How To Supplement Breastfeeding With Formula

baby formulaDone incorrectly, supplementing breastfeeding with formula can lower your milk supply and ultimately ruin your breastfeeding relationship. Luckily, you’ve come to the right place. Our six step approach gets your baby the nutrition he needs, while protecting and increasing your milk supply. Here are the six steps:

 How To Supplement Breastfeeding With Formula: The 6 Steps

Step 1: Decide if you should supplement
Step 2: Know how much to supplement
Step 3: Know what to supplement
Step 4: Know when and how to supplement
Step 5: Let your body know you are supplementing
Step 6: Evaluate weekly and ween off supplements

How To Supplement Breastfeeding With Formula: Step 1

Decide If You Should Supplement

Deciding to supplement is often emotionally charged. When my son was labeled “failure to thrive” and I was told to supplement by my lactation consultant, I felt like a failure. Overtime I came to realize that supplementing wasn’t the end I had feared but a means to an end. Supplementing gave my son the nutrition he needed and it gave me the time to work through my low milk supply issues. Ultimately, I weaned him from the supplements and breastfed until he was two.

If you’ve been told to supplement, but haven’t started out of fear of where it might lead, try to see it as a means to an end. Supplementing, using the methods described in this article, supports breastfeeding, gives your baby the nutrition he needs and gives you the time to solve your low milk supply issues.

You should definitely supplement if a health care professional (such as a doctor or lactation consultant) has told you to supplement. Their recommendation is likely based on your baby’s weight changes and on growth charts.

You should not supplement if your baby is in the 40th percentile or higher on the growth charts for weight and has been following his growth curve consistently (these are both things your doctor can tell you) and your baby has plenty of wet diapers (5 or more per day). This is a thriving baby and supplementing will be added expense and work without any benefit.

If you don’t fall neatly into either of the “definitely should supplement” or “should not supplement” groups, you’ll need to make your own call or get a doctor’s opinion. I recommend two things. The first is to trust your instincts. You know your baby better than anyone else on this planet and you probably know, in your gut, whether he needs supplementing or not. And second, we know how much milk the average baby consumes each day. If you have completed one of the milk measuring tests, you can compare how much milk you are making with how much milk a typical baby drinks in a day. Keep reading. The next step explains how to do this.

How To Supplement Breastfeeding With Formula: Step 2

Know How Much To Supplement

Most parents and professionals who take a guess at how many ounces per day of supplement the baby needs, end up overestimating. That’s certainly understandable and doesn’t hurt baby at all, but it does increase the odds of harming your breastfeeding relationship. Another common problem of bottle feeding happens when a baby spits out a bottle, satisfied, but a well-meaning caregiver will put the bottle back in and encourage baby to finish it, not wanting to throw out expensive formula or priceless breast milk. This well-meaning intention unfortunately overstuffs the baby, so he’ll go a longer time before he’s ready to breastfeed again. That leaves milk in the breasts for longer periods of time and milk left in the breasts signals the body that it is overproducing and that production should be cut. Talk about running backwards, up a hill, wearing roller skates.

Rather than guess how much supplement your baby needs, use either of the two tests described in another article to determine your current milk production per day. Next subtract your production number (in ounces per day) from 25. (We use 25 since an average 1-6 month old baby typically consumes about 25 ounces of breast milk per day – and somewhat more during growth spurts. A baby less than 1 month old typically needs a little less milk: 19 to 24 ounces per day.) The difference between your daily production and this guideline gives you the amount of supplement, in ounces per day, that you should give your baby.

For example, let’s say your pumping test showed you are producing 16 ounces per day. 25 – 16 = 9. You should plan to give your baby 9 ounces of supplement each day. If you breastfeed your baby 9 times a day, plan to give him 1 ounce of supplement at each breastfeeding session.

I strongly recommend that you do either of the milk production tests, but if you absolutely cannot there is another, though less accurate, way to estimate the amount to supplement. We know that
thriving babies 0 to 4 months gain about 6 ounces of body weight each week. If we know how your baby compares, we can get a rough estimate of how much you should supplement. Here’s how:

You’ll need to weigh your baby each week. Use an accurate baby scale and weigh your naked baby about the same time of day each week. Subtract your baby’s weight gain from the thriving baby’s weight gain who is the same age in the chart below. Multiply that result by 2 to get the number of ounces of supplement needed per day.

• Thriving babies 0 to 4 months gain 6 ounces per week.
• Thriving babies 4 to 6 months gain 4 ounces per week.
• Thriving babies 7 to 9 months gain 3 ounces per week.
• Thriving babies 10 to 12 months gain about 2 ounces per week.

For example, let’s say your three month old gained 2 ounces last week. From the chart above we see that a thriving three month old should gain 6 ounces per week. So we take 6 – 2 and get 4. Next we multiply 4 by 2 to get 8. Therefore, we estimate that baby needs 8 ounces of supplement per day.

Keep this method in mind, because we’ll use it during step 6: evaluate weekly and ween off supplements.

How To Supplement Breastfeeding With Formula: Step 3

Know What To Supplement

Here’s the what you should supplement in order of preference:

  1. Your own breast milk – fresh or frozen, produced from earlier pumping sessions.
  2. Breast milk from another mother – if it is available and is not objectionable or uncomfortable for you, it makes a healthy choice. See this article for how to pasteurize the milk.
  3. Formula.

The best supplement you can give your baby is your own pumped breast milk. Pumping is a great strategy for increasing your milk supply and you can use your freshly pumped breast milk as a supplement. If you banked up a supply of breast milk in your freezer from earlier pumping sessions, now is the time to use it. If you don’t have breast milk banked up or if you run out, breast milk from another mother, preferably a relative or friend is a good option.

Another option is a milk bank. See http://www.hmbana.org/index/locations for locations around the country. If there’s not a location near you, milk banks will often overnight frozen milk to your home. Milk from milk banks has been pasteurized – a process of heating the milk to kill possible harmful bacteria – so you can unthaw and use it immediately. If you’re getting milk from a friend or relative you may wish to pasteurize it before giving it to your baby. See our article How to pasteurize breast milk.

How To Supplement Breastfeeding With Formula: Step 4

Know How To Supplement

If you are already using a bottle to supplement, chances are you’re in big trouble. You’re on that slippery slope to exclusive formula feeding. It’s time for damage control. With much work and patience you can get back on the road leading out of Supplement Town. I’ll show you how later, but first let’s look at the best way to supplement while keeping and ultimately rebuilding your milk supply.

Monoject is great for supplementing with formula

A monoject 412 syringe.

First you’ll need to get a set of Monoject 412 periodontal syringes. A pack of 25 is enough to get started and you can find them online for less than $1 each. These are small capacity syringes that have a curved tip, rather than a needle. Here’s how to use them:

Each time you nurse your baby, you’ll use the syringes to give the supplement. Each syringe only holds 1/4 to ½ of an ounce (depending on how full you fill it), so you’ll need to determine ahead of time how much supplement baby needs at each nursing. If he needs 1 ounce then you’ll fill 2 or 3 syringes before starting breastfeeding. If he needs 2 ounces then you’ll fill 3 or 6 syringes depending on how full you fill each syringe.

Once your syringes are prepared and within easy reach of your nursing area, latch baby with as good of a latch as possible. Immediately take the first syringe and slide the curved tip into the corner of baby’s mouth. Lightly tap on the plunger to push the milk into the baby’s mouth. Empty the first syringe over the next minute to produce a slow flow of milk. Giving milk like this, right at the beginning, should invigorate baby and result in more vigorous sucking and better milk removal from the breast, which in turn increases your milk supply. Giving milk right at the beginning also helps babies who have negative feelings toward the breast to get immediate, positive response when they latch. This rebuilds their trust in the breast.

Have the next syringe handy and if baby starts getting frustrated or fussy, put it in his mouth immediately, otherwise give him a few minutes with just the breast. Continue to dole out the syringes throughout the breastfeeding session as evenly as possible. Try to use an even number of syringes per breast as well. When you switch breasts, watch baby’s cues, if he seems to be getting frustrated, give him a syringe right away just like when you started the session, however you may find that he is more patient after getting some satisfaction from the first breast.

Be sure to give all the syringes before the end of the breastfeeding session and allow baby to continue to nurse at the breast until he is finished.

Here are the benefits of supplementing with Monoject:

  1. Avoids the supplementing land mines of nipple preference, nipple confusion and flow preference.
  2. Maintains or increases milk supply, because your breasts get far more stimulation than when supplementing with a bottle.
  3. Keeps baby bonded to you and familiar with the breast.
  4. Baby learns (or relearns) that he can be satisfied at the breast which will reduce his frustration and fussiness with breastfeeding. Breaking the associations of feeling frustrated at the breast and satisfied from the bottle builds the foundation for conquering low milk supply and successful breastfeeding.
  5. It’s easy to change the amount of supplement and easy to ween from supplement.
  6. You decide when baby gets each syringe. This allows you to watch his mood and give him a supplement before he gets frustrated at the breast. This is a great way to bring baby back to the breast after he’s become attached to supplements from a bottle.
  7. By finishing at the breast, rather than with a bottle, you get to experience the peace and joy of a happy, satisfied baby in your arms. Your cozy baby may even fall asleep at the breast and continue to comfort suck, which will help increase your milk supply.

Supplementing With A Bottle

Monoject and the method just described is the best way to give baby the nutrition he needs while making your stay in Supplement Town as brief as possible. That being said there may be some times when you find you have to bottle feed. Here’s how to limit the damage of bottle feeding:

  1. Use the slowest flowing nipples you can find. Sometimes they’re marked as a 0 (zero) or labeled “newborn.”
  2. Pick a bottle nipple that’s most shaped (length and width) like your nipple. (This may help with nipple preference and confusion.)
  3. Latch baby on to the bottle much like you latch baby to the breast – get the nipple back in the mouth so that his lips are around the base of the nipple. When you look at baby’s mouth while latched on to the bottle, it should look much the same as when baby is latched on to the breast.
  4. Sit baby up and hold the bottle level with the floor to further reduce the flow. (This may prevent flow preference.) Pretend as though the bottle is a breast that has letdowns. After latching baby, let him suck a bit without much (or any) milk in the nipple. Don’t’ worry about baby sucking air – they swallow air all the time and it will just come back up as a burp. After he’s sucked for a little time, gently lift the bottle to fill the nipple with milk (this is the letdown). Let him suck for a minute or two then drain the milk out of the nipple again. Repeat as necessary.
  5. Use less supplement. If baby needs 1 ounce of supplement per feeding, only give about three quarters then put baby on the breast. Once he gets fussy, switch sides. The goal is for him to end, satisfied and happy with the breast and to associate those good feelings of being full and content with the breast. If after nursing on both sides, he is still fussy, you can finish with the bottle.

How To Supplement Breastfeeding With Formula: Step 5

Let Your Body Know You Are Supplementing

While you know your baby is being fed 9 ounces of supplement every day, your breasts have no clue. From your breasts perspective, baby consumed the 15 ounces of milk it produced and didn’t demand any more so all is right with the world.

Your body doesn’t know you are supplementing, so your breasts will continue to underproduce indefinitely because they don’t know they are underproducing! Your job is to let your breasts know they are underproducing.

You have to create an artificial demand for your milk to make up for the demand your body isn’t getting from baby. Here’s how.

You’ll need a decent pump. The best option is to rent a hospital-grade pump from a hospital or WIC office. A one month rental is typically $50 to $100. If you know you’ll be returning to work or school and will want to pump, you might consider investing now in a high quality consumer pump that you’d probably buy soon anyway. Expect to invest $200 to $400 for a good consumer pump.

If either of those options don’t work, get a quality manual pump over a “cheap” electric pump. You can build up your arms like pop-eye or get the foot pump accessory and build up your leg muscles! Plus it’ll remove milk effectively. These run about $50.

If you don’t to pump, you can still use hand expression to remove milk. See our article on how to hand express.

Once you have your pump or have decided to hand express, it’s very important to pump or express after each nursing session! The purpose here isn’t to extract milk – so don’t be discouraged if you get very little milk or none at all – the purpose is to let your body know that baby is demanding more milk than is being produced.

• Very Important: After each breastfeeding session (day or night), pump or hand express for 10 minutes on each side or for as long as milk is flowing, whichever is longer.

Next add one or more pumping sessions. Your body will see this as baby adding extra nursing sessions, just like what happens during a growth spurt, and your body will attempt to meet the increased demand with increased supply. In addition you can use the milk you pump as your first source of supplement.

Try to add a bonus pumping session in the middle of the longest gap between your baby’s typical nursing sessions during the day (this is usually nap time). Add another bonus pumping session a couple of hours after baby goes to sleep for the night (usually just before you go to bed). You can get up in the middle of the night for a bonus pumping session, but evidence suggest that getting more, high quality rest is equally beneficial. However if you can’t sleep one night try a bonus pumping session. Pumping releases oxytocin, a relaxing hormone, that may help you get back to sleep.

Here are the rules for Step 5:

  1. Pump or hand express after every breastfeeding session. If you want to leave Supplement Town this is not a rule you can bend or break. It is the most important point in this entire article, so I’ll say it again, pump or hand express after every breastfeeding session.
  2. Add 1 to 3 bonus pumping or hand expressing sessions each day

The more you let your body know that baby is demanding more milk, the easier it is to correct undersupply. If there are not any underlying issues, your supply will likely rise to meet the demand. Using an herbal supplement like Lactiful Supply Max can increase your milk supply even faster. Finally you’ll need to evaluate your baby each week and adjust the amount of supplement accordingly.

How To Supplement Breastfeeding With Formula: Step 6

Evaluate Weekly And Ween Off Supplements

Once you begin to supplement you’ll need to track your baby’s progress and for that you’ll need a baby scale. While you can plan to stop by your doctor’s office or WIC office each week, most moms find it more convenient to have a scale at home.

baby scaleThe best option is to rent a scale from your hospital, doctor’s office or WIC office. Alternatively, you can purchase a baby scale online for less than $100, but these won’t be as accurate as a rented one and you’ll have a baby scale to store or sell once you’re finished with it.

Once a week, about the same time of day, weigh your completely naked baby. No clothes, no diaper. If your baby has settled into a nursing schedule and has bowel movements so regular that you can set clocks by them, the ideal time to weigh baby is after a bowel movement and before nursing. Don’t worry if your baby doesn’t meet this ideal; weighing him at 3:00 PM every Monday works just fine.

What you are looking for week to week is baby gaining the amount of ounces he is supposed to be gaining for his age. Use this chart as a guide:

  • Thriving babies 0 to 4 months gain 6 ounces per week.
  • Thriving babies 4 to 6 months gain 4 ounces per week.
  • Thriving babies 7 to 9 months gain 3 ounces per week.
  • Thriving babies 10 to 12 months gain about 2 ounces per week.

If your baby gained more than the target ounces, you are over supplementing and can cut back on supplementing.

If your baby gained the target amount, you can cut back a little on supplementing. If your baby didn’t gain the target amount, you should supplement more.

Here’s how to adjust the amount of supplement:

Gained more than 4 oz over target Reduce supplement by 6 oz per day
Gained 3-4 oz over target Reduce supplement by 4 oz per day
Gained 1-2 oz over target Reduce supplement by 2 oz per day
Gained target ounces Reduce supplement by 1 oz per day
Gained 1-2 oz under target Increase supplement by 3 oz per day
Gained 3-4 oz under target Increase supplement by 5 oz per day
Gained 5-6 oz under target Increase supplement by 7 oz per day
Lost weight See below

If your baby lost weight, reweigh baby right away to rule out a false reading. If baby lost more than a couple of ounces it may indicate a serious problem and you should contact your health care professional right away. However if baby lost just an ounce or two, weigh baby again in 3 days. If baby is continuing to lose weight call your health care professional and increase supplement by an additional 10 ounces per day.

Each week, adjust the amount of supplement up or down, based on baby’s weekly weigh-ins.

Always keep in mind why you went to “Supplement Town”. It’s a place where baby can get the nutrition he needs to thrive and it buys you the time you need to figure out the cause of your low milk supply and take action to correct it.

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