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In the breastfeeding vs. formula debate, experts say breastfeeding is the optimal way to feed a baby. Breastfeeding has many health benefits for babies and mothers. Formula provides balanced nutrition for infants and is convenient for feedings, but it can be expensive, and it may come with fewer benefits and more side effects.
When comparing formula feeding to breastfeeding, experts agree that breastfeeding is the preferred choice for infant feeding and nutrition. The American Academy of Pediatrics (AAP) recommends that infants be breastfed exclusively for at least six months and then transitioned to breastfeeding with complementary foods for at least the first year.
The World Health Organization (WHO) echoes the AAP’s sentiment. According to WHO, breast milk is clean and safe, and it helps support a healthy immune system. Breast milk has also been shown to provide future developmental benefits for children and helps them to stay healthier as they age.
There are some instances when a mother may have to choose to feed a baby with formula, though a true medical contraindication to breastfeeding is uncommon, according to the AAP. These include HIV infection in the mother or a condition called galactosemia in infants. In other cases, mothers who are taking medications or have other medical issues may not be able to breastfeed. More often, mothers may have other reasons they choose not to breastfeed.
Babies born prematurely or babies with difficulty thriving may have special dietary needs. In these cases, a pediatrician may recommend baby formula feeding or supplementing breast milk with formula.
“Breastfeeding is the healthiest way to feed a baby, and it provides great benefits for the mother as well. However, certain reasons exist that make formula feeding a necessary alternative. If you choose to feed your baby with formula, be sure to coordinate with your child’s pediatrician on how to select the best formula option for your baby.” - Jennie Stanford, M.D., FAAFP, DipABOM (Family Physician & Obesity Medicine Specialist)
Breastfeeding Advantages
Research has shown breastfeeding has several advantages for both the infant and mother. Babies who are breastfed have a decreased risk of several childhood illnesses, which may last into adulthood. Breastfed children also perform better in intelligence tests, according to WHO.
A mother’s breast milk changes specifically for the baby’s needs as it grows, and a premature baby’s mother’s milk contains extra nutrition for at least the first few weeks. Even donor breast milk can provide many of the same benefits as the mother’s milk.
Breastfeeding may decrease a baby’s risk of these conditions:
Asthma
Atopic dermatitis
Being overweight or obese
Celiac disease
Crohn’s disease
Diabetes
Diarrhea
Ear infections, specifically otitis media
Late-onset sepsis in babies born prematurely
Leukemia
Necrotizing enterocolitis (NEC)
Respiratory tract infection
Sudden infant death syndrome (SIDS)
Ulcerative colitis
Mothers also benefit from breastfeeding their children. Breastfeeding lowers a mother’s risk of ovarian cancer, breast cancer, Type 2 diabetes and high blood pressure, according to the Centers for Disease Control and Prevention. Breastfeeding has also been shown to help mothers achieve a healthy weight after pregnancy.
In addition, the AAP says breastfeeding may decrease the risk of rheumatoid arthritis and excessive menstrual blood loss. Be sure to check with your medical provider for more health information on breastfeeding.
Breastfeeding Challenges
While breastfeeding is the recommended way to feed babies, breastfeeding challenges, such as the baby’s health or medical conditions of the mother, may make it difficult or impossible to breastfeed. Breastfeeding may also cause uncomfortable issues, such as fungal infections, nipple soreness, or mastitis.
Premature babies may have a difficult time breastfeeding because being underdeveloped makes it harder for them to coordinate suck, swallow and breathe actions. They may also need more nutrients that those occurring naturally in breast milk. In these cases, your preemie’s doctor may recommend supplementing breast milk with preemie formula or exclusive formula feeding.
“A small number of mothers are not able to breastfeed. This can be hard to accept, but it does not make you a bad mom. Infant formula is still a healthy choice, and your baby will get all the necessary nutrients.” Source: National Library of Medicine
Mothers taking certain medications shouldn’t breastfeed. For example, breastfeeding is contraindicated for mothers going through chemotherapy. Make sure to tell your doctor if you are taking any medications if you and plan to breastfeed to make sure it’s safe to do so. The National Library of Medicine provides a drug database for breastfeeding safety.
Other challenges include low milk supply, engorged breasts, plugged milk ducts, fatigue, heavy time commitment, feelings of sadness or depression and dealing with the judgement of others who may not support breastfeeding. Seek help from your medical provider or check out resources from the Office on Women’s Health for common problems and solutions.
“In addition to the primary care pediatrician, lactation experts can be largely helpful in assisting mothers and babies who have challenges with breastfeeding.” - Steven Powell, MSN, APRN, NP-C (Board-Certified Family Nurse Practitioner)
Baby Formula Advantages
Baby formula advantages include convenience and the ability to tailor nutrition for individual babies. Formula also provides an alternative way to nourish a baby if breastfeeding is not recommended by a medical provider. Lactose-free formula and hypoallergenic formula are available for babies with special needs.
Mothers who need to pause breastfeeding because of medications, illness or surgeries can use formula to feed their babies. Using baby formula may also help preemies with catch-up growth. Studies have shown that preemie formula can help premature babies achieve short-term growth and weight gain.
While breastfeeding is the preferred choice, baby formula is still a nutritionally balanced way to feed your baby. All commercial formulas for sale in the U.S. must adhere to the FDA’s guidelines for nutrition. Experts do not recommend trying to make homemade baby formula, especially from recipes you find online. Babies who consume homemade formula run the risk of being nutritionally deficient, experiencing dangerous electrolyte imbalances, and contracting infections.
Formula feeding allows others to help feed the baby and gives mothers precious time to rest, recover or get more sleep. Formula-fed babies may feed fewer times a day because formula takes longer to digest. Before switching baby formulas, be sure to check with your child’s pediatrician.
Baby Formula Disadvantages
Baby formula disadvantages include its cost, inability to provide antibodies and immune support to babies, and baby formula side effects.
Formula feeding is expensive. It can cost between $800 and $2,800 a year. With inflation, this figure could be higher. Brand-name formulas that babies are given at the hospital can be as much as 66% more expensive that store brands, but mothers are most likely to stick with the brand they know. Baby formula recalls may also cause extra stress because of formula shortages.
Babies who aren’t breastfed miss out on the unique immune and cognitive development benefits breast milk gives them. This includes antibodies and other health protections from breast milk. And while baby formula side effects are typically limited to mild digestive issues, some health risks may be serious or even fatal.
Preemies fed cow’s milk baby formula have a higher risk of a serious digestive disorder called necrotizing enterocolitis than preemies whose main diet is breast milk, and NEC can be fatal. According to one of the first NEC studies published in the Lancet, NEC was 6 to 10 times more common in exclusively formula-fed babies than in babies fed breast milk alone. Parents whose babies became ill with or died from NEC have filed baby formula lawsuits against the makers of Similac and Enfamil.
Lawsuit Information
Lawsuits are being filed by parents whose children were diagnosed with necrotizing enterocolitis (NEC) after consuming cow's milk-based formula. Learn more.
Supplemental Feeding
Doctors may recommend supplemental feeding if a mother can’t exclusively breastfeed or if a baby requires extra vitamins and minerals in addition to what breast milk provides. Premature babies often need supplemental feeding to help them catch up in growth.
According to Nemours KidsHealth, after a baby learns to breastfeed, a mother can introduce formula through a small tube placed by her nipple. Babies should be at least 3 to 4 weeks old before introducing artificial nipples.
While at the hospital and eventually when they come home, preemies may receive human milk fortifiers to add extra vitamins and minerals to their mother’s milk. Preemies may have to be fed through a tube in their stomach while in the hospital and slowly taught to breastfeed after.
Be sure to ask your medical provider for tips on how to introduce your baby to supplemental feeding and weaning your baby off breast milk.
Author: Jennie Stanford, M.D., FAAFP, DipABOM (Drugwatch)
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