Supplementation and the Use of Pacifiers

Supplements (water, glucose water, formula, and other fluids) should not be given to breastfeeding newborn infants unless ordered by a physician when a medical indication exists. Use of formula without a medical reason may interfere with the establishment and building of the mother’s milk supply. The more frequently the baby nurses, the more milk the mother will make, provided that milk transfer is effective. Using formula without a medical reason may cause a baby to be too full to nurse frequently.

According to research by DiGirolamo and colleagues (2008),25 two of the strongest predictors of early termination of breastfeeding are use of supplements in the hospital and delay of the first breastfeeding beyond the first hour of life. Other predictors include: not breastfeeding on cue, not sleeping near the baby, and use of pacifiers.3

Pacifier use is best avoided during the initiation of breastfeeding and used only after breastfeeding is well established. While some parents successfully use pacifiers after breastfeeding has been well established, pacifier use is inappropriate in healthy term newborns in the first weeks of life, unless it is being used in specific medical situations. A Swedish study showed that babies using pacifiers during their first month of life were 3.72 times more likely to discontinue breastfeeding.26 Pacifiers may mask the early signs of hunger, when feeding is important for establishing and building a milk supply. Mothers who use pacifiers often find that they do not make enough milk. If a baby is awake and alert, making movements with his mouth, or sucking his fist, he is probably hungry and needs to nurse.

There has been research indicating that pacifier use reduces the risk of SIDS, so it is recommended that mothers with healthy term infants should use a pacifier during infant sleep time, beginning 3 to 4 weeks after birth, giving adequate time for proper breastfeeding establishment.  For more information on SIDS and Safe Sleep Practices click here.  

Example Case

An 11-day old exclusively breastfed boy is gaining weight at roughly 1/2oz a day. the mother has noted about 10 dirty diapers per day several of which were soiled. The pediatrician wanted the baby to gain 1oz per day and recommended supplementing with one to two ounces of formula after nursing. The mother gave the baby the formula and the baby is gaining weight faster but the baby won’t take the breast anymore or fusses at it and now consumes 24oz of formula a day. In this situation, the baby was receiving an adequate amount of breastmilk, have plenty of wet and dirty diapers and gaining weight appropriately. Formula supplementation was not medically necessary in this example. This mother should have been praised for her efforts and told to continue breastfeeding exclusively. A weight check could have been scheduled to ensure that adequate growth continued. 

Many of the challenges encountered in changing breastfeeding practices relate to expectations of mothers and families.27 Babies need a great amount of attention and having a newborn is hard no matter how they are fed. They may exhibit cluster feeding behavior, nursing on and off for hours. This is normal newborn behavior. This timetable of breastfeeding frequently encourages the meconium to be expelled from the baby and greatly reduces any potential difficulties the baby may have with jaundice. Frequent feedings also encourage the transition to a mature milk supply to begin as soon as possible. The timing for this period of cluster feeding may coincide with the mother returning home from the hospital or birthing center.

Many mothers are surprised at how quickly and easily human milk is digested (often within 90 minutes of the last feeding). During the early weeks of breastfeeding, the American Academy of Pediatrics recommends that healthy, full-term newborns should breastfeed eight to twelve times in each 24-hour period, with mothers offering the breast whenever the infant shows early signs of hunger such as increased alertness, physical activity, mouthing, or rooting.1 Below is a table to outline the feeding patterns of a typical newborn.

Typical Newborn Feeding Patterns

DAY
Time
 (e.g. Weds 5pm to Thurs 5pm)
NUMBER OF BREASTFEEDSBEHAVIORSWET DIAPERSSTOOLSTYPEWEIGHT

1

 

________  

 

________

6+

□□□□□□

BABY: Tiny tummy, sleepy, quiet swallows

PARENTS:  Sleepy, Learning

1  

Black/Sticky

Birth Weight

2

 

________        

 

________

8+

□□□□□□□□

BABY: Tiny tummy, more wakeful, quiet swallows

 

PARENTS: Tired, worried about baby getting enough

2  

□□

1-2

□□ 

Black/Brown

Weight Loss

3

 

________        

 

________

ALL DAY CAFÉ !

10-12

□□□□□

□□□□□□□

BABY: Tummy expanding, baby very interested in feeding, fussy

 

PARENTS: Tired, teary, worried about baby getting enough, mom’s nipples may be slightly sore

3  

□  □  □

2-3

□□□

Brown/Green

Weight Loss

4

 

________        

 

________

 

MILK IN !!

8-10

□□□□□□□□□□

BABY: More settled after feeding, feedings may be shorter, gulping

 

PARENTS:  Mom’s breasts full, parents more confident about baby getting enough

4

□ □ □ □  

2-4

□□□□  

Green/Yellow

Weight Stable

5

 

________        

 

________

HOME & HAPPY

8+

□□□□□□□□

BABY:  Continues to feed every 2-3 hours w/ occasional cluster feeding

 

PARENTS: Becoming more confident and comfortable with baby and breastfeeding

6-8  

□  □  □     □  □  □

3+

□□□□

Yellow/Seedy

Weight Gain

Do Not Restrict Your Baby From Breastfeeding. If You Are Having Difficulty Waking Your Baby For Feedings, Ask For Assistance.

Courtesy of Melrose Wakefield Hospital

Prenatal education offers an excellent opportunity for creating appropriate expectations at delivery (e.g., practices that should occur in the hospital such as breastfeeding within the first hour of birth, skin-to-skin contact, breastfeeding on cue, abstaining from pacifier use and use of artificial teats or supplements, rooming in).

Post-natal education, attending support group meetings, and talking to other breastfeeding mothers or peer counselors can help manage expectations post-partum.