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Continuing with Step 6 of Ten Steps to Successful Breastfeeding

March 2019

To continue with Step 6 regarding no supplementation of breastfed infants unless medically necessary, we will now discuss another reason to avoid supplementation. In a 2014 study, authors Chantry, Dewey, Peerson, Wagner, and Nommsen-Rivers found, "Infants who received in-hospital formula supplementation were more likely to not be fully breastfeeding during days 30-60 than infants exclusively breastfed in-hospital...” (p. 6)


These researchers followed 448 women over a 24 month period to track maternal goal of exclusive breastfeeding, "any” breastfeeding, and the effect of formula supplementation during their hospital stay. When formula was given, "Infants in the in-hospital formula supplementation group were also more likely to experience breastfeeding cessation by day 60 than infants exclusively breastfed in-hospital...” (p. 6) with rational for formula use "most often because of maternal concern(s) about insufficient milk supply, perceived signs of inadequate infant intake, and/or poor infant breastfeeding behavior,” (p. 7).

Many studies point out that early use of formula supplementation, especially during the hospitalized period, increases the premature weaning rate, with many mothers reporting that they've not met their own personal goals for breastfeeding.

In your facility, how are maternal concerns about milk supply, inadequate infant intake, or breastfeeding difficulties handled? Is the staff quick to hand out bottles of formula? Or do they work with the mother to assess breastfeeding, teach hand expression and normal infant intake on the first 3 days following birth, teach about the negative consequences of artificial baby milk use, and assist the family in making a truly informed choice?

Early formula supplementation also brings up legal and ethical questions...we know that early introduction of cow's milk formula can increase rates of diabetes in children and adults. Can the staff with a hospital system be held liable for illness in later life? Is it ethical to give a product without medical need that can lead to problems later? Good conversation pieces for your staff!


Kathy Parkes, MSN-Ed, RN, IBCLC, FILCA CHC

Professional Development Educator



Chantry, C.J., Dewey, K.G., Peerson, J.M., Wagner, M.S., and Nommsen-Rivers, L.A.  (2014).  In-hospital formula use increases early breastfeeding cessation among first-time mothers intending to exclusively breastfeed.  J Pediatr. June ; 164(6): 1339-45.e5.  doi:10.1016/j.jpeds.2013.12.035.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120190/pdf/nihms567814.pdf


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