How do I counsel a patient who is only able to breastfeed (BF) 20% of the time and needs to supplement with formula 80% of the time, and is feeling disappointed about not being able to provide full benefits of breastfeeding to her baby?

Counseling a Mother About Partial Breastfeeding Benefits

Any amount of breastfeeding, even just 20% of feedings, provides significant health benefits to your baby compared to no breastfeeding at all. 1, 2

Benefits of Partial Breastfeeding

Partial breastfeeding offers numerous advantages over exclusive formula feeding:

• Dose-Response Relationship: The benefits of breastfeeding follow a dose-response pattern - more is better, but some is significantly better than none 1
• Immunological Protection: Even small amounts of breast milk provide protective antibodies and immunoglobulins that formula cannot offer 1
• Reduced Infection Risk: Partially breastfed infants have lower rates of respiratory infections and gastrointestinal illnesses compared to exclusively formula-fed infants 1
• Continued Bonding: Maintaining the breastfeeding relationship preserves the important skin-to-skin contact and bonding time 2

Scientific Evidence Supporting Partial Breastfeeding

The American Academy of Pediatrics (AAP) recognizes that:

• Exclusive breastfeeding for 6 months is ideal, but partial breastfeeding still provides significant benefits 1, 2
• Any breastfeeding is associated with reduced rates of otitis media, respiratory infections, and gastrointestinal illnesses 1
• Mothers who cannot exclusively breastfeed "need special support to overcome the disappointment that may accompany breastfeeding difficulties" 1

Practical Counseling Approach

When counseling this mother:

1. Validate Her Feelings: Acknowledge her disappointment while emphasizing the significant value of her current efforts

2. Reframe the Situation: Help her see that she is providing important benefits rather than focusing on what she cannot provide

3. Optimize Current Production:

   • Ensure efficient milk removal during breastfeeding sessions
   • Consider power pumping to potentially increase supply
   • Maintain consistent breastfeeding/pumping schedule to preserve current supply

4. Maximize Benefits of Limited Breast Milk:

   • Time breastfeeding sessions strategically (morning when supply is highest)
   • Consider using expressed milk for one additional feeding
   • Ensure proper storage of expressed milk to preserve nutritional components

Important Considerations

• Vitamin D Supplementation: All partially breastfed infants should receive vitamin D supplementation of 400 IU daily 1

• Formula Selection: When supplementing, choose an appropriate formula that meets nutritional needs

• Avoid Guilt: Emphasize that her 20% contribution is valuable and worth continuing

Common Pitfalls to Avoid

• All-or-Nothing Thinking: Avoid suggesting that only exclusive breastfeeding has value

• Unrealistic Expectations: Don't set unreasonable goals for increasing supply that may lead to further disappointment

• Overlooking Emotional Impact: Address the emotional aspects of her experience, not just the physical ones

Remember that the AAP states that "exclusive or any breastfeeding is not always possible, despite the best of intentions, and these mothers and families need special support to overcome the disappointment that may accompany breastfeeding difficulties." 1

By providing accurate information about the benefits of partial breastfeeding and emotional support, you can help this mother feel proud of her contribution to her baby's health rather than disappointed about not meeting an idealized standard.