Babies sometimes need more milk than they can take at the breast. This may be because they were born early or small, and don’t yet have enough energy to do all the work of breastfeeding. Sometimes, mothers don’t have as much milk as their baby needs. It is important that babies get enough milk to be healthy and to grow normally.
La Leche League groups welcome anyone who is breastfeeding or providing their own milk for a baby, or trying to do so. Please don’t feel awkward about needing to give your baby extra milk at an LLL meeting! We would love to meet you and your baby!
Get support from LLLGB here.
Why a baby might need extra milk
How to tell if your baby is getting enough milk
Normal growth
Why protecting the milk supply is urgent
Why a mother might not be able to make a full milk supply
Giving extra milk – what kind of milk
Mothers’ feelings about using formula milk
Extra milk – how to give it
Extra milk – when to give it
Extra milk – how much to give
Reducing the amount of extra milk
What if you need to keep using formula milk?
Syringe feeding a newborn
Why a baby might need extra milk
The most common reason for a baby to need extra milk is a slow start with breastfeeding, when not enough milk was removed from the mother’s breasts in the early days after birth. This can happen when a baby is early, small, unwell, very sleepy, or unable to breastfeed at first. It can also happen when a baby isn’t taking a deep enough mouthful of breast tissue to breastfeed effectively. In this case, the mother may get sore, damaged nipples and the baby may seem unhappy and unsatisfied, never wanting to let go of the breast. When not enough milk is removed, the mother’s milk supply doesn’t get a strong enough signal to increase to the level the baby needs.
You can read more about this here: My baby needs more milk.
How to tell if your baby is getting enough milk
When young babies aren’t getting as much milk as they need, the first sign is usually that they don’t poo as much as expected. A baby over 3 days old who isn’t doing at least 3 yellow poos – the size of a 2p coin or larger – every 24 hours needs to be checked by a healthcare provider. After about 6 weeks, babies find their own pooing pattern, which may be less often. As long as the baby is well and growing normally, it doesn’t matter by this stage how often they poo.
Weight loss is another important way to tell whether a baby is getting enough milk. Babies usually lose up to 7% of their birth weight in the first 3-5 days after birth. If they lose more than this, or keep losing weight after day 5, they need to be checked by a healthcare provider.
You can read more about this here (is my baby getting enough milk?) and here (what’s in a nappy?).
A mother pumps while bottle-feeding her expressed milk.
Normal growth
Babies usually get back to their birth weight by 10-14 days after birth. In the first 3-4 months of life, boys grow at an average of about 40g a day, and girls at an average of 34g a day. A baby who puts on less than 30g a day on average, or whose growth curve drops down across more than one “centile line” on their weight chart, needs to be checked by a healthcare provider.
Why protecting milk supply is urgent
Whatever the reason, when a baby isn’t taking as much milk as she needs at the breast, the mother’s milk supply may not increase enough to meet all the baby’s needs. Milk supply usually increases quickly in the early days after birth, reaching its peak level by the end of the first month. Most of this increase happens in the first 2 weeks, so the amount of milk that is removed at this time is really important. If too little is removed, it may limit how much milk a mother can make later.
When breastfeeding is going well, a baby nursing at the breast will remove milk much more effectively than any breast pump. However, if your baby isn’t breastfeeding at all yet, or isn’t taking as much milk as he needs at the breast, it is important to start expressing your milk as soon as possible. This will ensure that your body gets the signal it needs to make more milk. Babies who are not breastfeeding effectively may want to spend a lot of time at the breast, so it can be difficult to find time to express milk. Given the importance of protecting your milk supply at this stage, it may be necessary to limit the baby’s time at the breast to free up enough time to express. This is an investment of time to make sure you have enough milk later. Find good breastfeeding support as soon as possible.
You can read more about expressing and storing milk here.
Why a mother might not be able to make a full milk supply
Occasionally, a mother may have a medical history or health issues which limit the amount of milk she can make. These reasons can include:
- A history of infertility due to hormonal imbalances
- Past breast surgery, especially breast reduction
- Breast hypoplasia/Insufficient Glandular Tissue (IGT) – breasts may be unusually small, unevenly-sized, long and thin, with a wide space between them and there may be no breast changes (such as increase in size and tenderness) during pregnancy
- PCOS (polycystic ovary syndrome)
- Thyroid problems (over- or under-active)
- Obesity (BMI over 30)
If any of these apply to you, you may still be able to make milk normally. However, if your breastfed baby isn’t growing well it is important to find good breastfeeding support quickly.
Giving extra milk – what kind of milk
The first choice when extra milk is needed is your own expressed milk, which is tailor-made for your baby. The second choice is donated milk from another mother. This may be available from a Milk Bank if your baby is still in hospital.
You can read LLL’s policy on informal sharing of breastmilk here.
When none of these is available in the amounts needed, infant formula milk may be necessary. If you are not sure what kind of formula milk to use, check with your midwife or health visitor. You can find independent information about infant milks in the UK here.
Cup feeding a newborn
Mothers’ feelings about using formula milk
When you were looking forward to breastfeeding your baby, it can feel disappointing to realise that he needs formula milk as well. You might even wonder whether it is worth carrying on breastfeeding, or whether your baby will come to prefer formula milk. It can help to think of formula milk as a kind of medication, to give your baby the energy he needs to breastfeed well. Babies are “hard-wired” to breastfeed and even a small amount of breastmilk can have a significant positive effect on health outcomes that no formula can provide. Even if your milk supply is very low, you and your baby can still enjoy the cuddly, calming, comforting aspects of breastfeeding, for as long as you want to. Breastfeeding is about much more than just milk!
Extra milk – how to give it
There are several options for giving extra milk to a baby.
In the first 1-2 days after birth, when the baby needs small amounts, a teaspoon can work well. You could express your own milk directly into the spoon and use it to feed the milk to your baby. On day 1 after birth, a full feed is about 7ml (1 ½ teaspoons), on average. On day 2 after birth, this doubles to about 15ml (3 teaspoons) per feed. Newborns need at least 8-12 feeds in 24 hours.
By day 3, something larger is needed. Cup-feeding can work well, with practice. You can use any clean cup – a small one, such as a shot glass, can work well. Trying to feed your partner or support person with a cup of water and having them feed you in return can help you quickly learn how far to tip the cup so that your baby can sip from it.
A nursing supplementer (also known as a lactation aid) is a tool that lets you feed extra milk (either expressed milk or formula milk) while your baby breastfeeds. It can be useful if you want to breastfeed but don’t have enough milk. The extra flow of milk can encourage your baby to breastfeed. You can read more about supplementers here.
If bottles are used, it is important to know how to use them in a way that supports breastfeeding. It is easy to feed a baby too much, too fast by bottle, and this can be unhelpful for a baby who is finding breastfeeding difficult. You can find out how to do “paced” bottle feeding – at a good speed for your baby, letting him choose how much to take – here.
Extra milk – when to give it
It is often suggested that you breastfeed first, before giving the extra milk. This often means that the baby is at the breast when he is hungry and least happy, which can make breastfeeding stressful for both of you.
An alternative might be to try ending feeds with your baby at the breast. This may mean starting with some extra milk, to calm your hungry baby enough to help him breastfeed. Or you could start with one breast, give the extra milk in the middle, and finish on the second breast. It’s much nicer for your baby to fall asleep at your breast than with a cup or bottle!
Even if your baby isn’t breastfeeding much or even at all yet, spending happy time being at or near your breast will make it easier for him to breastfeed when he is ready. Carrying your baby in a sling, cuddling him skin-to-skin, taking a bath together and lying down together in a prepared bed (if it is safe for you and your baby to do so) are all good ways for him to spend relaxed time at the breast. Babies who feel comfortable at the breast are more likely to try breastfeeding when they are ready. You might like to give the extra milk with your baby’s cheek resting on your breast, letting him fall asleep on the breast as he finishes.
Extra milk – how much to give
Healthy, full-term babies are usually very good at knowing how much milk they need. If you are giving extra milk by cup or bottle, carefully watch your baby for signs that he wants more or has had enough. Your baby can show you how much they want.
Sometimes, though, a baby is so early, unwell or sleepy that they are not able to ask for as much as they need. A baby who has been getting less milk than he needs for a while may act as if he is not hungry, because he doesn’t have much energy. He may look as if he is finished after a very short feed, but he will not be pooing or growing as expected.
When this happens, it is important to encourage the baby to take more milk. Keep your baby close, doing skin-to-skin as much as you can. This will encourage your baby’s interest in feeding, and help you to notice the first signs that he is waking up and getting ready to feed. Your baby may only be able to feed for a short time, so he needs to do it very often. Feeds don’t have to be equally spaced, but they need to happen at least 8-12 times in 24 hours. It can be helpful to record the number of feeds, along with the number of wet and dirty nappies he has done each day.
When your baby is growing and pooing as expected, he is taking as much milk as he needs.
It is important to keep in close touch with your healthcare provider during this time. If your baby starts doing fewer wet nappies, or it is getting more difficult to wake him to feed, please contact your midwife or doctor straight away.
Once your baby starts to take more milk, his energy will increase. He will start to catch up with his growth, and he might want a lot more milk. Don’t panic! Give him as much as he wants, making sure that you feed carefully if using a cup or bottle, so that he can stop when he has had enough. Once his growth has caught up with where it needs to be, his appetite will calm down.
Reducing the amount of extra milk
If your goal is to feed your baby only with your milk, you will be wondering how to reduce the amount of donor or formula milk your baby is getting. It is important to work with your healthcare provider and your local breastfeeding supporters to come up with a plan tailor-made for you and your baby.
Read our article on Weaning from Supplements here.
What if you need to keep using formula milk?
Sometimes, however hard you try to increase your milk, your baby might need to keep having some formula milk. This might be an important part of his diet, or even most of it, but remember that breastfeeding is about much more than just milk. If you ask mothers of older breastfeeding babies or toddlers what they and their babies value about breastfeeding, they usually forget to mention milk! They talk about how much their babies enjoy it, how useful it is for calming them down and getting them to sleep, and how restful it can be for the mother to sit or lie down to feed. Breastfeeding can still work really well in all these ways, whether or not the baby is also having some formula milk.
It is sometimes possible to stop using formula milk after the baby has started eating other foods, usually from around 6 months. As your baby eats more food, he will need less milk. It is often possible to reduce the amount of formula he takes while still breastfeeding as much as you like. After a year, babies can drink unmodified animal milk (such as cow’s milk or goat’s milk) and no longer need formula milk. You can continue to breastfeed for as long as you and your child want to. Many mothers who have needed to use formula milk in the early months of their child’s life find that the later months and years of breastfeeding are much more enjoyable, because they no longer need to think about how much milk their child is getting.
Written by Jayne Joyce, LLL Oxfordshire, June 2018