Infants Supplemented More Than Once in 24 Hours


  • Infants given formula and/or pacifiers (including those who initially nursed well without supplementation in the first day) are 3 times more likely to develop breastfeeding problems by days 3 -7 (Dewey, 2003).
  • Mothers who intend to combination feed vs. exclusively breastfeed are less likely to likely to reach their OWN breastfeeding goals (Chezem 2003).
  • Professionals who underestimate the importance of their advice or believe they do not have time to encourage exclusive breastfeeding are more likely to have patients who discontinue exclusive or any breastfeeding by 12 weeks (Taveras, 2004; Taveras, Capra 2003).
  • The sharpest drop off in breastfeeding rates is within the first couple of weeks, with the most commonly sited reasons being insufficient milk production and problems with attachment (latch-on and milk transfer) (Taveras, 2003; National Immunization Survey, 2003).
  • Preventative measures should be initiated as early as possible, certainly when it is anticipated the infant will need to be supplemented more than once.

Suggested Measures

  1. Skin-to-skin contact as much as possible, to abbreviate the learning time to attachment and effective suckling and increase milk production
  2. Advise mothers to breastfeed at least 8-12 times per day
  3. If not nursing effectively by 12 hours, begin hand expression at least 8 times per 24 hours (See Appendix G).
  4. If not nursing effectively by 24 hours, begin pumping, in addition to hand expression, 8 times per 24 hours.
  5. Use alternative feeding modes to decrease the risk suboptimal outcome (Dewey, 2003) (See Appendix B for volumes per feed).

Suggested Scripts

Script for the mothers who have decided to combination feed:

We have learned that the very best thing for your baby (and for you, too!) is if you can give your baby nothing but your own milk as long as possible.

Good for you for providing your baby with your wonderful breastmilk. If you really think it will be necessary to give him other foods, it would be best if you wait as long as possible before you do that.

The doctors who care for your baby suggest you try to provide only breastmilk until your baby is about six months old. All the benefits of your milk are less if you add cow milk to his diet too soon.

Many mothers choose to both breast and bottle feed, and this is very doable, once your breasts produce lots of milk and your baby has become an “A” student at the breast. To reach your goal, first “turn on” your breasts by breastfeeding, hand expression or pumping. Teach your baby that the BEST nipples in town are yours, not a bottle; the BEST food in town is at “Mom’s, not from cow milk”. Once this is accomplished, back-up bottles are an easy next step. This way, you keep your plans to breast and bottle feed AND keep your options open.

Script for the mothers who are supplementing for medical reasons:

It is so important that you have decided to breastfeed. I know we talk about exclusive breastfeeding, and that is also important, but sometimes it is necessary to give breastfeeding babies formula. Think of this additional milk as “medicine” for your baby.

Even though we need to give your baby some additional food right now, the most important thing is to stimulate your breasts to produce much MORE than your baby needs. Just like riding a 2-wheeler, it’s easier to balance when you go fast. It’s easier for your baby to learn to breastfeed when milk flow is fast, so we need to help you make a great milk supply. By feeding often, expressing/pumping your milk frequently, you are "phoning in a double order (double latte)" by following these steps.