By Sr Teresa Hayward (RN, RM, Lactation consultant, Infant & Paediatric Nutritionist, Baby Sleep Consultant)
Giving your baby formula in addition to breastmilk is called supplementing. It's completely fine and perfectly safe to do if it is done properly.
Many families choose this type of combination feeding method, whether out of necessity (e.g. low breast milk supply), convenience, or simply personal choice. In some cases, breastfeeding and providing formula may be recommended by a doctor for medical reasons.
Reasons for Supplementing with Formula
The World Health Organization (WHO) recommends breastfeeding exclusively for the first six months and then continuing to breast up until a year or longer, along with the introductions of solid foods
For this and other reasons, including emotions and cost, making the decision to supplement with formula may not be an easy one.
While many parents breastfeed their babies and give them formula because they want to, others do so because they have to. Regardless of whether all or none of these reasons for supplementing apply to you, the decision is entirely yours, and you should never feel guilty for your decision.
Your Child Has Medical Issues
If your baby was born prematurely or with certain medical conditions, they may need more than just breast milk. Supplementing is often done for the purpose of helping a baby gain weight. Usually in these cases the dietician looking after your baby will select a formula that is both compatible with breastmilk and meets the necessary nutritional needs of your baby.
You Have a Low Breast Milk Supply
A previous breast surgery or certain medical conditions can interfere with the production of breast milk, though any woman can experience low supply. If you feel that your baby is not getting enough breast milk through breastfeeding alone, you may need to supplement with infant formula, but always consult with a Lactation consultant or Infant feeding specialist first to ensure there is a need.
Your Partner Wants to Participate
Your partner may want to take part in feedings (and you might welcome sharing the responsibility). You could pump and use your breast milk, or you can give your little one a bottle of formula occasionally.
You Have Multiples
Exclusively breastfeeding twins or triplets can be a challenge. Not only do you have to build and maintain a large enough breast milk supply, but you'll be breastfeeding very often. You may just need a break a few times a day (both physically and mentally), and formula feedings can help with that.
When Doctors Recommend Supplementation
When possible, doctors should be recommending exclusive breastfeeding. However, at certain times your physician may want you to supplement your breastfed baby with formula. This could include any of the following circumstances:
Fewer than six wet nappies in a 24-hour period
Fussiness and signs of hunger soon after feedings
Slow weight gain in the first few weeks
Weight loss of more than 10% of body weight in the first few days of life.
Always consult with a Lactation consultant or Infant feeding specialist 1st though, especially if you want to exclusively want to breastfeed. They will guide you in the correct way forward, by advising on ways to increase your milk supply and how much supplement should be given.
Introducing Formula
If you're not supplementing your child for medical reasons, experts recommend breastfeeding for at least one month before starting formula. This gives you time to build up a healthy breastmilk supply and ensure that your baby is breastfeeding well. At this point, you can slowly begin to add formula.
It is never recommended to mix your breastmilk and formula in the same bottle. If possible, give breast milk first, then finish the feeding with formula.
Always prepare formula according to the manufacturer's directions, using clean boiled water, even if it is bottled water, it should still be boiled first.
Before choosing an infant formula for your child, talk to an Infant feeding specialist. They will recommend a formula that is compatible with breastmilk and is suitable to your baby’s individual needs
If your baby develops a rash, vomiting, diarrhoea, excessive crying, fussiness, or gas after starting formula, notify your Infant feeding specialist. It can however take up to five days for a baby to adjust on to a new formula and remember, your baby’s gut is learning to digest something new.
How Adding Formula Affects You
Supplementing will be a change if you've been exclusively breastfeeding. If possible, add formula gradually so that your body can adjust.
Start With One or Two Formula Bottles a Day
Each day, your body makes breastmilk based on the concept of supply and demand. When you start to add formula, it can affect how much breast milk you make. This is why getting the right advise regarding volume of formula is important. If you are introducing due to low milk supply, you can decrease your volume further, if the wrong volume is introduced
If you plan on supplementing one or two bottles a week, it shouldn't affect your breast milk supply. But if you give your child one or two bottles of formula a day, your milk supply will begin to drop.
Add More Formula Slowly
Going from not supplementing to giving a lot of bottles in a short period could cause problems such as breast engorgement and blocked milk ducts and even Mastitis. It may also cause your child gastrointestinal issues.
Consider Pumping to maintain your milk supply and prevent some of the common breastfeeding problems that can pop up when you skip nursing to bottle feed. Removing your breast milk will help relieve the fullness that breast engorgement can cause.
Another benefit is that you can store your pumped breast milk to use at a later time. Depending on how you store it, breast milk can stay in the freezer for up to one year.
How Adding Formula Affects Your Baby
If you've been exclusively breastfeeding your baby and begin to add formula to their daily diet, there are some things you may start to notice. Usually, these are just part of the transition, and your baby will eventually adjust to the new routine.
Refusing the Bottle
Your child may refuse to take the bottle, especially if you're the one giving it to them. The transition may go more smoothly if your partner or another caregiver offers the formula.
Aside from simply wanting milk from the breast, some babies may have a hard time getting the hang of using a bottle. Others may just not like the taste of the formula.
Waiting Longer Between Feedings
Since your baby can digest breastmilk easier than infant formula, the latter allows them to feel fuller longer as it takes 4hrs to digest. They may not seem hungry as quickly after formula feedings as they do after breastfeeding.
Refusing the Breast
Refusing the bottle is usually no longer an issue after some time. After your child gets used to the formula and drinking from a bottle, however, you may have the reverse issue: They may no longer want to nurse. Drinking from the breast takes more work, and many babies end up finding formula more satisfying.
Changes in Bowel Movements
Adding formula to your baby's diet may change the pattern, colour, and consistency of your baby’s poo (e.g., it may be firmer, darker in colour, and have a stronger odour than before). Your child may also poop less often once you start giving them formula.
The ultimate goal of every parent is to have a happy, healthy baby who is growing and thriving. It's great if you can breastfeed exclusively, but it's not always possible or desirable for every parent.
Breastfeeding doesn't have to be all or nothing. Every baby and situation is unique, and a combination of breastfeeding and formula may work best for your family.
I am both a Lactation consultant and Infant feeding specialist, and I encourage moms to contact me, so we can get your baby on to the right formula for them. Contact me at 0824009501 to book a consult. A consult costs R350 (cash) but this can be claimed back from most Medical aids.
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