Sometimes, despite your intentions to breastfeed exclusively, your baby may need to be supplemented with formula.

Here are 5 reasons why this might happen:

  1. Blood Sugar: Whether your baby is preterm, large for gestational age, small for gestational age, just having a rough transition outside the womb or if you are diabetic (any type), sometimes babies have difficulty maintaining their blood sugar. The first option is always to feed the baby his mother’s milk, but if this is not available or is given and the blood sugar does not stabilize, often the doctors opt to feed formula before going to an IV to stabilize blood sugar. Read here to learn more about a newborn’s blood sugar.
  2. Dehydration: Sometimes, though rarely, despite a mother’s best efforts, babies aren’t getting enough breastmilk to keep them adequately hydrated. This is exhibited by extremely low or no urine output, or by urate crystals in the diaper. If the mother is unable to express additional breastmilk to use as a supplement, the baby may be fed formula to correct the dehydration. It should be noted that water is no longer given as it can negatively affect the baby’s blood chemistry. Both breastmilk and formula contain the appropriate amount of water for the baby to adequately hydrated without supplemental water. The key is getting enough. To understand the signs of baby getting enough, read here to learn more about appropriate diaper output.
  3. Maternal Complications: Occasionally there are instances where mothers are separated from their babies due to maternal complications. These can range from extended time in the OR, treatment with magnesium sulfate for blood pressure, or even transfer to a different unit such as the ICU. In these cases, babies are fed formula until the mother is able to express breastmilk for the baby or is able to be reunited with the baby to breastfeed.
  4. Baby transfer: If a baby is having critical difficulties, is extremely premature, or needs care beyond the level of the hospital where he is born, he will be transferred to a hospital with a higher level of care. When this happens, if the baby is stable enough to be fed, he may be fed formula if the mother’s own or donor breastmilk is not available. The mother will be set up to express milk until she can be reunited with her baby. Read here to learn more about pumping.
  5. Mother’s choice: While all major health authorities recommend exclusive breastfeeding for the first six months unless medically indicated, sometimes mothers choose to give formula without medical indication. This is called mother’s choice and it is okay. Ultimately, a mother knows what’s best for her and her baby and if she feels like she needs to give formula, then the healthcare provider’s job is to help the mother do that safely. Read here to learn more about why exclusive breastfeeding is recommended.

So, what can you do:

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