The Pitfalls of Supplementing

By Cheryl Taylor, CBE

I hear from moms regularly that are planning on using both breastfeeding and bottle feeding. Some of them are well informed about the many dangers of formula and have a pump ready to use to provide expressed breastmilk. Some are not, and the first place we begin is with a lesson on the many inadequacies of infant formulas. For the ones that do know that breastmilk only is the goal, but want their husbands to “bond” with the baby, our lesson begins with all the many, many ways in which fathers can interact with their babies without using a bottle.

Regardless of what is being put in the bottle, there are several areas of impact that remain the same.

Using an artificial nipple risks nipple preference.

Nipple preference, or nipple confusion (though this term is more commonly used, I don’t like it as much, since the baby is obviously not confused about it at all, but quite clear on their “preference”), is a serious risk when any artificial nipple is used. This includes any bottle nipple, regardless of “how like breastfeeding” it is considered to be by the individuals in charge of marketing for that company.

A bottle nipple drips milk out, and with very little effort, a baby can get a steady flow of milk going. There is no need to wait for a letdown upon initial “latch.” It begins pouring out immediately. THIS is why the nipple preference is exhibited. Our babies are very intelligent and even one exposure to a bottle can be enough for them to figure out that the bottle is faster. This is also the reason why nipple preference can happen at any age.

Some babies exhibit nipple preference from one exposure to a bottle. Some babies will exhibit it after several exposures. Some babies will go back and forth without any difficulty. Some go for a while without difficulty and then suddenly show nipple preference. Some babies seem to do fine going from bottle to breast, but there are subtle problems hidden in supply issues for mom. Even if EBM (expressed breastmilk) is being used for all bottles, it can become a supply struggle for the mother in that a pump will never offer the stimulation that the baby at the breast will.

Signs of Nipple Preference

  • Compromised latch that makes mom’s nipples sore
  • Fussing at the breast (Hey, Mom, it isn’t working fast enough)
  • Flailing arms and legs (this is the “why isn’t there milk pouring out” motion)
  • Pushing away from the breast with hands (this is the “I’m going to MAKE it come out motion)
  • Latching and unlatching over and over
  • Crying and turning head away
  • Outright screaming and complete refusal to latch

A pacifier can cause nipple preference as well.

The risk of nipple preference with pacifier use is less, in that there is no milk dripping out of a pacifier to make it a tempting option. However, there are some babies that will happily suck on a pacifier in the early stages of hunger. This will have an effect on breastmilk supply. It can cause a compromised latch, which will cause soreness for mom and potentially effect supply as well.

Use of bottles affects mom’s breastmilk supply.

If mom is using formula to supplement breastfeeding, she is telling her body, with every ounce of formula, to make less milk. Her body is not receiving all the signals it needs to make the perfect quantity for her baby, if she is interfering with those signals.

If mom is using EBM, she is still giving her body mixed signals, in that the pump does not provide the stimulation that the baby does at the breast. Mothers who have chosen to work and continue breastfeeding, do so with a serious mission to provide breastmilk for their babies. It takes a lot of stimulation from baby in the hours that mom is home to make up for the hours that a pump takes over. It is very possible to do, and I encourage any mom that is returning to work to do it.

Breastfeeding works optimally with feeding at the breast only.

The bottom line is that the supply and demand system that provides the perfect amount of breastmilk for your baby works optimally with baby at the breast. The use of a bottle compromises that perfect system. Some moms find a way to make it work. Some don’t and the breastfeeding relationship has slipped away from them before they even realized the source of the problem.

If you are returning to work, seek out some help from experienced working breastfeeding moms, La Leche League and/or an IBCLC to find some alternative feeding methods and special “tricks” that will help you make breastfeeding a success.

If you are at home with your children, there is no need to run the risk that the use of a bottle is to the breastfeeding relationship.