Decreasing supplements

Why and how should I decrease the amount of extra milk that I give my baby?

There are several reasons why mothers may want to decrease the amount of supplement they give their baby.  The reasons for starting supplements may no longer exist or mothers may have offered too much supplement, suppressing the milk supply or started supplements unnecessarily. Supplementing with breast milk is hard work as mothers must express regularly, and supplementing with other milk has risks. In general, mothers should ensure the baby can breastfeed well, offer both breasts whenever the baby is hungry, offer decreasing amounts of supplement, and ensure the baby continues to show signs of getting enough milk. Mothers who are expressing for their baby's supplement should continue to do so. Unless the amount of supplement is very small, mothers should decrease their baby’s supplements very gradually. This allows the baby to adjust, reduces the risk of underfeeding, and gives the breasts more time to start making more milk.

A) Reasons for decreasing supplements

A goal for many mothers is to breastfeed without milk supplements.

Supplementing with expressed breast milk is a lot of work and is not without risk. Supplements can also consist of other appropriate milk that are not the mother’s own breast milk (other milk). Other milk includes infant formula, donor human milk, and the milk of a peer. Similarly, supplementing with other milk when it is not medically needed has risks for mothers and their babies.

Supplements may be reduced or eliminated because they:

  • Were started without a medical need.
  • Were started when the milk supply was low but it has since increased.
  • Were started when the mother or baby could not breastfeed but now can.
  • Are required but are being used too much and are reducing the milk supply.

Depending on the cause, some babies will always need to be supplemented in addition or instead of breastfeeding.

Accordingly babies whose supplements are changed significantly should be closely monitored by health-care providers to make sure they are not underfed. They should show all the signs of taking in enough milk including appropriate weight gain. This is critical to the baby’s health.

B) The chances of decreasing or eliminating supplements

If the baby is supplemented with breast milk, the mother has enough milk to breastfeed without supplements. However, the baby must be able to latch and breastfeed normally.

Mothers whose milk came in late may be able to decrease or stop supplements.

Mothers whose milk supply is reduced may be able to increase their milk supply and it is often possible to decrease or stop supplements within one to four weeks.

Mothers who never had enough milk or whose milk supply is permanently reduced may be able to decrease but not stop supplements.

C) Why supplement amounts should be slowly reduced

We recommend decreasing supplements slowly, by 30 to 60 millilitres (1 to 2 U.S. fluid ounces) every 24 hours. There are three reasons for this:

1) It allows the baby to adjust to changes in feeding

Our clinic has found that babies often do not respond well to dramatic changes in how they are fed. Gradual changes let them adapt.

2) It avoids severe underfeeding

Large decreases in the amount of supplement can result in a very underfed baby. Some mothers overestimate the amount of milk they make. Suddenly reducing the amount of supplement the baby gets can result in very low milk intake. This may not be discovered until the baby is weighed, resulting in an extended period of underfeeding.

If the amount of supplement is decreased slowly, the degree of underfeeding is less. 

3) It allows the breast time to make more milk

Milk production increases if the demand for milk increases, but this can take days or even a few weeks. If the amount of supplement is decreased too fast, the breast cannot provide the baby with enough milk. Slowly reducing the amount of supplement prevents this.

D) How to decrease supplements if they are mostly other milk

This baby girl could not latch after birth and needed to be supplemented. Her mother was able to pump for all of her milk. As the baby learned to latch, the breast milk supplements were slowly decreased and then stopped. She gained well throughout.

To reduce or eliminate other milk, mothers need to:

  1. First ensure that the baby can latch and breastfeed normally and is currently getting enough milk. 
  2. Offer both breasts whenever the baby is hungry and continue supplementing the baby afterwards.
  3. Gradually decrease the supplements, by 30 to 60 ml (1 to 2 oz) every 24 hours.
  4. Use the third breast to settle the baby, if helpful.
  5. Consider expressing after breastfeeding to stimulate milk production and provide breast milk for the baby's supplement.
  6. Monitor the baby: 
    1. Always ensure that the baby continues to show signs of getting enough milk.
    2. Weigh the baby each week during this process.
    3. Increase the supplements if the baby shows any signs of poor growth.

Expressing after breastfeeding can be especially helpful if one-quarter or more of the baby’s milk is provided by other milk. Expressing can increase milk production and provide the baby with the mother’s milk.

Mothers can use the third breast to settle the baby after supplements and thereby increase breast stimulation.

Mothers may consider other ways of increasing their milk supply.

E) How to decrease supplements if they are mostly mother’s own milk

Normal growth of a premature baby girl. Her breast milk supplements were gradually decreased as she learned to breastfeed.

If all or most of the baby’s supplement is expressed breast milk, the mother probably has a normal milk supply.

As long as the baby can breastfeed normally and the amount of expressed breast milk supplement is small (under 150 ml [5 oz]), mothers can exclusively breastfeed and simply stop expressing and supplementing.

To eliminate larger amounts of supplements, mothers should:

  1. First ensure that the baby can latch and breastfeed normally and is currently getting enough milk.
  2. Offer both breasts whenever the baby is hungry and continue supplementing afterwards.
  3. Gradually decrease the supplements, by 30 to 60 ml (1 to 2 oz) every 24 hours.
  4. If the baby is receiving both other milk and expressed breast milk supplements, reduce the other milk first and then reduce the breast milk.
  5. Use the third breast to settle the baby, if helpful.
  6. Continue expressing for the baby’s breast milk supplements until the baby is off all supplements.
  7. Monitor the baby:
    1. Always ensure that the baby continues to show signs of getting enough milk.
    2. Weigh the baby each week during this process.
    3. Increase the supplements if the baby shows any signs of poor growth.

Some mothers express more milk than the baby needs and end up making too much milk. They need to gradually reduce the amount of milk they make and may need to continue expressing for a few days or weeks after the baby’s supplements have stopped.

F) Signs the amount of supplement is now too low

It can be hard to assess a milk supply and how well a baby is feeding. Sometimes supplements are decreased and the baby is suddenly not getting enough milk. These babies generally show dramatic changes in behaviour. The amount of supplement should be increased if the baby is:

  • Hungry after feeding.
  • Less happy and more irritable than previously.
  • Feeding more than 10 times a day.
  • Constantly scowling.
  • Not gaining well.

G) Weight-gain patterns when decreasing supplements

Sometimes the process of decreasing supplements is working well, the baby is contented and has a normal feeding pattern, but the weight gain, usually measured one week after the start of the process, is a little slower than expected from the growth charts. This is fairly common.

As long as the baby is feeding normally and is happy when fed and held, mothers can continue decreasing supplements until the baby is weighed after a second week. It is as if the baby has been overeating while supplemented and needs to reset a bit. If the second weight gain is lower than expected, the baby probably needs more supplement.