December 2025

 

Breastfeeding practices at times can be controversial. That is because many precepts governing this essential practice are not based on scientific or well documented data.

 

One issue that has been a source of debate concerning breastfeeding is supplementation with infant formula. This would apply to the infant that is failing to thrive on breastfeeding alone.

 

Too often the woman is led to believe she is a failure as a mother if the baby needs supplementation in order to grow within normal limits.

 

There are reasons beyond the maternal control that hamper breastfeeding. The usual maneuvers to enhance breast milk’s natural delivery do not help.

 

I came across an article by Flaherman, MD, MPH, et al in PEDIATRICS, vol 153, nu 1, January 2024, pg. 53 that documents the small volume that formula supplementation prevents infant growth impairment.

 

The supplementation did not provoke breastfeeding cessation. The volumes used were very small, but did show that supplementation did not cause stoppage of breastfeeding.

 

In my own practice I have encountered several infants failing to thrive because of inadequate caloric intake on the volume of breast milk the mother could provide. Consulting a lactation specialist did not correct the problem.

 

I advised developing a “3rd breast”, that is, after nursing on both breasts to offer a bottle with formula.

 

I must stress, OFFER THE BOTTLE AFTER TIME ON BOTH BREASTS, NOT BEFORE.

 

In those cases the infant thrived, gained weight and developed neurologically normally. Also, and most importantly, breastfeeding continued without cessation, as the author found in the study cited.

 

I must encourage these steps to enhance breast milk delivery before supplementing with infant formula.

 

When these fail we cannot let an infant cease to develop properly. Remember, it is not only height and weight but brain development that is also involved.

 

The old axiom “offer supplement and you will cease breastfeeding” is unfounded if you follow the above advice. Brain development is not something we can impair especially if it occurs because of outdated undocumented beliefs.