When breastfeeding doesn’t go as planned

Transitioning to motherhood is not easy. Often, things don’t go as expected. When it comes to breastfeeding, there are many reasons why a mother’s journey may not go as planned.

Feeding your baby with breast milk and formula, also known as mixed feeding or combination feeding, is sometimes the best solution for families. Parents may choose to supplement breast milk with formula for various medical or personal reasons, such as low milk supply, inadequate infant weight gain or challenges with pumping at work. In fact, more than one-third of breastfed babies receive supplemental formula before they turn 6 months old.

“While it is true that breast milk is ideal for your baby, breastfeeding does not need to be an all-or-nothing process,” says Lisa Simpkins, a private practice international board-certified lactation consultant and certified perinatal educator with Sharp Mary Birch Hospital for Women & Newborns. "The benefit of supplementing, either with breastmilk or formula, is that it allows other loved ones or care workers to feed the baby.”

Is it OK to supplement while breastfeeding?

Supplementing is a safe way to provide your baby with the necessary nourishment. If possible, Simpkins recommends establishing a good breastfeeding routine for at least a month to build a plentiful milk supply. Then, gradually replace nursing sessions with supplemental breast milk or formula bottles. If done over a few weeks, it can help prevent issues such as clogged ducts or engorgement.

“Any amount of breast milk is beneficial, and it's okay to supplement with formula if that's what's best for you and your baby,” Simpkins says. “If you are supplementing for medical reasons or want to maintain your milk supply, I recommend pumping to keep up with the baby’s demand.”

Are there benefits to supplementing with formula?

A baby may benefit from receiving both breastmilk and formula if they:

• Have a very low birth weight

• Are born premature (less than 32 weeks of gestational age)

• Are very ill or not gaining weight

Many breastfeeding parents find success by supplementing with formula. In a recent survey, 8 out of 10 new moms said that supplementing with formula allowed them to breastfeed longer than they would have if nursing alone.

Benefits for the breastfeeding parent may include:

• Additional confidence in baby’s growth and development if they are unsure or worried they aren’t providing enough milk

• Shared bonding with another caretaker

• Increased flexibility for people who do not have time to pump

Can supplementing upset the baby’s stomach?

There are a few ways supplementing with formula may affect your baby, such as differently colored and less frequent bowel movements, or a preference for a bottle over the breast. Formula is not as easily digestible as breastmilk, and gas often occurs when a baby takes in extra air from a bottle, so Simpkins recommends burping your baby frequently to help with any potential tummy issues.

Does supplementing with formula lose nutrients?

Iron-fortified commercial formulas can provide adequate nutrition for your baby with enough vitamins, calories, minerals, fat and protein to support growth. Typically, no additional supplements are needed.

“Although breast milk contains immune factors that formula does not and provides the strongest protection against gastrointestinal and respiratory infections, partial breastfeeding still provides some protection,” says Simpkins.

Which formula is closest to breast milk?

Your pediatrician can provide the best insight, but cow's milk-based, iron-fortified formula is the most common and recommended choice in the U.S. All commercial formulas sold in the U.S. are safe for babies. However, other types of formula are available for babies who need it.

If you choose to supplement breastfeeding with formula, Simpkins encourages you to talk with your doctor first to ensure your and your baby’s needs are met.

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