Breast milk fortification is a specialized nutritional strategy designed to enhance the caloric and nutrient density of expressed human milk. Standard breast milk naturally contains about 20 calories per fluid ounce, which is generally adequate for healthy, full-term infants. However, certain vulnerable populations require a higher concentration to support rapid growth and development. The goal is typically to boost the milk’s energy content to 22 calories per ounce, a significant increase for a medically fragile infant. This precise adjustment is made by adding a concentrated supplement to the milk before feeding.
Understanding the Need for Fortification
Increasing the caloric density of human milk is a practice reserved for infants with specific medical needs, most commonly premature babies. Infants born prematurely often miss the final trimester of pregnancy, a period of intense nutrient transfer from the parent to the fetus, leading to lower nutrient stores at birth. These infants require a diet that supports rapid catch-up growth and development outside the womb. Unfortified breast milk may not supply sufficient amounts of protein, calcium, phosphorus, and overall calories for these high demands.
The primary purpose of fortification is to increase nutrient intake without requiring the baby to consume a larger volume of liquid. This is helpful for infants with fluid restrictions or those who cannot tolerate large feeds. Providing extra protein is necessary for building tissues and organs. Added calcium and phosphorus are incorporated to improve bone mineralization, helping to prevent osteopenia of prematurity.
Types of Human Milk Fortifiers
Two main product categories achieve the 22-calorie concentration: dedicated Human Milk Fortifiers (HMFs) and standard infant formula powders. HMFs are specifically engineered supplements that contain concentrated protein, carbohydrates, fat, vitamins, and minerals. These products are usually sold in small, pre-measured packets or in bulk powder form.
HMFs are often preferred because their nutritional composition is designed to complement the natural profile of human milk, providing the specific nutrients a preterm infant needs in higher quantities. Some specialized HMFs are bovine-based, derived from cow’s milk protein, while others are human milk-based. Alternatively, some healthcare providers may prescribe using a small, measured amount of standard infant formula powder to supplement the expressed breast milk. Regardless of the type, the fortifier must be dosed precisely according to a medical recipe to ensure the target caloric density is met.
Step-by-Step Guide for Mixing to 22 Calories
The process of fortifying breast milk requires meticulous attention to hygiene and measurement to ensure the milk is safe and the caloric goal is accurately achieved. Begin by thoroughly washing your hands and ensuring all equipment, including bottles, measuring tools, and the preparation surface, is clean. The breast milk should ideally be at room temperature or slightly warmer, as cold milk can cause the fortifier powder to clump, affecting accurate dosing.
Next, precisely measure the volume of expressed breast milk you intend to fortify using a clear, calibrated container. A common recipe using a dedicated Human Milk Fortifier requires adding one full packet of powder to a specific volume, such as 50 milliliters (1.7 fluid ounces) of breast milk. If using standard infant formula powder, a typical recipe is adding one-half teaspoon of powder for every three fluid ounces of breast milk. Use a standard measuring spoon and level the powder exactly, avoiding heaping scoops, as accuracy is paramount for nutritional delivery.
Once the fortifier is added, gently swirl or rotate the container between your palms to mix the ingredients thoroughly. Avoid vigorous shaking, as this can damage the delicate immune-boosting proteins and bioactive components in the breast milk. The powder should fully dissolve, leaving no visible clumps or residue. The fortified milk is then ready for immediate use or storage; note that the final volume will be slightly greater due to the added powder.
Handling, Storage, and Safety Guidelines
Breast milk fortification should only be undertaken after consultation with and under the supervision of a healthcare professional, such as a pediatrician or registered dietitian. This medical oversight ensures the fortification level is appropriate for the infant’s current growth needs and medical status. Once the milk is fortified, its shelf life is significantly reduced compared to unfortified expressed milk.
Fortified breast milk must be refrigerated immediately and used within 24 hours of preparation to minimize bacterial growth and nutrient degradation. Never freeze milk that has already been fortified, as this can alter the nutrient composition. When warming the fortified milk, always use a warm water bath or bottle warmer, and never use a microwave, which creates dangerous hot spots and destroys beneficial nutrients. Any fortified milk remaining after a feeding must be discarded within one hour.