Making the transition from using bottles, cups etc., to feeding at the breast
There are lots of reasons babies might need more milk than they can get directly at the breast:
- They don’t have enough energy to do all the work of feeding. They may have been born early or small-for-dates, or are unwell, or jaundiced, or have lost a lot of weight. They may be keen to feed, and have good feeding skills, but they fall asleep before they’ve taken as much milk as they need. They need time, patience, and plenty of milk, before they can do all the work of feeding for themselves.
- There isn’t enough milk available at the breast to meet all their needs. This might happen if:
- Milk is slow to increase in the early days after birth, for example because the birth was very difficult, or if you have diabetes.
- Not enough milk is removed from the breasts in the early days after birth. This can happen because the baby wasn’t breastfeeding often enough (perhaps because they were very sleepy, or formula was being given instead of breastfeeding), or feeding was inefficient (perhaps they weren’t deeply attached at the breast, or had a tongue tie). Most of us need to remove milk from our breasts at least 8 – 12 times in 24 hours, in the early weeks, to bring in a full milk supply.
- You have a limitation on how much milk you can make. This could be because of previous breast surgery, hormonal issues, or other factors related to your breasts or your health.
- Here is more information on how milk production works.
Babies need enough milk to grow well, and to give them enough energy to feed. Some babies need extra milk – known as “supplements” or “top ups”, as well as, or instead of, direct breastfeeding. Here is more information about increasing your milk production, and how to give supplements.
Many babies who have needed supplements can go on to breastfeed exclusively (get all the milk they need, directly at the breast).1,2 But not all can. For many reasons, we are seeing more families with complications that make exclusive breastfeeding out of reach. No one can guarantee, right now, how this is going to turn out for you. But whether or not you need to keep using supplements, we can help you find a way of feeding that works for you and your baby.
Laying the foundations – Helping your baby to grow well
Your baby needs to be growing well, before you start reducing supplements. Babies who are well fed, feed better. The bigger and stronger they get, the more they can “grow into” breastfeeding. Work closely with your healthcare providers and a breastfeeding supporter (for example LLL Leader), to figure out the amount of supplement your baby needs.
It might be suggested that you feed your baby a certain volume of supplement each feed or each day, perhaps based on their weight. A simpler approach, if you’re not sure what to do, is to let your baby show you the amount they need. Offer more, if they seem to want it. They might take very different amounts at different feeds.
It’s important to use feeding tools carefully, to avoid over-feeding. Just because a baby drinks milk from a bottle doesn’t necessarily mean they needed it – babies will suck on anything you put in their mouth. “Paced feeding” enables your baby to take breaks, and stop when they’ve had enough. Here is more information on how to use bottles and other feeding tools.
If your baby is very sleepy, or premature, their appetite might not be working well yet, and they may need active encouragement to take as much as they need. Your baby’s growth is the most reliable guide to whether they’re getting enough milk. This article has information on how to work out if your baby is getting enough milk.
Define your feeding goal
If your baby needs supplements at the moment, what you do next depends on what your feeding goal is.
- You might already be happy with the mix of feeding you’ve got. Expressed milk and/or formula can be used alongside, or instead, of direct breastfeeding, for as long as you want. You can read more in Using Donor Milk and Formula to Support Breastfeeding.
- Some parents feed their babies entirely on expressed milk – a huge labour of love. You can find out more in Exclusively Expressing Breastmilk For Your Baby.
If you would prefer to be doing more breastfeeding, and less (or no) supplementing, read on…
You also need support from a breastfeeding helper, and your midwifery or health visiting team. You need a plan that is safe for your baby, and tailored to your individual situation.
It is really important to keep a close eye on your baby’s growth while you are working on reducing supplements. Babies are routinely weighed at certain times: around five days, ten days, six to eight weeks, and then once a month, if you want to. This is fine when feeding is going smoothly, and babies are thriving. This is not often enough while you’re working on transitioning from supplements to direct breastfeeding. Weekly weighing is more appropriate, gradually moving to fortnightly and then monthly, when it’s going well.
Gradual weaning is safest – both from the supplements and the scales!
You can find more information below on signs that your baby is ready to manage with less supplement. But your baby’s growth is the most reliable indicator of how things are going. You might find it useful to share this article with your healthcare team.
Plan to reduce supplements
Step One: Maximise Your Milk Production
[If your baby is already fed only on your milk, you can skip this step].
If your baby needs donor milk or formula at the moment, and your goal is to feed them more of your own milk, then the most urgent task is to work on your milk production. This is much more time-critical than your baby learning to breastfeed, or to breastfeed better.
Babies come hardwired to breastfeed, and can learn for many weeks (at least 2-3 months, maybe longer) after term birth. There are even case reports of adopted children aged over a year starting to breastfeed!3 You can read about what’s most urgent, and what can wait, in Getting Breastfeeding On Track After a Difficult Start (the “Three Keeps”).
The time-window for increasing milk production is shorter. Milk production normally reaches its peak by a month after birth, with most of the increase happening in the first two weeks. From 1-6 months, it stays about the same.4 After the first month, your body is not expecting to increase the amount of milk you’re making, so it tends to get harder to increase it. Though you never know what you can do until you try, after the early weeks there are no guarantees of being able to get a lot more milk.
If you want to make more milk, the earlier you act, the better your chances. To find out how, see How to Increase Your Milk Supply. Frequent, effective milk removal is key. If you want your breasts to make more milk, you need to keep reminding them that you need more (it’s a bit like nagging!).
“Just breastfeed more often”?
You might assume – or even be advised – that all you need to do to make more milk is to breastfeed your baby more often. This may be true, when a baby is good at breastfeeding, and breastfeeding is going smoothly. But it’s not true, and might be really unsafe, if breastfeeding is difficult for your baby, and it’s not yet going well.
It’s a bit like asking your baby to do two jobs: feed themself and do the work of increasing your milk production – even though they don’t yet have a track record of doing even one of these jobs successfully! For now, you will need to do some (or even all) of the work for them.
First Things First
It makes sense to concentrate on your milk production first – before reducing supplements. It can feel overwhelming to try and do everything at once – prioritise what is most urgent. When you have more milk:
- Your baby won’t have to work so hard to remove milk from the breast.
- Breastfeeding will be more rewarding – so it will be easier to transition your baby to doing more breastfeeding.
Signs that your milk production is increasing
- If you’re expressing your milk, the amount you’re able to express each day will have increased. (It’s normal to have times when you can express more, or less – the daily total is what counts).
- You might notice that your breasts start to feel fuller more quickly between feeds or expressing sessions (although this is not always the case).
- If your baby is doing some direct breastfeeding, they might swallow more often, feed for longer and seem more satisfied after feeds.
- If your baby is doing quite a bit of breastfeeding, they might grow faster.
How much milk do you need?
It might be useful to know that between about one and six months, an average baby takes about 800ml in 24 hours. But some babies thrive on as little as 600ml, while some take as much as 1300ml.5 The practical answer is:
- Enough to satisfy your baby and
- Enough for your baby to grow well.
The first step is to replace some or all of the donor milk or formula supplements with supplements of your own milk.
If your baby is premature or unwell, they might only be taking small amounts of milk at the moment. If your goal is to feed them only on your milk as they grow, you will need to aim to get the kind of amounts they’ll need later, not just the amounts they need now. The figures above can be a guide.
The earlier you start expressing, and the more often you express, the more milk you’re likely to make. If you end up making more than your baby needs at the moment, you could freeze it for later use, or donate it to a Milk Bank, to benefit other premature babies.
When you’re not able to produce all the milk your baby needs, it can feel really disappointing to realise that they will keep needing donor milk or formula as well. If, despite your best efforts, the amount of milk you’re making has stopped increasing, or hasn’t increased at all, you have probably reached the limit of the amount you can make. A breastfeeding supporter can help you work out if you’ve reached this point.
Some of us wonder whether, if we can’t make all the milk our baby needs, there is any point in carrying on at all. While only you can make the calculation about whether the effort you’re putting in is worth it, any amount of human milk protects babies in ways no other milk can.6,7 You can find more information about the power of your own milk (however much you’ve got!), and using other milk to support your baby’s growth.
Now you are in a new phase: maintaining the amount of milk you’ve got. You can experiment to see how many times you still need to feed or express, to keep up this amount. (This piece explains how to do it: The ‘Magic Number’ and Long-Term Milk Production). As long as you keep removing this amount, you will keep making this amount.
It’s a long game. After babies start eating family foods, around six months, their need for milk gradually reduces. It’s often possible to reduce, and maybe stop using, supplements of donor or formula milk, while keeping on breastfeeding or expressing for as long as you want. Many of us who’ve had to deal with low milk production in the early months find that we can really relax and enjoy breastfeeding at this stage.
Step Two – Transitioning to the Breast
When you’ve got as much milk as you need, or can get, you’re ready to think about reducing supplements. Work with a breastfeeding helper to make a tailored plan for you and your baby. Your local La Leche League Leaders (breastfeeding counsellors) may be able to support you themselves, or help you find someone else who can. Many areas have an NHS Infant Feeding Team to help families with complex feeding issues – ask your midwife or health visitor where you can get specialist help.
- If your baby isn’t breastfeeding yet, see My Baby Won’t Breastfeed for lots of tips on how to help your baby make a positive relationship with the breast.
- Celebrate the baby steps: drinking from a cup or bottle while in skin-to-skin contact; falling asleep afterwards with cheek pillowed on breast; having a short try at the breast after taking some supplement. If your baby is able to stay at the breast for even a short time, it’s valuable practice. Learning to breastfeed, when something is making it difficult, is like exercising: you wouldn’t expect to run a marathon without doing lots of much shorter training runs first. Your baby gets much more from breastfeeding than just milk – don’t forget to savour the other stuff!
- Make sure you’re using your feeding tools well. They’re there to support breastfeeding, not compete with it. Babies are very smart – if breastfeeding is difficult for them, and another method is much easier, they might prefer to stick with the other method. See Bottles and Other Tools for how to use bottles well, and lots of alternatives if you prefer not to use them.
- Consider some extra (or different) feeding tools.
- It might be as simple as replacing some or all bottle-feeds with a cup or supplementer (see below). Limiting or reducing use of artificial teats (including dummies) can encourage reluctant babies to spend more time at the breast.
- A “nursing supplementer” (sometimes also called a lactation aid) enables you to feed your baby expressed milk or formula at the breast while they breastfeed, via a thin tube placed by your nipple. This can be a great tool to help transition a reluctant baby to the breast, or for longer-term use if milk supply is low. Find out more: Nursing Supplementers. (Read two mother’s stories, here: Breastfeeding With a Nursing Supplementer and here: In Praise of At-Breast Supplementers.)
- Another tool is a nipple shield – a thin layer of silicone, placed over your own nipple. Fitted and applied well, they can help a bottle-feeding baby transition to the breast, or a baby with a weak suck (for example because they’re premature) take more milk.8
If you’re interested in trying these tools, it’s helpful to work with a breastfeeding supporter who knows how to use them.
When you’ve got all the pieces in place…
- Your milk supply is as high as you need, or can get
- Your baby is growing well
- You’ve chosen feeding tools carefully, and are using them well
- Your baby is willing to feed at the breast, at least sometimes
…What next? While the process will look different for every baby, these principles can help you and your breastfeeding supporters along the way.
- Never go “cold turkey”! Sometimes, parents are advised to stop using supplements suddenly, to “force” their baby to breastfeed. Unless your baby is almost exclusively breastfeeding already, and growing well, this is extremely unsafe. Babies never choose not to breastfeed well – if they don’t, it’s because they can’t, not because they won’t! Your baby needs their usual amount of milk throughout this process.
- Watch your baby for signs of readiness. Babies who lacked energy to feed show us when they are ready to take on more work. If your baby was premature and sleepy, or has had a tongue tie division, for example, there will come a time when you start to notice that their feeding is changing. It feels like they’re sucking more strongly, and maybe keeping it up for a bit longer. They might start wanting less supplement. Now they’re ready to begin doing more of the work of feeding.
- Take it steady. We know it’s really tempting to rush this – you want to breastfeed! – but it pays to make the transition carefully. Your baby doesn’t have a track record of breastfeeding yet, and it might take a while before they’re good at it. If they’re small, low in energy or unwell, they’re unlikely to be able to do all the work of feeding today, when yesterday they were doing little or none.
If your baby was born prematurely, expect it to take at least until their original due date, plus a bit longer, before they’re able to do all the work. They’ve had more to cope with out here in the world, than if they’d been born later. The more health complications they’ve had, the more time they’re likely to need. We know it’s really frustrating not to know exactly how long this will take. Connecting with other families who have already made this transition may be the most helpful thing you can do at this stage. Your local LLL group would love to support you.
- Do a small trial, keeping a close eye on your baby’s nappies, and weight. If you feel your baby might be ready for a step forward – try it! Breastfeed a bit more, and offer a little less supplement. If you’ve been giving, say, 300ml per day, see what happens if you reduce it to 270ml. You could spread this reduction out over more than one feed. If your baby is able to take more milk from the breast, they’ll continue to produce wet and dirty nappies as normal, and to grow well. If their nappy output reduces, or their weight gain slows, you will need to go back a step, and try again later.
It’s really important to weigh your baby regularly during this stage. Two weeks, or a month, is a really long time for a baby – and for your milk supply – if things turn out not to be going well.
- In between weight checks, notice how your baby is responding to any reduction in supplement. If your baby seems unsatisfied after the reduced supplement, this may be a sign that it’s been reduced by too much, too fast. You could try offering the breast after a supplement, and see how they respond. They might be satisfied with the comfort that being at the breast provides, rather than more milk – or they might need more supplement.
- If you’re expressing, cut back gradually. If you’ve already been working hard to build your milk supply by expressing, you know exactly how precious it is! Reduce the number of times you express one at a time. Only take the next step if your baby continues to grow well. For example: if you’ve been expressing six times in 24 hours, start by reducing to five, spending more time breastfeeding.
After a few days (ideally no more than a week), weigh your baby again. If your baby has grown well that week, reduce your pumping sessions to four, and repeat. It might feel frustratingly slow, but you don’t want to risk damaging the milk supply you’ve worked so hard for. If you notice your breasts becoming uncomfortably full, it may be a sign that your baby is not yet as efficient at the breast as you hoped. Over-full breasts reduce milk production. Keep your breasts comfortable by expressing a little more, until you’re ready to experiment with reducing expressing again.
- Expect some steps backwards, as well as forward. Babies who are finding breastfeeding hard work will do their best job when they’re in their best state: healthy, well-rested and calm. Expect better feeding early in the day, and for things to feel like they’re falling apart when they’re tired, frustrated, or in a bad mood. Anyone can have a bad day, including babies!
If a breastfeeding session isn’t going well, you can always hit “pause”, and offer a supplement instead. There’s no point forcing it, if both of you are upset. The next feed, or the next day, might go better. If it doesn’t, take a break, and talk to your breastfeeding helper about what to do next.
- Track changes. It’s helpful to collect some ‘data’ as you go along. This helps you, and your breastfeeding supporter, see how things are changing over time. You don’t need to go into huge detail – daily totals are fine. You could use an app, a spreadsheet or just a piece of paper, to record:
- How much expressed milk, donor milk or formula you used each day
- How many times your baby breastfed
- Your baby’s wet and dirty nappies
This, along with your baby’s weights recorded in their red book, will give you enough information to tell how your plan is working.
Reducing supplements is like crossing over a bridge which looks a bit rickety. You’re not quite sure if it will hold you up. You don’t jump straight into the middle – you take one step at a time, checking it’s holding your weight, before you take the next one. If it starts to give way – you jump backwards!
Just like breastfeeding, reducing supplements is an art. You need plenty of patience, and good support. Many mothers in our groups have been through this process, and would love to encourage you. Maybe you will get all the way to your goal – such as exclusively breastfeeding your baby, or feeding them only on your milk – or maybe you won’t. However it turns out, you can find a way of feeding that works for you and your baby, and which you can both enjoy. Whatever feeding looks like for you, we’re here to help.
Written by Jayne Joyce, March 2023. Review due March 2026.
Bottles and other tools
How to increase your milk supply
Engorged Breasts – Avoiding & Treating
Hand Expression of Breastmilk
My Baby Needs More Milk
My Baby Won’t Breastfeed
Sleepy Baby – Why and What to Do
Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production (2nd edition) by Lisa Marasco and Diana West
Mixed Up: Combination Feeding by Choice or Necessity, by Lucy Ruddle
Finding Sufficiency: Breastfeeding with insufficient glandular tissue, by Diana Cassar-Uhl
Why Breastfeeding Grief and Trauma Matter, by Amy Brown
- Azad MB, Vehling L, Chan D, et al. Infant Feeding and Weight Gain: Separating Breast Milk From Breastfeeding and Formula From Food. Pediatrics. 2018;142(4):e20181092. doi:10.1542/peds.2018-1092
- Mildon, A., Francis, J., Stewart, S., Underhill, B., Ng, Y. M., Rousseau, C., Di Ruggiero, E., Dennis, C. L., O’Connor, D. L., & Sellen, D. W. (2022). High levels of breastmilk feeding despite a low rate of exclusive breastfeeding for 6 months in a cohort of vulnerable women in Toronto, Canada. Maternal & child nutrition, 18(1), e13260. https://doi.org/10.1111/mcn.13260
- Post-Institutionalized Adopted Children Who Seek Breastfeeding from their New Mothers. Karleen D Gribble. Journal of Prenatal & Perinatal Psychology & Health; Spring 2005; 19, 3.
- Kent, Jacqueline C et al. “Principles for maintaining or increasing breast milk production.” Journal of obstetric, gynecologic, and neonatal nursing : JOGNN vol. 41,1 (2012): 114-121. doi:10.1111/j.1552-6909.2011.01313.x
- Kent, Jacqueline C et al. “Volume and frequency of breastfeedings and fat content of breast milk throughout the day.” Pediatrics vol. 117,3 (2006): e387-95. doi:10.1542/peds.2005-1417
- Thompson JMD, Tanabe K, Moon RY, et al. Duration of Breastfeeding and Risk of SIDS: An Individual Participant Data Meta-analysis. Pediatrics. 2017;140(5):e20171324. doi:10.1542/peds.2017-1324
- Chiu, C. Y., Liao, S. L., Su, K. W., Tsai, M. H., Hua, M. C., Lai, S. H., Chen, L. C., Yao, T. C., Yeh, K. W., & Huang, J. L. (2016). Exclusive or Partial Breastfeeding for 6 Months Is Associated With Reduced Milk Sensitization and Risk of Eczema in Early Childhood: The PATCH Birth Cohort Study. Medicine, 95(15), e3391. https://doi.org/10.1097/MD.0000000000003391
- Meier PP, Brown LP, Hurst NM, et al. Nipple shields for preterm infants: effect on milk transfer and duration of breastfeeding. J Hum Lact. 2000;16(2):106-131. doi:10.1177/089033440001600205
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