What should we know about topping up with formula?

When a mum has breast milk, but it seems as though the amount is no longer enough for her baby, topping up with formula may come up as a possible solution. A baby may receive a supplement at every feed, or, if there is less breast milk in the evening hours, during that part of the day.
It is important to know that breast milk supply is often mistakenly perceived as low, for example during a growth spurt. If supply really does decrease, it can often be supported and increased again. We also cover these situations in this article.

When breast milk supply seems to be insufficient, the first option may be to use the mother’s expressed and frozen breast milk, the second is to continue feeding with the mother’s own breast milk where possible, and the third option is to give formula.

Mum seeking professional advice about feeding concerns

To find out whether your baby needs formula top-ups, speak to your paediatrician, health visitor or lactation consultant as soon as possible if you notice that your baby still seems hungry after breastfeeding.

How can we tell if there is not enough breast milk for the baby?

Many mums feel worried about this issue. After all, during breastfeeding we cannot see exactly how much milk the baby has taken. We also cannot know for certain how much milk is available in the breast at any given moment. Especially in the first weeks, it is common for parents to weigh the baby before and after feeds for reassurance.

Milk production is an extremely important process, and its purpose is to nourish the baby. It does not dry up as easily as we may think. Certain life situations can have a negative effect on it, but fundamentally the stimulation created during breastfeeding and the hormonal response to that stimulation regulate the right amount.

Sadly, milk supply that is only believed to be low is a common reason for unnecessary formula top-ups. This can lead to breast milk supply decreasing sooner, or even drying up, because less breastfeeding leads to less milk production. As a result, the amount of formula may be increased further, which reduces breastfeeding even more and therefore reduces the milk produced by it. A vicious cycle can develop, although in many cases it can be reversed. Using a bottle can also cause nipple confusion, which may make latching on more difficult.

What are the signs that the baby may not be getting enough milk?

Mum changing her baby’s nappy

If your baby

wees fewer than 6 times a day,
has yellow, strong-smelling urine,
has fewer than 3 stools a day under the age of 6 weeks,
is still passing meconium on day 4 or 5,
has stopped gaining weight or has lost weight,
is unusually sleepy,

then it is likely that they are getting too little milk. In this case, seek help as soon as possible.

What can cause breast milk supply to decrease?

A sudden drop in breast milk supply may often be perceived during a baby’s growth spurt. In this case, however, it is not necessarily that there is too little milk, but rather that the baby’s need has suddenly increased. This is a natural change. Babies may also respond with a more frequent need to breastfeed in situations that disrupt their daily rhythm, such as after vaccinations, while travelling or during teething.

What is a growth spurt?

Did you know that in the first few months, your baby develops at a pace and goes through more changes than at any later stage of life? Movement, brain development, length and weight gain, as well as cognitive and emotional abilities all mature intensely at the same time. During a growth spurt, this pace suddenly increases, often within just a few days. It is usually observed at around 10 days, 3 weeks, 6 weeks, and at around 3 and 6 months. During this time, the baby needs more nourishment. You may also notice this period because your baby’s rhythm changes. They may sleep less, wake more often at night, become unsettled and want to breastfeed almost constantly. After a feed, they may relax contentedly, then after a short while, perhaps 20 or 30 minutes, ask to feed again.

Mum expressing extra breast milk for her baby

If you breastfeed your baby more often according to their needs, and by doing so support natural milk production, the supply and demand balance can soon settle again. Nature works beautifully in this way: more frequent stimulation encourages the milk-producing glands to work faster. As a result, the amount of milk produced in one day will increase. This effect can also be supported by frequent expressing.

So before giving formula straight away, it is worth trying to respond to your baby’s new needs with more frequent breastfeeding and help restore the balance.

Baby crawling in a bamboo sleeping bag with zip, soft LiaaBébé sleepwear for peaceful nights

However, there are situations when breast milk supply really is low. If you have doubts and are unsure whether your baby is getting enough nourishment, ask for help from a professional or a lactation consultant. A decrease or slowing of milk production can be reversible.

We should be careful with formula top-ups

A baby’s primary and healthiest source of nourishment is breast milk. Still, breastfeeding can sometimes become challenging. Formula should always be introduced with care. There can be significant differences in quality between products. Formulas are modified cow’s milk products, and their digestibility differs greatly from breast milk. The amount given as a top-up also needs careful attention.

Today, there are several tools that can support formula top-ups: a feeding teat, an open cup or a baby bottle may be used. You can also ask a professional for advice on which option is most suitable for your baby.

Mum breastfeeding her baby

It is helpful to know that during breastfeeding, the baby receives milk very slowly, and after 20 to 30 minutes their body signals that they have had enough. When feeding from a bottle, however, formula may be finished in 5 minutes, and in that short time the fullness centre may not yet have signalled satiety. The baby may still feel hungry, which can lead to overfeeding and tummy discomfort.

A supplemental nursing system is also worth mentioning, as it is a helpful device that allows the baby to receive the supplement through a safe, thin tube. This means the baby links the feeling of fullness with the breast, while also stimulating milk production and helping to prevent nipple confusion. Compared with bottle feeding, another advantage is that breastfeeding itself can be fully maintained.

Introducing formula often feels like an urgent SOS situation for mums, so if you are worried, do not wait until the next day. Ask for advice as soon as possible.

Baby lying in a bamboo baby bodysuit, ultra-soft and breathable wear for sensitive baby skin

What is the stool like in babies who receive breast milk and formula?

The stool of exclusively breastfed babies is yellowish in colour. Once a baby also receives formula, its colour and consistency change. It becomes thicker and darker, with more waste matter in it. Even a small amount of formula introduced alongside breastfeeding changes the baby’s gut flora. If formula is then stopped, this returns gradually over a longer period, around 40 days. This is another reason why it is important to consider formula top-ups only when they are genuinely needed.

How much formula should a baby have?

This is usually not easy to work out. The amount of formula should be given based on medical advice, while also taking into account the baby’s age and weight. A top-up after breastfeeding may vary each time, as a different amount of breast milk may be available and the baby’s hunger can also change.

It is common for breast milk supply to seem lower in the late afternoon and evening hours, and as the evening approaches, a baby may need more formula.

How long are formula top-ups needed?

This varies from baby to baby, but if the mum still has breast milk during weaning, the aim will be to reduce formula as new foods and purées are introduced. This happens gradually, because at first the baby only eats small amounts from a spoon, but later may eat enough to replace formula. So when new foods are introduced and breast milk is still available, formula should clearly be the one to reduce, not breastfeeding.

In many cases, formula can be consciously and gradually stopped.

Written by Mónika Veres

References:

NHS - How to make up baby formula

UNICEF UK - Baby Friendly Initiative