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

Originally published on September 22, 2019

Revised July 10, 2025

Author: Robin Kaplan, M.Ed, IBCLC, FNC

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 nursing relationship.

ABOUT SDBFC

The San Diego Breastfeeding Center was established in 2009 by Robin Kaplan, International Board Certified Lactation Consultant, Functional Nutritionist, and parent.  Her vision was to create a judgment-free, inclusive support system for families navigating infant feeding challenges.  SDBFC offers a wide range of one-on-one breastfeeding, infant feeding, and nutrition consultations - as well as classes, support groups, online articles, and social media - making it your one-stop-shop for all things infant feeding!

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: 

• Your own pumped milk (if baby is not removing your milk effectively)

• Donor milk (from a milk bank or from another lactating 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 6-8 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 the need for supplementation 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 the parent’s milk supply to make sure that they are producing enough milk for the 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 parent’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 or in place of nursing sessions.  Some parents 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 fuller milk is in (after those first few days), you might want to meet with an IBCLC to put together a nursing/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.

• 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.

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

• A Supplemental nursing systems (SNS) allows 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 well and you’re trying to increase your 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 supplementation?

Generally, the answer to this is YES!  Most reasons for supplementation are short-term challenges 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?

In Part 2 of this blog series, I 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

If you’re feeling unsure about how much milk your baby is getting while nursing, if your milk supply needs a boost, or how to wean from supplementing your baby —we’re here to help! Our team of experienced lactation consultants is ready to support you. Whether you need guidance on how to supplement, what to supplement with, or identifying the root causes for supplementation, we’re here to provide personalized care. Schedule a one-on-one appointment with one of our lactation consultants for expert advice tailored to you and your baby’s unique needs.

SDBFC is committed to providing high-quality lactation and functional nutrition consultations to parents in San Diego and beyond. Explore our postpartum, prenatal, and functional nutrition consultations, take a breastfeeding class or attend a workshop.

About the Author

Robin Kaplan has been an IBCLC since 2009, the same year that she opened up the San Diego Breastfeeding Center.  Robin was the founding host of the Boob Group podcast and published her first book, Latch: a Handbook for Breastfeeding with Confidence at Every Stage in 2018.  Melding her passions for supporting lactating parents and holistic health, Robin finished her Functional Nutrition Certification in 2023. In her free time, she enjoys hanging out with her two teenage boys, hiking, traveling, weaving, cooking, and searching for the best chai latte.

We Were Not Meant to Mother Alone

A few months ago, we sent out a Call for Breastfeeding Stories.  Our desire was to flood the Internet with beautiful breastfeeding stories of triumph, overcoming challenges and struggles, and positive outcomes, regardless of the total amount of milk a mom was producing.  We are thrilled to share these stories with you, our readers, and hope that they offer support and inspiration for you, wherever you are in your breastfeeding journey. 

Thank you to all of the mothers who submitted their stories!  If after you read these memoirs you are inspired to submit your story, feel free to send it to RobinKaplan@sdbfc.com.    

_____

Our first breastfeeding memoir is from Michelle

I booked at least 2 vacations for my maternity leave, all on airplanes. I was going to wear my baby everywhere, nursing her as we went along. I had the organic breast pads purchased, all the nursing tanks, and the most breastfeeding-friendly bottles, but of course I wouldn’t need those for at least several months. I would see Mamas nursing their babes at the beach and I would find myself staring as I daydreamed about my nursling that was to come. December 2013, my sweet baby girl arrived.  She latched and we were a nursing team. 24hrs later I was told she was Coombs positive and her jaundice levels were high. She was sleepy, was losing too much weight and I needed to give her formula in a bottle. I cried lots of tears. "FORMULA? No way!", but I had no other options. Every time I fed her, and I wouldn’t let anyone else feed her.  I felt awful and felt like I was letting her down. 7 days later I was told, "your daughter is failure to thrive". Queue more tears, more formula, more guilt, and not a lot of milk being produced from me. 

Over the next month, my journey consisted of doctors’ visits, pumping 8x a day, a baby screaming at the breast due to bottle preference and low supply, tube feeding, domperidone, and yet my milk never fully came in. 5 weeks in, a friend asked me to go to a breastfeeding support group.  I went and hoped no one would notice me feeding formula to my sweet baby who wouldn't latch more than 5 minutes. Everyone noticed, yet no one judged me. 

3 months in, at the Breastfeeding Support group that I now attended weekly, a Mama who I hardly knew asked if I wanted her to pump for me, and then another offered to help, as well. This would begin my donor milk journey, and a mental shift in my head that allowed me to stop seeing what I wasn't capable of, and start enjoying the beauty that came from a community that would end up feeding both of my babes! I threw away my pumping and tube feeding schedule right along with the lies that told me I wasn't enough because I couldn't get my body to do what I needed to do to fully feed my baby. We kept nursing as much as possible until 10 months and she got half formula and half donor milk. 

A few months later, I was pregnant with my son. After my prenatal appointment at the San Diego Breastfeeding Center, I got permission from my doctor to start hand expressing at 37 weeks to collect colostrum to give my baby in the hospital through syringe feeding at the breast to help flush any jaundice he would have since he would be Coombs positive, as well. I started to collect donor milk and I had a community that donated enough breastmilk to supply him 9 full months as I only provided him about 30% of his needs with my own supply. He was born and I had a tiny bit more milk and a lot more confidence. I knew that no matter what, a nourished baby is a loved baby. I knew now that if I needed to give formula, I wasn't less of a mother.  If I fed my baby pumped milk, donated milk, only could nurse a few times a day, used a cover, didn't use a cover, nursed for 3 months or nursed for 3 years, no matter what, I WAS ENOUGH. Even after a 6 day stay in the hospital for his Coombs, a tongue and lip tie revision, and a micro supply, we nursed for 10 months with donor milk through the SNS tube feeding at the breast. We then fed formula in a bottle and nursed as often as he wanted. He nursed until 16 months. 

Today I am working towards my IBCLC, because of the non-judgmental support I received from the San Diego Breastfeeding Center community. They didn't sprinkle magic fairy breastfeeding dust on me that fixed all issues, but they gave me a plan that was doable. They gave me tools to accomplish the goals I set for myself.  They gave me hope and they provided me with a community that was there to cheer me on. When I think about my breastfeeding journey, it is less about feeding my children, and more about the discovery that we Mamas cannot mother alone; we were never intended to do so. It takes a village to raise a baby, and for me, it took a village to feed mine. I am forever grateful. 

Breastfeeding After Breast Reduction - It IS Possible!

Written by Ashley Treadwell, IBCLC

Many women wonder if they will have a full supply after having a breast reduction.  While the basic answer to this question is “we don’t know yet” - there are many factors, as well as things she can actively do, that can affect her ability to breastfeed successfully.  In this article, we will discuss what those activities are and how a mom can maximize her supply when breastfeeding after a breast reduction. We will also look at what long-term supplementation can look like, if it is necessary.

It is important to remind you that breastfeeding does not have to be an “all or nothing” endeavor!  We need to re-define what “success” means when it comes to breastfeeding after a breast reduction. Anytime a woman has a physiological factor that can affect milk supply, we always want her to understand that ANY amount of breastmilk is amazing. Whether she is able to provide 10% or 100% of what her baby needs, she is doing a fantastic job.

What Factors Will Affect My Ability to Breastfeed Exclusively?

An initial factor is how the surgery was performed.  Fortunately, surgeons are currently performing breast reduction procedures in a manner that protects as much of the lactation function as possible - increasing a woman’s chance for breastfeeding later in life.  If a large amount of breast tissue has been removed, or the ducts that deliver the milk to the nipple openings are severed, breastfeeding may be negatively affected. There are many different types of procedures and it isn’t always possible to tell which type was performed by simply noting the shape and placement of a woman’s scars.  If you have had a breast reduction surgery and don’t know the specific type that was performed, the best way to gather this information is to contact the surgeon who performed the procedure.  The most popular surgery performed in the United States is one that is also known to have the best implications for breastfeeding later in life. In this procedure, the areola isn’t completely removed and, therefore, connection between the nipple and breast tissue/ducts is partially protected.  If the procedure involves removing the nipple completely and then surgically reattaching it, your chances of exclusively breastfeeding can be decreased.

Another factor that will affect your milk production is when the procedure was performed.  The longer the time between the birth of your baby and the procedure, the better your chances will be to develop a full milk supply.  Also, your milk supply is likely to increase with each subsequent birth - so if you are not able to exclusively breastfeed a first baby, there is still a good possibility you will be able to with a second or third child!  These factors are each important because with both time and breast stimulation, breast tissue can actually re-grow and re-connect.  This can be very encouraging for first-time moms to hear - that even if they are not able to provide their first baby with 100% of their breastmilk needs, all the hard work they are putting in is likely to pave the way for a larger milk supply with later children.

What Can I do to Maximize my Milk Supply - Before and After my Baby Arrives?

Something ALL moms can do to best prepare to breastfeed a baby (those who have had reduction procedures and those who haven’t!) is to educate themselves prior to the baby’s arrival.  Take a breastfeeding class taught by an International Board Certified Lactation Consultant (IBCLC) and find out which resources are available in your area.  Free support groups are a wonderful place to get help and support, as well as connect with other moms who are currently breastfeeding.  We encourage women to attend our breastfeeding support groups while still pregnant - it’s a great way to familiarize yourself with breastfeeding women. A breastfeeding class will teach you what normal breastfeeding looks like in the first few weeks - this knowledge can help to reduce a lot of stress and anxiety.

Find an IBCLC who is knowledgeable about helping women breastfeeding after a breast reduction.  Most offer prenatal consults that will specifically address what you can do to maximize your milk production, including different herbs available to help with supply.  And even if you don’t meet with one prior to birthing your baby, she can be there as soon as baby arrives to help, if needed.

Once your baby arrives, the very best thing you can do is to breastfeed that baby constantly!  The more stimulation your breasts receive in the early days, the better your milk supply will be.  Babies feed frequently in the early days - knowing the signs that baby is getting enough are important.  We have great information in a blog post about how to know baby is getting enough in the first week - I’ve Had My Baby, Now What? Breastfeeding During the First Week.

Some signs that baby isn’t getting enough are: baby not gaining weight after the 5th day of life, baby not having the recommended number of pee and poop diapers per day, or baby is well under birth-weight by 2 weeks of age.  If you are experiencing any of these issues, it is important to seek out the help of an IBCLC.

If Long-Term Supplementation is Necessary - What are My Options?

It may be the case that some amount of supplementation is necessary for a woman breastfeeding after a reduction, especially for her first baby.  If this is true - there are many options available.  Whether mom has little to no supply, or close to a full supply, the best way to supplement a baby to establish a wonderful breastfeeding relationship is to feed the baby the additional milk at the breast.  There are supplemental nursing systems (SNS) available that are made for this specific situation - an IBCLC can help a mom learn how to use this.  If mom doesn’t want to supplement baby this way, but does want baby to have time at the breast, she can still feed the baby at the breast and then follow up with another feeding method - like a slow-flow bottle.  If having baby at breast is important to mom, we do recommend that a bottle isn’t introduced until baby is latching well at the breast - some time after week 3.  Prior to then, mom can supplement using a SNS, and then move to some combination of that and a bottle after the baby is 3-4 weeks of age.  Supplementation can either be with mom's pumped milk, donor milk from another breastfeeding mother, or commercial formula. Here is our YouTube video showing one way a mom can supplement her baby at the breast: Supplementation: SNS at Breast

What Resources are Out There to Help Women Who Want to Breastfeed After a Breast Reduction?

Having support and help both before and after the birth of your baby is crucial and can have a lasting effect on your breastfeeding experience.  We encourage all moms, whether they’ve had breast surgery or not, to look for breastfeeding support in their communities.  Women who are breastfeeding after a breast surgery may need additional support and information specific to their unique situation.  One of our favorite places for support is the website Breastfeeding After Breast and Nipple Procedures.  Here you can find links to health care providers in your area who specialize in helping women post breast surgery, as well as a community of women who are in your same situation.  Robin also interviewed Diana West for The Boob Group podcast episode: Breastfeeding After Breast Reduction Surgery.  

Additional Resources:

Defining Your Own Success. Breastfeeding after Breast Reduction Surgery by Diana West.

Defining my Breastfeeding Experience: Inclusive Breastfeeding

Written by Aran Tavakoli

It has been nine months and I just put away my pump. Getting it ready for storage was bitter sweet. How many hours have I spent with that machine in the past 9 months? Its usefulness outweighed the annoyance.  Once again, at this point in time, I am redefining my breastfeeding relationship with my baby. 

Breastfeeding has been an extraordinary journey. I have experienced and learned so much. I keep searching for a word that captures and defines my experience, but I can’t find one. I believe the breastfeeding community is actually missing a term for mamas that fall into their own camp. There is the exclusively breastfeed group and the formula group. Research often distinctly divides mamas and babies into these two groups. But, there is an ever-growing group of mamas that breastfeed and give formula to support their breastfeeding relationship with their baby. The current words used to describe this group include combo feeding or more commonly, low supply needing supplementation. 

From the true definition, I do not "exclusively" breastfeed my baby. However, I do exclusively give my baby all the breast milk that I have.  But he needs more to be happy and healthy, so he also receives formula and when he was really little, he received donor milk. Honestly, I am so tired of the “low supply” conversation, I wish there was a different word for how I feed my baby. A word that matches the pride of the mamas who do exclusively breastfeed their little ones all that they produce.  

Per Merriam-Webster, ‘exclusive’ is defined as, “not shared: available to only one person or group.” ‘Inclusive’ is defined as, “covering or including everything: open to everyone: not limited to certain people.” 

Thinking about it, I have never been an exclusive type of person, so the opposite of exclusive is inclusive. I have inclusively breastfed my baby for 9 months (way longer than I would have thought in the beginning!). This is the word that I am using to define my breastfeeding experience. 

In the inclusive camp, mamas know the best and worst of both worlds. The best of breastfeeding includes that joys of nourishing your baby with your body and making personalized milk. Then there is the best of formula: the intervention that provides life saving nutrition to support healthy growth and development. The worst of breastfeeding includes the sometime difficulties: mastitis, plugged ducts, yeast, blebs and so on! On top of breastfeeding, there might also be pumping, all the equipment and time that is required. For formula, besides the cost, the worst includes the bottles to be cleaned, sterilized and cleaned again. 

In the inclusive camp, the mamas are incredible as they work so hard to maintain their milk supply for their little ones, while also accepting help in the form of formula or donor milk. It is not one way or the other, it is all the ways: the breastfeeding, the pumping, the supplementing, the love, the dedication, the tears and the sweat (especially on hot days)! The inclusiveness of the experience. 

I don’t want to use a breastfeeding definition that makes mamas feel bad that their milk supplies are low (I worked through that one) or that they feel badly for needing to use formula (I worked though that one, too). Saying that, 'I inclusively breastfeed" is so much more positive and empowering than saying, "I have low supply and need to supplement." My lactation consultant, Ashley, always said to me, “He is getting your milk.” That has become my motto. He’s getting my milk, the amount doesn’t matter, and he is getting my milk.

So...Mamas who Inclusively Breastfeed, shall we adopt a new term?