From Vincent Iannelli, M.D.,
Your Guide to Pediatrics.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

If you are told to just supplement and are not offered advice on improving your breastfeeding technique, then this advice is likely from someone that is not very supportive of breastfeeding and you should consider seeking help elsewhere. And keep in mind that if you do need to supplement, you can sometimes avoid bottles, and instead use a supplemental feeder or lactation aid, and if you have a good supply, then supplement with expressed breastmilk instead of formula. Most importantly remember that in most instances, giving a supplement is not necessary, especially if your child is showing signs that he is getting enough breastmilk. Just because you offer a bottle and your child drinks a few ounces, that doesn't necessarily mean he is not getting enough breastmilk.

So how do you know if your baby is getting enough? If he is passing four or more yellow and seedy stools by day of life four and urinating six or more times a day, then he is likely getting enough and you shouldn't need to supplement. Adequate weight gain is another good sign that he is getting enough, but you shouldn't generally wait to see what his weight is to know if you need help. Infants older than 1-2 months don't always have frequent stools and may sometimes only have one bowel movement every 1-2 weeks. If he has otherwise been gaining weight well and seems satisfied, then this probably isn't a sign that he isn't breastfeeding enough. This is usually because breastmilk is digested so well and there isn't a lot left over to make bowel movements.

Another sign that mothers often mistake for a need to supplement often happens at around four months of age. This is a time when infants get more curious about their surroundings and can get easily distracted during feedings. This is not a sign that he is losing interest in breastfeeding or that you need to supplement. You may just need to breastfeed in a less distracting place.

Many older infants also go through growth spurts where they want to eat 'all of the time'. If you breastfeed more often at these times, instead of supplementing with formula, then you will likely quickly build up your supply of breastmilk in 3-4 days to meet his new demands.

Once your baby is born, to help maximize the chance that you will breastfeed effectively, in addition to learning as much as you can about breastfeeding, I would recommend that you:

• try and breastfeed your baby right after he is born. room in with your baby so that you can breastfeed on demand when your baby is hungry.
• instruct the nursery staff to not give supplemental bottles of formula unless instructed to do so by your Pediatrician and if a supplement is required for some reason, ask if an alternative to a bottle can be used, such as a lactation aid, finger feeding or cup.
• have the hospital staff (and a lactation consultant if available) observe you breastfeeding your baby prior to discharge. This can help prevent problems with positioning, latching on or sucking.
• avoid supplementing with formula or using a bottle before he is 3-4 weeks old (unless instructed to do so by your Pediatrician). In fact, it is probably best to not use a bottle at all to maximize your chances of breastfeeding effectively. Finger feeding, cup feeding or a lactation aid are all better alternatives.
• avoid using a pacifier before he is 3-4 weeks old (unless he is already breastfeeding effectively, then it is probably all right to introduce a pacifier sooner). Again, it is probably best to not use a pacifier at all, since their use is associated with early weaning and prolonged use of a pacifier is associated with an increased risk of ear infections. don't smoke (smoking is associated with having a poor milk supply and many other negative medical effects on children and especially newborns), although if you do smoke, you can definitely breastfeed and it may help offset the increased risk of allergies and asthma that is found in children that are exposed to second hand smoke.
• limit the intake of foods and drinks that have caffeine in them.
• follow a well balanced diet with about 2000 - 2700 kcal/d.

And at the earliest signs of problems, including engorgement, nipple pain, or a low milk supply, get help. Many breastfeeding mothers place the number of their lactation consultant by the phone with other emergency numbers. This can be a good reminder to call when you need help or are having problems.