Breastfeeding at home with Breast Milk Fortifier (BMF)

Information for parents and carers of babies leaving Stoke Mandeville Hospital Neonatal Unit under care of the Neonatal Outreach Team. It explains how to supplement breastmilk with breast milk fortifier.

Introduction

Your baby is being discharged home to continue receiving breast milk feeds with the addition of BMF supplements known as fortifier boosts. BMF contains cow’s milk protein, energy and a range of vitamins and minerals which will help support your baby’s growth for a short period after you leave hospital.

To begin with, your baby will need frequent breastfeeds, every 2-3 hours or at least 8 breastfeeds over a 24-hour period, this will include night feeds.

How to make the fortifier boost

Before you start, make sure your work surface is clean and dry.
Wash your hands with soap and water and dry them well.
Express breast milk using your usual method.
Measure 5-10mls of expressed breast milk into a sterile bottle.
If the breast milk is cold, warm it to body temperature by standing the bottle in warm water.
Add 2 sachets of breast milk fortifier to the breast milk.
Gently swirl the mixture (do not shake as this can destroy the properties of the milk) until the powder has dissolved.
Once the BMF is mixed with expressed breast milk it cannot be stored in the fridge and needs to be given to your baby straight away.
Opened sachets should be used immediately or discarded.
Expressed breast milk can be frozen and fortified after it’s been thoroughly defrosted. If frozen breast milk is used, gradually defrost it in a fridge (under 4 ºC). DO NOT use a microwave oven or allow it to defrost at room temperature.
Ensure you’ve mixed it thoroughly before you feed your baby.
Please follow guidance on how to safely sterilise feeding bottles and breastfeeding equipment: www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/sterilising-baby-bottles/

How to give fortifier boosts at home alongside breastfeeds

Give the fortifier boost via a bottle, cup or syringe orally before each full breastfeed, check the temperature of the boost on your wrist before feeding it to your baby.
Offer your baby a breast feed after they have taken the boost.
Continue with the fortifier boosts until the neonatal outreach team advise you to stop.

How to give your baby fortifier boosts via a cup

You will have been supported with cup feeding on the neonatal unit to ensure you feel comfortable with this feeding method at home.
The cup should never be more than two thirds full of milk.
Direct the lip of the cup towards your baby’s upper lip and gums, with it gently touching or resting on their lower lip (make sure you don’t apply any pressure to their lower lip).
This will gently stimulate your baby’s natural rooting reflex.
Slowly tip the cup so that the milk touches your baby’s lip and then wait. Your baby will then sniff the milk, push their tongue forward and start to lap or drink the milk.
Gently tip the cup as your baby drinks so the milk is always just on the rim of the cup.
Leave the cup in the correct position during the feed. Do not remove the cup when your baby has occasional pauses. Allow your baby to resume feeding when they are ready and let them set their own pace (follow your baby’s cues).

How to give your baby fortifier boosts by syringe

Draw up fortifier boosts into a sterile syringe.
Hold your baby in an upright position.
Slowly syringe 0.2mls at a time into your baby’s mouth.
Slowly squeeze the milk to the side of their gums and cheek or onto the front part of their tongue.
Let your baby swallow the fortifier boost before giving another 0.2mls.
Continue to do this until all the supplement has been given.

How to give fortifier boosts by bottle

Offer the fortifier boost via a bottle before feeds. Usually boosts will be given 4-6 times in 24 hours, please follow the plan made by the neonatal team.
Make sure you pace the bottle feeds and follow your baby’s feeding cues.
Follow this with a breastfeed or a full feed of expressed breast milk in a separate bottle depending on your chosen method of feeding.

Monitoring your baby’s growth

It’s important your baby is weighed regularly. If they continue to follow their growth line (centile) on their growth chart, you can be reassured they are drinking sufficient breast milk to promote healthy growth.

Please contact the neonatal outreach team via the phone number in your red book (or email Buc-tr.community-neonatal@nhs.net) if:

Your baby has been weighed by your health visitor and has been given an updated weight. This is so the outreach team has the most up to date information and can monitor your baby’s growth and contact you if necessary.
You’re having any problems with making or giving the fortifier boost.
You’re concerned your baby is not tolerating the fortifier boost.
Your baby is having fewer than 6 feeds in 24 hours.
Your baby has not gained any weight in a week (or has lost weight).

Additional information

Sachets of breast milk fortifier are only supplied by the Neonatal Outreach Team.
Sachets of breast milk fortifier should never be added to infant formula.
If you choose to give your baby formula while your baby still requires BMF supplements, please contact the outreach team for further advice.
If you have any questions or concerns, please speak to the neonatal team caring for your baby.