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supplementing..ok or absolutely not?

Posted by on Feb. 17, 2013 at 9:06 PM
  • 21 Replies

I need opinions on supplementing during breastfeeding..my daughter is staying fussy more often than not.  I am not sure if it's due to a growth spurt, fighting her sleep, or if she's not getting full enough.  The later seems more likely. I realize this will decrease my milk supply but is it ok to supplement once a day or even once or twice a week? Thoughts?

by on Feb. 17, 2013 at 9:06 PM
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Replies (1-10):
audreesmama
by on Feb. 17, 2013 at 9:07 PM

I would say NOOOO! Any supplementing you do will affect your supply, this counteracting breastfeeding. What have you done to try to increase your supply?

                                       

K8wizzo
by Kate on Feb. 17, 2013 at 9:09 PM

How are her diapers?  How old is she?  What are you planning to supplement with?  Are you aware of the risks of formula--SIDS, ear infections, pneumonia, digestive issues, etc, both now and down the road?

lsherrill1402
by on Feb. 17, 2013 at 9:14 PM

I am only pumping once a day an hour after her first feeding of the morning.  As far as increasing my supply, Im not sure I have done anything..

lsherrill1402
by on Feb. 17, 2013 at 9:16 PM

 


Quoting K8wizzo:

How are her diapers?  How old is she?  What are you planning to supplement with?  Are you aware of the risks of formula--SIDS, ear infections, pneumonia, digestive issues, etc, both now and down the road?


Diapers are good..less poop ones than used to be..she is 7 weeks old. I haven't supplemented once..just wanted opinions.

 

K8wizzo
by Kate on Feb. 17, 2013 at 9:19 PM

If diapers are good, she's getting enough.  Less poop is normal at this age.  As a newborn (up to about 4 weeks old), was she pooping at least 3-4 times a day (quarter-sized spot of poop counts as 1)?

Quoting lsherrill1402:



Quoting K8wizzo:

How are her diapers?  How old is she?  What are you planning to supplement with?  Are you aware of the risks of formula--SIDS, ear infections, pneumonia, digestive issues, etc, both now and down the road?


Diapers are good..less poop ones than used to be..she is 7 weeks old. I haven't supplemented once..just wanted opinions.



K8wizzo
by Kate on Feb. 17, 2013 at 9:19 PM

Does any of this sound familiar?

Forceful Let-down (Milk Ejection Reflex) & Oversupply

AUGUST 20, 2011. Posted in: SUPPLY WORRIES

By Kelly Bonyata, BS, IBCLC

 Is forceful let-down the problem?

Does your baby do any of these things?

  • Gag, choke, strangle, gulp, gasp, cough while nursing as though the milk is coming too fast
  • Pull off the breast often while nursing
  • Clamp down on the nipple at let-down to slow the flow of milk
  • Make a clicking sound when nursing
  • Spit up very often and/or tend to be very gassy
  • Periodically refuse to nurse
  • Dislike comfort nursing in general

If some of this sounds familiar to you, you probably have a forceful let-down. This is often associated with too much milk (oversupply). Some mothers notice that the problems with fast letdown or oversupply don’t start until 3-6 weeks of age. Forceful let-down runs the gamut from a minor inconvenience to a major problem, depending upon how severe it is and how it affects the nursing relationship.

What can I do about it?

There are essentially two ways you can go about remedying a forceful let-down: (1) help baby deal with the fast flow and (2) take measures to adjust your milk supply down to baby’s needs. Since forceful let-down is generally a byproduct of oversupply, most moms will be working on both of these things. It may take a couple of weeks to see results from interventions for oversupply, so try to be patient and keep working on it.

Help baby deal with the fast milk flow

  • Position baby so that she is nursing “uphill” in relation to mom’s breast, where gravity is working againstthe flow of milk. The most effective positions are those where baby’s head and throat are above the level of your nipple. Some nursing positions to try:
    • Cradle hold, but with mom leaning back (a recliner or lots of pillows helps)
    • Football hold, but with mom leaning back
    • Elevated football hold – like the football hold, but baby is sitting up and facing mom to nurse instead of lying down (good for nursing in public).
    • Side lying position – this allows baby to dribble the extra milk out of her mouth when it’s coming too fast
    • Australian position (mom is “down under”, aka posture feeding) – in this position, mom is lying on her back and baby is on top (facing down), tummy to tummy with mom. Avoid using this positioning frequently, as it may lead to plugged ducts.
  • Burp baby frequently if she is swallowing a lot of air.
  • Nurse more frequently. This will reduce the amount of milk that accumulates between feedings, so feedings are more manageable for baby.
  • Nurse when baby is sleepy and relaxed. Baby will suck more gently at this time, and the milk flow will be slower.
  • Wait until let-down occurs, then take baby off the breast while at the same time catching the milk in a towel or cloth diaper. Once the flow slows, you can put your baby back to the breast.
  • Pump or hand express until the flow of milk slows down, and then put baby to the breast. Use this only if nothing else is working, as it stimulates additional milk production. If you do this, try to express a little less milk each time until you are no longer expressing before nursing.

Adjust your supply to better match baby’s needs

  • If baby is gaining weight well, then having baby nurse from only one breast per feeding can be helpful.
  • If baby finishes nursing on the first side and wants to continue nursing, just put baby back onto the first side.
  • If the second side becomes uncomfortable, express a little milk until you’re more comfortable and then use cool compresses – aim for expressing less milk each time until you are comfortable without expressing milk.
  • Avoid extra breast stimulation, for example, unnecessary pumping, running the shower on your breasts for a long time or wearing breast shells.
  • Between feedings, try applying cool compresses to the breast (on for 30 minutes, off for at least an hour). This can discourage blood flow and milk production.
  • If nursing one side per feeding is not working after a week or so, try keeping baby to one side for a certain period of time before switching sides. This is called block nursing.
  • Start with 2-3 hours and increase in half-hour increments if needed.
  • Do not restrict nursing at all, but any time that baby needs to nurse simply keep putting baby back to the same side during that time period.
  • If the second side becomes uncomfortable, express a little milk until you’re more comfortable and then use cool compresses – aim for expressing less milk each time until you are comfortable without expressing milk.
  • In more extreme cases, mom may need to experiment a bit with time periods over 4 hours to find the amount of time per breast that works best.
  • Additional measures that should only be used for extreme cases of oversupply include cabbage leaf compresses and herbs.

Even if these measures do not completely solve the problem, many moms find that their abundant supply and fast let-down will subside, at least to some extent, by about 12 weeks (give or take a bit). At this point, hormonal changes occur that make milk supply more stable and more in line with the amount of milk that baby needs.

Sometimes babies of moms with oversupply or fast let-down get very used to the fast flow and object when it normally slows somewhere between 3 weeks to 3 months. Even though your let-down may not be truly slow, it can still seem that way to baby. See Let-down Reflex: Too Slow?for tips.

K8wizzo
by Kate on Feb. 17, 2013 at 9:20 PM
2 moms liked this

Some other fussiness info from kellymom:

My baby is fussy! Is something wrong?

JULY 26, 2011. Posted in: PARENTING FAQ

What is normal baby fussiness?

Whether breastfed or formula fed, during their first few months, many babies have a regular fussy period, which usually occurs in the late afternoon or evening. Some babies’ fussy periods come so regularly that parents can set their clocks by it! The standard infant fussiness usually starts at about 2 to 3 weeks, peaks at 6 weeks and is gone by 3 to 4 months. It lasts on “average” 2 to 4 hours per day. Of course, there is a wide variety of normal.

To distinguish between “normal” and a problem, normal usually occurs around the same time of day, with approximately the same intensity (with some variation); responds to some of the same things each time, such as motion, holding, frequent breastfeeding, etc.; and occurs in a baby who has other times of the day that he is contentedly awake or asleep. Normal fussiness tends to occur during the time of the day that the baby usually stays awake more, the most common time is in the evening right before the time that the baby takes his longest stretch of sleep.

What causes babies to be fussy?

If you feel that your baby’s fussiness is not normal, it’s never a bad idea to get baby checked by the doctor to rule out any illness. A common cause of fussy, colic-like symptoms in babies isforemilk-hindmilk imbalance (also called oversupply syndrome, too much milk, etc.) and/orforceful let-down. Other causes of fussiness in babies include diaper rashthrushfood sensitivitiesnipple confusionlow milk supply, etc.

Babies normally fuss for many reasons: overtiredness, overstimulation, loneliness, discomfort, etc. Babies are often very fussy when they are going through growth spurts. Do know that it isnormal for you to be “beside yourself” when your baby cries: you actually have a hormonal response that makes you feel uncomfortable when your baby cries.

Comfort measures for fussy babies (many fit into several different categories)

Basic needs
  • Nurse
  • Burp baby
  • Change his diaper
  • Undress baby completely to make sure no clothing is “sticking” him
Comforting Touch
  • Hold baby
  • Carry baby in a sling
  • Give baby a back rub
  • Carry baby in the “colic hold” (lying across your forearm, tummy down, with your hand supporting his chest)
  • Lay baby across your lap & gently rub his back while slowly lifting & lowering your heels
  • Lay baby tummy-down on the bed or floor and gently pat his back
  • Massage your baby
Reduce stimulation
  • Swaddle baby
  • Dim lights and reduce noise
Comforting Sounds
  • Play some music (try different styles and types of voices to see which baby prefers)
  • Sing to baby
  • Turn on some “white noise” (fan, vacuum cleaner, dishwasher)
Rhythmic motion / change of pace
  • Nurse baby in motion (while walking around or rocking)
  • Give baby a bath
  • Rock baby
  • Hold baby and gently bounce, sway back and forth or dance
  • Put baby in a sling or baby carrier and walk around inside or outside
  • Put baby in a baby swing (if he’s old enough)
  • Take baby outside to look at the trees
  • Take baby for a walk in the stroller
  • Go for a car ride
  • Set baby in a baby carrier (or car seat) on the dryer with the dryer turned on (stand by him, as the vibration can bounce the seat right off the dryer onto the floor)

One of the most interesting things I’ve seen in the research regarding infant fussiness is that almost anything a parent tries to reduce fussiness will work, but only for a short time (a few days), and then other strategies need to be used.

If you nurse and it doesn’t seem to help, then try other comfort measures. If you pick him up or nurse him, and baby is content, then that was what he needed. If it works, use it!

I’m worried about spoiling my baby

Your baby will not be spoiled if you hold him and nurse him often – quite the opposite, in fact. Studies have shown that when babies are held often and responded to quickly, the babies cry less, and the parents learn to read baby’s cues more quickly. A young child’s need for his mother is very intense – as intense as his need for food. Know that your child really needs you. It is not about manipulation or something you can “fix” with the right discipline. Often a baby who is perceived as fussy is simply a baby who needs more contact with mom (and is smart enough to express this need) and is content once his needs are met. See the links below to read more aboutspoiling.

Conclusion

Caring for a fussy baby can be very stressful! Give both yourself and baby some extra TLC. Surround yourself with supportive people, de-stress in other areas if possible (for example, minimize housework), and tell yourself you are doing a great job. It is very difficult to feel good about yourself as a parent when you have a fussy baby. Don’t be too alarmed if your efforts seem to have no positive effect – they are. When you stay with your baby to try to provide comfort you are beginning to teach your baby that he can count on you and that he is loved.

Additional Resources

kellymom.com

@ other websites

Baby Massage

maggiemom2000
by Ruby Member on Feb. 17, 2013 at 9:27 PM
1 mom liked this

Know the risks of supplementing with formula before you choose to do it. In addition to lowering your milk supply, there are risks to baby as well, most related to higer risk of infection due to the formula changing the gut flora in baby and "inactivating" some of the antibiotc properties of breastmilk.

Here's some info on that:

“Just One Bottle Won’t Hurt”—or Will It?

By Marsha Walker, RN, IBCLC

  • The gastrointestinal (GI) tract of a normal fetus is sterile.
  • The type of delivery has an effect on the development of the intestinal microbiota.

Vaginally born infants are colonized with their mother’s bacteria.

Cesarean born infants’ initial exposure is more likely to environmental microbes from the air, other infants, and the nursing staff which serves as vectors for transfer.

  • Babies at highest risk of colonization by undesirable microbes or when transfer from maternal sources cannot occur are cesarean-delivered babies, preterm infants, full term infants requiring intensive care, or infants separated from their mother.
  • Breastfed and formula-fed infants have different gut flora.

Breastfed babies have a lower gut pH (acidic environment) of approximately 5.1-5.4 throughout the first six weeks that is dominated by bifidobacteria with reduced pathogenic (disease-causing) microbes such as E coli, bacteroides, clostridia, and streptococci o babies fed formula have a high gut pH of approximately 5.9-7.3 with a

variety of putrefactive bacterial species.

In infants fed breast milk and formula supplements the mean pH is approximately 5.7-6.0 during the first four weeks, falling to 5.45 by the sixth week.

When formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached.

Breastfed infants who receive supplements develop gut flora and behavior like formula-fed infants.

  • The neonatal GI tract undergoes rapid growth and maturational change following birth.

* Infants have a functionally immature and immuno-naive gut at birth.

Tight junctions of the GI mucosa take many weeks to mature and close the gut to whole proteins and pathogens.

Open junctions and immaturity play a role in the acquisition of NEC, diarrheal disease, and allergy.

* sIgA from colostrum and breast milk coats the gut, passively providing immunity during the time of reduced neonatal gut immune function.

Mothers’ sIgA is antigen specific. The antibodies are targeted against pathogens in the baby’s immediate surroundings.

The mother synthesizes antibodies when she ingests, inhales, or otherwise comes in contact with a disease-causing microbe.

These antibodies ignore useful bacteria normally found in the gut and ward off disease without causing inflammation.

  • Infant formula should not be given to a breastfed baby before gut closure occurs.

Once dietary supplementation begins, the bacterial profile of breastfed infants resembles that of formula-fed infants in which bifidobacteria are no longer dominant and the development of obligate anaerobic bacterial populations occurs. (Mackie, Sghir, Gaskins, 1999)

Relatively small amounts of formula supplementation of breastfed infants (one supplement per 24 hours) will result in shifts from a breastfed to a formula-fed gut flora pattern. (Bullen, Tearle, Stewart, 1977)

The introduction of solid food to the breastfed infant causes a major perturbation in the gut ecosystem, with a rapid rise in the number of enterobacteria and enterococci, followed by a progressive colonization by bacteroides, clostridia, and anaerobic streptococci. (Stark & Lee, 1982)

With the introduction of supplementary formula, the gut flora in a breastfed baby becomes almost indistinguishable from normal adult flora within 24 hours. (Gerstley, Howell, Nagel, 1932)

* If breast milk were again given exclusively, it would take 2-4 weeks for the intestinal environment to return again to a state favoring the grampositive flora. (Brown & Bosworth, 1922; Gerstley, Howell, Nagel, 1932)

  • In susceptible families, breastfed babies can be sensitized to cow’s milk protein by the giving of just one bottle, (inadvertent supplementation, unnecessary supplementation, or planned supplements), in the newborn nursery during the first

    three days of life. (Host, Husby, Osterballe, 1988; Host, 1991)

Infants at high risk of developing atopic disease has been calculated at 37% if one parent has atopic disease, 62-85% if both parents are affected and dependant on whether the parents have similar or dissimilar clinical disease, and those infants showing elevated levels of IgE in cord blood irrespective of family history. (Chandra, 2000)

* In breastfed infants at risk, hypoallergenic formulas can be used to supplement breastfeeding; solid foods should not be introduced until 6 months of age, dairy products delayed until 1 year of age, and the mother should consider eliminating peanuts, tree nuts, cow’s milk, eggs, and fish from her diet. (AAP, 2000)

  • In susceptible families, early exposure to cow’s milk proteins can increase the risk of the infant or child developing insulin dependent diabetes mellitus. (IDDM) (Mayer et al, 1988; Karjalainen, et al, 1992)

The avoidance of cow’s milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible individuals. (AAP, 1994)

* Sensitization and development of immune memory to cow’s milk protein is the initial step in the etiology of IDDM. (Kostraba, et al, 1993)

  • Sensitization can occur with very early exposure to cow’s milk before gut cellular tight junction closure.
  • Sensitization can occur with exposure to cow’s milk during an infection-caused gastrointestinal alteration when the mucosal barrier is compromised allowing antigens to cross and initiate immune reactions.
  • Sensitization can occur if the presence of cow’s milk protein in the gut damages the mucosal barrier, inflames the gut, destroys binding components of cellular junctions, or other early insult with cow’s milk protein leads to sensitization. (Savilahti, et al, 1993)
K8wizzo
by Kate on Feb. 17, 2013 at 9:28 PM

I'm going to add this.  Absolutely no judgement if you decide to supplement, but I want you to be well-informed before you make that decision.  Both of my children have needed formula at one point or another and I am very thankful for its existence, but giving just one formula bottle does change your baby's gut forever and there are risks.  Anyway... just go into it eyes wide open. :)

What should I know about infant formula?

AUGUST 2, 2011. Posted in: MILK

Parents consider giving their babies formula for many reasons. In some cases it is medically necessary. At other times, mom may believe that her milk supply is low (and thus think that formula is needed) when her supply is just fine.  In the vast majority of cases, formula is not medically necessary. If you feel that your baby genuinely has a need for formula supplementation (or your baby’s doctor has suggested or recommended it), then contact a lactation consultant (preferably IBCLC) for guidance. A good lactation consultant can assess the need for supplementation and guide you in the use of supplements so as to preserve the nursing relationship. Here is some information on how to find a lactation consultant.

Keep in mind that formula does come with its own set of risks, and every mother needs to be aware of those so she can make a truly informed decision on whether to use it or not. The use of formula can, and often does, sabatage and/or shorten the nursing relationship, not to mention the various health risks.

I do not want to imply that breastfeeding has to be “all or nothing” – any amount of breastfeeding is beneficial to both mom and baby. I do, however, want moms to be informed on this issue, as most are not nearly as aware of these risks as they need to be.

Many knowledgable authors have put together information on this subject, and I really don’t think I can say it better than they can. Following are some links to information on infant formula.

Just One Bottle?

Need to use formula? Here are some specifics…

Articles on infant formula (health effects)

Soy Formula

Formula Marketing

Information from breastfeeding advocacy & formula industry watchdog groups

  • IBFAN (The International Baby Food Action Network) works to achieve universal implementation of the International Code of Marketing of Breast-milk Substitutes and subsequent, relevant Resolutions of the World Health Assembly and to encourage all appropriate parties to abide by them.
  • National Alliance for Breastfeeding Advocacy NABA REAL functions to educate the public, state and federal legislators, policymakers, government agencies, and the health care system about breastfeeding and the hazards of not breastfeeding.

maggiemom2000
by Ruby Member on Feb. 17, 2013 at 9:31 PM


Quoting lsherrill1402:


Diapers are good..less poop ones than used to be..she is 7 weeks old. I haven't supplemented once..just wanted opinions.


While she may need to nurse more during growth spurts, or at certain times for comfort, she has already reached her maximum intake of milk. There is lots of good research that shows that baby's maximum dialy milk needs (for breastfed babies) peaks at around 4 weeks old. So, basically, if you could make enough milk for her at 4 weeks, you can make enough for the rest of the time she is nursing. You never need to make more than that.

If baby is having enough wet diapers and is gaining weight on track then you are making enough milk, regardless of how baby acts.


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