Medical Indications for Supplementation

Infants Who Should Not Receive Breast Milk

• Some inborn errors of metabolism e.g. galactosemia, maple syrup urine disease, phenylketonuria

Infant Conditions That May Require Supplementation

Infant conditions that may require supplementation for short periods of time, with continued breastfeeding:

• Birth weight < 1500 gms
• Gestation < 32 weeks
• At risk of hypoglycemia
• Significant weight loss >10% and the mother’s breast milk production is not established
• Birth weight not regained by 10 days after birth*
• Inadequate weight gain of less than:
  • 20 – 35g (2/3 – 1 1/4 oz) per day for the first 3-4 months of age (post lactogenesis)
  • 115 g/week for the first 2-4 months

*If an infant is monitored closely and begins to gain weight again within the 10 days, even if the birth weight has not been regained, it may be appropriate to wait another few days before prescribing supplements.

Medical Conditions That May Require Avoidance or Complete Cessation of Breastfeeding

• Severe illness such as sepsis, psychosis, eclampsia or shock that prevents a mother from caring for her infant
• HSV-1 direct contact between lesions on the mother’s breast and infant’s mouth should be avoided until active lesions near the nipple and areola resolve. The infant may continue to feed on the other breast if there are no lesions
• Maternal HIV – in developed countries
• Human T-lymphotropic virus
• Specific maternal medications (Breastfeeding Protocols for Health Care Providers, Protocol # 17, p.126)

Medical Conditions That Are of Concern But Breastfeeding May Continue

Maternal conditions during which breastfeeding can still continue but close monitoring and possible supplementation may be required:

• Delayed lactogenesis, 5 days or later (e.g. retained placenta, Sheehan syndrome)
• Breast abscess (breastfeeding should continue on unaffected breast; feeding on the affected breast can resume once treatment has started)
• Breast surgery or injury that results in insufficient breast milk supply
• Hepatitis B – infants should receive hepatitis B vaccine within 48 hours or as soon as possible after birth
• Hepatitis C – at this time there is no case of mother to baby transmission via breast milk
• Substance Use