Should I Supplement with Formula?


This is a loaded question.

Many breastfeeding moms worry about how much their baby is getting when breastfeeding since there isn’t exactly a measuring system that they can visually see. Couple that with other issues like low weight gain, a fussy baby, jaundice, etc and even the most seasoned mom will be asking if they should start supplementing. 

Supplementing can be done with either expressed breast milk or formula. Often times, moms do not have enough expressed milk saved to supplement and thus need to turn to formula if supplementing is necessary. 

A parent may make the decision to supplement some or all feeds for a variety of reasons. Such as:

  1. Illness in Mother or Baby
  2. Primary breast insufficiency
  3. Mother may feel her supply is low
  4. Baby is not meeting weight milestones
  5. Baby is separated from the mother for various reasons

So how do you know when to supplement with formula?

The first step before beginning to supplement with formula is to determine and understand the reason for supplementing. Is it a permanent issue or a temporary one? Is this a recommendation from a doctor or lactation consultant or something as a parent you feel is best?

Understanding the why will help you know where to go next and how to fix the issue (if it can be fixed) going forward.

what-percentage-of-women-breastfeedThe decision to supplement can be heartbreaking for some moms. Many of us have this perfect picture in our mind of how our breastfeeding journey will go. It will be easy and flawless because it’s natural, right?

Well, the thing about breastfeeding is that while it is natural, it is also a learned skill. For both mom and baby. So if you are reading this because your doctor is recommending you supplement or you are considering it on your own, then understand that you aren’t alone. Babies don’t come into this world knowing exactly how to breastfeed. We have to teach them and sometimes it’s not perfect.

(Related: Need a boost in your milk supply? Read reviews of these natural supplements and see what can work for you.)

We can do little to control some of the reasons formula may need to be used, such as, a medical condition in the mother or baby that makes breastfeeding not possible (cleft lip, injury, medication mother is on, etc). But the good news is that most reasons for supplementing can be resolved and overcome.

Outside of medical conditions and medication that can interfere with breastfeeding, here are some reasons it may be time to start supplementing:

1 –  Hypoglycemia (Low Blood Sugar)

Babies need glucose for energy and most of that glucose is used by the brain. Babies receive glucose from the placenta during pregnancy and from their mother’s milk after birth. If those levels are found to be low and not improving with nursing, then a baby will need to receive additional feedings likely with formula.

This will typically resolve itself within a few hours or days. The help of a Lactation Consultant should be sought to check baby is getting enough from nursing alone and address any supply issues. 

2 – Jaundice

A doctor may recommend a mother start supplementing with formula if baby’s serum bilirubin levels are elevated. The goal, of course, by supplementing is to promote more stools from baby to lower those levels. Some mothers don’t see their milk come in for several days (though they are producing colostrum) and that delay can contribute to the lower number of stools in a baby.

Often times, a mother can pump and feed that pumped milk to their baby and this allows the doctor and mother to see how much the baby is getting. If the mother’s milk has not come in yet or is low, then formula would need to be given.

3 – Baby Not Gaining Sufficient Weight

Typically, a newborn will see their doctor a few times, including in the hospital, in the first weeks of their life. Doctors use growth charts to plot a baby’s growth to ensure it is within a healthy range. If the baby is losing weight or just not gaining as they should, a doctor may recommend supplementing.

when-should-i-supplement-with-formulaIt is important to note that per the LLL, breastfed babies don’t always follow these growth charts the way the doctors intended for them too. The growth charts are primarily based on a mix of breast and formula or solely formula fed babies. Breastfed babies have been shown in recent studies to gain more in the first 6 months of life and less in the next 6 months. Ideally, they should gain 4 to 7 ounces a week in the first 6 months.

It is, however, never normal for a baby to fall off their own curve especially if they are losing weight.

Wet and soiled diapers, or lack thereof, can be a sign a baby is not getting the nutrients it needs. In all cases, it is important to listen to a doctor’s recommendations to ensure baby does not get extremely ill. Supplementing is often appropriate in these extreme cases where weight loss is involved.

If the issue is related to a suspected low milk supply in the mother, then a Lactation Consultant should be contact immediately to help address the issue.

4 – Low Milk Supply / Primary Breast Insufficiency

This may come as a surprise, but only less than 5% of nursing mothers do not produce enough milk to adequately feed their infant. While extremely rare, Primary Breast Insufficiency basically means the mother lacks the glandular tissue to produce enough milk. This is a true medical condition and almost always means a mother will need to supplement some or all feedings with formula.

The number one reason that I hear from moms on why they started to supplement with formula is that they believed their milk supply was insufficient to meet the demands of their baby.  It is important to note, most breastfeeding/supply issues can be resolved on their own or with the help of a professional Lactation Consultant but some supplementing may be necessary while those issues are worked out.

Breastfeeding is supply and demand. The breast should always be offered on demand. A breastfed baby cannot be overfed despite seeming to want to be at the breast for hours on end. This is the natural way a baby increases his mothers milk supply. It is important to allow cluster feeding and put the baby to the breast often. Stimulation will help increase and sustain a good milk supply.

For tips on how to use your pump to increase your milk supply, click here.

At the end of the day, it is best to listen to your doctor. If your baby is losing weight or having some other issues, then your doctor will likely ask you to supplement.

(Related: Low milk supply? Find out how this supplemental nursing system can help!)

how-to-warm-breast-milkThis is not the end of the world.

While it can be difficult especially if the mother wanted to exclusively breastfeed, it doesn’t have to be all or nothing. A fed baby is best. And a healthy baby is even better. So if you have been asked to supplement or suspect that you should, try not to let it stress you out.

The best thing you can do is work on increasing your milk supply during the time you need to supplement so that you can get back to exclusively breastfeeding. But keep in mind that any amount of breast milk is beneficial to your baby. So offer what you can and keep your head up!

If you have any questions or comments, please leave them below as I love hearing from my readers!

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  1. Pitin says:

    My breastfeeding journey had been full of ups and down. And if there is one thing that I learned the hard way – it’s not all doctors would advise something that will make you happy.

    I, for instance, has to formula-feed my baby from Day 1. Ironically, my doctor told me that my milk supply will be delayed due to C-section, which I believe is true. But little did I know that my 1-day old baby only needs very little milk since her tummy was only very small.

    My colostrum could have been enough. But no. They asked for a formula to feed to my baby. Groggy from meds, I obliged. And day after day, formula and bottle are what my daughter got used to therefore totally refused to latch.

    My milk supply has dried up. Exclusively pumping did not help. Lactation consultant after lactation consultant, it took four months to try to breastfeed my daughter. My milk supply dried up and no supplement was able to bring it back – not even pumping every 2 hours and domperidone. I had to directly latch!

    I gave up on the fifth month. My formula-fed baby was healthy, happy and active. She is turning 3 years old in two months and she has never had a major health issue.

    The greatest lesson I learned is that, while breastmilk is indeed best for our babies, as long as we have done our best to give it to them, then we should rid ourselves of guilt for having a formula-fed baby. There are other equally important things you can give like healthy solid foods, time and love.

    • Heather Grace says:

      Thank you so much for sharing your journey. You touched on a very important point that often times misinformation can lead to breastfeeding issues. I am sorry that happened to you but at the end of the day, your baby was fed and thriving and that is what matters most. You certainly gave it a great effort to try and stick with it for so long!

  2. Jasmine Ungaro says:

    This is very useful information to any new mother out there. Personally, I am breastfeeding exclusively, but it has crossed my mind, what if I need to use formula because I don’t have enough milk? This article is so helpful, and I love, too, how you don’t promote just breastfeeding or using formula, but how you make moms feel that the choice is theirs, and no matter what they choose it’s a good decision. Thanks for writing this! 🙂

    • Heather Grace says:

      Breastfeeding doesn’t come with a manual and there are a lot of moms who like you question what they should do. I hope moms find this info helpful and are encouraged that there are solutions and it’s okay if supplementing ends up being the option. There is enough mommy shaming going on out there and moms should not have to defend their feeding choices. Thank you so much for your comment and good luck on your breastfeeding journey!

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