Breastfeeding with a low milk supply

What if I can’t make more milk and breastfeed exclusively?

Even if mothers have a permanently low milk supply and need to supplement their baby with extra milk, there are benefits to breastfeeding for both. Aside from the benefits of the breast milk itself, breastfeeding calms the baby, promotes jaw development, provides good bacteria, helps mother and baby bond, and may increase the milk supply. To breastfeed with a low milk supply, mothers breastfeed first and then supplement the baby with milk. The amount of supplement is generally determined by the baby’s hunger signs after breastfeeding. Mothers will need to choose an efficient supplementation tool. Supplementing with a tube-at-the-breast system is slightly different. Mothers also need to decide on a type of milk. Realizing that the milk supply is low is difficult for many mothers. Mothers may feel guilt, frustration, anger, and even depression. We encourage mothers to breastfeed, supplement as needed, be proud of their efforts, enjoy their babies, and find support.

A) Describing a low milk supply

Most mothers have enough milk to breastfeed exclusively. Some mothers with a full milk supply worry that their babies are not getting enough milk and supplement their babies without a medical need to do so. This situation can often be reversed.

The few who do not have a full milk supply may:

While continuing to breastfeed has many benefits, such babies need to be supplemented with extra milk or else they will grow poorly

B) Reasons for breastfeeding with a low milk supply

Breastfeeding with a low milk supply has benefits for mothers and babies. The benefits for babies come both from the sucking at the breast and from any breast milk they take in.

1) Benefits of sucking at the breast

Sucking at the breast can:

2) Benefits of breast milk

The baby will benefit from any breast milk obtained. For example:

  • Breastfeeding, whether exclusive or partial, results in better development of the thymus, a gland that has a vital role in the development of certain white blood cells (T cells) that fight infection and kill cancerous cells (Hossny 2019).
  • Breast milk improves the type of microbes in the baby’s gut by:
  • Compared to infant formula feeding, partial breastfeeding or breast milk feeding can reduce the risk of:
    • Constipation (Rippey 2020).
    • Obesity (Wood 2020).
    • Sudden infant death syndrome (SIDS) (Thompson 2017).
    • Wheezing in the first two years of life (Greer 2019).

3) Benefits for the mother

Partial breastfeeding can help the mother: 

  • It benefits the mother’s health by decreasing the risk of high blood pressure and heart and blood vessel disease (Kirkegaard 2018).
  • Any use of breast milk will reduce the cost of infant formula
  • Healthy babies are easier to care for.

C) Breastfeeding with a low milk supply and supplementing

1) Making a plan

Mothers who are breastfeeding with a low milk supply need to consider a number of issues:

  • How to supplement
  • What tools to use for supplementing
  • What type of milk to use for the supplement.
  • Identifying and removing possible reasons for a low milk supply
  • Possible steps to increase their milk supply

Mothers should see their health-care providers if they have a low milk supply. Breastfeeding specialists can also be very helpful in this situation.

2) Breastfeeding with a low milk supply

The mother’s milk supply will not decrease as long as she continues to breastfeed on both breasts whenever the baby is hungry, before supplements are given and she does not over-supplement the baby. If a mother is using a tube-at-the-breast system, she would supplement while breastfeeding.  

Some mothers with a low milk supply find it helpful to know exactly how much milk their baby gets from the breast. There are a number of tools to estimate this.

3) How to supplement the baby

If the milk supply can be increased, supplements may be temporary or if not, permanent.

A healthy baby who can latch and breastfeed normally can generally be supplemented with amounts that are based on the baby’s hunger signs after breastfeeding. 

Babies should be carefully monitored to ensure they are taking in enough milk. In addition to breastfeeding with a low milk supply, some babies may have other problems. A sleepy newborn may need to be supplemented more aggressively. Premature or sick babies may have other medical or feeding challenges that must be addressed in addition to supplementing.

D) The emotional aspects of a low milk supply

Some mothers worry that breastfeeding and supplementing will take a lot of time, but breastfeeding with a low milk supply results in short feeds at the breast. In addition, the time the baby needs at the breast gets shorter as the baby gets older. In this situation, it may only take a 6-month-old 10 minutes to breastfeed on both breasts.   

Realizing that the milk supply is low and the child may be underfed is difficult for many parents. Mothers who need to supplement may feel many emotions, including guilt, grief, frustration, anxiety, anger, sadness, and even depression. Some mothers have told our clinic that they view supplementing as a sign of failure. It can take time to fix the breastfeeding problems, to process these emotions, and to heal.

We encourage mothers in this situation to breastfeed, supplement as needed, be proud of their efforts, enjoy their lovely babies, and to find support

References

Greer FR, Sicherer SH, Burks AW; COMMITTEE ON NUTRITION, SECTION ON ALLERGY AND IMMUNOLOGY. The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods. Pediatrics 2019; 143(4)
 
Hossny EM, El-Ghoneimy DH, El-Owaidy RH, et al. Breast milk interleukin-7 and thymic gland development in infancy. Eur J Nutr. 2019 Jan 3. doi: 10.1007/s00394-018-01891-5
 
Kirkegaard H, Bliddal M, Støvring H, et al. Breastfeeding and later maternal risk of hypertension and cardiovascular disease - The role of overall and abdominal obesity. Prev Med. 2018 Sep;114:140-148

Liang G, Zhao C, Zhang H, et al. The stepwise assembly of the neonatal virome is modulated by breastfeeding. Nature. 2020 May;581(7809):470-474

Rippey PLF, Aravena F, Nyonator JP. Health Impacts of Early Complementary Food Introduction Between Formula-fed and Breastfed Infants. J Pediatr Gastroenterol Nutr. 2020;70(3):375‐380 

Thompson JMD, Tanabe K, Moon RY, et al. Duration of Breastfeeding and Risk of SIDS: An Individual Participant Data Meta-analysis. Pediatrics. 2017 Nov;140(5). pii: e20171324

Wood CT, Witt WP, Skinner AC, et al. Effects of Breastfeeding, Formula Feeding, and Complementary Feeding on Rapid Weight Gain in the First Year of Life. Acad Pediatr. 2020 Sep 19:S1876-2859(20)30507-6