Ali Weatherford

The word “supplementation” has become almost completely associated with breastfeeding. Many new parents believe that supplementation is just part of the deal. It actually is NOT! Supplementation can be a really critical part of a family’s feeding experience, but it may not be part of the picture at all for many other families.

What is supplementation?

Essentially, supplementation just means offering the baby more food than what they are getting at the breast. It might mean giving some additional nutrition using:

It might mean giving the baby this additional milk by:

The way you offer milk supplementation depends on the age and needs of your baby and your ultimate goals. If it’s in the first few days of life, or you just need temporary supplementation, and you eventually plan to exclusively breastfeed, then you may consider not using a bottle. Using alternatives like a spoon, cup, syringe, or supplemental nursing system might be better alternatives in this case, because using a bottle can sometimes make it harder to transition to the breast if offered first or primarily.

It’s best to seek help from a lactation professional to determine whether your baby needs supplementation and how to best go about it.

When is supplementation recommended?

There are a lot of reasons a baby might need more milk than you can provide directly from the breast. If your goal is to mostly or exclusively feed your baby directly from the breast, but supplementation is recommended because there is a need for more, know that it’s very possible to just supplement temporarily.

If you do NEED to supplement, it can sometimes be hard to figure out why you’re having problems, so before you do it, you should definitely see a lactation consultant. They can devise a plan for you, and also help you ensure that your baby doesn’t become dependent on the supplementation so you can transition off of the plan.

Some of the more common reasons they will recommend supplementation include:

  • Improper latch
  • Ineffective sucking
  • Low milk supply
  • Slow growth or weight gain for baby
  • Separation of parent/baby

An improper latch means the baby is not holding on to the breast correctly. There are a lot of different reasons for this, but it can mean that the baby can not get enough milk out of the breast. Or a baby might latch on correctly, but might not be able to draw out enough milk. They might be weak or have an issue with their tongue or mouth that means they can’t suck hard enough to get the milk out effectively.

When the baby can not draw out milk effectively, that can actually lead to low milk supply, which could end up being an additional reason to supplement. Low milk supply can also be caused by other factors.

If there is not enough milk, supplementation is necessary, but it might only be a temporary need. A lactation consultant can prescribe some treatment strategies that might involve a pumping schedule to get your milk supply back up.

If your baby is growing slowly, not gaining enough weight, or even losing weight, supplementation may also be recommended. The cause of the baby’s slow weight gain should be explored. If it’s an issue of improper latch or suction and/or low milk supply, that can usually be fixed.

If you and your baby need to be separated for any amount of time, supplementation may also be needed. Often, you can do some quick hand expression so your baby can be fed your milk from a spoon, cup, syringe, or bottle.

However, pumps and bottles are often not recommended in the first few days when the milk (colostrum) is very thick and there are only very small amounts available. Much of that precious milk can end up in the pump parts or lining the inside of the very big bottle and nipple. That is why hand expression and other methods like spoons, cups and syringes are recommended. If you are separated for longer, pumping will likely be needed, and you may need to bottle feed.

Pumping is important for building and maintaining a good milk supply until you and your baby are reunited and you can do more direct breastfeeding.

It’s important to recognize that most of the time breastfeeding works, and supplementation is not necessary. It happens often though! A lot of times, people supplement on their own because they perceive that their baby needs more. Most of the time, that’s not actually the case.

There are a lot of normal behaviors and phases that babies go through when they are breastfed. For example, sometimes they cluster feed and seem much more hungry than usual. When this happens, a lot of people might want to supplement so the baby can get full. But cluster feeding is actually a normal and important part of maintaining a healthy milk supply. Supplementing in response to cluster feeding can sometimes lead to milk supply problems.

When might you choose to supplement?

Not everyone supplements out of necessity. Some people just want to supplement for reasons of convenience. If you like the flexibility of direct breastfeeding sometimes, and bottle feeding other times, supplementation may be right for you.

In this case, it might not technically be supplementation. It might be called combination feeding or just your feeding style. Or it might actually be both. If you want to be able to feed your baby from the breast AND using formula from a bottle, your milk supply might not be quite as full. If you are combination feeding using formula, and you are not also pumping on a good schedule, your milk supply might suffer and you may not be able to offer breast milk anymore at some point.

Tips for successful combination feeding:

  • Consider using breast milk in a bottle if your goal is to get your baby using a bottle. The pumping that you will need to do to provide milk for those bottles will help ensure that your milk supply doesn’t dwindle.
  • If you’re using a bottle for the first time, try introducing it when your baby is happy and relaxed. Don’t wait until your baby is SUPER hungry. They may just get very upset and refuse the bottle.
  • Try letting someone else feed your baby the first few bottles. They will often be more likely to accept a bottle from someone else who is not associated with breastfeeding.
  • Try a different position for bottle feeding than you typically would for breastfeeding. Again, they won’t associate that position with breastfeeding and be more likely to accept something new.
  • Pump on a regular schedule that mimics when your baby might be needing to eat. That will be less likely to have an impact on your milk supply. So, if you know your baby will be getting a bottle around 1pm, you could pump at that time. Your body is getting the signal to make milk at that time similar to how it would if your baby was there breastfeeding.
  • Add in the bottle feeds gradually. Start with just an occasional bottle, then one per day, etc. You might plan this around when you’ll be going back to work and work backwards from there. For example, if you have four weeks until you’ll be working away from home:
    • Week 1: Give your baby a bottle every other day.
    • Week 2: Give your baby one bottle feed per day.
    • Week 3: Give your baby two bottle feeds per day.
    • Week 4: Give your baby three bottle feeds per day.

That might be all you need! Three bottles a day might be the right number for your baby when you’re not with them. You can continue to feed from the breast when you’re together.

Tips for successful breastfeeding and formula mix:

  • Always start with breastfeeding first. If your baby is full and doesn’t need the bottle, you can skip it if you choose. If your goal is to introduce formula as part of the baby’s normal feeding routine, you might just breastfeed for a shorter amount of time, and then finish the feeding with the bottle. Starting with breastfeeding will ensure that you continue to stimulate the breast so your milk supply doesn’t decrease too much.
  • Don’t mix breast milk and formula in the same bottle. Some people choose to do this, and it’s not dangerous as long as you properly mix the powdered or concentrated formula using the right amount of water first, but we don’t usually recommend it for a practical reason. If your baby doesn’t finish the bottle, you end up throwing away some breast milk that you spent time pumping! We recommend first giving the bottle of breast milk, and then a separate bottle of formula. If the baby gets full before finishing all the formula, it’s less difficult to have to throw that away.

There is not just one right way to feed your baby. You may come to find that you have your very own way of feeding your baby that works for your family, and that’s great!

However you choose to feed your baby, we always start by ensuring that your milk supply is protected if you want to continue to provide breast milk. As long as you’re taking some basic precautions, it’s very possible to breastfeed and provide milk in other ways.

Reference

https://pmc.ncbi.nlm.nih.gov/articles/PMC8573934/

About the Author

Ali Weatherford, ICCE is the manager of Parent Education at Breastfeeding Success and a childbirth educator certified by the ICEA. She has also trained with Birthing From Within™, DONA International, Spinning Babies™, and regularly attends annual conferences and training related to childbirth education, perinatal mental health, and more because she will never be done learning! She has a BA in Psychology with a background in research and writing. When she’s not teaching and learning about birth, she’s probably cooking and hanging out with her two wonderful kids and many pets at home in Austin, TX.