How To Supplement the Breastfed Infant
Infrequently, as a breastfeeding supporter, educator, staff nurse, or lactation consultant, you may also need to feed the breastfed infant a supplement. This may lead you to wonder what you should give and how you should give it. In this blog post, you will be provided with 4 things to keep in mind before feeding the infant.
1.) Carefully consider your options and make the healthiest choice based on what is available. But avoid water or glucose water.
The Academy of Breastfeeding Medicine (3) recommends expressed breast milk from the infant’s mother to be the first choice. If not available, then donor human milk should be the second choice. If neither of the human milk choices is available, then the use of a protein hydrolysate formula should be considered. Cow’s milk or soy artificial infant milks should only be chosen after examining the risks vs. benefit. You must also consider the family allergy history, available resources, family resources, infant age, and the impact that the formula use would have on breastfeeding. The use of water or glucose water is no longer advised.
2.) Research shows that bottles may cause side effects so breastfeeding is the healthiest option.
“Give infants no food or drink other than breast milk, unless medically indicated,” per Step 6 of the Ten Steps to Successful Breastfeeding. Although this is our goal, there have always been those, both staff and families, who say it won’t make any difference if the infant gets just this one bottle or one day or one week of formula. Does it really make any difference? Let’s look at the work of Marsha Walker, IBCLC, from 2016.
In her review of the research, Walker found that “just one bottle” can:
- Change the gut flora and pH for 2 to 4 weeks
- Decrease protection against overweight and obesity
- Increase potential for infection and inflammatory states
- Increase allergic sensitization
- Decrease immunity to illness
- Increase risk for lifelong diseases such as Type 1 Diabetes Mellitu
3.) Avoid feeding supplements with a bottle, unless it's the only choice.
When feeding the supplement, providers should consider the many other choices that may be healthier than a bottle: spoon, cup, syringe, drip method, finger-feeding, or others as suggested by Watson (1) or Walker (2). If a bottle is the only choice then use a slow-flow nipple. Pacing the feed will allow the infant to feed only to satiety and it will also allow the infant to breathe more comfortably while being fed.
4.) Avoid overfeeding the infant.
Lastly, avoid overfeeding the infant. Knowing the physiologic (4) size of the infant stomach will prevent overfeeding and stretching of the stomach itself. The amount of supplement that you use should always depend on the age and gestation of the infant being fed in order to determine the right amount.
Conclusion
So how does your facility choose a supplement for a breastfed infant? Are alternative feeding methods used when a supplement is needed? How much supplement is given? It is your responsibility to the families with whom you work to be informed and well-practiced in the supplementation choices for the breastfed infant.
Given that parents have the right to make a fully-informed decision, and knowing that even one non-medically indicated or unnecessary feeding of breast milk substitutes can have a profound difference in the health of the infant, how do you provide judgement-free teaching? Withholding the negative effects of formula supplementations does not allow parents to make an informed decision in the best interest of their family. Using the wrong wording, body language, or tone of voice can often imply negative judgement and could create difficult decision-making scenarios.
So how do you provide truthful, research-based information to encourage informed decision-making and to follow the guidelines of the Baby-Friendly Hospital Initiative? Remember that the decision is ultimately in the hands of the parents, and they will need factual information to make a truly informed decision for their infant.
Stay safe,
Kathy
Referrences
- Watson Genna, C. (2016). Selecting and using breastfeeding tools: Improving care and outcomes. Praeclarus Press. Amarillo, TX, USA.
- Walker, M. (2016). Breastfeeding management for the clinician: Using the evidence, 4th Jones and Bartlett. Burlington, MA, USA.
- Kellams, A., Harrel, C., Omage, S., Gregory, C., Rosen-Carole, C., and the Academy of Breastfeeding Medicine. (2017). ABM Clinical Protocol #3: Supplementary Feeding in the Healthy Term Breastfed Neonate, Revised 2017. Breastfeeding Med; 12(3). https://www.bfmed.org/protocols
- Bergman, N.J. (2013). Neonatal stomach volume and physiology suggest feeding at 1-h intervals. Acta Paediatrica; 102:773-777
- Baby-Friendly USA. (2019). Interim guidelines and evaluation criteria for facilities seeking and sustaining Baby-Friendly Designation. Albany, NY: Baby-Friendly USA.
- Walker, M. (2016). Just one bottle won’t hurt—or will it? Free to download at https://massbreastfeeding.org/just-one-bottle/
