Supplementing With Formula Milk: When & How

Even if you’re a die-hard breastfeeding momma, there are good reasons to supplement with formula.

Your baby may not be gaining weight properly, a cluster-feeding session could leave you in so much pain that your nipples are too sore to feed again, or you need to leave for longer than a few hours and weren’t able to pump enough breast milk.

Supplementing with formula gives you options that can make breastfeeding easier.

A study in the Journal of Pediatrics concluded that supplementing with formula could actually help some newborns, and supplementing at a young age didn’t impact breastfeeding rates or intestinal bacteria as was previously thought.

Given that it’s safe and won’t harm your breastfeeding experience if done correctly, what are the do’s and don’ts of supplementing breastfeeding with formula?

Why Supplement With Formula In Addition To Breast Milk?

Milk supply issues are one good reason to supplement with formula.

Supplementing can take some of the pressure off of you if your milk supply isn’t coming in, especially since stress over whether or not your baby is getting enough milk can impact your production.

It can also free you to pump, stimulating production, while your baby is getting a bottle.

Baby’s weight gain is another reason. If they haven’t regained their birth weight fast enough, or aren’t growing per your pediatrician’s guidelines, temporarily supplementing with formula can get them there. See more below.

Your pediatrician might also want you to supplement if your baby is born with jaundice. Jaundice is caused by high levels of bilirubin in your baby.

Your initial breast milk is almost all colostrum, and supplementing with formula causes them to poop and pee more, which will move bilirubin out of their system faster.

This nurse’s video gives a great overview of why to supplement.

When Should I Supplement My Baby With Formula Milk In Addition To Breast Milk?

Every medication you take will reach your baby in your breast milk, even if only small amounts of it.

There are some medical conditions that might require you to take medicine that would be bad for your baby if delivered in breast milk.

If you have to take a medication on the ‘no’ list, you CAN’T breastfeed.

In that case, your pediatrician might recommend that you temporarily feed your baby formula while pumping to keep up your supply and just discard your pumped milk.

At What Age Is It Safe To Start Supplementing Breast Milk With Formula?

There are no age guidelines for supplementing with formula. Newborns with jaundice are started on supplemental formula feedings straight away, and it’s generally considered to be safe at any time.

What Are The Signs That My Baby Needs Supplementing With Formula Milk?

It’s normal for a breastfed newborn to lose 7-10% of their birth weight within the first few days.

Weight loss above 10% is a sign of the following problems; your milk may not be coming in properly, your milk may not have enough nutrients for the baby, or your baby could be dehydrated.

At this point, your doctor will likely recommend supplementation.

After you leave the hospital, your pediatrician or lactation consultant will weigh your baby at every check-up. They should regain that lost birth weight within 10-14 days. If their weight gain isn’t what your doctor would like to see, your baby may not be getting enough nutrition from your breast milk.

Wet diapers are another sign that you may need to supplement. After the first week, a newborn should have 5-7 wet diapers and 3-4 bowel movements a day. Carefully monitor the frequency of diaper changes and their contents.

You know what isn’t a sign that your baby needs supplementing? If they’re nursing three to four times an hour. While you may think that this is a sign they’re still hungry and need formula, this is common for newborns as they’re still learning and practicing how to breastfeed.

How Can I Tell When No Supplementing Is Needed?

If your baby has regained all their birth weight within 10-14 days, they are likely getting enough nutrition from breast milk.

After they’ve recovered their birth weight, and if they are continuing to gain weight at a rate of 5-7 ounces per week, then they are within norms and supplementation probably isn’t needed.

Monitor your baby’s weight gain using the charts specifically made for breastfed babies put out by the CDC for both boys and girls.

An easy way to weigh a baby without buying a baby scale is to step on the scale by yourself and get your weight, then step on the scale holding the baby and subtract the difference. Voila, a rough baby weight estimation!

When Should I Not Supplement My Baby With Formula Milk? And Why?

Unless there is a medical reason for it, a mother shouldn’t supplement feed their baby until breastfeeding is well-established, which is typically around four to six weeks.

Before this point, supplementing with formula increases the risks of nipple confusion, the baby rejecting the breast, or reducing your supply.

This also decreases the risk that your breasts will stop milk production if you’ve been producing enough.

Supplementing Using An At-Breast Supplementer

An at-breast supplementer system (or supplemental nursing system, “SNS”) is an excellent way to supplement with a newborn or very young baby.

Because the formula is given to the baby at the breast, mama and baby still have the bonding benefits of breastfeeding and baby will continue to associate the breast with nurturance and food.

Plus, these systems can stimulate your milk production because the baby is still latched on and sucking at your breast.

Here’s a step-by-step guide to using one;

  • Mix the formula that you’re using, ensuring that there are no clumps.
  • Pour the formula into the bag system.
  • Screw the top on the bag. Make sure it’s on tight so you don’t dump the formula out in the next step.
  • Hang the bag or bottle around your neck, settling it between your breasts.
  • Tape the attached tube to one or both breasts. Get it on there securely so the tube doesn’t pull lose when feeding and frustrate the baby. The tube’s end should be placed next to your nipple.
  • Place both tube and nipple in the baby’s mouth, ensure they have a good latch and begin feeding!

Here’s a video with instructions.

It may take several tries to get the hang of using an at-breast supplementer, and you may have to try more than one system.

There are different types available, each with small variations such as; tube size, disposable or reusable containers, and whether or not you can nurse with them lying down.

There is no at-breast supplementer that is discreet, so I don’t recommend using one in a public setting.

With an at-breast supplementer system it’s extremely important that you properly clean the tubes to avoid bacteria building up in them and formula clumping. When cleaning your tubes;

  • Place the tubes in soapy water, forcing it through the tubing and teat by squeezing the teat. Use a clean bucket or large bowl, not a dirty sink.
  • Thoroughly rinse the soapy water out of the tubing with distilled or boiled water. Some mothers use a water/vinegar solution to thoroughly sanitize but this will require an additional rinse step.
  • Squeeze the teat to remove all water droplets from the tubing.
  • Lay everything out on a clean towel to dry.

Here’s one mom’s instructions on how to clean an at-breast supplementer system.

Supplementing Using A Bottle

Many moms find that supplementing with a bottle is an easier process than an at-breast supplementer system. If you want to supplement feed with a bottle, here are the steps to follow;

  • Prepare and mix your bottle.
  • Use clean, sterile water.
  • Make sure there are no clumps of formula in the bottle.
  • Hold the baby in an upright position, not lying down as if to breastfeed. Bottle feeding a baby lying down increases bottle caries and ear infections.
  • Switch from side to side when feeding, to continue to support breastfeeding routines.
  • Stroke your baby’s lips from top to bottom with the bottle’s nipple to encourage rooting.
  • Allow your baby to draw the bottle’s nipple into their mouth, do not force it.
  • Feed the baby for 10-20 minutes at a time. Do not rush or force the baby to eat.
  • Allow your baby to pause during the feeding, just like when breastfeeding.
  • If possible, finish the feeding at the breast.

Tips If You’re Having Problems

If your baby is rejecting formula, it might be because they don’t like the taste. Try mixing a bottle of half breast milk and half formula, then slowly decreasing the amount of breast milk over time.

If your baby is absolutely refusing to take a bottle and you’re not using an SNS, try leaving the room or even the house. Make sure there’s a pre-mixed bottle in the fridge and let your partner do the feeding.

Keep at it! Just like breastfeeding, it may take a lot of trial and error before your little one will accept different ways of being fed.

What To Avoid When Supplementing With Formula

Start with the bottle and then finish at the breast. That way, your baby will associate feelings of fullness and satisfaction with the breast.

According to Diana West, a lactation consultant and author of the book The Breastfeeding Mother’s Guide to Making More Milk, if you end with the bottle – your baby may start to prefer it, so avoid giving the bottle last at a feeding.

Also, don’t just use any old bottle. If a baby who is fed with both bottles and breast is given the wrong type of bottle, this can cause nipple confusion.

The latch is different on the bottle than on the breast, and they may struggle to latch again at the breast if given the wrong type of bottle nipple.

One of the risks of supplementing with formula is that the baby grows accustomed to the fast-flowing bottle milk and doesn’t want to do the work to get your breasts to let down.

Look for a bottle with slow flow, paced feeding and a breast-feeding nipple.

What Types Of Formula Milk Are Best For Supplementing A Breastfed Baby With?

The best types of formula for breastfeeding moms to use as supplements to breast milk depend on their baby’s needs.

It’s important to talk with your pediatrician or lactation consultant about which formula will be best for your child. Their age, weight, and other factors will need to be considered.

A preemie who is struggling to gain weight will need a formula specially formulated to provide extra nutrients. Within the range of preemie formulas available are those specifically for babies who have acid reflux or lactose intolerance.

Most formula has cow’s milk as a base, so if your baby isn’t tolerating lactose well they’ll need a lactose-free formula. If there is a history of lactose intolerance in the family, your pediatrician may recommend this type of formula as a precaution.

If your baby already struggles with gassiness and stomach upset, look for a formula that is 100% whey, versus the more common mix of whey and casein.

Generics are often processed in a way that doesn’t break down all the proteins, which means that your baby won’t receive as many benefits from the formula.

If they get more breast milk than formula, this won’t be a problem, as the breast milk will provide the proteins they need. But if they’re being formula fed more than breastfed, stick to name brands instead.

Because research, label information, and types of formula available vary and change all the time, there is no one definitive guide to the right formula to give a breastfed baby.

What Types Of Formula Milk Should I Avoid?

The only type of formula milk that should never be given to a baby is a homemade version.

While recipes exist online, they haven’t been studied to ensure that they deliver the proper nutrition, you aren’t preparing them in a sterile environment, and any milk you’re using may not have undergone pasteurization processes to remove bacteria.

What About Liquid Versus Powder Formula?

Liquid formula comes pre-mixed in sterile, disposable bottles. If you’re new to formula and are intimidated by mixing ratios, it can be the easier choice.

But it has to be used quickly, so you may throw a lot out if your baby doesn’t take the full bottle. And you can’t choose the nipple on the bottle, so it may not be the proper kind for breastfed babies.

Powder formula takes more work to prepare, but it costs less. It’s important that you have access to a clean, safe water supply for mixing. With powdered formula, you can choose the bottle and be one hundred percent certain that it’s designed for a breastfed baby.

Will Supplementing With Formula Affect My Baby In Any Way?

You’ll notice some changes in your baby when you begin supplementing with formula.

For starters, formula takes longer for a baby to digest than breast milk. If you feed them before a nap or bedtime, they’ll sleep longer and won’t wake as soon for a feeding – which is why supplementing is great if you’re exhausted and really need to catch up on sleep.

A baby’s bowel movements are an indicator of their overall health and nutrition. Once you begin feeding them with formula, their stool will change.

Instead of the yellowish color typical of breastfed babies, their stool may darken to a shade of brown. It will also be firmer, and they may poop less frequently.

Wrapping It Up

And that’s all you need to know about how to supplement breastfeeding with formula milk.  If you try any of these processes, let us know how it goes!

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