Feeding Your Baby: How and When to Supplement With Formula

You’ve heard that breastfeeding (chestfeeding) is the recommended way to feed your newborn, so you’ve been doing so since their birth. But it seems like your little one isn’t growing fast enough. And they won’t stop fussing — even after meals. How can you be sure they’re getting enough to eat? Is it time to give your baby formula or donor breast milk along with your own breast milk? And is that OK?

Most pediatricians agree naturally nutritious breast milk has a lot of benefits for you and your little one. Breastfeeding may help reduce your risk of getting postpartum depression or Type 2 diabetes. It may also help your baby avoid things like repeated ear infections or digestive problems.

Experts at the American Academy of Pediatrics (AAP) recommend breastfeeding for the first six months — until your baby tries solid foods. They then suggest breastfeeding and solid foods up to age 2.

But what if breastfeeding isn’t working for you or your baby, no matter how hard you try — or want to make it happen? You’re at a loss over what to do next.

It may be time to supplement breastfeeding with formula or donor breast milk. But are you letting your child down if you need to do this? The answer? Absolutely not.

“That’s a big misconception,” says pediatrician Heidi Szugye, DO. “Many breastfeeding challenges are out of our control.”

Why you may need to supplement

There are many reasons why you may need to supplement with formula. You might have also heard this called combo-feeding. And there are many different reasons why you may need to take this step or use formula instead of breast milk.

Why you may need to use formula and breast milk

Problems with your milk supply can complicate breastfeeding. Your milk may not come in fast enough. Or your body might not make enough. These breastfeeding hurdles don’t affect your value as a parent. Not all parents have an instantaneous or abundant milk supply. Any breast milk your baby gets is great, but you may not be able to exclusively breastfeed. And that’s OK, Dr. Szugye reiterates.

“Your worth as a parent isn’t tied to the number of drops of breast milk you feed your baby,” she stresses. “Some parents are limited in how much milk they can produce. And some babies need temporary supplemental formula or donor breast milk for medical reasons. Many of these children go on to breastfeed exclusively.”

When you’re breastfeeding, look for signs your baby isn’t getting enough nutrition from breast milk alone. You may notice they:

• Struggle to latch on and feed.
• Are fussy even after eating.
• Seem slow to grow or gain weight.
• Aren’t peeing or pooping enough.

Other newborn health conditions like hypoglycemia (low blood sugar) or jaundice are other reasons you may need to combo-feed your baby.

Why you may need to only use formula

Your pediatrician may ask you to completely stop breastfeeding and feeding with pumped (expressed) milk. This may happen in a few rare circumstances.

Your little one may have a serious condition called galactosemia. This keeps them from processing a sugar called galactose. It’s in dairy products, breast milk and milk-based formulas. You’ll use soy-based or elemental formulas instead.

Pediatricians may also recommend formula feeding if you:

• Have Ebola, HTLV or HIV with a high viral load.
• Take certain prescription medications (such as some chemotherapy or antiseizure drugs).
• Use nonmedical drugs.

Sometimes, you may only need to stop breastfeeding temporarily. This can happen if you:

• Have an infection like brucellosis, hepatitis with cracked nipples or untreated tuberculosis.
• Need to do certain radiology procedures.
• Take certain short-term medications.
• Have active herpes virus lesions on your breast or nipple.

How to supplement safely

Before jumping into supplementing, you’ll want to talk with your pediatrician, lactation consultant or breastfeeding medicine providers. They can help you find the best breastfeeding and formula feeding schedule. And if you’re moving to feeding exclusively with formula, they can help you make that transition, too.

“You shouldn’t make this decision alone,” Dr. Szugye says. “If you’re struggling, I recommend talking with your medical providers. They can help you understand the reasons why you may need to supplement and if it is temporary or long term. We can go over all the options, so you feel you’ve made the best choice for you and your child.”

Your providers will help you learn how to supplement with formula. If you hope to go back to breastfeeding exclusively, you’ll want to keep pumping as much milk as you make. This can help keep your milk supply from drying up before you’re done supplementing.

If your baby can drink breast milk, and you have enough pumped milk for a bottle, try supplementing with that first. Use straight formula if you can’t express your milk or your child isn’t able to drink it.

Paced bottle-feeding

This way of bottle feeding mimics breastfeeding. It allows your baby to lead feeding (responsive feeding) using a slower flow of pumped breast milk or formula. Look for cues from them, like rooting or sucking. Give them breaks and switch them between the sides of your lap like you would with breastfeeding. And allow them to stop feeding when they’re ready. It’s important not to force your baby to feed.

Cup-feeding

Cup-feeding is exactly what it sounds like — feeding your baby breast milk or formula using a small cup. How? By sitting them upright on your lap and holding a small cup of milk to their mouth. Make sure the rim rests on their lower lip. Then, slowly tilt the cup so they can sip and swallow on their own.

Tube- or syringe-feeding

Your provider may recommend one of two ways to use a tube or syringe for supplemental feeding:

• Finger feeding using a narrow feeding tube along your finger while having your baby suck on your finger at the same time.
• At the breast, using the same method as finger feeding, but placing the tube or syringe at your nipple to mimic breastfeeding.

How to know it’s working and when to see a doctor

Your healthcare providers will keep an eye on you and your baby while you supplement or formula feed. They’ll look for things like whether your baby is growing or gaining weight or if your milk supply has improved.

While you’re mixing breast milk and formula, you’ll want to watch your baby for signs of complications. It’s time to call the pediatrician if your baby:

• Has fewer or no wet or poopy diapers.
• Isn’t waking to feed.
• Runs fevers.
• Seems lethargic.
• Is increasingly jaundiced.

Everyone’s parenting experience is different. Maybe exclusive breastfeeding is the approach that works for you. Or maybe combo-feeding or formula feeding is best in your situation.

Either way, remind yourself that you’re doing everything in your power to help your baby be healthy and happy. If you need to supplement with formula, you’re doing what your baby needs to help them grow and thrive in the best possible way. And that’s one of the most important decisions you can make.