Infrequently, as a breastfeeding supporter, educator, staff nurse or lactation consultant, you may need to feed the breastfed infant a supplement. What should you give and how should you give it?
The Academy of Breastfeeding Medicine (3) recommends expressed breast milk from the infant’s mother to be the first choice. If not available, donor human milk is the second choice. And if neither of the human milk choices is available, the use of a protein hydrolysate formula should be considered. Cow’s milk or soy artificial infant milks should only be chosen after examining the risks vs. benefit considering the family allergy history, available resources, family resources, infant age, and the impact formula use would have on breastfeeding. Water or glucose water are no longer advised.
When feeding the supplement, providers should consider the many choices other than a bottle: spoon, cup, syringe, drip method, finger-feeding, or others as suggested by Watson (1) or Walker (2). Should a bottle be the only choice, use of a slow-flow nipple and pacing the feed will allow the infant to feed only to satiety as well as stop to breathe comfortably throughout the feed.
Knowing the physiologic (4) size of the infant stomach will prevent overfeeding and stretching of the stomach itself. The amount of supplement used will depend on the age and gestation of the infant.
How does your facility choose a supplement for a breastfed infant? Are alternative feeding methods used when a supplement is needed? How much supplement is given? It is your responsibility to the families with whom you work to be informed and well-practised in the supplementation choices for the breastfed infant.
Kathy Parkes, MSN-Ed, RN, IBCLC, FILCA CHC
Professional Development Educator
1. Watson Genna, C. (2016). Selecting and using breastfeeding tools: Improving care and outcomes. Praeclarus Press. Amarillo, TX, USA.
2. Walker, M. (2016). Breastfeeding management for the clinician: Using the evidence, 4th edition. Jones and Bartlett. Burlington, MA, USA.
3. Kellams, A., Harrel, C., Omage, S., Gregory, C., Rosen-Carole, C., and the Academy of Breastfeeding Medicine. (2017). ABM Clinical Protocol #3: Supplementary Feeding in the Healthy Term Breastfed Neonate, Revised 2017. Breastfeeding Med; 12(3). https://www.bfmed.org/protocols
4. Bergman, N.J. (2013). Neonatal stomach volume and physiology suggest feeding at 1-h intervals. Acta Paediatrica; 102:773-777.
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