I want to weigh in on the debate over whether to have mom pump and 
bottle feed for her poorly gaining baby. One post suggested 24 hours of 
doing this. One post reminded us how this can turn the baby to the dark 
side and preferring bottles.

As a reminder, the first rule is feed the baby, the second is protect 
the milk supply. A weak baby who self limits or is not participating is 
not protecting or increasing the milk supply.

What I find is that those weak babies who have lost 7% or more and who 
the test weights show very poor intake, must be fed by another method 
than "just breastfeeding" for about 48 hours to get their strength up 
and wake them up. Mom pumps during this time on a rental quality pump 
and gives what she has to the baby by bottle if nothing else works well 
enough. Usually the first 24 hours are rough as baby still self limits 
and sleeps a lot. It often takes a bottle to make baby eat more when 
they are this weak and sleepy. But the second 24 hours are better, you 
see the bowel movements increasing. We see a new and alert baby by 48 
hours and then can go back to the breast. These are the babies that are 
not participating in the feeding anyway, are very sleepy, and need help.

The weak baby who has lost a lot of weight usually doesn't seem to have 
problems going back on the breast at 48 hours like one might think. 
Rather the opposite is true -- if we don't feed more and a proper 
amount, we don't have quick success. We have long slow agonizing days 
watching and waiting for baby to perk up "on it's own."

I don't love formula and I don't do this to assess mom's milk supply, I 
suggest it to help the baby eat more and gain weight properly within 2-3 
days.

Now for babies doing fair but not terrible and who just need a little 
bit more to gain weight properly, then supplementing at the breast is 
better than bottle feeding to keep baby at the breast. Supplementing at 
the breast also teaches baby to actively suck and expect good intake at 
the breast. Sometimes just increasing how often baby nurses does the trick.

Kathy Eng, BSW, IBCLC

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