breastfeeding track again, if possible, and it may buy you time until you can see an IBCLC and address any issues.  If, on the other hand you have a professionally diagnosed (by an IBCLC) case of low milk supply or another reason why your breastmilk alone is not sufficient for your baby, we hope that knowing the truth about formula supplementing will motivate the masses to demand better, more affordable access to donor milk, and safer, better standards for infant formula–formula is 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 Booby-Trap moms in the first place and cause moms to have unnecessary difficulty breastfeeding!

Top Tip:  If you have been told by your physician, health care provider, friends or family that you need to supplement, make sure that you get instructions that fit you and your body and your baby from an IBCLC, CLC, Breastfeeding Counselor, La Leche League Leader or other qualified lactation expert.   What works for one mother may not work with another.

© 2008 Best for Babes, LLC, All Rights Reserved.

Resources:

Search www.kellymom.com, www.askdrsears.com and www.drjacknewman.com for “newborn jaundice” for additional helpful information.

The Academy of Breastfeeding Medicine has developed an outstanding protocol for the management of jaundice at 35 weeks gestation or later.

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

References

Bowles BC, Stutte PC, Hensley JH. New benefits from an old technique: alternate massage in breastfeeding. Genesis 1987/88;9:5-9,17

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

Hörnell A, Hofvander Y, Kylberg E. Solids and formula: Association with pattern and duration of breastfeeding Pediatrics 107; March 2001, p. e38 www.pediatrics.org/cgi/content/full/107/3/e38

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.