Breastfeeding Newborns: Answers from an IBCLC

Early breastfeeding often comes with questions about if baby is getting enough milk, especially if milk production seems low or they have an unexpected challenge such as baby being in the NICU. Amy Black, IBCLC answers the two questions she is asked most in the hospital in Breastfeeding Newborns.
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By Amy Black, IBCLC
​Breastfeeding Newborns 

​FAQ's about supplementation

• My newborn has lost a significant amount of weight in the first week and our pediatrician said that we must supplement immediately with formula.  I am worried that this is going to ruin our breastfeeding relationship.

A breastfed newborn typically is at their lowest weight at the 5-6 day mark.  Mature milk can take up to 5 days to come in, so this can contribute to infant weight loss at the beginning.   Most pediatricians would like to see a newborn return to his or her birth weight by the two- week mark. Unless there is a medical reason, supplementation does not have to be done by formula.  You can supplement your baby with your own milk!  If your doctor would like to see an additional X amount of ounces, you can use a breast pump and/or hand expression to remove this amount from your breasts to feed the baby.

If you need help with infant weight or milk supply, a multi-user hospital grade pump is recommended for the first few weeks.  A single user breast pump is wonderful for an established milk supply, but the first few weeks are better served by a hospital grade pump.  You can rent breast pumps from lactation consultants and/or hospitals for a period of time to get you over the hump.

Let Mommy Sleep medical advisory board member and pediatrician, Dr. Holly Pfeferman Spanier, states, "If baby loses more than 10% of birth weight, supplementing is highly suggested. Moms need to realize that because you supplement with formula, it doesn’t mean that you won’t be able to exclusively breastfeed later."  It is just important to establish and keep up with your milk supply.
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When supplementing a breastfed newborn with formula and/or breastmilk, some lactation consultants recommend finger/syringe feeding, cup feeding or spoon-feeding the infant to not interfere with the integrity of the breastfeeding relationship.

Please note, if there are true concerns about the quantity of milk you are producing, a visit to a lactation consultant in the early days can benefit the breastfeeding relationship by troubleshooting causes of weight loss. Some common issues may be a bad latch that is contributing to insufficient milk transfer from the breast or health problems with either the infant or mother.

• Our baby is in the NICU, but I am dedicated to breastfeeding.  How can I make sure my supply doesn't get too low?

It is recommended that a mother with a baby in the NICU pump and/or hand express eight to twelve times a day, including overnight to build the milk supply and feed her baby. A good source of information is two videos available from Stanford University and Dr. Jane Morton.  She has done a lot of work with infants in the NICU and helping mothers keep their supply healthy.  These two videos are instructional in helping any mother learn to hand express and/or keep up their milk supply when returning to work.

http://newborns.stanford.edu/Breastfeeding/HandExpression.html
http://newborns.stanford.edu/Breastfeeding/MaxProduction.html

• What about healthy newborns who are home from the hospital?

For breastfeeding parents who are home from the hospital that want to increase milk production, skin to skin contact and allowing baby to suck are effective ways to stimulate milk production. Additionally cluster feeding is not only normal, but encouraged as it not only feeds baby, but helps the body produce milk!

Remember that for all of those who are breastfeeding, milk comes in around Day 4 so don't think you're doing anything wrong if milk isn't flowing before then. As always, a visit with an LC  or your pediatrician can only help.  

Breastfeeding Newborns: Answers from an IBCLC