Relactation is the process through which breast milk production begins once again after it had diminished or had stopped completely. When beginning this process it is important to be sensible and know that formula feedings cannot be suppressed cold turkey if the baby drinks more than 100 ml a day. With more than 100 ml, it must be done little by little and give the mother’s body time to increase milk production. If the baby drinks 100 ml or less of formula and they gain weight adequately, formula can be stopped at once.  

The first step to reduce formula intake is the most complicated. You must be confident in your own capacity, be patient and persevere. The process may be slow and require family support. Here are some step-by-step tips to begin relactation:

• Before anything else, try and identify why formula had to be introduced in the first place. Reach out for help with a breastfeeding professional, support group or doctor and have them look at your breasts, the baby’s suckling, a possible tongue-tie, hormonal issues, etc. These are all situation that can disrupt milk production. Therefore identifying what happened before may help avoid those issues reoccurring during relactation.
• Babies usually nurse better while they are half asleep. It is not necessary to wait for them to be wide-awake. If they reject the breast, do not force it. Skin-to-skin contact is the next step. Let the baby get comfortable near the breast; let it be an option, not an obligation.
• Encourage skin-to-skin contact and be imaginative: bathe with the baby, play under the sheets, read them a story on the couch, etc.
• Offer the breast at least once every two hours throughout the day and every three hours overnight or any time the baby is willing to take it.
• Enjoy co-sleeping as a way to rest and facilitate overnight feedings.
• Ideally, eliminate pacifiers so that the baby focuses solely on the suckling of the breast. Since giving formula may still be necessary, find a method that is more suitable. más adecuados.
• During the first few days of attempting increased milk production, if the baby is drinking mostly formula, the same amount of formula recommended per age should continue to be fed to the baby. The breasts should be stimulated by the breast pump or manually.
• It is recommended to give the extracted milk (breast milk or formula) through non invasive supplementation.
• Using a supplemental nursing system can be considered if the baby accepts nursing and shows interest in doing so but gets frustrated after nursing for some time and milk does not come out at the rate they would like.
• It is important to control the baby’s weight gain (30 grams per day during the first 6 weeks of life) and check for 5-6 dirty diapers with clear urine to assure they are drinking enough milk. Some babies, when relactation is initiated, plateau with their weight gain or lose a few grams in weight but that weight loss should not be excessive.  
• If the baby is not obtaining enough milk due to not gaining weight adequately or they seem restless, do not reduce their formula intake for a few days. If necessary increase it for a day or two.
• If the baby seems confused when near the breast or has difficulty latching, try the drip and drop method. A dropper or cup is used and slowly drips the milk over the breast towards the nipple while the baby is nursing.

Increasing milk production:

Begin to stimulate the breast with the breast pump and finish with manual extraction since that helps you achieve better stimulation and more milk.  

• Do it as many times as possible throughout the day, it only takes a few minutes. The more often it is done, no matter if it is just a few minutes, the better.
• Complete an extraction when the sun sets and one first thing in the morning. If possible, once every two or three hours throughout the day.
• Consider the possibility of adding a galactagogue. (Discuss with your doctor before doing so).

* In this LactApp article you can find more information on how to extract milk.

One useful way to reduce formula once your production has been increased is by trying the following:

Reduce the amount of formula administered in 24 hours (about 60 cc total): This reduction is maintained over a few days. That amount can be divided between many feedings. For example, reduce ten cc in five of the formula feedings or reduce two feedings to 30 cc.

Continue with the reduced amount of formula during the days immediately following. If the baby shows trough their behavior that it is enough, and if after a week they have gained 125 grams or more, reduce the formula supplementation once again for a few days and then check the baby’s weight. If the baby displays any signs of hunger or they have not gained enough weight at the end of a week, do not reduce the supplementation of formula and continue with the same amount for another week. If the baby continues showing signs of hunger or they have not gained after another week, increase the formula to what it originally was before the reduction.

There are many routines to administer the formula and every mother chooses what is most convenient for them. Some mothers choose to supplement with formula only in certain feedings. Another approach is to breastfeed during the day and at night when the breasts are a bit softer and babies get more irritable, then the formula is provided. You may also alternate between feedings.

Relactation is not simple but it is achievable!