There’s so much information out there on breastfeeding. It’s clear there are health advantages for both mother and baby, and with this in mind, the American Academy of Pediatrics continues to work toward a goal of more nursing moms.
A lot of what’s out there, reading-wise, spends a lot of time listing the many pluses of breastfeeding. Somewhat less literature for parents is available regarding debugging nursing problems. And largely missing, except perhaps for literature distributed by infant formula companies, is anything on supplementing or feeding by bottle. Yet many parents want to know more about supplementation: Is there a place for formula? What about breast milk by bottle? Given the advantages of my breast milk, am I a bad mother for even thinking about using something else?
No parent should ever be made to feel guilty about formula feeding. Parents are ultimately the decision makers for their children, and supplementing with a proper formula will not cause undue harm to their child. That said—and still with that goal of optimizing breastfeeding whenever possible—it’s worth exploring whether to supplement, when to do it, with what, and tips on how.
Talking About the Whether (and When)
In order to answer questions about whether to supplement, it’s worth looking at not only when, but also why. Certainly many parents have decided to use formula—either partially or exclusively—before their baby is born. Obstetric practices and labor and delivery units have been getting better about pointing out the advantages of breastfeeding, and most don’t automatically offer formula without a parent’s or doctor’s OK.
Of those parents who do want to supplement breast milk with formula right off the bat: why? Our local hospital, in encouraging breastfeeding, asks all Moms that question, and the most common answer: “Because I want to use formula”! Looking into this a little more, it appears that some families want the flexibility of another caregiver being able to feed. Some find bottle feeding more convenient under certain circumstances. Some cultures feel that some formula gives the “best of both worlds.”
Other mothers plan to exclusively breastfeed, but ask for formula by feed #2 or 3 in the hospital. Most commonly, this appears to result from the perception that the baby isn’t getting enough. In fact, newborns need surprisingly little feeding that first day or two. Many providers who care for pregnant Moms and newborns carry around a marble in order to show parents just how big the baby’s stomach is those first few days. Bottom line: if you feel your baby isn’t taking an adequate amount, let your newborn’s provider know. But realize that our youngest patients are closely monitored for urine, bowel movements, weight and overall health, which is our best way of telling whether they are truly getting enough or not.
Finally, it’s worth exploring a few medical reasons why a mother might need to supplement. Certainly if the baby is not putting on weight as expected despite some troubleshooting measures, providers will usually OK and even encourage supplementation. It’s possible this is only needed temporarily, and Mom might be able to exclusively breastfeed in the future.
Another issue, jaundice, used to cause providers to recommend supplementation. However, unless the jaundice is severe, most providers nowadays would continue to recommend exclusive breastfeeding, even if the baby is being treated for jaundice.
OK, so let’s assume you have a healthy baby, but want to supplement. One additional thing you should be aware of is the time that breast milk normally takes to be well established. It does indeed take a few weeks; thus, if at all possible, it’s a good idea to wait until one month of age before beginning to use formula. In the meantime, your baby’s provider can continue to monitor his weight gain and look for additional signs that he’s getting enough.
OK, So Where’s the How-to Manual?
Introducing a bottle, particularly with the goal of continuing breastfeeding, can be tricky. Most babies will take to the bottle fairly well, but they do tend to like what they have been used to. Not only is the bottle a new method of feeding for your baby, but there are taste differences between formula and breast milk (taste also varies from formula to formula).
There are various theories on just when within a 24-hour feeding cycle to introduce a bottle. You might read that you should do so when she is at her hungriest; you might also read that you should avoid something new when she is at her most ravenous and likely to be fussy. If you would like to bottle feed, try it both ways and see what works best for your baby.
More often than not, your baby will accept the bottle due to its faster flow. (Incidentally, bottle fed babies do tend to take more, and breastfeeding is thought to be a protective factor against childhood obesity!) The downside is that they may have more difficulty returning to the breast. This is known as nipple confusion. Certainly exclusively breastfed infants don’t have this problem, but for part-timers, there are a few measures that may alleviate the problem.
If you’re reaching for formula so that other family members can join in the feeding ritual, have you considered pumping and freezing breast milk? It will stay good for one month, keep your milk supply solid, relieve engorgement, and give your baby the advantages of exclusive breastfeeding. For many parents it’s the best of both worlds. In addition, for Moms who have trouble with milk supply, donor milk is increasingly available.
Your baby’s provider will continue to encourage the choice to exclusively breastfeed, and this is as it should be. There are just too many advantages not to. At the same time, it’s a pediatrician’s job to support families and make feeding time go well whatever the choice.