Temporary Supplementation – What is it, and how do I do it ?
Part 1. What is Temporary Supplementation
Temporary supplementation simply means a baby is fed by either formula or safe donor breastmilk for a short period of time.
The difference between this and combination feeding lies in the fact that combi feeding is usually a long term choice made by parents who are happy using both formula and breastmilk. Whereas temporary supplementation is exactly as the name implies…it’s a stop gap to get you and your baby through a difficult time, most often used by parents who would prefer to breastfeed long term.
Such supplementation is not a modern invention, it is perfectly normal in all cultures, with babies being fed throughout our history by other mothers/wet nurses (often family members or friends), with whatever milk substitutes they had access to, often milk, goats, sheep, horses, camels etc. The Roman, of course, gave honey and wine, not great for the baby ! Luckily for us we have access to safe, highly regulated formula designed especially for our human babies.
Supplementation is mostly used in the first few days of the babies life to help keep them fed and healthy until the mothers milk supply comes in.
The milk supply can arrive from day 3 onwards, but can sometimes take much longer than that, 11 days is the longest that one of my clients has experienced, but 4, 5 or 6 days is not uncommon.
In the first 2 to 3 days babies rely on their own body reserves, and on colostrum produced by the mother.
If all goes well mum produces enough colostrum to keep the baby healthy and satisfied until her milk comes in.
But it doesn’t always work like that.
• Sometimes mum doesn’t produce enough colostrum, or she has a very hungry baby, or she is too weak/exhausted/ill after the birth to breastfeed.
• Sometimes mums milk is slow to come in, or there isn’t enough to keep baby satisfied.
• Sometimes baby is ill, or weak, or has problems latching on to the breast.
These factors can come right with time, effort and support, but in the meantime baby MUST be fed.
In the UK there is a supply of safe donor breastmilk that has been tested and stored properly, but this is usually kept for premature babies, so in reality, temporary supplementation involves using formula, which is a perfectly safe and healthy alternative.
Is My Baby Hungry ?
If your baby latches on, sucks for a while, and then they either stop sucking and seem relaxed and happy (they can look drunk, with milk dribbling out of their mouths so are often described as milk drunk) or fall asleep and are happy to be put down to sleep after some winding, then you can be pretty sure your baby is well fed.
In my experience a new born baby with a full tummy, once winded, can be wrapped up and put down in their bassinet, and will sleep for 2 to 3 hrs. They don’t waste any effort crying for no reason
Signs your baby may need temporary supplementation (in the first few days)
• Your baby latches on, seems to be sucking, but never gets to that milk drunk or sleepy stage.
• Your baby feeds, falls asleep, but then wakes again after a short time.
• Your baby latches on and feeds for hours at a time.
• Your baby doesn’t latch on but cries at the breast.
• Your baby only sleeps in your arms and can’t be put down.
• Your baby cries a lot, often for hours.
If your baby is showing any of these behaviours try supplementing and see how they react. If they drink then seem happier and more relaxed you did the right thing.
I hate to worry you, but there are also danger signs that indicate your baby is in urgent need of supplementation. This is known as Accidental Starvation which is not your fault, and can happen to anyone. The graphic below, from The Fed Is Best Foundation, shows symptoms to keep an eye out for if you think your baby might not be getting enough milk.
If you are in hospital and you are worried about your baby being hungry or being at risk you should not hesitate to ask one of the medical staff. It may turn out to be nothing, but you should always raise your concerns.
The 3 main risks for your baby at this point are dehydration, low blood sugar, and jaundice, all of which are very serious and can be fatal if not addressed so they should take your concerns seriously.
Unfortunately in some hospitals that are more focused on promoting breastfeeding, there can be some resistance to supplemental feeding.
In these hospitals they may tell you that babies stomachs are tiny and they don’t need much colostrum/milk, that its ok and normal for them to cry a lot, or that a baby feeding for hours at a time is just ‘cluster feeding’ and is perfectly normal.
Believe me…it is not normal and is not ok, not in the first few days.
Trust Your Instincts
If you think that your baby might be hungry, then go with that and offer them formula.
If they take a couple of mouthfuls then stop, they weren’t really hungry and no harm was done ( contrary to social media hysteria, formula will not harm your baby in any way !)
If they gobble down the milk then quite happily pass out and go to sleep, then your baby was hungry and you did the right thing.
Again, hospitals promoting breastfeeding can be very resistant to giving you formula so rather than put yourself in the stressful situation of having to ask, my advice would be to take in your own emergency supply of Ready Made Formula and bottles and teats so you have what you need, when you need it. You don’t need their permission to feed your baby ! If they continue to try and persuade you not to supplement, simply ask them to leave.
Myth – Just one bottle will ruin your chances of ever breastfeeding
Truth – Careful supplementing with the right bottle and the right feeding routine has been shown to actually extend the length of time a woman breastfeeds (so stop worrying)
How to Supplement
Ok, you have your formula …how do you get it in to your baby ?
There are several methods including spoon (messy), cup (very messy), syringe (easy), bottle (easier).
You can tell from that last sentence which I prefer. A bottle is simple, easy and it gives the baby what they love most…the chance to suck on something.
The other methods tend to be preferred by health professionals who believe the ‘just one bottle’ myth above and so try to avoid bottles at all costs. The other methods just spill milk, stress and frustrate a hungry baby, giving them wind at the same time.
Life with a baby can get very complicated so I always go with the quickest, easiest and simplest option wherever possible.
Use Ready To Feed formula because that means you don’t have to bother with any complicated or messy preparation, just pour room temperature formula in to a sterilised bottle and you are ready to go. Even easier is buying starter packs of small bottles filled with formula (sterile), and pre-packed/sterilised teat.
All the brands are pretty much the same, just make sure it says Stage 1 on the label ( and don’t bother with anti-colic, anti-reflux, comfort etc etc. these tend to be thicker and may constipate your baby at this stage,)
Will Supplementing Ruin Breastfeeding ?
The two biggest fears about using bottles in the first few days is that the baby will come to prefer the bottle, and that the mum’s milk supply will be affected due to the lack of breast stimulation.
All you need to do to guard against both of these is to put baby to the breast at the start of each feed, then top up later with formula.
If you breastfeed for 10 to 20 mins each breast, every 3 hours, then top your baby up with formula until they are content you won’t have any problems. If you have a partner on hand at the hospital or at home this is a great chance for them to experience the joy and satisfaction of feeding their baby, and give you, and your sore nipples a break at the same time.
** Nipple Confusion is a Myth ! **
Babies are programmed to suck on absolutely anything…try it !
Babies don’t get nipple confusion, they get flow preference.
In other words, if the bottle teat flows faster than the mothers nipple, baby can get lazy and not want to put the work in at the breast. It doesn’t tend to happen in the first few days due to baby’s over riding instinct to suck for survival, but if you think you will end up supplementing for more than a few days it is sensible to find the slowest flowing bottle you can and use that to help counter the problem. Just remember to always start each feed at the breast and they will get used to that pattern.
Don’t be tempted to try Paced Feeding at this point. It has no relevance to a full term baby with no health complications, and just frustrates baby, stresses you, puts you both in an uncomfortable feeding position, and gives baby much more wind.
Just snuggle down, get comfortable, put the bottle in baby’s mouth and enjoy the experience .
I know this is a big topic and I’ve tried to keep it to a brief overview, but even so, it grew to the point where it was too long for a blog post so I’ve split it in to 2 parts.The next part will cover the different scenarios during the first few months when temporary supplementation might become necessary, or might prove a practical solution to immediate issues so keep an eye out for that.
If you have any questions or concerns about anything in this article please don’t hesitate to get in touch via the comments here, or message me on my Baby Detective FB page.
** NOTE – any anti-formula comments or shaming will be deleted**
If you would like more personalised help and support please come along and join my free Baby Detective Support Group, where there is no judgement or shaming, just me and a great group of people helping each other out.
I am currently working on my second book ‘The Baby Detective Investigates:Infant Feeding’ in which I will go into much more depth about all aspects of Infant Feeding, but for those wanting more information I have included a link to an excellent article by Dr Brian Symon which is well worth a read. https://fedisbest.org/2017/03/dr-brian-symon-words-advice-early-supplemented-breastfeeding-full-milk-production/
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Sarah Norris is one of the UK’s most accomplished maternity nurses, with over 25 years experience caring for hundreds of babies and families in the UK and internationally.
She treats all babies and families as individuals, and respects all forms of parenting and feeding, aiming to help and empower new parents with sensible, practical tips and advice that is always non judgemental and non biased.
She is the author of ‘The Baby Detective’ with Orion Books, out now.