I had great dreams of breastfeeding both of my children for as long as possible. I was very against supplementing with formula in the beginning. Breastfeeding was not easy with my first child (she had a tongue and lip tie). The only way I could get her to feed in the beginning was with a nipple shield for the first few months. That posed a problem. Many times, in the middle of the night I couldn’t find a nipple shield anywhere. It always ended up falling into the bed somewhere or onto the floor and I was crawling around searching for it in the dark as she screamed.
Eventually, we were able to work it out with the assistance of a lactation consultant, and we were able to ditch the nipple shields. However, when I went back to work my supply started to drop. Even with pumping at work I could never keep up with her needs. I tried all the tricks to increase my supply. I eventually made the choice to supplement with formula to enable me to continue breastfeeding longer. My daughter took 1-2 bottles a day of formula and the rest was breast milk. This enabled me to continue working and breastfeed my daughter until she was 9 months old.
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What Does the AAP Recommend?
The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond.
The AAP understands that this can be very difficult, and that society is not always supportive of breastfeeding into the 2nd year of life. Their research showed that 50% of women chose not to tell their pediatrician they were still breastfeeding, and 38% of women that chose to breastfeed after 1 year of age reported their provider was unsupportive of breastfeeding past one year. They chose to select a new pediatrician. More support is definitely needed for women that make this choice.
There is significant research that supports the benefits of breastfeeding for both mother and baby. Infants that are breastfed have lower incidence of otitis media (ear infections), acute diarrheal disease, lower respiratory illnesses, sudden infant death syndrome (SIDS), inflammatory bowel disease, childhood leukemia, diabetes mellitus, obesity, asthma, and atopic dermatitis. Mothers who breastfed also experienced lower risk of type 2 diabetes mellitus; breast, ovarian, and endometrial cancer; and hypertension (high blood pressure).
Can I Supplement with Formula?
Everyone’s situation is different and ultimately the goal of the AAP is to increase the number of infants who continue to breastfeed for 12 months. I believe that supplementing with formula as needed in your breastfeeding journey can help you get there. At the end of the day, it is a recommendation, and you can take the information and make a choice that is best for you and your baby. The benefits of breastmilk can still be achieved while supplementing with formula to meet your child’s needs. Your mental health and your child’s health will not suffer if you choose to supplement as needed.
Combination feeding is becoming more popular. The CDC (center for disease control and prevention) reports one out of three mothers in the US supplements her breast milk with formula by the time their child reaches the age of 6 months.
If you choose to feed soley with formula that is a great choice as well. There are some great and healthy choices out there when it comes to formula. I will eventually make a post listing some of the best formulas out there in my opinion. Things I have tried and what I would recommend. You can also choose to exclusively pump if you can’t breastfeed or if breastfeeding is just not your thing. It has its pros and cons but can give you the benefits of breastmilk while bottle feeding.
Is My Baby Getting Enough Milk?
One of the hardest challenges of breastfeeding is that you never know how much milk your infant is consuming. The best way to know if your baby is getting enough milk is to look for these cues:
- baby is content/happy after feedings
- Has regular wet and dirty diapers
- Day 1: 1-2 wet diapers and 0-1 bowel movement (often black and tarry)
- Day 2-3: 2-4 wet diapers and 1-2 stools per day.
- Day 4: 4-6 wet diapers and 3-4 stools per day (should start to look more yellow and seedy)
- 1 Month: 6 wet diapers a day with clear or pale-yellow urine and 3 loose, seedy, or curd-like yellow stools a day
- 6 weeks +: About 6 wet diapers a day with no more than 8 hours between wet diapers. It is normal for breastfed babies to go 3-4 days between bowel movements. Some babies older than 6 weeks can go a week without having a bowel movement. If you are concerned always call your doctor.
- Gaining weight appropriately (regular increases in weight, length, and head circumference)
Problems That Can Arise
Just like with breastfeeding, you may not have a slam dunk success right away. You are introducing something new for your baby so take it slow and be patient. Here are some of the common problems you may see and ways to navigate them when supplementing with formula.
Having Problems Eating from A Bottle
A bottle nipple is very different from your breast. This will take some time to adjust. Try introducing a bottle for one feeding a day that is when your child is most happy. This will make the transition a little smoother. It is also best to have your spouse, grandmother, friend, or childcare provider be the one introducing the bottle, so your child is more likely to accept the bottle.
Feeding from a bottle often requires less work than your infant is used to. Be aware of the nipple size and how to pace the feeding so your child isn’t drowning in milk. This can be an adjustment for you and your child.
Increased Gassiness or Fussiness
This is common when switching to a bottle as infants can take in more air while eating when using a bottle. It can also be related to the type of formula you are using. First, try burping baby more thoroughly after each feeding. Maybe repositioning your baby during the feeding or a different type of nipple or bottle to adjust the flow. It could be an ingredient in the formula you have chosen, so if you have tried the other options without success, consider trying a new formula.
Baby Won’t Take the Bottle
Your baby may be refusing the bottle all together. I myself went through this. Here are a few options to try to increase success.
- have your partner offer the bottle
- try filling the bottle with breastmilk and slowly transition to formula
- wait a little longer in-between feedings so your child will be much hungrier.
- try different nipples or different bottle temperatures
- have mother leave so child doesn’t have the cues from mom
Refusing the Breast
Bottle feeding is a lot easier than the work that is required with breastfeeding. Some babies really enjoy the fact that they get their food faster with less work. I mean so do we, don’t we. Why else do we have fast food restaurants on every corner?
If your baby is refusing to breastfeed, stop bottle feeding for a few days if possible. Nurse in a quiet room with few distractions. Once you reestablish your breastfeeding routine you can again supplement with formula using bottles.
Tips For Success When Supplementing with Formula
- Introduce the bottle early: if you plan to go back to work or just want more freedom make sure you introduce the bottle well before you want your child to take the bottle. They need time to adjust. Make sure you do wait long enough though to establish breastfeeding and get the hang of it. Usually this takes about 3-6 weeks.
- Use the right size nipple: start with a wide nipple and a slow flow to mimic your breasts flow. If your baby is older you may have to get a larger nipple as your flow may be a little faster and cause some frustration if the nipple is slower than what they are used to.
- Get help if needed: This is going to be an adjustment. Enlist help early. Lactation consultants are a great help when making this adjustment. Most insurance companies will cover the cost of a lactation consultant, or some hospitals offer walk in consultations.
- Relax: Find a time when your baby is relaxed and happy. Try not to put too much pressure on having success quickly. This will lead to a better experience and will help your baby be more open to trying a new way to eat.
- Don’t force them to take the bottle: forcing a bottle will not lead to success. If they refuse give it some time and try again later. Look for hunger cues or try to introduce it a little before they usually get hungry when they are still content.
- Prevent engorgement and mastitis: Your body produces milk on demand. Slowly introduce the bottle at a rate that your breasts can adjust. Start with replacing one feeding a day. This will reduce the risk of painful engorgement or clogged ducts forming.
Frequently Asked Questions
Supplementing your breastfeeding journey with formula might be necessary or it might be a choice. Either way, once you make that choice these tools can help you achieve the vision you have for your journey. I wish you success and as always reach out if you have any questions or concerns. I made the choice to supplement with formula for my children and my mental sanity. I believe it allowed me to continue my breastfeeding journey longer. In the future I might make a different choice and that’s okay too. You don’t need to explain your reason to anyone. Do what works for you and use the tools that you have at your disposal. I wish you the best of luck on your journey.
Jess is a registered nurse with over 6+ years of critical care experience for patients young and old and is the mother of two small children. After having her own children she felt inspired to provide mothers with real actionable guidance and education to make informed decisions throughout their pregnancy and postpartum experience.