Supplementing with formula: what are legitimate reasons for it?

[Lady Penelope Creighton-Ward]

A friend of mine has a two-month old son who is really quite skinny and
little, and she has been advised by her pediatrician to supplement her
breastfeeding with formula. She plans to put him in daycare pretty
soon when she goes back to work full time, and was concerned that if he
has no deposits of fat he would have a harder time fighting any
illnesses he picks up in daycare.

So she started giving him one bottle of formula from yesterday, in
addition to the usual breastfeeding, and he lapped it up.

She says he sleeps quite a lot normally, and her mother in law believes
it's because the little one has no energy due to insufficient
breastmilk. Any truth to this??

My friend is quite unhappy about having to supplement, and the mothers'
group she attends doesn't have much sympathy for her.

What's the wisdom of the group here on this issue?

Thanks!

[al]

Lady Penelope Creighton-Ward wrote:
> A friend of mine has a two-month old son who is really quite skinny and
> little, and she has been advised by her pediatrician to supplement her
> breastfeeding with formula. She plans to put him in daycare pretty
> soon when she goes back to work full time, and was concerned that if he
> has no deposits of fat he would have a harder time fighting any
> illnesses he picks up in daycare.
>
> So she started giving him one bottle of formula from yesterday, in
> addition to the usual breastfeeding, and he lapped it up.
>
> She says he sleeps quite a lot normally, and her mother in law believes
> it's because the little one has no energy due to insufficient
> breastmilk. Any truth to this??
>
> My friend is quite unhappy about having to supplement, and the mothers'
> group she attends doesn't have much sympathy for her.
>
> What's the wisdom of the group here on this issue?
>
> Thanks!

I think there's more information needed. How "skinny" is he? Newborns
aren't roly poly generally, and it takes awhile for them to fill out.
Where does he fall on the height and weight charts? Some kids are just
small normally (hey, somebody has to be at the lower end for there to
be a lower end). Has the doctor prescribed special formula? From
reading other posters experiences over the past couple of years, it
seems that if there is a problem with weight gain, then a special
high-cal formula is usually prescribed. If it hasn't been, I think I
would question the need for formula. At least that way she could get
more answers as to what the the problem is (if there truly is one) and
correct it. FWIW, my two were always"skinny," in other words they were
always at a lower percentile for weight than for height...by as much as
25%. My pediatrician wasn't at all concerned. Also, I'd ask how much
the baby sleeps. Young babies sleep alot. Does he wake by himself? I
don't remember how much my 2 slept at that age, but I don't recall that
they did much but eat, sleep, cry, and dirty their diapers at that age.
Which reminds me (sorry for the rambling nature of this), you should
ask your friend how many wet and dirty diapers the baby has per day. If
they are the correct number, then that is additional support for not
needing to supplement.

I'm sure someone else will say this, plus more, much better than I
have.

annette

[Amy]

Lady Penelope Creighton-Ward wrote:
> A friend of mine has a two-month old son who is really quite skinny and
> little, and she has been advised by her pediatrician to supplement her
> breastfeeding with formula. She plans to put him in daycare pretty
> soon when she goes back to work full time, and was concerned that if he
> has no deposits of fat he would have a harder time fighting any
> illnesses he picks up in daycare.
>
> So she started giving him one bottle of formula from yesterday, in
> addition to the usual breastfeeding, and he lapped it up.
>
> She says he sleeps quite a lot normally, and her mother in law believes
> it's because the little one has no energy due to insufficient
> breastmilk. Any truth to this??
>
> My friend is quite unhappy about having to supplement, and the mothers'
> group she attends doesn't have much sympathy for her.
>
> What's the wisdom of the group here on this issue?

Rule Number One - Feed the Baby.

There is a lot of dogma, and a lot of passion, when it comes to
breastfeeding. I think it's because there are times when breastfeeding
is really hard, and you have to have passion to see it through. You
have to have passion to fight against stupid signs in bathrooms like
the other Amy. You have to hape passion to be able to withstand the
stares and the comments. You have to have passion to keep your cool
when someone throws your stroller because you're nursing in public.
You have to have passion to be able to reply with love when some
underinformed relative says some dumb damn thing...

However, all the dogma in the world, all the passion in the world,
won't feed the baby. If the baby is truly hungry, he may sleep all the
time - he may not have the energy to wake up, or to fuss. He may truly
NEED formula, because she may not be producing enough, and none of us
can tell through the computer whether that's the case, or whether the
doctor is a bottle pusher.

There are things she can do to increase supply. She can take
domperidone or reglan (prescriptions). She can take fenugreek, blessed
thistle, mother's milk tea, brewer's yeast, or any combination of the
above. She can eat oatmeal by the gallon. She can get enough rest
(when you don't rest enough, you don't produce enough). Kellymom.com
has a lot of good resources about supply, and how to tell if the baby
is getting enough.

She also could have the baby undergo a thorough physical to make sure
that there's nothing interfering with his growth. A tongue tie might
be to blame, or acid reflux, or something else that's getting in the
way...

However, when it comes right down to it, the only person who can decide
whether or not the need to supplement is legitimate is your friend.
She's the one who has to deal with the consequences of NOT
supplementing, or supplementing. She is the expert on her baby.

I went through hell and back trying to get my supply to work. It
turned out that we had a bad latch (even though MANY people told me
that it looked good!). I would strongly suggest that your friend keep
seeing LCs until she finds one that gets it right. In the end, it was
the third one I saw who tipped things for us. But she's the one who
has to do the leg work, and if she's not willing to, because she's
going back to work or whatever, that's just life. Millions of babies
are formula fed, or are fed a combination, and they turn out just fine.
My husband being the best example I can think of - tall, dark,
handsome, rocket scientist, healthy as a horse, no allergies, etc.

Try your best to support her. Let her know that it's not the end of
the world. Give her strength to tell the mother's group to **** up a
rope. Let her know that she can do both, if she wants, for as long as
it works. And if she decides to tell the doctor to go to hell (as I
did) and keep breastfeeding exclusively (actually, it was more my kid -
she would let the formula run out of the corner of her mouth - she just
refused to consume it, the little bugger!), support her in that, too.
Don't judge. Don't give advice unless asked. And give her my e-mail
if you think she needs help from someone who has been there, done that,
and has the t-shirt. I can't give her medical advice, but I can tell
her what I did that worked, and give her a shoulder to cry on.

Incidentally, rule number two is - Don't Drop the Baby. Everything
else is just details.

Good luck to your friend,
Amy

[Irrational Number]

Lady Penelope Creighton-Ward wrote:

> A friend of mine has a two-month old son who is really quite skinny and
> little, [...]
>
> So she started giving him one bottle of formula from yesterday, in
> addition to the usual breastfeeding, and he lapped it up.

Sounds like she's not nursing him long
enough. When baby is done nursing, he
should not want anything more. Is she
limiting the time that baby is nursing?

> She says he sleeps quite a lot normally, and her mother in law believes
> it's because the little one has no energy due to insufficient
> breastmilk. Any truth to this??

Of course not! He's 2 months old! He
should be sleeping a lot. Sleep time
is brain growth time.

> My friend is quite unhappy about having to supplement, and the mothers'
> group she attends doesn't have much sympathy for her.
>
> What's the wisdom of the group here on this issue?

Stop the formula. Nurse on demand, as
long as it takes for baby to get full.
Don't worry about the weight, unless he
is falling in percentilies, i.e., he
used to be 95%-ile, then dropped to 50,
etc. If he has been hugging the 5%-ile
line, then he's fine.

-- Anita --

[Anne Rogers]

if a baby is not thriving, it is legitimate to do something, but formula
isn't the first thing to do, your friend needs to spend some time working on
getting as much breastmilk into him as possible, which can literally mean
having him at the breast constantly, after a few days it should calm down
and space out again. We had some problems like this with our first and
literally I would shove a breast in his mouth everytime it was open. We
didn't completely avoid formula supplementation, but it was a fairly extreme
case, DS was born on the 2nd centile and after 8 weeks was off the bottom of
the chart, then more than once he actually lost weight from one week to the
next, rather than just gaining slowly.

Cheers

Anne

[Lady Penelope Creighton-Ward]

Thank you everyone for your truly useful advice. I think my friend is
particularly stressed right now because the day the baby starts daycare
is fast approaching, and she worries he won't be strong enough to fight
the diseases that he's bound to be exposed to. Do you think she should
still try to avoid formula? He will be in daycare for up to 10 hours a
day for five days a week.

As for where he falls in the percentiles, I think he's not off the
charts, but he is little, no question, hasn't got the typical baby
chubby cheeks etc. On the other hand, his parents aren't big people,
so you could argue that he's where he should be in terms of size.

[Jess]

"Lady Penelope Creighton-Ward" > wrote in message
oups.com...
> As for where he falls in the percentiles, I think he's not off the
> charts, but he is little, no question, hasn't got the typical baby
> chubby cheeks etc. On the other hand, his parents aren't big people,
> so you could argue that he's where he should be in terms of size.

Sproglette's a long, skinny little girl-she's been sitting between the
5th-10th percentiles since she was about two months old. She started daycare
a few months ago, and yes, the first couple of months were entertaining in
terms of colds, but she came through it fine.

Matter of fact, she seems to have inherited my side's steel-reinforced
immune system. Both her parents got strep followed by sinus infections, and
she just cut two more teeth and went on her merry way. Make sure the daycare
is clean (they wash the toys/changing tables/tables/hands/floors/hands) and
the peanut'll be fine.

Jess

[Anne Rogers]

"Lady Penelope Creighton-Ward" > wrote in message
oups.com...
> Thank you everyone for your truly useful advice. I think my friend is
> particularly stressed right now because the day the baby starts daycare
> is fast approaching, and she worries he won't be strong enough to fight
> the diseases that he's bound to be exposed to. Do you think she should
> still try to avoid formula? He will be in daycare for up to 10 hours a
> day for five days a week.

There is no evidence that suggests low weight makes you vunerable, it's poor
immune system that does that, and breastfeeding will give him the best
possible immune system. The concern with low weight and bugs is that if they
do get something, they have less resources to fall back on. My very skinny
baby never really got much, even though he was in some childcare, just
occasional mild colds, but so has my chubby baby whose not in any daycare!

Anne

[oregonchick]

My first daughter was born a week late and only weighed 5.5 lbs. She had no
fat deposits, and had to wear preemie diapers and clothes. My doc never
suggesting supplementing with formula, but advised me to feed often, and we
also had to go in for very frequent weight checks. I don't know, but does
formula have more calories or better nutrition than breast milk? I hardly
think so, but am not sure. Do you know if her supply is good? The only
reason I can think of to supplement the breastmilk is low supply, since the
quality is surely fine. I wonder if there is such a thing as pumping and
adding a "booster" of some sort to the breastmilk for underweight babies.

Betsy

"Lady Penelope Creighton-Ward" > wrote in message
oups.com...
>A friend of mine has a two-month old son who is really quite skinny and
> little, and she has been advised by her pediatrician to supplement her
> breastfeeding with formula. She plans to put him in daycare pretty
> soon when she goes back to work full time, and was concerned that if he
> has no deposits of fat he would have a harder time fighting any
> illnesses he picks up in daycare.
>
> So she started giving him one bottle of formula from yesterday, in
> addition to the usual breastfeeding, and he lapped it up.
>
> She says he sleeps quite a lot normally, and her mother in law believes
> it's because the little one has no energy due to insufficient
> breastmilk. Any truth to this??
>
> My friend is quite unhappy about having to supplement, and the mothers'
> group she attends doesn't have much sympathy for her.
>
> What's the wisdom of the group here on this issue?
>
> Thanks!
>

[Irrational Number]

Lady Penelope Creighton-Ward wrote:

> Thank you everyone for your truly useful advice. I think my friend is
> particularly stressed right now because the day the baby starts daycare
> is fast approaching, and she worries he won't be strong enough to fight
> the diseases that he's bound to be exposed to.

Fat babies do have some extra reserves,
but babies self-regulate when fed on
demand and he will be where he's supposed
to be, weight-wise, if she feeds him as
much as he needs (i.e., let him decide).

And breastfeeding will help him more,
if she spends as much time as she can
with him even after he starts daycare.
If she can try to get exposed to what
he gets exposed to, she will make those
antibodies and pass them on to him.

-- Anita --

[Lady Penelope Creighton-Ward]

> Do you know if her supply is good?

My understanding was that her supply was indeed the issue...

[[email protected]]

Lady Penelope Creighton-Ward > writes:
:> Do you know if her supply is good?

: My understanding was that her supply was indeed the issue...

If that is the case, do you know what action she had previously
taken to increase it?

Larry

[Lady Penelope Creighton-Ward]

>> My understanding was that her supply was indeed the issue...

>If that is the case, do you know what action she had previously
>taken to increase it?

Not really, to be honest. I just discussed this with her yesterday for
the first time and didn't really go into too much detail. I do believe
she feeds the baby on demand.

[V.]

"Lady Penelope Creighton-Ward" > wrote in message
oups.com...
>>> My understanding was that her supply was indeed the issue...
>
>>If that is the case, do you know what action she had previously
>>taken to increase it?
>
> Not really, to be honest. I just discussed this with her yesterday for
> the first time and didn't really go into too much detail. I do believe
> she feeds the baby on demand.
>

I'm no expert by any means (newbie here), but if the baby is sleeping alot,
couldn't that in fact be part of the problem? I know it's a bit of the
chicken and the egg argument, but if the baby is sleeping alot, even if
she's feeding on demand it might not be often enough to keep her supply up.
Maybe she needs to wake him often to feed, even if it's only for short
feedings?
Just a thought,
Amy

[[email protected]]

Lady Penelope Creighton-Ward > writes:
:>> My understanding was that her supply was indeed the issue...

:>If that is the case, do you know what action she had previously
:>taken to increase it?

: Not really, to be honest. I just discussed this with her yesterday for
: the first time and didn't really go into too much detail. I do believe
: she feeds the baby on demand.

If she is concerned about supplementing formula, there are a lot of
additional things she can do to increase supply before resorting to
formula. However, if she has not had good advice she may not be
aware of the opportunities open to her. You might want to bring
this up with her, and suggest this newsgroup or offer to help her
gain some information on the situation.

Larry

[Donna Metler]

> wrote in message ...
> Lady Penelope Creighton-Ward > writes:
> :>> My understanding was that her supply was indeed the issue...
>
> :>If that is the case, do you know what action she had previously
> :>taken to increase it?
>
> : Not really, to be honest. I just discussed this with her yesterday for
> : the first time and didn't really go into too much detail. I do believe
> : she feeds the baby on demand.
>
> If she is concerned about supplementing formula, there are a lot of
> additional things she can do to increase supply before resorting to
> formula. However, if she has not had good advice she may not be
> aware of the opportunities open to her. You might want to bring
> this up with her, and suggest this newsgroup or offer to help her
> gain some information on the situation.
>
> Larry
I'd like to point out that supplementing doesn't have to be an always and
forever thing. I had to supplement for the first few weeks with Alli while I
built up my supply via pumping, because her low sucking reflex hadn't been
enough to stimulate my supply. By the end of her first month, she was back
to getting breastmilk exclusively, and we managed to maintain that until 7
months when she started eating solids, and to avoid giving other milk until
12 months.

My pediatrician prescribed a high-calorie formula for Alli to use while we
were supplementing, so that she didn't have to work as hard to get as many
calories in since it was really hard for her to eat enough with her sucking
difficulties to maintain her weight, let alone gain at first. And yes, we
had to wake her up to eat quite often at first. If you didn't wake her up at
least every 2 hours to eat, she'd sleep until she was completely starving,
and then would get too frustrated to eat much, scream, and eventually scream
herself to sleep without eating much. By waking her up and getting her to
take a little every 2 hours or less, she got more overall and did much
better.

Regardless, if the child isn't gaining weight, low supply may not be the
primary cause (although if the child isn't feeding well, supply will take a
hit as well). Similarly, a child can have a great latch and still not feed
well. If the normal things have been tried, and the child has been losing
weight, I can't recommend finding a good lactation consultant who is
experienced with the more unusual situations, especially if you're
considering supplementing/pumping/bottlefeeding. I had two LCs make me feel
horrible because my daughter was losing weight when it looked like she had a
great latch, and who dismissed my concerns that I didn't feel her drawing
any milk out or sucking before I found one who specialized in
premature/special needs infants. And it is only because of her (and this
group), that Alli made it so long on breast milk, and is still getting some
breast milk now, despite never having nursed successfully.

[tristyn]

Lady Penelope Creighton-Ward wrote:
>>Do you know if her supply is good?
>
>
> My understanding was that her supply was indeed the issue...
>

Based on what indicators? Skinny doesn't equal low supply; some babies
are genetically predisposed to being little peanuts.

--
tristyn
www.tristyn.net

[JennP]

"oregonchick" > wrote in message
. ..

I don't know, but does
> formula have more calories or better nutrition than breast milk? I hardly
> think so, but am not sure.

More calories? I really don't know. I know they make high calorie formulas
for special situations.

Better nutrition? No.

JennP.

[Lady Penelope Creighton-Ward]

Thanks again for all your great and supportive responses. My friend
has decided to really give breastfeeding a try and hold the formula for
a little longer. I think she's well informed and will not give up
without a big fight!

(As for indications on her supply being low, I believe she concluded as
much from the fact that her baby wasn't making progress at the expected
rate.)

[Amy]

Lady Penelope Creighton-Ward wrote:
> Thanks again for all your great and supportive responses. My friend
> has decided to really give breastfeeding a try and hold the formula for
> a little longer. I think she's well informed and will not give up
> without a big fight!
>
> (As for indications on her supply being low, I believe she concluded as
> much from the fact that her baby wasn't making progress at the expected
> rate.)

I'd like to offer again, since it may have gotten lost in the volume of
my first post -

Please give your friend my e-mail address if she wants support from
someone who has been there, and who made it work. I'd be happy to tell
her what worked for me.

Amy
amyeaustin at gmail dot com

[ls]

What a wonderful reply/explination. Thanks...

I had a very hard time with breast feeding. We couldn't get a good
latch for the first 2 weeks. (Painful, cracked and bleeding nipples.
Ouch!) Then things were going well until she 4 months old. I seemed
to be feeding constantly and she would always fall asleep. Thorughout
the whole feeding I would have to fight to keep her awake. She was
gaining weight but ALWAYS hungry!
Then I started pumping (for backup bottles and to prepare her for
daycare when I returned to work at 5 1/2 months). We'll my supply
started to decrease immediately. The Dr. said maybe my breasts aren't
fooled by the pump! I'm trying natural supplements but they didn't
seem to work. No matter how many time a day I pump get less and less.
Now I can barely get one ounce from both breasts at a time, pumping 5-6
times a day for 20-30 min (5-6 oz a day) . So, in order to fill a
bottle I have to add formula to the breast milk.
I've been back to work for a week now and pumping every two hours is
just about impossible.
I don't think I have ever felt so bad about anything I have ever done
in my life. It's terrible.
It's been a month now (since supplementing) and it still makes me cry
sometimes. And when some women out there get on their high horse about
how you should not supplement, just because they had no problems with
it, it really gets to me.

Breastfeeding in an individual thing. I know women today who simply
don't want to do it so they don't. Their babies are fine. A lot of
healthy and intelligent people I know where not breastfed (because it
simply wasn't done back then). I also know of some sickly (with asthma
and allergies) kids who were exclusively breastfed.

You try to do the best for your child. That could include giving them
formula.

[Amy]

ls wrote:
> What a wonderful reply/explination. Thanks...

You bet.

> I had a very hard time with breast feeding.

<snip>

Sounds like it! Wow. I still remember sobbing like it was killing me
when we gave her the first bottle. It was one of the hardest things
I've ever done. I felt like such a failure. Oh, it sucked. I just
went in the other room and sobbed and sobbed - I've cried less at
funerals. God, the guilt. Why do we do this to ourselves? I would
never call another mom a failure for using formula, so why did I think
that of myself?

Reglan worked for me. You might talk to your doctor about it, if
you're still upset about your supply/supplementing. That, and tons and
tons of fenugreek. I ended up buying it online because it was cheaper
to buy in bulk, and I kept buying out the local health food store.

> You try to do the best for your child. That could include giving them
> formula.

Absolutely right. I'm glad you found a solution that works for you.

Hugs,
Amy

[PattyMomVA]

"Amy" wrote and I snipped:
>
> Reglan worked for me. You might talk to your doctor about it, if
> you're still upset about your supply/supplementing. That, and tons and
> tons of fenugreek. I ended up buying it online because it was cheaper
> to buy in bulk, and I kept buying out the local health food store.

I'd like to point out that increasing supply will do no good for a mother
who can't let down for a pump. There may be some tricks that will help with
pumping, but some women never get good output with a pump, no matter whether
they've just nursed or they've been away from their baby at work. In these
cases, perhaps donated milk is available for when the child is in day care,
but it usually comes down to using formula during the work day.

And, yes, I don't think less of moms who need to resort to formula.

HTH,
-Patty, mom of 1+2

[Mum of Two]

"JennP" > wrote in message
...
>
> "oregonchick" > wrote in message
> . ..
>
> I don't know, but does
>> formula have more calories or better nutrition than breast milk? I
>> hardly
>> think so, but am not sure.
>
> More calories? I really don't know. I know they make high calorie formulas
> for special situations.

Standard formula is modelled on breastmilk, to be as close in calories as
possible, though of course it doesn't vary naturally from foremilk to
hindmilk as breastmilk does. There's a lot of blanks that would need to be
filled in to really know what is going on, but it sounds like a bottle-happy
Dr. to me. If poor supply is really the issue, supplementing is likely to be
counter-productive, especially without investigation into the source of the
supply and suggestions on how to build it. Conditions where supply is due to
a physical problem with the breasts requiring supplementation are rare.


--
Amy
Mum to Carlos born sleeping 20/11/02,
& Ana born screaming 30/06/04
http://www.freewebs.com/carlos2002/
http://www.babiesonline.com/babies/a/ana%5Fj%5F2004/
My blog: http://spaces.msn.com/members/querer-hijo-querer-hija/