Adding formula to breast milk for weight gain

Along with the question of using cloth versus disposable diapers and whether to sleep train your baby, breast versus bottle feeding is one of those new-mom decisions that tends to trigger strong opinions. (Just open up Facebook and you’ll see Mommy Wars raging on the subject.)

Thankfully, though, feeding your baby formula or breast milk doesn’t have to be an all-or-nothing equation — and it doesn’t have to be a choice laden with guilt. There can absolutely be a middle ground of adding formula alongside breast milk. This is known as supplementation.

You may need or want to supplement your baby’s feedings with formula for any number of reasons, some of which may be recommended by your pediatrician.

“While it’s true that breast milk is ideal for feeding your baby, there may be times where formula supplementation is medically needed,” says holistic pediatrician Dr. Elisa Song.

According to Dr. Song, adding formula may be best when an infant isn’t gaining weight adequately or isn’t feeding well at the breast. Sometimes newborns also have jaundice and need extra hydration while you wait for your own milk supply to come in.

Some people need to supplement with formula for their own health reasons, too. People with chronic illnesses or those who have had recent breast surgeries may have problems breastfeeding. Meanwhile, those with less weight or those who have thyroid conditions may not produce enough milk — though low supply can happen to anyone.

“Sometimes breastfeeding has to be stopped temporarily while mama is on certain medications,” adds Dr. Song. “During this time, formula may be needed while mom ‘pumps and dumps.’”

Besides medical issues, circumstances can also dictate the decision to supplement. Perhaps you’re going back to a job where you don’t have time or space to pump breast milk. Or, if you have twins or other multiples, supplementing can give you a much-needed break from serving as a milk machine around the clock. Formula also provides a solution for women who aren’t comfortable breastfeeding in public.

Finally, many parents simply find breastfeeding exhausting and emotionally draining. Your needs matter. If supplementation benefits your mental health, it can be a perfectly valid option. Remember: Take care of you so you can take care of them.

As you consider starting your breastfed baby on a bit of formula, you’re probably wondering how exactly to begin. (Where’s that baby manual when you need it?)

There are differing views on the best way to introduce formula into your feeding regimen, and there’s no one right way (or perfect time) to do so.

The American Academy of Pediatrics (AAP) and the World Health Organization both endorse exclusively breastfeeding during the first 6 months of baby’s life. Even if this isn’t possible, many experts encourage breastfeeding for at least 3 to 4 weeks to establish your supply and baby’s comfort with the breast.

No matter baby’s age when you decide to start formula, it’s best to ease into it — and do so at a time when baby is in good spirits. A sleepy or cranky little one isn’t likely to be thrilled with trying something new, so steer clear of introducing formula too close to bedtime or to that early evening crying jag.

“In general, I would recommend starting with one bottle per day at the time of day where your baby is at their happiest and most calm, and most likely to accept the formula,” says Dr. Song. Once you’ve established a one-bottle-a-day routine, you can gradually up the number of formula feedings.

Now for the nitty-gritty: What exactly does a supplementation look like from one feeding to the next?

First off, you may have heard you should add breast milk to formula to give baby a taste of the familiar — but Dr. Song says you can skip this.

“I don’t recommend mixing breast milk and formula in the same bottle,” she says. “This isn’t dangerous for the baby, but if the baby doesn’t drink the entire bottle, the breastmilk that you’ve worked hard to pump may go wasted.” Good point — that stuff is liquid gold!

Next up, what about keeping up your supply? One strategy is to nurse first, then give formula at the end of a feeding.

“If you need to supplement after each or most feeds, nurse the baby first to completely empty your breasts, and then give supplemental formula,” says Dr. Song. “Doing that ensures that your baby still receives the maximum amount of breast milk possible, and reduces the chance that formula supplementation will lower your supply.”

Beginning to supplement isn’t always smooth sailing. There may be an adjustment period while your baby gets used to this new form of feeding. Here are three common problems you may encounter.

Baby has trouble eating from the bottle

There’s no denying a bottle is pretty different from your breast, so the switch from skin to latex may be disconcerting for your little one at first.

It’s also possible that baby simply isn’t used to the amount of flow from the bottle or nipple you’ve selected. You can experiment with nipples of varying flow level to see if one hits the sweet spot.

You may also try repositioning your baby during feeding. While a certain position may be just right for breastfeeding, it might not be ideal for eating out of a bottle.

Related: Baby bottles for every situation

Baby is gassy or fussy after formula feeding

It’s not uncommon for babies to seem extra colicky after starting formula — or to start tooting up a storm. In both cases, excess intake of air is likely to blame.

Be sure to burp your baby thoroughly after each feeding. Or, again, try repositioning during feeding or offering a nipple with a different flow. In some cases, your baby may be reacting to an ingredient in the formula, so you may need to switch to another brand.

Related: Organic baby formulas worth trying

Baby won’t take the bottle

Uh-oh, it’s the scenario you feared: Your baby refuses the bottle altogether. Before you panic, try to keep your cool with a few troubleshooting techniques:

• Wait longer between feedings to increase baby’s hunger (but not so long that they’re a ball of baby rage).
• Have your partner or another caretaker do the feeding.
• Offer the bottle at a time of day when baby is usually in a good mood.
• Dribble a little breast milk on the nipple of the bottle.
• Experiment with different temperatures of formula (though never too hot), as well as different bottles and nipples.

Many moms who choose to supplement fear that their baby won’t get adequate nutrition when formula is introduced. While it’s true that formula doesn’t contain the same antibodies as breast milk, it does have to pass rigorous nutrient testing before it can be sold.

The Food and Drug Administration (FDA) specifies that all infant formulas must contain a minimum amount of 29 important nutrients (and a maximum amount of 9 nutrients babies need less of). The FDA also states that it’s not necessary to fortify your baby’s diet with any vitamins or minerals when formula feeding.

Every baby-feeding situation comes with its pros and cons. On the plus side for supplementation, your baby will continue to get immunity-boosting antibodies from the milk your body creates. At the same time, you can enjoy more flexibility in your career, social life, and day-to-day activities.

On the other hand, reducing your rate of breastfeeding means losing its function as a natural birth control, since nursing is only proven to be effective for preventing pregnancy when done exclusively on demand. (This method of birth control is not 100 percent effective in preventing pregnancy.)

You might also see postpartum weight loss slowing down. (However, research is mixed on the effects of breastfeeding as a weight loss aid. A 2014 study showed exclusive breastfeeding for 3 months resulted in just a 1.3-pound greater weight loss at 6 months postpartum compared to women who didn’t breastfeed or breastfed non-exclusively.

Related: Which forms of birth control are safe to use while breastfeeding?

Browse the baby aisle of any grocery store and you’ll be met with a wall of multicolored formulas tailored to every conceivable need. How do you know which one to choose?

It’s actually hard to go wrong, since formula has to pass those rigorous FDA standards. However, the AAP recommends infants who are partially breastfed be given iron-fortified formula until they’re 1 year old.

If you know or suspect your baby has a food allergy, you may want to opt for a hypoallergenic formula that can reduce symptoms like runny nose, tummy upset, or hives. And though you may notice many soy-based options, the AAP says there are “few circumstances” where soy is a better choice than dairy-based formulas.

Talk to your pediatrician if you have specific questions or concerns about choosing the best formula.

We’ve all heard that “breast is best,” and it’s true that exclusively breastfeeding comes with plenty of health benefits for baby and mama. But your own peace of mind can affect your baby’s health and happiness more than you may realize.

If supplementing with formula is the best decision for your circumstances, you can rest easy knowing that when you feel good, baby is more likely to thrive, too. And as you navigate the switch to part-time breastfeeding, don’t hesitate to reach out to your pediatrician or lactation consultant. They can help set you on the right path.