How to fortify breast milk to 22 calories

Courtney Lee MS, RDN, CLT, CFCS

Fortifying breast milk has become a topic of interest for breastfeeding moms although the concept isn’t new. In the not-too-distant past, we were adding baby cereals to bottles and cutting open wider nipples for babies before bed to increase caloric intake. Healthcare providers know now that we shouldn’t be giving babies extra calories that way, but what is appropriate for increasing caloric intake for breast-fed babies?

Breast milk is the best source of nutrition for babies for many reasons. Breast milk has the perfect macronutrient profile to support baby’s nutrient needs, it’s easy to digest, and it passes mom’s immunity to baby. Breast milk is produced on demand — milk supply is directly related to how much baby is breastfeeding. Breast milk is the preferred milk for all babies — including those born prematurely and with medical conditions. If breast milk is so great, why would it need to be fortified?

Does Breast Milk Need To Be Fortified?

Actually, breast milk rarely does need to be fortified. It is rare for a breastfeeding mom to be unable to produce enough milk to support her baby’s growth or that the nutritional quality of the breast milk would need enhancement. The exceptions would be for vitamin D and iron.

Breastfed babies generally need a vitamin D supplement, and an iron supplement may be needed after six months of age in healthy babies. But when it comes to calories, needing fortification of breast milk is rare. The way to know if baby needs some extra calories is by his or her growth. If baby is growing, no supplementation is needed. If baby is not growing (according to your pediatrician), baby needs supplementation. This most often occurs in premature babies when they experience rapid growth spurts.

Breast Milk Fortifying Options

Fortifying breast milk is the first-line treatment for increasing calories in babies under six months of age. This allows the baby to still receive all the benefits of breast milk plus additional nutrients, as opposed to the exclusive use of formula first.

Commercially prepared human breast milk fortifiers are available in liquid and powder form. Breast milk can also be fortified by adding powdered formula to it and giving the combination in a bottle. It is not appropriate to use cow’s milk or other milk alternatives to fortify breast milk.

Remember, unless the pediatrician believes that a child’s growth is inadequate, breast milk typically doesn’t need to be fortified. If baby does need some additional nutrients, encourage moms not to give up on breastfeeding! It’s the best nutrition for baby. If fortification is needed, determine the best method for both mom and baby before switching to formula.

Want to learn more? Check out more resources for dietitians on this topic from Dietitians On Demand.

Are you a consumer looking for more pregnancy and breastfeeding nutrition information? Check out these courses from our new branch, Dietitians On Demand Direct:

• Nutrition During Breastfeeding
• Nutrition During Pregnancy (free!)
• First Foods for Baby

Courtney Lee, MS, RDN, CDN, CLT, CFCS consults locally with Dietitians On Demand and also has a virtual private practice, Kitchen Nutrition, LLC. Courtney enjoys equipping dietitians and dietetic interns with the tools they need for professional success so they don’t have to learn the hard way. Courtney enjoys baking, running, and hosting friends and family in her home.
Find her on Instagram @yourkitchennutrition.

Dietitians On Demand is a nationwide staffing and recruiting company for registered dietitians, specializing in short-term, temporary and permanent-hire positions in acute care, long term care and food service positions. We’re dedicated to dietitians and helping them enhance their practice and excel in the workplace. Check out our job openings, request your coverage, or visit our store today!

Before you make any changes to your baby’s diet, make sure to consult your child's pediatrician. 

Some babies need extra calories in less volume to help them grow. One way that parents can achieve this is to add formula to their breast milk in a bottle. Adding powdered formula to breast milk increases the number of calories per ounce. This is one of the easiest ways to get in some extra calories and you can keep giving your baby’s mothers milk. 

Please don’t give up on nursing! Breast milk is still the best nutrition for your baby. I know pumping can be really time consuming, but likely you won’t need to fortify every bottle and once you baby catches up on growth, you can stop fortifying the bottles.

Breast milk rarely needs to be fortified, but there are times that a baby isn’t meeting growth expectations, and fortifying milk is an easy way to get in some extra calories. Only use formula that is specifically made for babies to fortify breast milk and do not use cow's milk or other milk alternatives. Fortifying is not the same as supplementing or just mixing breast milk and formula. Fortifying should be carefully done to ensure that your baby is getting enough hydration.  

When warming your breast milk we recommend warming your milk first before adding the powdered formula. A bottle warmer like The Baby’s Brew is perfect for warming breast milk to the exact temperature you select. Most breastfed babies prefer a bottle that is heated to 98ºF which is body temperature. 

How to prepare a fortified bottle:

1. Wash hands thoroughly.
2. Warm breast milk to 98º using your Baby’s Brew Warmer.
3. Once the milk is warmed use a standard measuring spoon or the scoop provided to measure your powdered formula of choice.
4. To know how much formula you should use, you should consult your pediatrician to see how many extra calories your little one needs. Typically there are around 43 calories in a scoop of infant formula, so you likely will need less than a scoop depending on how much breast milk you are warming.
5. Once the formula amount is determined, add formula to warmed breast milk and gently shake the bottle to combine.
6. If you are not using a bottle warmer that heats to an exact temperature, make sure to test the temperature of the bottle before feeding it to your baby. On a side note, breast milk should never be heated over 104ºF.

As a reminder, infant formula can not be kept as long as breastmilk so make sure you discard it 1 hour after feeding. Please make sure to consult with your pediatrician to find out how much formula you should add to the breast milk bottle. 

Q&A 

How can I warm breastmilk? 

Take the guesswork out of warming your breastmilk by using The Baby’s Brew Portable Bottle Warmer! You don’t need to worry if your breastmilk will get too hot when you can set the temperature to the perfect temp! The Baby’s Brew will hold the temperature for up to 8 hours so you can always warm a little ahead of time so a bottle is ready in a moment's notice. Or it's just 5-10 minutes to a perfectly warmed bottle! 

How long do babies drink out of bottles?

The American Academy of Pediatrics (AAP) recommends fully weaning from the bottle by 15 months. Most dentists recommend starting weaning from a bottle to a sippy cup at 12 months. 

Do baby bottles actually need to be warmed?

It is not unsafe to give your baby a cold bottle, so no, it is not required that your baby’s bottle be warmed if they will take it cold. Most babies prefer warm milk, however. We suggest using a portable bottle warmer such as the Baby’s Brew for safe and convenient warming of breastmilk and formula baby bottles.

 Why would you need to fortify a bottle?

Some babies need extra calories in less volume to help them grow. Adding powdered formula to breast milk increases the number of calories per ounce. This is one of the easiest ways to get in some extra calories and you can keep giving your baby’s mothers milk. 

Written by: Kristen Bickel

Kristen is a mom of 4 and an employee at The Baby’s Brew.

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