Sometimes babies need additional milk, but many get “little top-ups” or are supplemented when they don’t need it. Supplementing milk is mostly associated with artificial milk, which can create problems for breastfeeding.

Today, we will talk about supplementing additional milk to breastfeeding, when a milk top-up is necessary, if it is needed, and the best options of how to give them.

What are “top-ups”, and what is supplementing?

These are variable amounts of milk, which are given to the baby once or several times a day after the usual breastfeeding sessions to help them gain or regain their weight.

Does supplementing always have to be with artificial milk?

Although most people understand that artificial milk should be offered first, it shouldn’t be that way at all. The recommendations included in UNICEF’s document “Infant and Young Child Nutrition, Global Strategy for Infant and Young Child Feeding” are very clear:

“The vast majority of mothers can and should breastfeed, just as the vast majority of infants can and should be breastfed. Only in exceptional circumstances can a mother’s milk be considered unsuitable for an infant. In those few health situations where infants cannot or should not be breastfed, we can choose the best alternative (breast milk expressed from the infant’s own mother, breast milk from a healthy wet nurse or human milk bank, or a breastmilk substitute offered in a cup, which is a safer method than a bottle and nipple) it depends on each individual’s circumstances.

So the first option to supplement is always to offer the baby expressed breast milk, if the mother does not want to or cannot express milk, artificial milk is the third option.

When is supplementing needed?

Although many babies who do not need it receive additional milk, there are babies who do need to receive these small amounts of extra milk (either breastmilk or formula). The most common cases are:

• Premature babies who have sucking difficulties
• Infants who are sick or lose weight
• Babies who lose more than 10% of their weight in the first few days of life
• Babies who have not regained their birth weight by 15 days of age.
• Babies with hypoglycemia
• Babies whose mothers become pregnant before they are one year old

In these cases, it is advisable to encourage the supplementing feeding of the baby in order to correct the situation as soon as possible. Once recovered, the top-ups can be eliminated. In the case of artificial milk supplementing and depending on the amount the baby needs, it will be necessary to relactate.

In the case of babies who are breastfed, once they have recovered, the top-ups can be eliminated straight away, as the baby will get the milk she needs at the breast.

How much supplementing is needed?

The amount of milk offered to the baby is usually small amounts- 20 or 30ml (less than 1 oz)- several times a day. This amount can vary depending on your baby’s situation and needs. The most important thing is that the baby manages to normalize its weight.

Does supplementing always have to be given in a bottle?

It can be offered in a bottle, but there are always alternatives if you don’t want to use them. Depending on the situation and the age of your baby, you can choose the most appropriate method in each case such as the syringe-finger technique, cup feeding, spoon feeding or a supplemental nursing system.

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