Written by Jody Segrave-Daly, RN, IBCLC and Lynnette Hafken, MA, IBCLC
There have now been six studies showing that in some infants, a little bit of supplementation with two teaspoons (10 mL) of formula or donor breast milk after nursing had no effect on long-term breastfeeding. One study showed it prevented hospital readmissions in all of the supplemented newborns. Another showed it actually helped breastfeeding!
Why aren’t medical and lactation professionals recommending this intervention?
Many medical and lactation professionals believe that a tiny amount of formula will contaminate the baby’s gut, causing lifelong health problems. They refuse to admit that formula supplementation can be helpful, and they have baseless concerns that temporary formula supplementation will become routine for all babies. According to Baby-Friendly USA, “donor [breast] milk takes the fight out of this.” What they mean is that the few babies who are born in a hospital with donor milk can be fully fed, while the vast majority of babies who are born in hospitals without donor milk just have to tolerate hunger and thirst so as to avoid a few teaspoons of formula.
Did you know two teaspoons of formula or donor milk has seven calories?
They argue that formula will change the beneficial bacteria in the baby’s gut, but this change is safe and only temporary—and pales in comparison to the risks of potentially life-threatening complications from insufficient colostrum, like jaundice, low blood sugar, and dehydration, which can be caused by acute starvation. What about sensitizing the infant’s gut to cow’s milk protein? There is no evidence that early limited formula supplementation has any impact on babies’ future health. If someone has this evidence, please come forward. In addition, if anyone has is concerned about cow’s milk formula, there are formulas that have those proteins broken down (hydrolyzed) that can also be used. The fact that lactation and medical professionals have not promoted and implemented this life-saving solution shows that the real issue is bias against formula use, pure and simple. Do they hate formula products so much that they don’t care if your baby suffers from hunger?
The question is, how many randomized, controlled studies support Step 6 of the WHO’s Ten Steps to Successful Breastfeeding to avoid supplementation from birth in order to improve breastfeeding outcomes? None. Absolutely none.
In the meantime, parents and health care professionals can be assured that if a baby shows signs of persistent hunger after breastfeeding, just a few teaspoons of formula or donor milk (if available) can satiate the baby’s unrelenting hunger, will not cause breastfeeding problems, and even reduces the risk of re-hospitalization due to the baby not getting enough milk.
As long as the mother’s milk supply is protected by the baby breastfeeding at least eight times a day, or in some cases adding milk expression to the feeding plan, the baby can return to exclusive breastfeeding when the mother’s milk comes in.
Supplementation does not destroy mothers’ confidence in their bodies; it gives them the confidence to know they can care for their babies no matter what happens, and it gives them the knowledge they need to support their milk supply until it increases to meet the baby’s needs.
Do you want to be successful with breastfeeding while protecting your baby from hunger? Follow your instinct and your baby’s cues, and don’t be afraid of giving your baby a little extra nutrition until your milk comes in!
The Fed Is Best Foundation IBCLC Team
#JustTwoTeaspoons #FedIsBest #SafeBreastfeeding
*Only some infants were supplemented. Babies received 10 mL of formula by syringe after breastfeeding if they met the following criteria: >75th %ile weight loss for age, irritability such as crying and hungry behavior, and if their mothers requested it. Mothers were instructed to stop supplementing after their milk came in.
Note: If a baby is still showing hunger cues after those 10 mL, you can repeat with another 10 mL until the baby is satisfied.
Resources
- Limited Amount of Formula May Facilitate Breastfeeding: Randomized, Controlled Trial to Compare Standard Clinical Practice versus Limited Supplemental Feeding
- The Effect of Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota: A Randomized Clinical Trial
- Limited Amount of Formula May Facilitate Breastfeeding: Randomized, Controlled Trial to Compare Standard Clinical Practice versus Limited Supplemental Feeding
- Effect of Donor Milk Supplementation on Breastfeeding Outcomes in Term Newborns: A Randomized Controlled Trial
- Effect of Early Limited Formula on Breastfeeding Duration in the First Year of Life
- In-hospital formula supplementation and breastfeeding initiation in infants born to women with pregestational diabetes mellitus
The Scientific Evidence on the Effects of Underfeeding on the Newborn Brain
I Supplemented My Baby Until My Milk Came In And We Are Still Breastfeeding At 3 Months
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