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:
- Illness in Mother or Baby
- Insufficient Glandular Tissue
- The mother may feel her supply is low
- Baby is not meeting weight milestones
- 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.
The 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 the baby’s serum bilirubin levels are elevated. The goal, of course, by supplementing is to promote more stools from the 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.
You can read more about Jaundice and Breastfeeding, here.
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.
It 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 your 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 contacted immediately to help address the issue.
Tools like a Supplemental Nursing System are something to look into- you can read about those, here.
4 – Low Milk Supply / Insufficient Glandular Tissue
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, Insufficient Glandular Tissue 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 mother’s milk supply.
It is important to allow cluster feeding and put the baby to the breast often. Stimulation will help increase and help 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!)
This 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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I just wanted to say that it IS possible to exclusively breastfeed after supplementing. I had to turn to formula when my baby was 2 weeks old. We struggled with latch issues and because of that my supply dropped. I tried everything to get it back up. Finally when she’s 4 months old, she has been exclusively breastfed the past 3 weeks.
I honestly don’t think I could’ve gotten my supply up if I wouldn’t have fed so often, and took different things to increase supply. For me it was lactation cookies (Brewers yeast) and an herb called malunggay/moringa oleifera Lam. (Go-lacta) that helped me bunches.
I am no longer taking anything to increase supply and my supply has stayed up. So don’t think that just cause you have to use a galactagogue means that you’re stuck using it forever. You might not be stuck! There is hope! I never thought there was, but we did it! ❤️
That is amazing, Courtney! Thank you so much for sharing your story! I know that there are so many moms reading this thinking that it is hopeless so hearing from a mom who has been there and made it to the other side is so inspiring.
I love hearing about your experience with Go-Lacta supplements as well! I have also tried them (full review coming soon) and love them as well. Thank you for including that resource for other moms!
Any moms interested in pricing and info on Go-Lacta, can see that here!
Huge congrats on your success!
We were told to supplement because my milk wasn’t coming in quickly enough and our girl was having a hard time getting enough colostrum to come out. She was also very small at birth (4 days late and under 6lbs), so weight gain was top priority. We were told to feed on demand day or night, to get calories in her no matter what.
Our struggle was knowing the balance of how much/when to give formula versus breastfeeding. No one at the hospital nor our pediatrician would give guidance, since they didn’t want us getting on a schedule. We were just told “give her some of each, whatever feels normal, just make sure she doesn’t act hungry.”
It was very frustrating as it led to more and more formula feedings, so less breastfeeding and ultimately killing my supply. We’re expecting #2 any day now so I’m trying to do my research and have a fresh perspective this time around, but I’m still a little nervous we’re going to have similar experiences. I’m 100% supportive of supplementing and/or EBF, whatever works to get baby fed. I just want to give it my best shot in the hopes I can BF longer than I was able to last time. Any thoughts or recommendations if this situation arises again?
Hi Bronwyn,
I’m so sorry you had that experience with your last baby. Especially the lack of direction from your doctor and nurses. It can be very frustrating. There are a few things that come to mind when reading your story and I can definitely provide some tips and better insight for you to help you prepare.
I am going to try my best to sum this up and break it down (for other moms reading this as well) but before I do, I want to make sure to be clear that I am 100% supportive of supplementing. Nutrition for a newborn is so important as they can get very sick, very fast. So following a doctors recommendation for supplementing is important. BUT with that said there are ways to supplement without interrupting breastfeeding when both mom and baby are healthy.
1) Often doctors use the term “supplement” without clarifying what that means… supplementing does NOT have to mean formula. It often does since most brand new moms do not have pumped milk saved but it is perfectly acceptable to supplement with pumped milk.
2) It is also completely possible that your supply was way more than enough to support your baby. I have found doctors to be very fast to push formula vs working with moms to educate them on breastfeeding especially when it comes to a baby like yours that needs to be reminded to feed often due to their size.
So what can you do to prepare for next time?
Meet with a Lactation Consultant in the hospital! My number 1 recommendation!
They can check your baby’s latch, help you understand how to wake them to feed, what is normal vs concerning, address the concern of supplementing and when to know there’s an issue etc.
From there, if your doctor came back and told you to supplement, I would run to the LC’s office and ask for a weighted feed. This is where you nurse your baby for a specific amount of time and they weigh the baby before and after the feed. This will give them down to the ounce how much your baby took in from the breast.
They can educate you on supplementing if your baby is not getting enough and how to properly supplement.
In addition to LC support, my top recommendation is to get a good Supplemental Nursing System that allows you to feed your baby pumped milk/formula through a tube while they are on the breast.
This allows you to supplement without taking your baby away from the breast which is the best way to increase your milk supply (nursing often and on-demand). You can see more about the Supplemental Nursing Systems, here.
If low supply is the issue, there are a number of ways to increase your supply, which you can read about, here.
The bottom line, I would ensure low milk supply is the reason for the doctor to recommend supplementing. Keeping your baby off the breast and giving a bottle will result in low milk supply which begins a crazy cycle that is hard to get out of (bottle feeding to address low milk supply which leads to lower milk supply….).
You have to be very diligent about pumping to replace any feeding that you supplement. You can read more about pumping, here.
Some times premies/small babies do not have the energy to suck at the breast efficiently and that might have been your case (which will cause low milk supply since your milk is not being stimulated). The SNS I mentioned above will help with that. You can also use a syringe. An LC can show you how to use these tools.
You will still need to pump after each feeding, however, in most cases.
It is very important to ensure a newborn is well nourished but there are tools and resources to help! I hope this helps!
As a Pediatrician, it’s sometimes really hard for me to convince moms to breastfeed. They know that I am 100% supportive of their breastfeeding journey, but they just feel so crippled by the thinking that supplementation is going to ruin their baby. When the baby just isn’t gaining weight and there’s no other reason for it, breastfeeding moms have to trust their health provider that supplementing is the best thing to do. Thanks for this post!
Love this comment so much! Thank you for chiming in. As moms, we put so much pressure and mom guilt on everything. But at some point, we need to trust that everything will work out. I am always telling moms that it’s ok to supplement but again, there is a right and wrong way. Many moms are able to go on and have a wonderful supply and long breastfeeding journey supplementing! It certainly is not the end of the world! A healthy baby is what is important!
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.
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!
I think the greater lesson was to not let doctors interfere so much, cause if it weren’t for the doctor you would be breastfeeding. That is what is best for your baby and I think the ending of your comment misses that point entirely.
I know it helps you not feel as bad to think of it that way, but what happened to you is tragic and it’s the doctor’s fault.
This is certainly a hot topic that I see often in mom groups/circles. I am heartbroken every time I read these stories (and I read them a lot on this blog and in the direct messages I receive!) I do not think any mom needs to feel bad about the choice of supplementing, however. The bigger dragon to slay here is the misinformation given to new moms from their healthcare providers (as you pointed out). I am continually shocked and saddened by the breastfeeding “advice” given by pediatricians/doctors.
Most new moms are not educated in breastfeeding. They are told a fussy newborn is still hungry and to give a bottle. So they do and then wonder why their milk supply is dwindling. They are told a baby fighting at the breast means their milk supply is gone. Or a small baby needs formula to “fatten them up.” Ect, ect, etc
These are DOCTORS telling them this. So I don’t blame moms one bit for following that advice and when they do follow it, they certainly have nothing to feel bad about. They have done their best with the information they had at the time. New moms are hormonal and fragile, to begin with, and to be told that you are basically starving your newborn plays on those emotions. With no resources or advice on where to get help other than “give formula” I can 100% see how this happens time and time again. I guess that is why I write these articles! To try and get that conversation started so that moms can educate themselves!
I strongly believe that Lactation resources should be in every pediatrician’s office and available to all moms! And doctors need more lactation training. It’s an extremely sad situation all around.
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! 🙂
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!