How To Transition From Formula To Breastmilk

by Sabrina Granniss, IBCLC July 12, 2022

Are you using supplements in addition to breastfeeding and would like to wean your baby off of them? It will be important to collect some information about your baby's feeding and your milk supply, create a plan for safely reducing formula, increasing your milk supply and be in touch with your IBCLC for support and guidance along the way.

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 6 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.

How to begin

Before you can begin reducing formula, you will need to increase your supply. Milk supply responds to demand. When the breast/chest 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 the use of formula? Resolving any issues you initially faced with breastfeeding or management of breast milk production will help with your efforts to make more milk and transitioning from formula to breastmilk with your baby.
Record your baby’s present supplement use. You will want to have a clear picture of how much formula your baby has in 24 hours, how much of your expressed milk your baby has in 24 hours and how and when your baby feeds directly on your breast/chest.
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.

Making a plan

After recording how much supplement your baby needs, you will have a good understanding of 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 in additional sessions in order to bring up your supply and collect the amount of milk you calculated to replace formula. If you do not normally pump, make sure you have flanges that are the appropriate size. Your nipple should be the only tissue pulled into the flange tunnel. Pumping should be completely comfortable. If you have any discomfort, get in touch with an IBCLC who has experience with flange fitting and options for getting the right fit for you. Work in time to pump in between times you nurse your baby. Depending on how much milk you need for replacing formula, power pumping may be an option to jump start your process.

Using a supplemental nursing system - there are different options either homemade or purchased for a supplementer to use directly on your chest. With an SNS, your baby nurses for every feeding getting milk you produce directly and the nursing system holds 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 chest, they are further stimulating your milk production and boosting 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 more milk to be made. Prolactin is naturally highest between 2-5 am during the middle of the night. Removing milk when prolactin is already elevated, is like 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 and this affects your daytime milk supply. When you are increasing your supply to be able to reduce formula use, middle of the night milk removal is critical to boost your supply as well as maintain your production.
Diet and supplements - Support your body with nutrient dense foods and high quality supplements. Relactation requires time and energy. Stay hydrated, eat foods that support lactation and consider supplements with nutritional herbs that boost vitamins and minerals. Herbs found in blends like Cash Cow or Liquid Gold boost prolactin levels, help with milk production and milk flow. Goat’s rue is an herb in each that has also been shown to increase mammary tissue and milk storage capacity.(3)

Your plan in action

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 important 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 the first few days. If you are feeding your expressed milk in bottles, as you increase your milk production, you can replace the same amount of formula for expressed milk.
Monitor your baby - you want to see your baby is satisfied and happy between nursing sessions or bottle feeding sessions with expressed milk while reducing formula and having plenty of wet and dirty diapers per day. Your baby may begin to refuse bottles of formula as they are nursing more and getting more breastmilk.
In a few days, if your baby is doing well, 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 will be able to drop pumping sessions.

Success boosters

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 in.
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 great. 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.

Communication with your baby’s health care provider and your IBCLC will help you stay on target with your relactation goals and make sure your baby is continuing to gain weight while you shift from formula to breast milk. Each parent and baby is different and may experience a different timeline for making more milk and reducing formula with breastmilk. Each drop of milk you provide your baby is amazing and beneficial.

Footnotes:

Resources:

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

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

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How To Transition From Formula To Breastmilk

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