Most women are able to produce enough milk to exclusively breastfeed their babies, even those who have had twins. Nature is wise and the body will be able to produce twice as much milk.
Primary hypogalactia (inability of the mother to produce enough milk for her baby) is very rare. But there are cases in which babies do not express enough milk (frenulum, premature babies, poor attachment, very rigid schedules …) and they must receive an extra supply of milk. It is what we call supplementing . And although the use of the bottle is very widespread, we can give them in many other ways.
When are supplements necessary?
Most babies don’t need supplements. Not even in the first days of life, when they feed on colostrum; These very small amounts are enough to provide them with everything they need. However, there are some special situations in which it may be necessary to supplement breastfeeding . In most cases, these supplements will be temporary.
- Premature or very underweight babies. At first they have little strength to suckle and tire quickly, they may not be able to get all the milk they need from the breast.
- Babies who lose a lot of weight in the first days of life. It is normal for babies to lose weight after birth; they usually recover it after 10-15 days of life. When the loss is greater than 10% or if after 2 weeks they have not regained their birth weight, they will probably need supplements (while we look for the cause and solve the problem).
- In situations in which the rise in milk is delayed (for example due to maternal illness) and the weight loss is around 8-10%, it may also be necessary to supplement temporarily.
- Babies who suffer hypoglycemia (low blood sugar) despite very frequent breastfeeding. It is also usually a temporary problem, for example in premature babies, underweight and / or who have grown little during pregnancy (delayed intrauterine growth)
- In primary hypogalactia . Fortunately, they are the exception, but there are situations in which mothers cannot produce enough milk to exclusively breastfeed: women with breast hypoplasia, breast surgeries in which the surgery is performed through the areola and ducts are sectioned, and nerves or hormonal disturbances.
Should supplements be formula?
Absolutely. It is indisputable that breast milk is the ideal food for the newborn and, whenever possible, it is recommended that it be the only food during the first 6 months of life .
When we have to give supplements, it is recommended that they also be made from breast milk. The benefits of breast milk are so great that even in very premature babies who are admitted, if the mother cannot provide all the milk they need and the possibility exists, they are offered donated breast milk.
However, many people have the false belief that formula is “fattening” more. And it is totally wrong. In fact, formula milks are made trying to be as similar as possible to breast milk, both in components and in calories, but there are unique characteristics of breast milk that are impossible to imitate and this makes its benefits greater.
Breast milk has been shown to reduce the risk of certain diseases both in children (lower incidence of otitis media, gastroenteritis, asthma, obesity or diabetes) and in their mothers (lower risk of ovarian and breast cancer, lower risk of diabetes ), in addition to promoting the mother-child bond.
In addition, breast milk has the peculiarity of being able to change its composition during breastfeeding, and it is different if the baby is premature or at term; it can even vary during the day and during the intake; thus, the first part of the intake is richer in carbohydrates and less caloric, while the final part of the intake is more fat, more caloric and therefore more satiating.
If we focus on “fattening” and we talk about calories, both are very similar. Breast milk provides between 62 and 70 kcal per 100 ml, while artificial milk contains between 60 and 75 kcal per 100 ml. Thus, formula milk does not make you fatter.
Therefore, we will try to make the supplements from breast milk whenever possible and we will have a double benefit; On the one hand, the extraction (both with a breast pump and manual) will stimulate and increase the production of milk in the mother; on the other, the baby will have all the benefits of breast milk.
How do I express milk to supplement my baby?
Each mom finds the way that works best for her. We can perform manual extraction or with an electric breast pump, and we can also collect the milk that drips from the other breast when we are breastfeeding (there are containers specially designed for this called collectors or collecting shells, but we can use any other).
A good time to express milk is while the baby is breastfeeding, placing the breast pump on the other breast (we take advantage of the ejection reflex of the other breast); but we can also do it at the end of the shot or between takes. Sometimes we do not get large amounts but it helps us to stimulate the breast and increase production; it’s like a workout. In these it may be necessary to administer formula milk temporarily.
Supplement with finger-feeding (finger-syringe)
Finger-feeding means finger-feeding. In Spanish we speak of finger-syringe. This supplementation method is suitable for small amounts and can be helpful in the first days of life , when babies are very asleep or have difficulty latching on to the breast.
It consists of giving the milk through a syringe while the baby sucks our finger. To do this, we will put our little finger in the baby’s mouth touching the upper part of the palate and keeping his mouth wide open. Meanwhile, we will introduce the syringe through the corner and when we notice that the baby is sucking, we will let the milk fall little by little. You can see it in the video.
We can use a normal syringe or one specifically designed for this purpose. It is convenient that the baby is semi-upright and we face him. This form of supplementation is quite similar to breast feeding and helps “train” babies.
Supplement with cup
As incredible as it may seem, babies are able to drink from a glass if we tip it and bring the milk to their lips. There are containers on the market specially designed for this purpose but many families use normal glasses or cups without problem. You can see how it is done in this video.
This method is also useful when mothers go to work and babies refuse the bottle.
Supplement with reporter
This method is perfect if the baby latches on to the breast but for various reasons is not able to extract all the milk that it should. It is also used in relactations (mothers who breastfed their babies but stopped) and in breastfeeding inductions.
The relactator is made up of a container where we will put the milk and a small probe that we will place next to the nipple. In this way, when the baby latches on, he will take the nipple and probe and when sucking he will extract milk from both the breast and the relactator. The probes are thin and flexible and do not usually bother the baby. It is a good way to provide more milk, for the baby to remain hooked longer and to stimulate more milk production (the more suction, the greater the stimulus). In this video the IBCLC Alba Padró tells how a relactor works
More information about the use of the relactator in the LactApp app
Supplement with bottle
As a lactation consultant, I prefer to use other forms of supplementation as bottle use is associated with shorter lactations and teat-nipple confusion syndrome may appear ; The way in which babies suck on the bottle differs greatly from the technique they use to suckle and the use of a bottle could make them latch on to the breast worse (it does not happen in all cases, far from it).
However, there are situations in which the supplements are given with a bottle (parents not sure with other methods, large amounts, difficulties of the baby …). In these cases we can use the Kassing method , created by an American lactation consultant, which tries to recreate conditions similar to the breast. For this, we must use a long and narrow, round and soft nipple.
We will first brush the nose and lips to stimulate the search reflex and insert the nipple when the mouth is wide open. We will give the bottle as horizontal as possible, for the flow to be slower and we will try to make several breaks during the feeding.
Are supplements forever?
No way! We have commented that in most cases women are capable of producing enough milk, but sometimes there are circumstances that prevent the baby from expressing all the amount it needs and from stimulating our production adequately. Most of these situations can be corrected (braces that are cut, premature babies that grow, inadequate latches that improve …) so the supplementation of breastfeeding should be temporary.
There are specific cases in which we cannot withdraw the supplements and mixed breastfeeding continues to offer additional benefits to the exclusive formula and we can maintain it for as long as the mother and baby wish.
In Babies and more | “I don’t have enough milk”: the great concern of nursing mothers, and how to fix it
