fortifying breastmilk with powdered formula?

Kadydidnt · June 2013

Ok so my LO is 4 months and is slightly underweight according to where the doctors want to see him. Not enough to cause them any real concern and he is otherwise healthy and well fed, EBF from me. He's got a bit of the baby chub on his arms and legs, but he's not a fat baby. And he goes thru the normal 6-8 or more wet/poop diapers a day. (Side note, neither his father nor I are large people, nor were we large babies).

The doctor advised me to 'fortify' my pumped breastmilk with a scoop of powdered formula, (kind of like adding a scoop of protein powder to a smoothie) to try to get his weight up.

Well, I looked up to see how to do this and everything I have found says explicitly NOT to do this. You can't shake breastmilk, and adding powdered formula to it changes the composition of the BM as well as being very hard on an infant's immature kidneys b/c of the high concentration. Even making up a batch of formula into liquid form and then adding it to BM was not advised. I talked to an LC and she said basically try to feed him more and do breast compressions/massage to try to get more of the hind-milk into him during a feeding.

Anyway, I've decided not to mix my BM with formula, and if I truly need to supplement, then the LC said to offer 1/2oz to 1oz of formula AFTER a full feeding. I'm going to do what the LC advised first and see where he is after 2 weeks. He goes back to the pediatrician in a month for a weight check.

Anyone else go thru something similar and get strange advice from their pediatrician? Or, has anyone found a way to get to more hind-milk into their baby so LO gets more of the fatty good stuff during a feeding?

tokenhoser · June 2013

Not all pedi's really know much about breastfeeding. Do not take strange advice as gospel.

First of all, look at your baby's growth on the WHO percentile charts.https://www.childgrowthcalculator.com/ Some doctors use the CDC charts - those are based on formula fed babies and simply do not work for breastfed babies.

There's nothing wrong with a baby because he is small - it's about the curve of the growth and if it is consistent for that child. And even then, there can be fluctuations - DS was 50th percentile for the first 4-6 months and then slowly fell down to about 15th percentile. He's fine, not sick, and does not require me to trick him into drinking more calories. Fortunately, my doctor agreed.

TJ1979 · June 2013

How under weight? Like, why is their measure here? My LO was in the 10th percentile at 4 months. There is nothin wrong with her, she's just petite. I never supplemented at all and she is now fat and happy and up to the 24th percentile.
Now, if LO isn't on the growth chart, that's a different story. Or if LO has dropped on the chart significantly.

CLLDLL · June 2013

While I didn't receive the same advice as you, I have received a ton of bad advice from my pedi regarding BF'ing. I think pedi's in general just aren't educated enough in BF'ing.

My LO did slip a little under the WHO growth curve he had been on at the 4 month check up. My pedi wasn't really concerned. She just decided to watch LO closely, and sure enough by his 6 month check-up he was back up on the original curve. I think he just grew "unevenly" where he didn't grow much from 2 month to 4 month check up , but then had a growth spurt right after the 4 month check up.

I think what you are doing is exactly what I'd do. If you are concerned with growth, consider renting a scale and doing weighed feedings for a day or two. LO should be getting around 24-30oz of BM a day.

Stillharbor · June 2013

We had to do same thing b/s LO was underweight and we are looking at surgery soon, so she needed to gain weight and we were dealing with severe acid reflux . However, we discovered that DD has a milk protein allergy and the Alimentum formula was so smelly she wouldn't take it. The gastroenterologist we were referred to said that we could use Saff Flower Oil. 1/4 of a teaspoon per ounce of BM. You may have to do a little less if baby develops dihaerria. DD gets slightly less than 3oz of BM and 1/2 teaspoon(we err on the side of caution.) of Saff flower oil per bottle.

Smartie26 · June 2013

If your LO is gaining at least .5oz to 1 oz a day and having lots of wet and poopy diapers a day then you are just fine and IMO absolutely do not need to fortify your BM.

I purchased an at home baby scale to moniter my LOs growth for peace of mind. You can get them on Amazon for cheap. Every baby grows at a different rate!

Please Google kellymom
Is my baby getting enough milk?

It talks about growth curves and if Mom and Dad are smaller people how baby fits differently a standard growth chart your ped may be referring to.

SarahinMD · June 2013

Like PP have said, drs advice sounds ridiculous. Where on growth curve is LO--when they say LO is not where they want does he mean not on growth curve or not high enough? DD hovered around 5-10% generally. At one appt she was close to falling off curve and NP said we needed to get a hands on that or we'd have to look at supplementing with formula. I nurse DD more frequently, and by next appt she was back on curve and stayed there. DD has always been petite, but now has been about 25% for a year and a half or so. Good luck!

MommyPace · June 2013

I can tell you that I worry daily about my daughter's weight. We switched peditricians because my first doctor said I had low calorie breastmilk and I needed to switch to only formula. Mind you I go to breastfeeding support group at the local hosptial and the LC's said low calorie breastmilk is unheard of. My new doctor ran all sorts of blood work and it came back fine. At 10 months, my LO weighed 13 lbs 9 oz. she's very petite and not on the growth chart. We do add a half table spoon of formula powder to make the breastmilk richer in calories. We just started this a few months ago and honestly I have not seen a change in her weight either way.

+ASH+ · June 2013

I was told to fortify in the beginning. This was advice from a large hospital with excellent staff - they said to NEVER shake the breastmilk because it breaks down the proteins. I was told to do 1/2 tablespoon of formula for every 2-2.5 ounces of breastmilk and swirl it until it was dissolved. She did great with it, but a week ago we were going to practice breastfeeding and she latched on like a champ, so she hasn't had a bottle since then.

lcmilla · June 2013

Have you thought about fortifying your milk with more breastmilk? If you're able to pump more than your LO needs, you can spoon the fatty part off of one bottle and add it to another to make a higher fat content milk.

kristine618 · June 2013

My LO has been in the 2nd percentile since the 2nd month and since then we have been fortifying all of her bottles at daycare with 1-2 tsp of formula per ped's recommendations. We got several opinions from doctors on her weight since we were so concerned, and they all recommended doing this. The reason being because LO's will typically not take in more ounces than their belly can fit, but you can get more calories in by making the bottles 22 KCal with formula. We have been doing this for 4 months now. For what it's worth, we never noticed any problems with her digesting the formula, but she is still only in the 2nd percentile for her weight at nearly 6 months. At least she's stayed on her growth curve rather than fallen off, but I can't say it's helped a ton.

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