I'm Told that my Breastfed Baby Needs to be Supplemented.... What Should I Do?

Being told that your breastfed baby needs to be supplemented can feel extremely overwhelming and can often feel like quite a blow to the self-esteem.  You might be concerned about your milk supply and if your baby will prefer the bottle to your breast. You may feel confused as to why your baby isn’t gaining the appropriate amount of weight while breastfeeding.  

So, let’s talk about the reasons why a baby might need to be supplemented and how to do this without sabotaging your milk supply and your breastfeeding relationship.

What is a supplement?

A supplement is anything in addition to what your baby receives from your breast while breastfeeding.  Babies can be supplemented with: 

Mom’s own pumped milk (if baby is not removing her milk well enough)

Donor milk (from a milk bank or from another breastfeeding/pumping parent)

Formula

How do I know if my baby truly needs supplemental feedings?

Babies are expected to gain a certain amount of weight based on their age.  So, if a baby is NOT gaining that expected amount, additional supplementation is often recommended.  Here are the weight gain expectations for the first year of baby’s life:

Initial weight loss in the first few days of life - no more than 10% of baby’s birth weight

2 weeks - baby should be back to birth weight (or very close, if he/she lost more than 10% in the first 2 weeks

2 weeks - 4 months - baby should gain about 7 ounces per week

4 months - 6 months - baby should gain about 4-5 ounces per week

6 months - 1 year - baby should gain about 2-4 ounces per week

Why might a baby need to be supplemented?

There are many common reasons why a baby might need supplemental feedings.  

Some common medical issues that can arise shortly after birth that may lead to supplements are prematurity, low birth weight, poor feeding, low blood sugar levels (hypoglycemia), elevated bilirubin levels (jaundice), dehydration, excessive weight loss or poor weight gain.  After those first few weeks, some common reasons for supplementation are baby not removing milk well while breastfeeding (due to tongue tie, reflux, very long feeding sessions) and a low milk supply. In all of these cases, the first step is to ensure that baby is breastfeeding effectively.  Next we want to assess mom’s milk supply to make sure that she is producing enough milk for her baby. Sometimes all it takes are a few modifications to the baby’s feeding routine to help baby start to gain weight. Other times it requires a lactation consultation (done by an IBCLC) to assess baby’s feeding and mom’s milk supply for the cause for baby’s low weight gain.

What if I can't express enough milk for my baby?

First you’ll want to make sure that you have everything you need to express your milk.  If using an electric pump, make sure the pump flanges fit correctly and that you are pumping for about 15 minutes after breastfeeding.  Some moms let down for the pump easily. Others find that they prefer a hand pump or hand expression. You will want to find what works best for you.

In those first few days after birth (when milk production has not quite yet surged), it can be a bit challenging to express a measurable amount of milk.  In this case, sometimes baby might need to be supplemented by donor milk or formula.

Once your mature milk is in (after those first few days), you might want to meet with an IBCLC to put together a breastfeeding/pumping plan to see if you are able to express enough milk for your baby, as well as increase your milk supply, if necessary.  If you are not yet able to express enough milk for your baby’s supplemental feedings, donor milk or formula would be recommended.  

Do I have to use a bottle when giving my baby supplemental feedings?

Not at all!  There are several ways to supplement a baby.  Each way has its pros/cons and will be determined by what works best for you and your baby.

Cup feeding is great for older babies, as well as some younger babies who will not take a bottle

Finger feeding is great for the first few weeks of life, as the flow is slow and your finger can help organize your baby’s sucking rhythm.

Supplemental nursing systems (SNS) allow your baby to be supplemented at the breast so that he/she still thinks everything is coming from you!  The SNS has a tube that slips into your baby’s mouth, at the breast, to provide the supplement at the same time baby is breastfeeding. This works best when baby is latching/breastfeeding well and mom is trying to increase her milk supply.

Bottles are definitely an option, as well.  You will want to offer a bottle in a baby-led (paced) manner so that your baby doesn’t begin to prefer the ease and flow of the bottle, compared to your breast.

Will my baby ever be able to fully breastfeed after supplements?

Generally, the answer to this is YES!  Most reasons for supplementation are short-term problems that are resolved relatively quickly with good treatment.  Premature babies grow and get stronger, and typically get better at breastfeeding around their due dates or shortly after.  A baby who is having difficulty with breastfeeding immediately after birth will often be ready for breastfeeding within a few days after birth.  If breastfeeding challenges linger for more than a few days, an IBCLC can help identify the reasons and set you on a path for reducing and hopefully eliminating supplementation as soon as possible. In the meantime, expressing your milk in addition to breastfeeding will help maintain and build your milk supply as challenges resolve.  

When can I stop supplementing?

Part 2 will discuss how you’ll know it's time to wean from supplements and helpful tips for doing so. 

For more information about supplementation reasons, methods, and choices, check out these The Boob Group podcast episodes: 

Exclusive Breastfeeding and Early Supplementation 

Breastfeeding the Jaundiced Baby

When Breastfeeding Doesn’t Go As Planned 

Low Milk Supply: Donor Milk, Milk Banks, and Formula

Partial Breastfeeding: When Supplements are Needed

Help! My baby won’t take a bottle!

Seen this face before?

Photo by Brytny.com on Unsplash

Good luck trying to get a bottle in this mouth!

So, breastfeeding has been going well!  Your little one feeds like a champ.  You have stored a bunch of breast milk in your freezer.  You have found a caregiver that will love your sweet, little muffin almost as much as you do.  Now, it is time to make sure your baby will be fed right while you are back at work and suddenly you run into a hiccup..... your adorable, lovely little one has decided that she is not interested in a bottle and downright refuses it!  

WHAT?  How can this happen?  

This is precious breast milk that you pumped with love!  How can she be that stubborn at such an early age? 

If it brings you any consolation, I see this all of the time at our breastfeeding center.  I have seen the stress in a parent's eyes when she has to return to work and her baby refuses everything, but the breast.  Well, I am here to alleviate that stress with a bunch of tricks to help your sweet, albeit opinionated, infant take a bottle before you return to work. 

List of Tricks to Help your Breastfed Baby Take a Bottle

1. Have dad/partner try to give the bottle, not the breastfeeding mom. If he/she is not completely successful, have an experienced bottle feeder (grandma/grandpa, aunt/uncle, friend, nanny, daycare provider, etc.) give it a try. They may also not be as offended as dad/partner may be:)

2. Patience is key! If your baby isn't interested, try at a different time of day. My kids were usually more calm in the morning than in the afternoon, so I would always try new things at the beginning of the day.

3. Be playful! Rest the nipple on your baby's philtrum (the crease that connects her upper lip to her nose) and let her decide when she will take it in her mouth. This mimics what goes on during breastfeeding.

4. Try different feeding techniques. Try feeding your baby with a bottle in a cradle hold. If that doesn't work, try feeding her facing you, either on your lap or in a bouncy chair. You can also try walking around.

5. Some babies like to smell their moms while bottle feeding, so let her snuggle in one of mom's t-shirts or with her pillow case while bottle feeding.

6. Choose a bottle nipple that looks most like your anatomy. Start with the slow-flow nipple. This will give your baby more sucking time, just like at breast. If your baby is a little older, or if you have a really fast-flow, your baby may prefer a faster flow nipple. Choose what most resembles you and your baby's breastfeeding experience.

7. Use baby-led bottle feeding techniques to make bottle feeding more like breastfeeding. You can check out our YouTube channel for a video on how to do this!

8. Experiment with different bottles and nipples. Babies have preferences, so give yours an opportunity to choose her bottle and nipple....without breaking the bank, of course!

9. Warm the nipple under running water before offering it to your baby. She might have a temperature preference, too.

10. You can always try a cup. Yes, even infants can drink from a cup. They usually lap it up rather than actually gulping. For more info on cup-feeding, check out Dr. Sear's article on alternatives to bottle feeding

11. Try and try again! Something that didn't work the first time around may work on another day. It is like introducing avocado to your baby for the first time. Some babies love it. Others need to taste it over 10 times before they enjoy it.
    

If all else fails, call a lactation consultant!  We often can identify the root cause of why a baby isn’t taking a bottle and can offer suggestions for other bottles or other feeding methods.  At the San Diego Breastfeeding Center, we also have a variety of bottles to try in our office that we can try during a bottle-feeding consult!  You can make an appointment for one of those consultations HERE.

Hopefully this list has put your mind at ease and offered some advice to help you get through this challenge.  If the first trick doesn't work, just keep on going down the list.  If you have one that has worked for you, please add it to the comments.  Let's share our advice so that all parents can use this as a resource!

Help a Mama Out: What to Do When Your Baby Refuses a Bottle

What tricks have worked for you when your breastfed baby refused a bottle?

Michelle La Plante: Bottle boot camp with daddy!  I left the apartment for the day, leaving baby and daddy there with plenty of expressed breastmilk and a bottle.  By the end of the day, they had figured it out.  (Kudos to hubby for this – it was tough on him to see her cry and fuss…. But, then again, his breasts didn’t leak at the sound of the baby crying!)

Amanda Garfinkel Young: Early and often worked well with my second.  With my first, the nanny had a good trick.  She held him facing out, looking out the window and fed him with the bottle in the other hand.  A little awkward, but it seemed to distract him from the fact that he wasn’t looking up at mama while eating.

Danielle Smith: Try lots of different bottles.

Stephanie Lorenzen: After trying a number of different bottles, we used a spoon and a shot glass.  We then moved on to a straw cup after 4 months of age.

Julie Chapin: As a nanny, I went through this.  Had to have mama away at first.  Plus, baby had to be laying or sitting out of arms… could not resemble nursing at all.  First successes were warm bottle given in a drowsy state as baby was waking in her bassinet.  Windows and toys distracting baby at other times or in a bouncy chair.  Had to use droppers and spoon feeding with a few babies leading up to the bottle.

Natalie Quebodeaux Cavender: Sippy cup!  Turns out he hated the warmed milk and not the bottle.  He likes mama’s milk cold when not from the tap!!!  LOL!

Jennie Bever: My first one took a straw cup fine.  Second one reverse cycled.  Now that he’s older, he’ll also take breastmilk warm in a straw cup.  He would also drink out of a regular cup, although it’s a bit messier!

Liz Anderson Weaver: At daycare, we have had to resort to using medicine droppers with two babies.  Then we tried ERERy NIPPLE EVER until we found their perfect bottle combo.  Both suck ‘em down like champs now!

Stacey Singh: I read that if you have the person who is feeding your baby wear the robe or another article of clothing you wear frequently, it can really help.  I had my husband try it and my baby actually did take a little from a bottle.  We’re still working on it though.

Sylvia Padilla Sullivan: We tried different bottles.  Because he is older (4.5mos), one with a pretty fast, easy flow worked better than the ones we had been trying (like when he was tiny and still learning to suck.)

Thanks to everyone who responded to our questions on our San Diego Breastfeeding Center and The Boob Group Facebook pages.  Check back every Tuesday for a new Help a Mama Out tip!