How to Supplement a Breastfed Baby While Maintaining Breastfeeding
Sometimes, women have insufficient colostrum or mature breast milk to adequately feed their baby. Despite what parents are commonly told, insufficient colostrum in the first days after birth and insufficient milk intake due to delayed onset of full milk production is common and can result in underfeeding if babies are not supplemented with banked donor milk or formula.[1-4] Beyond the first days, studies have found that true low milk supply, even with good lactation support, is also common, occurring in 15-33% of mothers at the end of the first month.[5,6]
Knowing how to supplement your breastfed baby while maintaining the stimulus the body needs to produce milk is important to sustaining breastfeeding long term. In addition, encouraging a baby to continue to latch with each feed as much as possible is important if you wish to nurse directly.
The following is a guide to supplementing a breastfed newborn while maintaining your milk supply. This is important to know before you deliver in case you have insufficient colostrum or delayed onset of full milk supply. The same principles apply for older babies except they may require larger volumes of supplemental milk.
Read more articles about supplementing newborn feeding: Supplemental Nursing Systems, Ensuring Sufficient Newborn Feeding in the First Days, WHEN TO SEEK URGENT MEDICAL ATTENTION
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- Confirm the presence of colostrum by manually expressing before each feed.
- Ensure that your newborn is nursing every 2- 3 hours for 10 – 15 minutes on each breast with good quality latch and suck.
- If HUNGRY signs or other need for supplementation occurs, it can be done with expressed human milk, banked donor human milk, or formula through the one of the following methods:
- 15 mL at a time with a curved tip syringe slipped into the corner of your baby’s mouth while latched at the breast.
- 15 mL at a time with an SNS or bottle with a slow flow nipple. (Note 5-7 mL feeds have not been shown to be effective at reversing feeding complications.)
- Pause and burp baby after each 15 mL feeding to prevent gas and to observe for signs of continued hunger.
- Repeat supplementation until indications for supplementation and newborn distress or hunger are resolved.
- Express milk manually or with a pump if nursing is ineffective and feed it to your baby at the next feeding.
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From Fed Is Best: The Unintended Harms of the “Breast Is Best” Message and How to Find the Right Approach for You and Your Baby. Dallas: BenBella Books, 2024.
References
- Ikuko Kato et al., “The Trajectory of Expressed Colostrum Volume in the First 48 Hours Postpartum: An Observational Study,” Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine 17, no. 1 (January 2022): 52–58, https://doi.org/10.1089/bfm.2020.0366.
- Kathryn G. Dewey et al., “Risk Factors for Suboptimal Infant Breastfeeding Behavior, Delayed Onset of Lactation, and Excess Neonatal Weight Loss,” Pediatrics 112, no. 3 Pt 1 (September 2003): 607–19, https://doi.org/10.1542/peds.112.3.607.
- Laurie A. Nommsen-Rivers et al., “Delayed Onset of Lactogenesis among First-Time Mothers Is Related to Maternal Obesity and Factors Associated with Ineffective Breastfeeding,” The American Journal of Clinical Nutrition 92, no. 3 (September 2010): 574–84, https://doi.org/10.3945/ajcn.2010.29192.
- Caroline J. Chantry et al., “Excess Weight Loss in First-Born Breastfed Newborns Relates to Maternal Intrapartum Fluid Balance,” Pediatrics 127, no. 1 (January 2011): e171-179, https://doi.org/10.1542/peds.2009-2663.
- M. Neifert et al., “The Influence of Breast Surgery, Breast Appearance, and Pregnancy-Induced Breast Changes on Lactation Sufficiency as Measured by Infant Weight Gain,” Birth (Berkeley, Calif.) 17, no. 1 (March 1990): 31–38, https://doi.org/10.1111/j.1523-536X.1990.tb00007.x.
- Jacqueline C. Kent, Hazel Gardner, and Donna T. Geddes, “Breastmilk Production in the First 4 Weeks after Birth of Term Infants,” Nutrients 8, no. 12 (November 25, 2016), https://doi.org/10.3390/nu8120756.