Milk supplements

What is a milk supplement?

A supplement is milk given to a baby during, after, or instead of breastfeeding. If it is given instead of breastfeeding, it can be called a replacement feed. Supplements are needed when a mother and baby are separated or if the mother chooses not to breastfeed. They are medically necessary if the mother doesn’t have enough breast milk or if the baby is underfed because of ineffective breastfeeding. On the other hand, some babies are given supplements unnecessarily.

A) Describing milk supplements

A supplement is milk given to a baby:

Some babies need supplements for medical reasons, but sometimes supplements are given when they are not necessary.

A supplement given instead of breastfeeding is usually called a replacement feed. They are given when the mother and baby are separated, when the baby is unable to breastfeed, or if the mother wishes to partially breastfeed.

Because of the health benefits for babies, the mother’s expressed milk or colostrum is the first milk choice when supplementing. 

B) Medically necessary supplements

Appropriate supplements can be essential to a baby’s health, growth, and development (Kellams 2017).

Supplements are medically necessary when mothers do not have enough breast milk due to:

Babies may be underfed because of breastfeeding or health challenges.  

To supplement an otherwise healthy baby, the supplements are given following the baby's hunger signs. A sleepy newborn may need to be supplemented more aggressively. Premature or weak, sick babies may have other medical or feeding challenges that must be addressed in addition to supplementing.

C) Breastfeeding and supplementing

Whenever possible, babies should be allowed to breastfeed to the best of their abilities whenever hungry.

1) Babies who can breastfeed normally

Some babies are vigorous and can latch and suck effectively. They should be allowed to breastfeed in addition to being supplemented. This will maximize milk production and is often less work and more effective than expressing.

Expressing after breastfeeding may be ineffective if the mother’s milk supply has always been low but can be helpful in increasing a reduced milk supply. The process of breastfeeding, supplementing, and expressing can be called triple feeding. 

2) Babies who have breastfeeding difficulties

If the baby has difficulty breastfeeding, as with a latching problem or is weak or sick, the mother can offer the breast when the baby is hungry. This allows the baby to practise breastfeeding and stimulates the breast. The breast should be offered gently and only for as long as the baby can tolerate.

In this situation, the mother needs to express after each of the baby’s feeds. This allows the mother to maintain and maximize her milk supply and provide some or all of the baby’s milk supplement.

D) Preparing to supplement

When preparing to supplement mothers should choose a supplementation approach that:

  • Works for her and her baby.
  • Allows the whole process of breastfeeding, supplementing, and expressing to be completed in no more than an hour and ideally less.
  • Does not interfere with the baby’s breastfeeding efforts.

Mothers need to consider the following:

Please work with your health-care providers to ensure that your baby is growing well.  

References

Boban M, Zakarija-Grković I. In-Hospital Formula Supplementation of Healthy Newborns: Practices, Reasons, and Their Medical Justification. Breastfeed Med. 2016 Nov;11:448-454. Epub 2016 Aug 22
 
Kellams A, Harrel C, Omage S, et al. ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017. Breastfeed Med. 2017 May;12:188-198
 
Paramasivam P, Earan SK, Arunagirinadhan A, et al. Life Threatening Severe Hypernatraemic Dehydration in Neonates: A Report of Two Cases. J Clin Diagn Res. 2017 Jul;11(7):SD10-SD12