Infant Formula: The "Supplement" Paradox
I'm an absolute stickler for language when it comes to infant feeding, and "supplement the baby" is one of those phrases that really creates conflict for me.
This isn't an article about supplementation of babies with infant formula, the reasons why it's sometimes necessary, or the science of how it affects babies and their parents. That's a story for another day.
For now, let's just look at the word "supplement". The Cambridge dictionary defines the noun as "something that is added to something else in order to improve it or complete it; something extra," while the verb is defined as "to add to something." There's a few different implications here: first, that a supplement makes something whole, and second, that a supplement improves something.
Is there any particular reason the word "supplement" is used to mean "give the baby some formula?" This is common in the United States, and that cannot be by chance. A quick Google search demonstrates that all infant formula manufacturers which are currently active in the U.S. use this term in their marketing.
So even though "supplement the baby" could be taken to mean "give the baby some expressed human milk or some donor milk or some infant formula," it is most often associated in our culture with feeding infant formula in addition to breastfeeding. To a new parent, the use of the word "supplement" generally implies that giving the baby formula makes breastfeeding better. After all, when we are deficient in a nutrient, we can take a - say it with me now - supplement.
Why are we using this word? It's not the right word for the situation. When a baby needs a supplement, that means they need more volume of the food they are taking. We can always be more specific in our conversation around this topic. It's important to helping parents understand the why of their need or choice to give their baby more food. Infant formula does not inherently make breastfeeding better. It is not a supplement in the way that most people understand a supplement to be - and that's because, in the end, this is actually an article about the why of supplementation and the reasons and the science. Infant formula is not better than human milk, it does not correct a deficiency (other than a lack of appropriate volume), and it does not make breastfeeding work better (as some research articles have actually implied.)
Infant formula is a substitute for human milk, best reserved for situations where it has been determined that a mother's own milk is not available and pasteurized donor human milk is not available. Should a baby in that situation require additional food, then safely-prepared infant formula would be the appropriate option for ensuring proper intake. This requires access to sanitary conditions as well as a clean water supply.
When we use the word "supplement" as a way of saying "give the baby formula," it is confusing and inaccurate. Parents may think that breastfeeding is not enough, or that feeding their baby only expressed breast milk does not provide the proper nutrients. This can lead to them being vulnerable to predatory infant formula marketing which makes incorrect and unproven claims about health.
Through consultation with an IBCLC©, a physician trained in breastfeeding medicine, or another appropriately qualified health care provider, it can be determined whether a baby requires more food than they are currently receiving. It is only in those situations that there is a medical indication to give a baby additional food, and the first way to do that is by improving the quality of breastfeeding as well as the frequency when possible. Let's not confuse parents with the word "supplement." Let's talk to them about what's actually happening, based on excellent clinical observation, and let's give them very specific instructions on how to proceed if additional feeding is needed. That's how we level the playing field and respect the value of breastfeeding and human milk feeding.