Human Milk Fortification: Myths & Facts

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Shreya gave birth to her baby 3 weeks before her due date. Her baby was a smaller than she had imagined and the doctors advised her to fortify her breastmilk. Until now, she had always believed that there was nothing better than her own breastmilk for her baby and so this news came as a bit of a shock. A lack of information made her question the quality of her own breastmilk.

There are a number of myths surrounding human milk fortification and it is important to be able to distinguish between myth and fact.

Myth: If you eat a healthy diet, you won’t need human milk fortification

Being advised to fortify your breastmilk does not mean that there is something wrong with your breastmilk. Unequivocally, mother’s milk is the best source of nutrition for a baby but the nutrient value for preterm milk and full-term milk differs. Often, based on the baby’s birth weight and gestational age, extra nutrition may be required. Unfortunately, since a baby’s tummy has a limited capacity, simply feeding him/her more milk is simply not a solution.
Human milk fortifiers contain a mix of essential nutrients such as proteins, calcium and phosphates that can help the baby gain weight, build stronger bones and help maturation of organs. Thus, they boost the overall nutrient value that the baby received per feed.

Myth: You can consider human milk fortification only if you are lactating properly

Many women who give birth to extremely premature babies find themselves unable to produce sufficient breastmilk in the first few weeks. This does not mean that cows milk-derived products such as infant formula are the only options. You can use donor milk along with human milk fortifiers to ensure your baby gets the adequate nutrition it needs. Donor milk refers to breastmilk that has been expressed, pasteurized and frozen by other lactating mothers having an excess supply of breastmilk.

Myth: All premature babies need fortified milk

Not all premature babies need fortified breastmilk. Typically, this is advised if your baby weighs less than 2500 grams at birth.

It may also be advised if your baby is born very prematurely with the risk of not being able to absorb the nutrients (typically absorbed during the last few weeks of pregnancy). In such cases, if you have not started lactating properly as yet, donor milk may be used in conjunction with the Human milk fortifier. If you have an extremely premature baby, giving him/her fortified donor breastmilk instead of cow’s milk products can help lower the risk of diseases such as necrotizing enterocolitis.

Myth: Once you start giving your baby fortified breastmilk, you cannot give your baby un-fortified breastmilk

There is no fixed timeline for the period your baby will need fortified breastmilk, but it usually stops when your baby has gained weight appropriate to its corrected gestational age. Based on the baby’s growth markers such as Height, Weight and Head circumference, your doctor will advise you on when you can stop fortifying your breastmilk and switch back to nursing your baby directly through breastfeeding.

In some cases, this may be required only while your baby is in the NICU while in others yourbaby may continue to need fortified milk even after they come home. Once you get an ‘all ok’ from the doctor, you can resume breastfeeding your baby.

Myth: You can add other flavoring agents along with the fortifier

Fortifiers must always be added to breast milk / donor milk in the recommended quantity. Do not add anything else to this – no water, sugar, or honey. The ratio of fortifier to breastmilk should also not be changed, unless advised to do so by the doctor.
After a few weeks of fortifying her breastmilk, Shreya’s doctor advised her to stop the fortifier and resume breastfeeding. Shreya followed her doctor’s advice and her baby soon began meeting his developmental milestones.

Human milk fortification has been clinically proven to be beneficial for many babies like Shreya’s. So, if your doctor advises, don’t hesitate to try it.

References:-
https://thewomens.r.worldssl.net/images/uploads/fact-sheets/Breast-milk-fortifier.pdf
http://www.adhb.govt.nz/newborn/Pamphlets/WhatisBreastMilkFortifierA42013.pdf
https://parenting.firstcry.com/articles/human-milk-fortifier-for-preterm-baby/
https://www.rchsd.org/programs-services/neonatology/parent-education/human-milk-fortifiers-for-preterm-infants/
https://www.stanfordchildrens.org/en/topic/default?id=adding-to-mothers-milk-90-P02333

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