Feed the Baby

The First Rule of Breastfeeding

It is natural to have an emotional attachment to the idea of how you will feed your baby, and we hope you will give yourself grace if you struggle when introducing medically indicated supplementation. 

The messaging that “breast is best” runs deep, and many new parents are excited to exclusively breastfeed. Others go into their breast/chestfeeding experience knowing they will likely combo feed their babies their own milk along with donor milk or formula. But when low supply comes as a shock, parents and even some providers may hesitate to introduce supplementation. It is true that the introduction of medically unnecessary formula is associated with the early cessation of breastfeeding (Chantry et al., 2014). In-hospital formula introduction is linked to early discontinuation of breastfeeding and there may be a potential causal relationship (Whipps et al., 2021). In addition, when there is no medical need, early use of formula deprives the baby of the manifold benefits of exclusive breastfeeding and can contribute to reduced maternal milk supply (Walker, 2015). While such messaging in prenatal lactation education and the first days or weeks of life may be in service of mammotypical parents whose goal is to create a full supply, it can leave the low supply population, and especially their babies, behind. 

The truth is that, by definition, people with primary low supply must rely on supplementation so their babies can thrive (Whelan et al., 2025). And whatever the cause of secondary low supply, in many cases supplementation is a vital tool to prevent serious complications due to malnourishment and dehydration (Konetzny et al., 2009), even though interventions to increase supply will often ultimately be successful.

In those early days, there are a lot of unknowns for most people with low supply. Only time will tell if they are able to make a full supply, if that is their goal (and we should not assume it is). In the meantime, the first priority must always be feeding the baby. So if a provider asks you to give your baby supplementation because it is medically necessary, please understand that doing so with careful management is typically compatible with continued breastfeeding (Flaherman et al., 2018). Another study found that limited, controlled use of formula did not negatively effect long-term breastfeeding rates (Straňák et al., 2016). In fact, healthy, thriving babies feed actively, while undernourishment is associated with lethargy (Lavagno et al., 2016), which in clinical practice is distinct from the normal sleepiness of most neonates.

Let us emphasize: it is normal for exclusively breastfed babies to lose weight in the first several days while the milk supply is being established (Thulier, 2015). But in one study of newborns experiencing weight loss above the 75th percentile for age at 24–72 hours, short-term, limited supplementation did not compromise breastfeeding continuation at one month (Flaherman et al., 2018). The Academy of Breastfeeding Medicine lists weight loss above the 75th percentile for age as a possible indication for supplementing healthy, term infants (Kellams et al., 2017).

Of course please follow your pediatrician’s advice and Feed The Baby, including with supplementation if it is necessary for your child’s health. But also know that there is a space for you in our support group to process how you are feeling.

And providers, please take a look at this interview with two breastfeeding medicine physicians on what should happen (but sometimes doesn’t) when babies are not getting enough breastmilk and share with colleagues and especially those you are training.

Note: This post is in no way an endorsement of medically unnecessary supplementation when exclusive breastfeeding is desired. We support exclusive breastfeeding as the biological norm and the best way for those who are capable (i.e., the large majority of the breastfeeding population) to establish a full milk supply. We are just presenting a resource for people with true low supply and the providers they will encounter. Many families in our community have stories of being told not to supplement only to later realize that our babies had no hope of meeting their nutritional needs with our breastmilk. And it’s also common for parents with low supply to grapple with the decision to supplement even when the pediatrician has recommended it.

For more information on best practices when supplementing your baby, see the links on paced bottle feeding, pumping, donor milk and SNS on our resources page.

 

References

Chantry, C. J., Dewey, K. G., Peerson, J. M., Wagner, E. A., & Nommsen-Rivers, L. A. (2014). In-hospital formula use increases early breastfeeding cessation among first-time mothers intending to exclusively breastfeed. The Journal of Pediatrics, 164(6), 1339–45.e5. https://doi.org/10.1016/j.jpeds.2013.12.035

Whipps, M. D. M., Yoshikawa, H., Demirci, J. R., & Hill, J. (2021). Estimating the impact of in‑hospital infant formula supplementation on breastfeeding success. Breastfeeding Medicine, 16(7), 530–538. https://doi.org/10.1089/bfm.2020.0194

Walker M. Formula Supplementation of Breastfed Infants: Helpful or Hazardous? (2015). ICAN: Infant, Child, & Adolescent Nutrition. 7(4):198-207. 10.1177/1941406415591208

Whelan, C., O’Brien, D., & Hyde, A. (2025). Breastfeeding with primary low milk supply: A phenomenological exploration of mothers’ lived experiences of postnatal breastfeeding support. International Breastfeeding Journal, 20, Article 7. https://doi.org/10.1186/s13006-025-00699-4

Konetzny, G., Bucher, H. U., & Arlettaz, R. (2009). Prevention of hypernatraemic dehydration in breastfed newborn infants by daily weighing. European Journal of Pediatrics, 168(7), 815–818. https://doi.org/10.1007/s00431-008-0841-8

Flaherman, V. J., Narayan, N. R., Hartigan-O’Connor, D., Cabana, M. D., McCulloch, C. E., & Paul, I. M. (2018). The Effect of Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota: A Randomized Clinical Trial. The Journal of Pediatrics, 196, 84–90.e1. https://doi.org/10.1016/j.jpeds.2017.12.073

Straňák, Z., Feyereislova, S., Černá, M., Kollárová, J., & Feyereisl, J. (2016). Limited amount of formula may facilitate breastfeeding: Randomized, controlled trial to compare standard clinical practice versus limited supplemental feeding. PLOS ONE, 11(2), e0150053. https://doi.org/10.1371/journal.pone.0150053

Lavagno, C., Camozzi, P., Renzi, S., Lava, S. A. G., Simonetti, G. D., Bianchetti, M. G., & Milani, G. P. (2016). Breastfeeding‑associated hypernatremia: A systematic review of the literature. Journal of Human Lactation, 32(1), 67–74. https://doi.org/10.1177/0890334415613079

Thulier, D. (2015). Weighing the facts: A systematic review of expected patterns of weight loss in full‑term, breastfed infants. Journal of Human Lactation, 32(1), 28–34. https://doi.org/10.1177/0890334415597681

Kellams, A., Harrel, C., Omage, S., Gregory, C., Rosen-Carole, C., & Academy of Breastfeeding Medicine. (2017). ABM clinical protocol #3: Supplementary feedings in the healthy term breastfed neonate, revised 2017. Breastfeeding Medicine, 12(3), 188–198. https://doi.org/10.1089/bfm.2009.9991