Transitioning from Formula to Breast Milk: Key Considerations for Infants

Issues with Switching from Formula to Breast Milk

Hello Dr.
Hsiao,
My baby is currently 2 months and 11 days old.
At birth, the weight was 3165g, and during the vaccination on February 13, the weight was 6.3kg, with a length of 59.1 cm and a head circumference of 39.7 cm.
Due to mastitis, I have been on antibiotics and had to pause breastfeeding for about 3 weeks.
I would like to switch my baby back to breast milk.
Previously, he was consuming about 150ml of formula per feeding, with approximately 5 to 6 feedings a day, occasionally sleeping longer and having only 4 feedings.
On the day I switched back to breast milk, I noticed a significant decrease in his intake; out of the 6 feedings, he only drank 90 to 120ml for 4 of them.
I would like to ask if the sudden decrease in milk intake after 3 weeks of formula is due to the baby not adapting, or if this switch could affect his gastrointestinal system? Should the transition be gradual? The baby shows no signs of discomfort; he just falls asleep while drinking and stops feeding, so I let him sleep.
(Previously, he would have a bowel movement about every 2 to 3 days with formula, but on the day I switched to breast milk, he had 2 bowel movements.)
Also, considering the baby's current weight, is the total daily milk intake sufficient? Thank you, doctor, for taking the time to respond.

Jocy, 30~39 year old female. Ask Date: 2017/02/19

Dr. Xiao Kaiwen reply Pediatrics

If the baby is experiencing gastrointestinal discomfort, it may result in diarrhea or the presence of rashes on the skin.
If the infant's activity level is normal, weight gain is appropriate, and the decreased appetite is not due to illness (such as gastroenteritis or enterovirus), it is considered a benign phase of milk aversion, and observation is sufficient; typically, it will resolve after some time.
Generally, the minimum total milk intake to prevent dehydration in infants is calculated as 100 cc per kilogram of body weight per day, but other factors, such as urine output, also need to be considered.

Reply Date: 2017/02/19

More Info

Transitioning from formula to breast milk can be a significant change for both the infant and the caregiver. In your case, your baby is currently 2 months and 11 days old and has been on formula for about three weeks due to a temporary interruption in breastfeeding caused by mastitis. Now that you are considering returning to breastfeeding, there are several factors to keep in mind.

First, it's important to understand that infants can have varying responses when transitioning between different types of milk. The fact that your baby is consuming less milk after switching back to breast milk could be attributed to several factors. One possibility is that the taste and consistency of breast milk differ from formula, which may lead to a temporary decrease in intake as your baby adjusts. Additionally, breast milk is digested more quickly than formula, which might explain why your baby seems to be drinking less but may still be getting adequate nutrition.

When transitioning back to breastfeeding, it is generally advisable to do so gradually. This means you might want to start by mixing breast milk with formula or gradually replacing one feeding at a time with breast milk. This approach allows your baby's digestive system to adjust and can help prevent any potential gastrointestinal discomfort. It also gives you the opportunity to monitor your baby's response to the change and ensure that they are still receiving enough nutrition.

Regarding your concern about your baby's total milk intake, at this age, the average daily intake of milk (whether breast milk or formula) is typically around 24 to 32 ounces (approximately 720 to 960 ml). Since your baby was previously consuming about 150 ml per feeding and now seems to be taking in less, it's essential to keep track of their overall intake throughout the day. If your baby is having fewer feedings but still appears satisfied and is producing an adequate number of wet diapers (usually around 6-8 per day), they may still be getting enough nutrition.

It's also worth noting that the frequency of bowel movements can vary widely among infants. The fact that your baby had two bowel movements on the day of the switch back to breast milk is not uncommon, as breast milk can sometimes stimulate more frequent bowel movements due to its natural laxative effect. As your baby continues to adjust, you may find that their bowel habits stabilize.

In summary, transitioning back to breast milk after a period of formula feeding can be done successfully with careful monitoring and gradual changes. Pay attention to your baby's cues, ensure they are hydrated and satisfied, and consult with your pediatrician if you have any concerns about their growth or feeding patterns. It's essential to maintain open communication with your healthcare provider, as they can offer personalized guidance based on your baby's specific needs and circumstances.

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