I'm Told my Baby Needs Supplementation...Now What?

Written by Danielle Blair, MS, IBCLC

If you are planning to exclusively breastfeed your baby, the thought of being told to offer supplements (meaning extra milk in addition to direct breastfeeding) for your baby may be downright terrifying.  You may be concerned about nipple confusion, milk supply, or exposing your baby to formula.  Hopefully by learning about common reasons for supplementation and supplementation methods, you can avoid unnecessary supplementation and learn how to offer supplements in ways that are less likely to interfere with breastfeeding.


Why might a baby need to be supplemented?

There are many common reasons why a baby might need supplemental feedings.  It is important for you as a parent to advocate for your baby by making an informed decision that the supplement is medically necessary.  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.  In all of these cases, the first step is to ensure that baby is breastfeeding effectively.  If not, a supplement might be called for as part of the baby's medical treatment.


What is a supplement?

Often we think of supplements as formula in a bottle, but in many cases, a supplement can be expressed breast milk.  Mothers can express their own milk, either by hand or with a breast pump, and offer it to baby by spoon, cup, syringe, supplemental nursing system, or bottle.  Each feeding method has pros and cons, and not all are appropriate for every situation.  If you are instructed to offer your baby a supplement, ask your healthcare provider or IBCLC to help decide which method is best to feed your baby.


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

In most cases, the only milk a baby needs is what he can take from the breast or what mom can express from her breast.  However, sometimes the medical treatment for baby's condition may include milk volumes that exceed mom's current supply.  This is especially true if supplements are recommended before mom's milk production surges about 3-5 days after delivery.  In this case, you may need to use donor milk or formula.  Your IBCLC can help you with pumping or hand expression techniques.  She might also recommend renting a hospital-grade pump until your milk production increases.


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.  By expressing milk to feed to your baby, you are helping to establish and maintain the milk supply that your baby will need.


When can I stop supplementing?

Part 2 (next week) will discuss how you 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