by Cadey Harrel MD

When is it appropriate to supplement the healthy term breastfed infant?

It is well established that most mother/infant dyads will successfully establish breastfeeding if given early opportunities to breastfeed and adequate breastfeeding assistance. However, supplementary feedings of healthy breastfed newborns in the hospital are a commonplace practice despite widespread recommendations against doing so outside of medical indications.

Supplementation with formula in the neonatal period is associated with decreased exclusive breastfeeding in the first 6 months of life, and an overall shorter duration of breastfeeding. Unnecessary supplementation can be reduced by implementing optimal breastfeeding support as outlined by the Baby Friendly Hospital Initiative’s Ten Steps to Successful Breastfeeding, both in the hospital and in communities.

The Academy of Breastfeeding Medicine released a new evidence-based protocol in March 2017 with guidelines for management of healthy, term, breastfed neonates. This includes strategies to prevent the need for supplementary feeds, and outlines medical indications for and methods of supplementation for healthy, term, breastfed infants.

What do you think the protocol outlines as a medical indication for supplementary infant feedings in term, healthy, breastfed infants? (choose 1 or more)

1. Maternal malnourishment or illness.
2. Perceived insufficiency of colostrum prior to the milk ‘coming in’ (aka secretory activation) and copious milk production.
3. Weight loss of 9% at 48 hours of life with a normal infant exam and normal voiding and stooling.
4. Hyperbilirubinemia at day 5 of life with continued weight loss and limited voiding and stooling.
5. To prevent asymptomatic hypoglycemia in an infant born to a mother with Gestational Diabetes Mellitus.