18/10/2026
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“Your baby has lost more than 10%. We need to start top-ups.”
I hear this so often: a baby crosses a weight-loss threshold, a top-up protocol kicks in, and suddenly parents are questioning whether breastfeeding is working.
But for an otherwise healthy term newborn, more than 10% weight loss should trigger a thorough assessment and skilled breastfeeding support, rather than automatic supplementation.
The Academy of Breastfeeding Medicine’s Protocol #3 states:
“Ten per cent weight loss is not an automatic marker for the need for supplementation but is an indicator for infant evaluation.”
Why does this distinction matter?
Unnecessary top-ups can mean less feeding at the breast and less breast stimulation, which can reduce milk production. They can also undermine a mother’s confidence. Early formula supplementation is associated with shorter breastfeeding duration. And there is emerging evidence that it increases food allergies. (Bhasin et al. 2026)
A recommendation intended to help can therefore make breastfeeding harder, particularly when the underlying difficulty hasn’t been addressed.
And has anyone asked about IV fluids during labour or birth?
Fluids given to mum through a drip may also affect the baby’s fluid balance. Some babies may carry extra fluid when their birth weight is recorded, then pass it as urine after birth.
That temporarily higher starting weight can make the percentage lost afterwards look larger. Some early weight loss may therefore reflect fluid shifts, rather than insufficient milk intake.
Parents deserve more than a top-up instruction.
They deserve someone with breastfeeding expertise to watch a feed, assess milk transfer, consider baby’s age, nappies and overall wellbeing, and provide practical help.
When extra milk is needed, the plan should also support milk production, address feeding difficulties and include follow-up.
You can ask:
💬 “What, alongside the weight loss, suggests my baby needs extra milk?”
💬 “Have the IV fluids I received been considered?”
💬 “Can someone with breastfeeding expertise watch a full feed?”
💬 “If top-ups are needed, how will you help me protect my supply, and when will you review them?”
If you followed advice to supplement, you did what you believed was best for your baby. The responsibility sits with services to provide thorough assessment, clear explanations and skilled support.
Hospital protocols should protect babies while supporting breastfeeding. A percentage should prompt us to investigate, rather than automatically determine the top-up feeding plan.
Save this for your birth preparation, or share it with someone supporting new parents.
Reference: Academy of Breastfeeding Medicine, Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate (2017).
Bhasin M, Cooper M, Macchiaverni P, Joys RS, O'Sullivan TA, Keelan JA, Venter C, Palmer DJ, Lowe AJ, Prescott SL, Silva D, Verhasselt V. Colostrum as a Protective Factor Against Peanut Allergy: Evidence From a Birth Cohort. Allergy. 2026 Feb;81(2):552-562. doi: 10.1111/all.70043. Epub 2025 Sep 18. PMID: 40968490; PMCID: PMC12862506.
