Breastfeeding and Formula Feeding

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Quiz: Your Baby's First Year!

Breastfeeding facts

  • The ability of the breasts to produce milk diminishes soon after childbirth without the stimulation of breastfeeding.
  • Infants triple their total body weight during their first year of life.
  • The immunity factors in breast milk can help the baby to fight off infections.
  • Breast milk contains vitamins, minerals, and enzymes which aid the baby's digestion.
  • Breast milk is the ideal form of nutrition for infants.
  • Breastfeeding mothers return to their prepregnancy weight faster than those who do not breastfeed.
  • Breastfeeding reduces mothers' risk for breast and ovarian cancer.
  • Many problems associated with breastfeeding can be overcome.

Many important concerns arises upon confirmation of pregnancy. Certainly one of the important ones is "How will we feed our baby?" In this article, we will review advantages and disadvantages of breast and formula feeding and helpful concepts in preparation for breastfeeding. This article is intended to help parents feel comfortable in making an educated decision about feeding their child based on scientific information.

When should we decide about breastfeeding?

Generally, it is a good idea to meet with the baby's doctor prior to the birth in order for all to get to know each other in a controlled, non-rushed, quiet environment. This is a perfect opportunity to discuss your concerns and wishes about feeding your baby. One important reason to have the decision to breastfeed made before the delivery is that it can be very difficult or even impossible to start using formula and then later try to switch to breastfeeding. This is because the ability of the breasts to produce milk diminishes soon after childbirth without the stimulation of breastfeeding.

Why is the choice so important?

During your baby's first year of life, he/she will more than triple his/her total body weight, and the vast majority of this weight gain will come from the milk that he/she drinks. According to the American Academy of Pediatrics, human milk is the preferred feeding for all infants. This includes premature and sick newborns, with rare exceptions. Of course, breast milk would appear to be the most ideal food for your newborn. It is the food least likely to cause allergic reactions, it is inexpensive, it is readily available at any hour of the day or night; babies accept the taste readily; and the immunity factors in breast milk can help the baby fight off some infections.

Although breast milk is the ideal food for human infants, because of medical or other reasons, some women opt for formula feeding. Infant formulas have been developed to artificially duplicate human milk, although no formulas have been developed that are an exact replacement for human milk.

Quick GuideBaby's First Year: Month to Month Development Milestones

Baby's First Year: Month to Month Development Milestones
What's the best way to wean a baby?

Signs to Wean Your Baby

First be sure to check with your child's pediatrician before weaning off formula or weaning breastfeeding.

The following are signs it's time for weaning a baby:

  • The baby wants to breastfeed or drink formula often.
  • The baby has doubled his birth weight.
  • The baby seems interested in solid food you're eating.
  • The baby mouths his hands and toys.
  • The baby opens his mouth when he sees others eating.
  • The baby can sit without support.
  • The baby can hold his head upright and steady (this shows swallowing muscles are strong).

What are the disadvantages and benefits of breastfeeding?

The nutritional advantages of breast milk are certainly numerous. The amino acids in breast milk, the building blocks of proteins, are well balanced for the human baby, as are the sugars (primarily lactose) and fats. The baby's intestinal tract is best aided in its digestion by the vitamins, enzymes, and minerals found in breast milk. Breast milk also contains infection-fighting antibodies from the mother, and breastfed babies are believed to be at a reduced risk for many acute and chronic infections early in life. The cholesterol content is also high in human milk and very low in formulas. Cholesterol promotes brain growth and provides the building blocks of hormones, vitamin D, and intestinal bile.

Breast milk is also the least expensive way to feed an infant. However, the mother must maintain good nutrition and continue taking any vitamin/mineral supplements her doctor recommended during the pregnancy.

Formula-fed babies may also have the risk of developing an allergy to a particular formula. When a baby develops an allergy to formula, he or she may have symptoms that include irritability, crying after feedings, nausea, vomiting, diarrhea, or a skin rash. Concerns that your baby is having a formula allergy should be discussed with your baby's doctor.

Nursing helps most women lose weight (though not fluid) after delivery, as 500 calories or more are used by breastfeeding each day. Women who breastfeed also have a reduced risk for postpartum bleeding and a reduced risk for ovarian and breast cancer in the future.

Breastfeeding facilitates bonding between mother and baby. There is a well-accepted extra closeness that breastfeeding mothers experience that is both hormonal and emotional in nature.

The only disadvantages for the baby in breastfeeding occur when things are not going well, for example, if there's an inadequate supply of breast milk or an inefficient suck reflex in the baby. However, it is unusual for a mother not to produce enough milk for her baby unless she is not breastfeeding correctly or frequently enough. The disadvantages that most commonly arise involve the rest of the family. Siblings and dad often feel "left out" of baby care since mom is the only one who can do the nursing. However, other family members can be involved in helping with different aspects of the baby's care, and this gives them a valuable feeling of importance and allows mom a chance to rest.

Breastfed babies eat more often than formula-fed babies since breast milk is more quickly digested and leaves the stomach empty more frequently. This puts a little more stress on the mother because of the potential necessity for more frequent feedings. If the mother develops certain medical conditions, whether or not to continue breastfeeding may need to be reassessed. These conditions should always be discussed with the doctor. However, it is rare that breastfeeding would need to be discontinued completely. In any interaction, the mother's doctor and/or pharmacist should be informed that she is breastfeeding. Some medicines should be avoided during breastfeeding. Numerous other medications have not yet been adequately studied in the context of breastfeeding and the possible effects on the baby. If a breastfeeding mother is required to take a medication which has not been fully studied, she may want to consider discussing this matter with her doctor.

What are the advantages and disadvantages of formula feeding?

For some parents, or when the baby has certain medical conditions, it is very important to know exactly how much their baby is receiving at each feeding, and formula/bottle-feeding allows exact measurement. Foods, medications, or physical conditions in the mother are no longer a concern for the baby who is receiving formula. The entire family can immediately become intimately involved in all aspects of the baby's care, including feedings, allowing the mother to get more rest. Formula-fed babies actually need to eat somewhat less often since formula is less readily digested by the baby than human milk. The disadvantages of formulas are primarily their expense, the lack of maternal infection-fighting antibodies that are in breast milk, and the fact that no formula can exactly duplicate the ideal composition of breast milk.

Can we use both forms of feedings for our baby?

According to the American Academy of Pediatrics, exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first six months after birth. Furthermore, it is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired. Infants weaned before 12 months of age should not receive cow's milk feedings but should receive iron-fortified infant formula.

Supplementing breastfeeding with formula is usually discouraged, although it may be helpful in cases where the mother is not producing an adequate supply of milk or the baby is not able to breastfeed well.

Lactation aids are also available as an option to avoid using a bottle when supplementation is necessary.

Is there any special preparation required for breastfeeding?

Education about the benefits and practice of breastfeeding are keys to optimal preparation. Your local hospital may offer breastfeeding classes as part of the childbirth class, or you can join your local La Leche League or other breastfeeding support group. These classes can put you in touch with a lactation specialist who may later be your personal breastfeeding consultant. These classes can also help you to learn proper positioning and latch-on techniques.

Contrary to some popular beliefs, it is not necessary to stimulate or prepare the nipples in advance for breastfeeding. Moreover, some techniques of stimulating the nipples may actually be harmful.

No specific physical preparation is necessary for optimal breastfeeding, although some doctors may want to know about things like inverted nipples or previous breast surgery even before the baby is born. General good health measures and adequate hydration are helpful measures. Most doctors recommend continuing basic prenatal vitamins while breastfeeding.

Quick GuideBaby's First Year: Month to Month Development Milestones

Baby's First Year: Month to Month Development Milestones

When can breastfeeding begin?

Breastfeeding can begin within minutes after birth for most babies. Most babies take a few licks or sucks and then pause at the beginning. Frequent bursts of sucking interrupted by pauses is the usual pattern for the first few hours and sometimes even the first few days.

The first milk the mother produces, called colostrum, is the best food for a newborn. The nipple stimulation that occurs during breastfeeding also helps the uterus contract and can help stop uterine bleeding.

When a baby begins to open its eyes, look around, and put his or her fist into his or her mouth, then it is time to offer your breast. Breastfeeding experts recommend that the baby not be given sugar water or other types of bottle feedings in the hospital unless specifically prescribed by the doctor. Some experts recommend not starting a pacifier until good breastfeeding is established.

What is the proper technique for breastfeeding?

Observing other breastfeeding mothers and talking with breastfeeding support organizations can help new breastfeeding mothers learn techniques for optimal breastfeeding that can help reduce the likelihood of any discomfort or complications. These techniques are briefly outlined below.

After the mother has assumed a position comfortable for her, she can nestle the baby in a cradle hold (cradling the baby with the mother's arm on the same side as the breast being presented). The baby's body should be on its side, so that the baby does not have to turn his or her head to reach the nipple.

  1. First, manually express a few drops of milk to moisten the nipple.
  2. Cup the breast with your hand and using the milk-moistened nipple, gently massage baby's lips, encouraging the baby to open its mouth.
  3. When the baby's mouth is opened, the nipple is inserted into the center of the baby's mouth while pulling the baby in very close. The baby's gums should take in at least a 1-inch radius of the areola.
  4. The mother may have to make adjustments for the baby's breathing by changing the angle of baby's position slightly or using the thumb to press gently on the breast to uncover the baby's nose.
  5. Hold the breast throughout the feeding so the weight of your breast does not tire your newborn's mouth.
  6. When feeding is over, to avoid trauma to your nipples, do not pull your nipple from baby's mouth without first breaking the suction by inserting your finger into the corner of baby's mouth.

When should breast pumps be used?

Many women find the convenience of a breast pump to be an invaluable aid in breastfeeding. Basically, breast pumps allow the nursing mother to expel (and store, if desired) breast milk at times when she is not available to nurse the baby.

There are different types of breast pumps. Large, dual-action pumps are typically used in the hospital setting and may be rented for home use. The options for personal use and purchase include automatic models that are comparable to hospital-grade pumps, small electric or battery-operated units that double- or single-pump, and one-handed manual pumps.

Breast pumps may be useful for working mothers who wish to provide a supply of breast milk for their newborn and keep up their own milk production. Sometimes, women must stop breastfeeding on a temporary basis due to an infection or need to take certain medications. In these cases, use of a breast pump can keep milk production active during the breastfeeding hiatus.

Should certain foods be avoided while breastfeeding?

Some babies appear to be sensitive to certain foods in the mother's diet, while other babies never appear to have negative reactions to foods. A baby may become fussy, may have trouble sleeping, or may develop gas after the mother eats certain types of foods with strong flavors. Some of the most common triggers of fussiness in babies include chocolate, spices, citrus fruits, and gas-causing vegetables like cauliflower, cabbage, and broccoli. However, not all babies will have a reaction to particular foods.

Most experts recommend limiting consumption of caffeine while breastfeeding, since high levels of caffeine can make the baby fussy or disturb the baby's sleep patterns. Having more than one alcoholic beverage is also not recommended, since two or more alcoholic beverages at one time can increase blood alcohol levels to a point where the alcohol enters the breast milk. If a nursing mother consumes more than two drinks, she should wait at least two hours until nursing the baby to allow for elimination of alcohol from the body. If the breasts become engorged, it is fine to pump and discard breast milk while waiting. Studies have also shown that alcohol can interfere with the body's ability to "let down" (enable the free flow of breast milk) during breastfeeding.

Symptoms of allergy in a nursing baby may or may not be due to something eaten by the mother. If an allergic reaction to mother's food is present in the baby, it usually develops two to six hours after the mother consumed the offending food.

Because of concerns about mercury poisoning, the U.S. Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) recommend that nursing mothers limit their exposure to mercury in fish. The FDA and EPA advise eating no more than 6 oz. (about one serving) of canned albacore or "white" tuna a week and limiting intake of canned "light" tuna and other cooked fish to about 12 oz. (about two servings) per week. Nursing mothers should completely avoid eating shark, swordfish, king mackerel, and tilefish (also called golden or white snapper) because of potentially high levels of mercury.

Quick GuideBaby's First Year: Month to Month Development Milestones

Baby's First Year: Month to Month Development Milestones

Clogged milk ducts

Clogged milk ducts may appear as small, red, tender lumps within the breast. Milk ducts may become clogged with dried milk or other material. The goal of treatment is opening these blocked ducts. This can be aided by increasing the breastfeeding frequency and offering the affected breast first, as well as pumping the breast after breastfeeding if the baby is not emptying the breast.

Moist heat packs can be applied to the affected area to increase blood flow and healing. A warm shower and massaging of the area may also enhance resolution of this problem.

Sometimes, the baby will refuse the affected breast because the milk develops a sour taste. Pump the breast and empty it as well as possible. Continue to offer that breast to the baby until he/she accepts the affected breast again.

Sore nipples

Sore nipples can be relieved by exposing the nipples to the air as much as possible. Using a hair dryer on a low setting to dry nipples after breastfeeding may also provide relief. Nipples should be washed only with water, never with soap, alcohol, benzoin, or premoistened towelettes. Petroleum-based ointments and other cosmetic preparations should not be used, but unmedicated lanolin may help alleviate nipple cracking.

When should one seek medical care for problems with breastfeeding?

It is important to call your health-care provider if the above techniques do not alleviate the problem or if you develop serious symptoms such as fever or signs of mastitis (a breast inflammation that may be caused by an infection). Symptoms of mastitis include increasing pain in the breast, fever, chills, sweats, breast swelling and/or hardness, and redness of the skin over the affected area. A delay in treating mastitis could lead to a more severe infection and possible breast abscess.

Can supplements or medications increase a low milk supply?

Most experts agree that increasing the number of feedings and receiving coaching and assistance on proper breastfeeding technique can help increase what is perceived to be a low milk supply. Some women find that using breast pumps after each feeding stimulates milk production because of the increased degrees of emptying of the breast.

Medications that are reported to increase milk production are known as galactogogues. The most common examples are dopamine receptor antagonists (such as metoclopramide [Reglan, Reglan ODT, Metozol ODT, Octamide] and domperidone). However, there have been no data to demonstrate that these drugs are more effective than interventions that focus on improving breastfeeding technique and increasing breastfeeding frequency. Most doctors do not support the use of these medications to augment milk supply.

Although a number of dietary supplements and/or herbal preparations have been claimed to stimulate milk production, including alfalfa, fenugreek, or blessed thistle, there is no scientific data to support the claims that any herbal or dietary supplement can increase milk production.

Is it possible to breastfeed while pregnant?

While breastfeeding typically is associated with a decrease in fertility, it is possible to become pregnant while breastfeeding, and breastfeeding does not afford 100% protection from pregnancy. For most women, it is safe to continue breastfeeding if they desire, provided they ensure that they are receiving adequate nutrition and fluid intake. While breast milk from a pregnant mother is still nutritionally strong, the hormonal changes of pregnancy will result in some changes in the content of the breast milk and the way the breast milk tastes.

Some women who have had premature labor in previous pregnancies may be advised to stop breastfeeding if they become pregnant. This is because the stimulation of the nipples that occurs during breastfeeding may trigger contractions of the uterus. In a woman prone to preterm labor, these weak uterine contractions might increase her risk of developing preterm labor. Both pregnancy and breastfeeding place high demands on the body in terms of nutritional support and rest. Other women may be advised to stop breastfeeding during pregnancy if their nutritional status is poor or if they are suffering from extreme fatigue due to the pregnancy. These decisions should be made with advice from the mother's doctor.

Is smoking harmful when breastfeeding?

Tobacco smoking is always harmful, and all mothers should be encouraged to quit smoking prior to pregnancy and breastfeeding. However, smoking cigarettes is not considered to be a reason for not breastfeeding, since breastfeeding is the optimal nutrition for newborns. According to the American Academy of Pediatrics' policy statement on breastfeeding, "tobacco smoking by mothers is not a contraindication to breastfeeding, but health-care professionals should advise all tobacco-using mothers to avoid smoking within the home and to make every effort to wean themselves from tobacco as rapidly as possible."

Nursing mothers should understand that nicotine is passed to the baby in breast milk, and they should never nurse their baby immediately after smoking or while smoking. Babies exposed to secondhand smoke also are at risk for a number of health issues, so if a woman smokes, she should nurse her baby after smoking, in a room away from cigarette smoke. Of course, the safest policy for both mother and baby is to abstain from tobacco use while breastfeeding and forever thereafter.

Do breast implants, surgeries, or reductions affect breastfeeding?

Strictly speaking, neither breast augmentation surgery nor breast reduction surgery are indications that a woman should not breastfeed. However, all types of breast surgery can interfere with milk production. In women who have received implants, the location of the implant and the type of incision used in the procedure will determine the extent, if any, to which the implant may affect breast milk production or nursing ability. In some cases, operations on a woman's breast may have involved incisions in the nipple area (such as surgeries for biopsies), and in these cases, the milk ducts may have been disrupted. Surgical disruption of milk ducts and scar tissue may also predispose women to plugged ducts, mastitis, or milk retention cysts during breastfeeding.

Concerns have been expressed in the past that the content of breast implants (particularly with silicone implants) could leak out and be absorbed into breast milk, but studies have failed to show that this is a risk. Ideally, a woman who is planning breast surgery should discuss in advance with her surgeon the risks that the procedure may pose to future breastfeeding.

How should one wean a baby from breastfeeding?

Weaning is the process of transitioning from breastfeeding to other sources of nourishment. There are no established standards on when to wean a baby, although the American Academy of Pediatrics recommends that babies receive only breast milk for the first six months of life and a combination of solid foods and breast milk until the baby is at least 1 year old.

Sometimes babies will signal their mothers that it is time to begin weaning; they may nurse for shorter periods of time or appear indifferent, fussy, or distractible when nursing. Other babies may even be resistant to weaning even when the mother is ready. As babies begin to eat more solid foods, their consumption of breast milk may decrease, making breast engorgement less of a problem for the mother.

Weaning does not have to take place all at once. For example, a woman may choose to continue breastfeeding only in the evening, and to wean during the day. Weaning is also easier when the baby has been exposed to another source of milk, such as taking breast milk from a bottle.

No matter when weaning occurs, experts suggest that the process take place gradually. Many women wean by dropping one breastfeeding session a week. Slowing down the process can also help milk production gradually decrease, making engorgement less of a problem. Some mothers prefer to leave the weaning process up to the child; when a child is eating solid foods at every meal, there is often a decreased interest in breastfeeding.

REFERENCES:

American Academy of Pediatrics. "AAP Policy on Breastfeeding." <https://www2.aap.org/breastfeeding/policyonbreastfeeding.Html>.

United States. Centers for Disease Control and Prevention. "Breastfeeding." Aug. 22, 2016. <https://www.cdc.gov/breastfeeding/>.

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Reviewed on 8/26/2016
References
REFERENCES:

American Academy of Pediatrics. "AAP Policy on Breastfeeding." <https://www2.aap.org/breastfeeding/policyonbreastfeeding.Html>.

United States. Centers for Disease Control and Prevention. "Breastfeeding." Aug. 22, 2016. <https://www.cdc.gov/breastfeeding/>.

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