ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017

Abstract

is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. Definitions used in this protocol Exclusive breastfeeding: Feeding only breast milk (at the breast or own mothers' expressed breast milk), no food or water except vitamins, minerals and medications. Supplementary feedings: Additional fluids provided to a breastfed infant before 6 months (recommended duration of exclusive breastfeeding). These fluids may include donor human milk, infant formula or other breast milk substitutes (eg. glucose water). Complementary feedings: Solid or semi-solid foods provided to an infant in addition to breastfeeding when breast milk alone is no longer sufficient to meet nutritional needs. Term infant: In this protocol 'term infant' also includes early term infants (gestational age 37-38 6/7 weeks). BackgroundGiven early opportunities to breastfeed, breastfeeding assistance, and instruction the vast majority of mothers and infants will successfully establish breastfeeding. Although some infants may not successfully latch and feed well during the first day (24 hours), most will successfully breastfeed with time, appropriate evaluation and

A dose–response relationship found between the Ten Steps to Successful Breastfeeding indicators and in‐hospital exclusive breastfeeding in US hospitals

“…7 The Academy of Breastfeeding Medicine Clinical Protocol on Supplementary Feedings in the Healthy Term Breastfed Neonate outlines possible medical indications for formula supplementation, and there are some circumstances (e.g., hypoglycemia and hyperbilirubinemia), in which supplementation should occur. 21 This protocol also supports proper assessment of medical indications, supports strategies to prevent supplementation (e.g., skin-to-skin and rooming-in), recommends the provision of lactation management support before supplementation, and recommends expressed breast milk from the infant's mother as the first choice for supplementation. 21 Furthermore, the American Academy of Pediatrics also places emphasis on the need to discontinue policies that provide non-breast milk supplements to breastfed infants.…”

“…21 This protocol also supports proper assessment of medical indications, supports strategies to prevent supplementation (e.g., skin-to-skin and rooming-in), recommends the provision of lactation management support before supplementation, and recommends expressed breast milk from the infant's mother as the first choice for supplementation. 21 Furthermore, the American Academy of Pediatrics also places emphasis on the need to discontinue policies that provide non-breast milk supplements to breastfed infants. 4 Additional work is needed to examine whether appropriate steps to prevent supplementation with non-breast milk supplements are implemented in hospitals.…”

Meeting Families Where They Are

“…Frequent voids in the first 24 hours of life for a breastfed newborn with a large weight loss at 24 hours of life may be indicative of a fluid balance issue rather than a caloric deficit. The Academy of Breastfeeding Medicine (ABM) 13 provides detailed guidance on infant and parental factors to consider when making the decision to provide supplementation (eg, infant hypoglycemia, parental delayed secretory activation, primary glandular insufficiency).…”

“…ABM offers recommendations for total feed volumes based on infant age in the early postpartum period, with more general guidelines for supplementation volumes. 13 How to offer the supplement is another important point of discussion. Bottle-feeding is often the default choice, but there are other options.…”

“…These options may be helpful in maintaining or returning to direct chest/breastfeeding. 13 Supplemental nursing systems can be used for large-volume supplements and have the added benefit of allowing for breast and nipple stimulation during the feeding but may be perceived by parents as complicated.…”