This is the first post in a series that will address the central questions around supplementing a breastfed baby. Whether you’re the parent or the professional, you’ll want to know:
- What do I need to know before I agree to this?
- How much of the supplement will the baby need each day?
- What’s the right amount to offer at each feeding?
- How can I tell if the baby’s needs are being met or not?
- When and how should the supplement amounts be adjusted?
You don’t want to hear the word “supplementation.” You’ve probably already heard the message of “exclusive breastfeeding only.”
Right. Okay. Before you cast a vote for yay or nay, slow down.
The Association of American Medical Colleges says, “Patients have a right to make an informed, voluntary decision about their care. That means they need to know the nature, risks, and benefits of their options — which includes declining treatment.”
This is a matter of informed consent, so use your B.R.A.I.N. (I have known this acronym for decades, but I cannot find the original source.)
The mother’s own milk is, with rare exception, the most beneficial option.
But in this situation, the question becomes: Is there any benefit to supplementing a breastfed baby?
We all need a certain amount of food and fluid to be alive and thrive. If the baby is taking in too little food and fluid through suckling at the breast, there’s a distinct benefit to supplementing. No doubt.
Entire books have been written about the risks of formula. But that’s not what we’re talking about here.
Here, the question is about the risk of giving formula as a supplement.
The risk of supplementing means that the baby is likely to be taking less milk at the breast. So that’s a problem. The less the baby suckles the breast, the less milk the breast will make. I’ve explained that how this works.
Is formula the only answer?
If intake at the breast is inadequate, start figuring out a way to use the mother’s milk by using an alternative feeding device. There are many to choose from, but the default is usually a bottle with a nipple.
If there’s not enough of mother’s own milk, the question is, would donor milk be an option for supplementing a breastfed baby?
This part is critical. I usually discuss the indications first, but because it comes fourth in the BRAIN acronym, I’ll discuss it now.
Whether I was the parent or the professional in this situation, I’d make sure I understood the whole clinical picture of what’s really going on. If I were the parent, I’d advocate for myself and my child until I got that clear picture.
But let’s say I’m the RN and IBCLC in this situation. Here are the first questions I’d ask before I did anything else.
What’s the situation with the baby? Is this a full-term, mostly healthy baby who is temporarily having a rough time with adequate intake? Or is this a baby who is premature or compromised in some way?
In situations where the baby is preterm or compromised, I would not take full responsibility for decision-making about types and amounts. I’d try to forge a collaborative relationship with the primary care provider who has prescriptive privileges. (I am in no way licensed or qualified to calculate the amount of food or fluid a baby needs in those situations.)
And, in all situations, I’d press harder to get the physician or provider with medical and diagnostic privileges to give some specific guidance. Just “needs supplementation” is pretty vague.
I’d make sure that everyone who is involved — especially the family — has a clear understanding of whether the baby is failing to thrive, or simply slow to gain. In her book, Breastfeeding: A Guide for the Medical Profession, Dr. Ruth Lawrence makes a clear distinction between the two conditions.
Those questions should be asked, answered, and clearly understood before supplementing a breastfed baby.
There’s a lot of what-when-why and how-much that needs to be addressed and understood.
No; not now; negotiate
This is my personal version of “N” in the BRAIN acronym. Certainly, “No” is a possible response. But another “N” might work, too.
According to FindLaw.com, “Parents usually have the right to make medical decisions for their children.” (The operative word there is “usually.”) And “no” (refusal of treatment) is one possible decision.
“Not now” might be a good response. This would provide the opportunity to get more information, including a second opinion. One physician may have an opinion, but the patient or parent is always entitled to a second opinion.
Negotiation might be another strategy. Perhaps you could supplement for a day or a few days but insist on re-evaluating the baby’s condition within that timeframe.
Like most decisions we make in a day, this decision does not necessarily need to be immediate, dichotomous, or permanent.
At the end of the day, the important piece is asking the right questions to help determine if supplementing a breastfed baby is the best option.
In short, no, and not now and negotiation are all ideas for the “N” part of BRAIN.