Diane Wiessinger writes:
I always feel that formula supplementation is a barrier that shouldn't be
breached if possible, but that once it's breached, an "in for a penny, in
for a pound" attitude makes sense, and it ought to be used as liberally as
is needed. Am I right?
I'm really glad you brought this up, Diane. I've been grappling with just
this question for awhile. I believe babies need to have adequate wt. gain and
just as importantly should not be experiencing unrelenting hunger. If our
goals are to meet an infant's needs then the baby who nurses continously all
day without sufficient wt gain as well as the baby who gives up demanding
food because s/he just isn't going to get enough is not getting these basic
needs met. I'm beginning to think that supplementing just enough early on to
meet hunger needs and get adequate wt. gain, while working vigorously on
increasing mother's supply might be the direction I'm going to go in.
Babies should be supplemented the amount they need to grow, but this can be
downright tricky. I'll share an example. Mom brings baby into lactation
center at 4 weeks and infant is a few ounces below birth wt. Mom is shocked
that infant is not gaining well--he nurses most of the time around the clock.
We assess a fdg., do a test wt. and realize that he is not removing an
adequate amount of milk and supply is low. (sorry , can't remember the
numbers. I do remember his suck seemed fine and mother had no risk factors
for low supply and nursed more than freuqently). Mom was shown how to do
breast compression and intake was better. She pumped after for about 20 ml.
We added this to about an ounce of formula and infant inhaled it on a slow
flow bottle (mother unwilling to use supplementer at breast). Plan: BF on
demand. Breast compression and massage. Pump after. Supplement with 1 - 1.5
ounce EBM and formula. Fenugreek and Mother's Milk Tea...might have even
taken Reglan or Domperidone...don't remember. Three or four days later,
infant returns...a different baby--2 oz. gain/day, frown and furrowed brow
missing, smiling... no longer starving. Mom followed plan meticulously for
weeks and even though supply became adequate this little one could not
tolerate hunger ever again. I advised mother to nurse more often but if this
baby was hungry at the end of BF, he pulled off and screamed until his mother
gave him a bottle. Mom described it to me and then I saw it with my own eyes.
He got to the point where he mostly breastfed but needed 1-2 oz. formula a
couple times per day. I find this frequently. Once an infant has been hungry
for awhile and then is supplemented liberally, even if supply becomes
adequate, infant is not satisfied. Might it be better to supplement just a
little early on (*only* when warranted) so infant isn't hungry all the time.
Or if an infant first comes to our attention further down the road, like
this one, should supplementation be a little less liberal so infant is not so
used to a full stomach. I do find when a mothers realizes her baby has been
hungry all the time and begins supplementing she is unlikely to not liberally
feed the baby ever again. I'd love to hear what others think about this.
Once supply is adequate, I so wish these mothers could get back to exclusive
breastfeeding.
Kathy Boggs, RN, IBCLC
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