Breastfeeding: Will supplementation decrease your milk supply?

I am 38 years old and have a two-month-old son. I think my milk supply is diminishing. My baby wakes every two hours through the night to nurse. My pediatrician suggested that I start supplementing with formula to extend his sleeping time. His weight gain is on target for his age but he is only having a bowel movement every four to five days and he wets around eight diapers a day. I'm concerned he doesn't get enought milk becaue he gets fussy after about seven minutes on a side. The pediatrician suggested I offer him four ounces of formula after a feed -- and he will take the whole thing. Could supplementing be adding to my problems?

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Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

It is quite normal for a breastfed two-month-old to be nursing about every two hours. That is approximately the length of time that it takes for your milk to be digested. Frequent, effective nursing is probably the most important factor in building and maintaining a good milk supply.

You mentioned that your baby is gaining weight well and has good output -- wetting about eight diapers a day and stooling once very four to five days. Breastfed babies over five to six weeks of age may stool several times a day, or as little as once every week or so. As long as your baby is healthy, happy and growing well, less frequent stooling should be of no concern.

Supplementing will decrease your milk supply. Just because your baby will accept the four ounces you offer following a feed doesn't necessarily mean that he wasn't getting enough breastmilk. Many babies will finish a bottle following a feed, for the simple reason that they enjoy sucking.

Next: Ways to help increase your milk supply


Breastfeed often. The more you breastfeed and express, the more milk you will make. When nursing, allow your baby to finish the first breast before offering the other side. If he still seems fussy after about seven minutes, try gently taking him off your breast and burping him. He may have a bubble that needs to come up. If he is fussy at the breast, remove him from the breast and help him to calm, before offering the breast again. Fussy babies don't nurse well. When he's relaxed and ready to nurse, you can offer him the "used" breast again. You don't need to worry that your breast will be empty. Your breasts continue to produce milk as your baby nurses. The milk will be transitioning to rich hindmilk and this may help to keep him satisfied for a longer period of time. When he is done nursing on this side and comes off on his own, you can offer the other breast. Many babies are very happy nursing from one breast per feed.

Are you and baby comfortable? Observe your baby as he nurses. Is your baby correctly positioned at your breast? He should be hugged in really close as he nurses. Does he have a good mouthful of your breast tissue? He needs to be taking (and keeping in) at least one inch of your areola. His nose and chin should be gently resting on your breast, and his body should be in alignment. If you are nursing him in the cradle hold, you should be belly to belly with him. Do you hear him sucking and swallowing? If he is improperly attached or positioned he will not be properly accessing your milk supply.

Express your milk frequently. If your other breast is at all uncomfortable, express enough milk for comfort. Appropriate times for pumping would be following a feed (again, don't expect to produce much milk at this time), in between feeds, and from one breast as your baby nurses on the other. When you begin to express your milk, it is normal to obtain fairly small quantities. Even the best hospital-grade electric breastpump will not be able to remove milk as well as a baby who is nursing well.

Use an effective breastpump. For women having real problems with their milk supply, it is essential to use a hospital-grade electric breastpump.

Allow your baby to meet all his sucking needs at your breast. During this time, do not use a pacifier. By allowing your baby frequent access to your breasts, and expressing your milk, if you feel this is necessary, you will probably soon be producing enough milk for your little guy.

Gradually decrease supplementation. If you want to preserve your milk supply, I would recommend gradually decreasing supplementation until your baby is exclusively breastfeeding. To start out, make sure you are not supplementing following each feed. Allow at least several feeds where your baby breastfeeds exclusively. To gradually decrease supplementation, decrease by about two ounces every four days.

Watch your baby's output. As you make these changes, it is important to keep an eye on your baby's output. He should be having at least five to six wet diapers daily and regular substantial bowel movements. I would also recommend taking him into his health care provider for weekly weight checks as you make these changes. Normal weight gain is four to eight ounces per week.

Schedule a visit with a Lactation Consultant. If you continue to have difficulties with your milk supply I would recommend working with a Lactation Consultant familiar with your situation. You can contact ILCA (International Lactation Consultant Association)office at ilca@erols.com. You will be referred to a Lactation Consultant in your area.

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