Are you supplementing in addition to breastfeeding and would like to wean your baby off of the formula? It will be necessary to collect some information about your baby's feeding and your milk supply to create a plan for safely reducing formula while increasing your milk supply. Breastmilk math can be challenging. You can measure formula, but when your baby is feeding directly at the breast, no measurements tell us exactly how much milk they drink at each feeding, and their intake can vary from one nursing session to the next. You can get support and guidance as you navigate the transition from your IBCLC (International Board Certified Lactation Consultant). 

Your baby’s intake will remain the same as you adjust the amount of breast milk and formula they have. Between the ages of 1 month and six months of age, babies take between 22-30 ounces per day. (1) Babies need to nurse a minimum of 8 times per 24 hours, although it is normal for babies to eat 10-12 (or more) times per day when following the baby’s natural feeding cues. 

• Before you can begin reducing the formula, you will need to increase your supply. Milk supply responds to demand. When the breast is stimulated by either a pump or the baby nursing, it signals for more milk to be made.
• Consider why you were giving formula or donor milk to your baby. Have you addressed any underlying causes that led to using the formula? Resolving any issues you initially faced with breastfeeding or managing breast milk production will help with your efforts to make more milk and transition from formula to breast milk with your baby.
• Record your baby’s present supplement use. You want a clear picture of how much formula your baby has in 24 hours, how much of your expressed milk your baby takes in 24 hours, and how and when your baby feeds directly on your breast. 
• Record your baby’s wet and dirty diaper output. Note how many diapers they have per 24 hours, along with the amount and consistency of the diapers. 

• After recording how much supplement your baby needs, you will understand how much you need to increase your milk supply to transition to exclusive breast milk to meet your baby’s needs. For example, if you record that your baby takes 8 ounces of formula per day, you will need to boost your supply by that same amount to replace the formula with breast milk.
• Pumping schedule - If you are already pumping, you will need to add additional sessions to bring up your supply and collect the amount of milk you calculated to replace the formula. If you do not normally pump, make sure you have flanges that are the appropriate size. Your flange size will often differ from the sizes that came with your pump. Your nipple should be the only tissue pulled into the flange tunnel. Pumping should be completely comfortable. If you have any discomfort, contact an IBCLC who has experience with flange fitting and options for getting the best fit for you. Work in time to pump in between times you nurse your baby. Power pumping may be an option to jump-start your process depending on how much milk you need to replace the formula.
• Using a supplemental nursing system - there are different options, either homemade or purchased for a supplementer to use directly at the breast. With an SNS, your baby nurses for every feeding, getting milk you produce directly, and the nursing system holds the formula to supplement the rest of the amount of milk needed to be a full feeding for that session. Each time your baby is at your breast, they further stimulate and boost your milk production.
• Middle of the night milk removal - signaling the breasts to make more milk is driven by demand and hormones. The hormone prolactin is released after your baby begins to suck or you begin to pump. As milk is released from the alveoli, prolactin signals that more milk needs to be made. Prolactin is naturally highest between 2-5 am during the middle of the night. Removing milk when prolactin is elevated is a big boost for overall milk production and influences milk composition. (2) If milk is not removed for long periods of time during the night, it tells the body you are making too much milk, affecting your daytime milk supply. When you are increasing your supply to reduce formula use, middle-of-the-night milk removal is critical to boost your supply and maintain your production.

Diet and supplements - Support your body with nutrient-dense foods and high-quality prenatal and lactation supplements. Relactation requires time and energy. Stay hydrated, eat foods that support lactation, and consider supplements with nutritional herbs that boost vitamin and mineral levels. Herbs in blends like Cash Cow or Liquid Gold boost prolactin levels and help with milk production and flow. Goat’s rue is an herb in each that has also been shown to increase mammary tissue and milk storage capacity. (3)

• Go slow - as you increase the number of times you are breastfeeding, you can decrease the amount of formula you need to give by small amounts. Aim to breastfeed 8-12 times, including the critical middle-of-the-night feedings. You can choose to drop a small amount of formula from a few bottle-feeding sessions, replacing it with nursing. It is not recommended to drop more than 1 oz total in the first few days. If you feed your expressed milk in bottles, as you increase your milk production, you can replace the same amount of formula with expressed milk.
• Monitor your baby - you want to see your baby satisfied and happy between nursing sessions or bottle feeding sessions with expressed milk while reducing formula and having plenty of wet and dirty diapers daily. Your baby may begin to refuse bottles of formula as they nurse more and get more breast milk.
• If your baby is doing well in a few days, you can reduce another small amount of formula to be replaced with your expressed milk or breastfeeding. 
• Getting your baby’s weight checked at the doctor confirms they are continuing to gain weight appropriately and stay on their growth curve during this process.
• As you supplement less and nurse your baby more, you can drop pumping sessions.

• Skin-to-skin time with your baby increases oxytocin. Your baby is likely to nurse more often when you are skin-to-skin. 
• Take baths together! They are relaxing for you and your baby and a great place to get more nursing time.
• Avoid pacifiers and offer to nurse instead. Any opportunity for your baby to stimulate your milk production, even if only for a short session, is excellent. Calories are only a part of breastfeeding. Babies nurse for comfort as well. Each time they do, it signals your body to make more milk.

1. Gradual adjustments: As you begin the process of reducing formula and increasing breast milk, keep in mind that your baby's intake will remain the same. They typically consume between 22-30 ounces, nursing about 8-12 times in 24 hours. You'll ensure a smooth transition by gradually replacing formula with breast milk.
2. Plan and record: Before you start reducing formula, focus on increasing your milk supply. Address any underlying issues you faced with breastfeeding or milk production, and record your baby's present supplement use along with their wet and dirty diaper output. This information will help you gauge progress and adjust accordingly.
3. Strategies for success: Implement a pumping schedule that includes additional sessions to boost your milk supply. Consider using a supplemental nursing system (SNS), which allows your baby to nurse while supplementing with formula if needed. Take advantage of middle-of-the-night milk removal to stimulate milk production and support your body with nutrient-dense foods and lactation supplements. Slowly decrease the amount of formula while monitoring your baby's satisfaction and weight gain, and remember to maximize skin-to-skin time and avoid pacifiers to encourage nursing.

Believe in yourself and your ability to nourish and comfort your little one. Each step forward is a success; you're giving your baby the best start in life. Communication with your baby’s health care provider and IBCLC will help you stay on target with your relactation goals and ensure your baby gains weight while you shift from formula to breast milk. Each mom and baby is different and may experience a different timeline for making more milk and reducing formula with breast milk. Each drop of milk you provide your baby is amazing and beneficial. You’ve got this!

1. https://pubmed.ncbi.nlm.nih.gov/6620057/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387861/
3. https://www.legendairymilk.com/blogs/news/goats-rue-a-popular-galactagogue?_pos=1&_sid=cb673a46c&_ss=r

https://nursingrubysue.wordpress.com/homemade-supplemental-nursing-system/

https://www.cdc.gov/growthcharts/who_charts.htm