Low Milk Supply -- Supplementing

Is Supplementation Necessary?

It's normal to worry that your baby isn't getting enough milk. Fortunately, it doesn't have to be something to guess at. You can use objective criteria to know for sure.

Your baby should regain birth weight by 10 days of age OR gain at a rate of at least 0.85 ounces (25 gm) per day.
After day four, or after your milk comes in (whichever happens first), your baby should be gaining weight at the following rate:
- First four months: at an average rate of at least 0.85 ounces (25 gm) per day, or six ounces (170 gm) per week.
- Four to six months: at least one-half ounce (15 gm) a day or four ounces (113 gm) per week.
- Six to twelve months: at least two ounces (57 gm) per week.
Between days two and three, your baby’s stools should change from black to green, and then to yellow, with “seeds” or “curds,” by day four.
After day four, your baby has at least three stools per day that are bigger than a US quarter (2.5 cm). After the first four to six weeks, stools may be less frequent but are larger in size.
After day four, or 24 hours after your milk comes in, your baby has at least five very wet diapers . Four wet diapers may be adequate if they are heavily soaked.
After day three, your baby produces odorless urine that is pale yellow or colorless. (Staining one or two diapers with urine that is slightly orange or red is normal between days one and three).
Baby can be weighed before and after feedings on a sensitive electronic scale (most lactation consultants use such scales in their consultations) to determine how much milk is transferring. Ideally, this reading is taken several times thoughout a day to improve accuracy.

Day	Minimum Number of Wet Diapers	Minimum Number of Soiled Diapers
1	1	1
2	1-2	2
3	2-3	3
4	4	3
5 and beyond	5	3

To learn what a “very wet” disposable diaper feels like, take a fresh diaper and pour two tablespoons of water (1 oz or 30 ml) on it. If baby weighs more than 8 lbs (3639 gm), use three tablespoons of water (1.5 oz or 45 ml). After the water is absorbed by the diaper, pick it up and notice how heavy it feels. Keep this wet diaper at your changing station (put it in a plastic bag so the water doesn’t evaporate) and compare the weight to your baby’s wet diapers when you change him. If the diaper is also soiled, the total weight will be greater.

While the objective criteria are tremendously valuable, don't dismiss your subjective information. Listen to your own "mother's heart." There may be times when you feel an unshakable certainty that something is wrong even though you have been reassured that all is well. Once you have separated your feeling from normal worry and parental anxiety, give it credence and try diligently to search deeper for the cause of your concern.

If, on the other hand, your health providers, friends, or family are aware that you may have low milk produciton and are unsupportive or dubious of your breastfeeding efforts, convinced that successful breastfeeding is an impossibility, you may find that the subjective information your baby and your own heart provide is tremendously important in deciding for yourself whether breastfeeding is good for you and your baby. You may also find that objective resources will help you separate fact from fear in determining an accurate assessment of your baby's progress.

You must always put the nutrition and hydration needs of your baby before any emotional needs. Your baby must be fed no matter what. But remember that a baby can be fully supplemented with donated breastmilk or formula at the breast. As long as the baby is willing and able to, breastfeeding is always possible, and in almost all circumstances, the baby will receive some of your breastmilk. The true bottom line is that you must use all your resources, including those that are objective and subjective, to determine what is best for you and your baby.

References

Dewey, K., Nommsen-Rivers, L., Heinig, M., et al. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 2003 Sep; 112(3 Pt 1):607-19.

Dewey, K., et al. Growth of breast-fed infants deviates from current reference data: A pooled analysis of US, Canadian, and European data sets. Pediatrics 1995; 96(3):495-503.

Dewey, K., et al. Breastfed infants are leaner than formula-fed infants at one year of age: The DARLING study. Am J Clin Nutr 1993; 57:140-45.

Dewey, K., Heinig, M., Nommsen, L., et al. Growth of breast-fed and formula-fed infants from 0 to 18 months: the DARLING Study. Pediatrics 1992 Jun; 89(6 Pt 1):1035-41.

Dewey K., et al. Adequacy of energy intake among breastfed infants in the DARLING study: Relationships to growth velocity, morbidity, and activity levels. J Pediatr 1991; 119:538-47.

American Academy of Pediatrics, Policy Statement, Breastfeeding and the Use of Human Milk. Pediatrics 2005 Feb; 115(2):496-506.

Shrago, L. Adequacy of breastmilk intake: assessment and interventions. Presented at the La Leche League International Lactation Consultant Workshop. October 30, 1998, Chicago, IL.

Mohrbacher, N. and Stock, J. The Breastfeeding Answer Book, 3 rd Rev Ed. Schaumburg, IL: LLLI, 2003.

American Academy of Pediatrics, Policy Statement, Breastfeeding and the Use of Human Milk. Pediatrics 2005 Feb; 115(2):496-506.