Breastmilk: When is formula needed?

May 26, 2021

The first years of any infant’s life form a critically important window of growth and development. Heart, lungs, brain, and bones undergo lots of important growth during the first year. Because of this, a baby’s growth, development, and nutrition intake are very closely monitored. Weight, length, and head circumference are routinely measured and provide important information for clinicians on how a baby is eating and thriving. Any illnesses or change in food intake can cause changes in growth patterns that can be difficult to correct and prolonged poor growth can have negative long-term health impacts.

Breastmilk* is the gold standard for infant nutrition and most infants will thrive on breastmilk as their sole source of nutrition. Working with a baby’s dietitian, lactation counselor or consultant, and other members of the medical team early and often can help optimize breastfeeding and breastmilk delivery. However, for some groups of infants, breastmilk alone may not be enough to meet a baby’s nutrition needs.

When might breast milk alone not be enough?

Some groups of infants, such as those with a history of prematurity, babies born small for their age, infants with Cystic Fibrosis, and infants with Congenital Heart Defects will have very high nutrition needs that often go beyond what is in the breastmilk they consume. Some infants may have fluid restrictions in place due to lung, heart, or liver disease requiring calorically dense formula. Infants may physically be unable to consume an adequate volume of breastmilk to meet their nutrition needs. Other times, mom may simply not be able to pump or produce enough breastmilk for her baby, and formula is an excellent and safe alternative.

How do clinicians supplement breast milk with formula?

While every effort is made to preserve breastfeeding and provide breastmilk, it is equally important that infants receive the nutrition that they need, when they need it. A delay in good nutrition should always be avoided.

Doctors and dietitians use several strategies to increase nutrient intake with formula which can be used short-term or long-term:

  • Using infant formula as a fortifier by adding formula to pumped breastmilk in the bottle to increase the nutrition content.
  • Offering infant formula in a bottle after an infant has breastfed if milk supply is low
  • Using high-calorie infant formula by alternating feeds – formula / breast milk / formula etc. – in order to increase the overall nutrition intake in a day.
  • Infant formulas can provide 100% of an infant’s nutrition needs, if necessary.

Your little one’s healthcare team can explain which strategy may be best for you and your baby’s needs.

Breastmilk and formula both provide necessary nutrition to growing infants. There is a wide range of options for feeding any and every infant which all support the ultimate goal: a well-nourished, thriving baby.

June Garrett MS, RD-AP, CSPCC, CNSC, CLC

June is a medical science liaison who joined the Nutricia team in 2020. June is an advanced practice clinical dietitian specialized in pediatric critical care with over 10 years of experience practicing in level IV NICUs. She has dedicated her career to evidence-based medical nutrition therapy, research, and educating clinicians of all levels about nutrition support. June is based in California and is an avid equestrian in her spare time.

*Nutricia North America supports the use of breast milk wherever possible 

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