Moms who receive early breastfeeding education in addition to support will often successfully establish breastfeeding. Exclusive breastfeeding (no other food or drink besides breast milk) for the first 6 months of your baby’s life is associated with the greatest protection against health concerns for both the baby and the mom.¹ Unfortunately, early formula supplementation is quite common in hospital and birthing center settings.^2,3

Oftentimes moms feel they are not making enough milk during the first few days of their baby’s life, and so supplementation is often started.^4,5 The first milk your baby will receive is your nutrient-rich colostrum. Colostrum is the best nourishment for your baby’s first few days of life, and no other supplementation is needed.⁶ Inappropriate use of supplementation could undermine a mom’s confidence in her ability to breastfeed and provide enough milk to her infant. It may decrease the amount of times the infant is breastfed which could eventually lead to less milk production.^4,5,7 In order to make more milk, you need to remove more milk.  

When Is Supplementation Not Recommended?

According to the Academy of Breastfeeding Medicine, supplementation is not recommended in these circumstances:⁷

• A healthy, term baby who is feeding well, having the appropriate number of wet and dirty diapers, weight loss is in the appropriate range, and bilirubin levels are in the healthy level do not require supplementation.
• A baby who is fussy at night or has several short feeds closer together over a few hours normally occurring in the later afternoon and evening; this is referred to as cluster feeding. 
• A tired or sleeping mom.

Possible Reasons Why Supplementation May Be Needed for Healthy, Term Infants

Below are reasons why supplementation may be needed for your healthy, term baby.⁷  Supplementation recommendations are different for infants who were born prematurely or at a low birth weight. Supplementation should only be given if medically indicated.⁷

• Baby’s Indicators:
  • Diagnosed with asymptomatic (no symptoms) hypoglycemia. Breastfeeding should continue during IV glucose therapy to help increase blood glucose levels. 
  • Diagnosed with dehydration not resolved after mom receives breastfeeding support to increase and transfer milk to the baby.
  • Weight loss greater than 10% on day 5 or later. 
  • Delayed bowel movements, fewer than four bowel movements on day 4 of life, or if they continue to have meconium in their bowel movements on day 5.
  • Diagnosed with hyperbilirubinemia associated with poor milk intake despite breastfeeding support. Baby often has ongoing weight loss, limited bowel movements, and uric acid crystals (oftentimes look yellowish or reddish-brown) in their wet diapers.
  • Requires protein, carbohydrate or fat supplementation. This might be needed if the baby has an inborn error of metabolism condition (e.g., galactosemia, maple syrup urine disease, phenylketonuria), which is rare.
• Mom’s Indicators:
• • Delayed milk production by day 3 to 5, and inadequate intake by the baby.
  • Abnormal breast shape or poor breast growth during pregnancy which can lead to decreased milk gland production; normally occurs in only 5% of women.
  • Breast anatomy concerns or prior breast surgery resulting in poor milk production.
  • Temporarily stopping breastfeeding due to certain medications (e.g., chemotherapy) or temporary separation of mom and baby without expressed breast milk available.
    • Many medications are safe during breastfeeding, please talk with a trusted healthcare provider regarding medication use during breastfeeding.
  • Severe pain during feedings not helped by breastfeeding support and intervention. Lactation consultants can assist with recommending different breastfeeding positions and latching techniques to assist with relieving sore nipples.

If Supplementation is Needed, What Supplementation Should be Used?

Below are a list of tips to consider when making a decision on what supplement to use.⁷ When supplementary feedings are needed, there are a number of delivery methods you can choose from including a supplemental nursing system (SNS) at the breast, cup feeding, spoon or dropper feeding, finger feeding, syringe feeding, or bottle feeding.⁷ It is important to talk with your baby’s healthcare provider about your preferred supplementation type so everyone is on the same page.

What If I Have Questions?

If you are interested in learning more, these Aeroflow classes expand on some of the topics discussed above:

• Ultimate Breastfeeding Prep
• Pumping 101

Want More Info?

For a directory of Aeroflow’s other Care Guides offering information on pregnancy, baby care, and more, browse our comprehensive list of titles:

References