When it comes to breastfeeding, it doesn’t have to be all or nothing. When parents hear their baby is losing more weight than most during the first few days of life, supplementing with formula can be a hard choice, as some mamas may worry it means they’re choosing not to breastfeed—but it doesn't.

A new study in the Journal of Pediatrics found opting to supplement with formula after first breastfeeding improves outcomes for infants and is tied to higher rates of breastfeeding in the coming months.

“Our research shows that in healthy newborns with pronounced weight loss, adding formula for a limited period did not interfere with breastfeeding,” says first author Valerie Flaherman, MD, an attending pediatrician at UCSF Benioff Children’s Hospital San Francisco and principal investigator for the study. “These results indicate that it may be time for guidelines to include specific guidance about which infants may benefit from supplementation until the mother’s milk comes in.”

For the study, researchers looked at 164 exclusively breastfed infants between one and three days old whose weight loss was in the 75th percentile or above. Half of the mothers began supplementing with syringe-fed formula for the next few days until their breastmilk came in. The other mothers continued exclusively breastfeeding.

By one week of age, a slightly higher rate of the supplemented babies were still breastfeeding.

As for the concern that supplementing limits the benefits for babies’ gut health, stool samples from both groups shows “no differences.” And, what’s more, the supplemented infants were less likely to be readmitted to the hospital within the first month of life due to hyperbilirubinemia, a condition sometimes caused by inadequate nutrition.

Current guidelines from organizations such as the American Academy of Pediatrics and the World Health Organization recommend exclusively breastfeeding. In light of these findings, Flaherman says she hopes these policies can be reexamined.

“The targeted use of a limited volume of syringe-fed formula may provide the best of both worlds: improved hydration in the first few days, with sustained breastfeeding over the first month,” she says.

And when it comes to parents making the best decisions for themselves, this is a reassuring sign that breastfeeding isn’t about being all in or all out. It’s just about feeding your baby.

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