How much to supplement?


Well, it’s happening. The doctor just told you to start supplementing. It’s day five of your baby’s life, and he’s at 14% weight loss.  It’s obvious that he needs more milk, but why?  Do you have a low supply? Did your milk come in late?  Or at all?  Or do you have plenty of milk but your baby just isn’t getting it out? What happens when you pump? Can you supplement with your own milk or do you need to use formula?  Most likely,the only one who can answer all of those questions is a lactation consultant (IBCLC), and whenever unplanned supplementing is on the menu, seeking out an IBCLC’s help should be as well.

However, while you are waiting for your lactation appointment, you need to know how much you should be putting into your baby’s bottle, be it breastmilk or formula.
So there’s good news and bad news and then some REALLY good news regarding solving the “how much” question….
The good news is that we know how much your baby’s stomach should be holding for each day of life.  Baby should be eating about this much per feeding, at least 8 times a day*:

Day One -2-10 ml

Day Two – 5-15 ml

Day Three – 15-30 ml

Day Four – 1-2 ounces (30-60ml)

Day 5 – Day 7: between 2-3 ounces (60-90ml)

Week 1- Week 2: Your baby will be working up to 3-4 ounces by the end of week 2. She will take roughly 3-4 ounces per feeding for the first 6 months of life, and then may drink a little less milk when solids are introduced.

The above numbers work well when baby is not going to the breast at all, i.e. you are replacing a breastfeeding with a bottle feeding.

But what if you are breastfeeding before offering a supplement?
The bad news is that we don’t know whats coming out of your boob.  We just know that it’s not enough right now for whatever reason. You know that something is coming out if you see your baby taking big long pulls, hear swallows, and feel as though your breasts are softer after a feeding. But after 45 minutes of nursing on both sides, your baby is still showing signs of hunger.  And so you bring out the bottle, but you’re kind of clueless about how much should go in it at this point.
The REALLY good news is that your baby can tell you when he’s full, and so you don’t actually need to worry about how much is the right amount!  If you use a paced bottle feeding method, (and here) your baby will be able to give you clear cues when he has had enough.  When he shows you satisfaction cues, you know that you fed him the right amount, whatever that happened to be.
So here’s a temporary plan: Start with an ounce in your supplemental bottle. Practice paced feeding with your baby. Make sure that you are spending about 10-15 minutes on the bottle feed as that’s how long it takes your baby’s brain to know that his stomach is full. If he takes the ounce and still wants more, give him another ounce. Or, if he takes half an ounce and says he is done (mouth closed/turning head away), start with a half of an ounce the next time you supplement.  If he wants more after two ounces, give him more.  Trust that your baby’s body is working, so that if he can tell you when he is hungry, he can also tell you when he is full.**
Continue to monitor all of the signs that your baby is getting enough to eat , and talk to your pediatrician if you have any concerns.
Working on breastfeeding can be a challenge, but now you can always feel good about the fact that your baby is being well fed while you figure things out!
*Volumes taken from the Academy of Breastfeeding Medicine’s supplementation protocol.
**If you have a pre-term baby, a baby under 7 pounds, a jaundiced baby or a sleepy baby you should be working very closely with your pediatrician and an IBCLC to determine the correct amount of supplement. These babies are not as trustworthy as healthy full term babies at telling us their needs, and may not eat as much as they need to before tiring out or falling asleep.

photo credit: Chronic drinker via photopin (license)
photo credit: Baby & Bottle via photopin (license)
photo credit: bottle V via photopin (license)

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