Many a new mother has struggled with whether to breast-feed or give her newborn formula. A recent study, published in the journal Pediatrics, says the best approach might be both. In fact, the study suggests that giving newborns a little bit of formula may actually help new mothers, who choose to breast-feed, continue feeding longer.
The lead author of the study, Dr. Valerie Flaherman, an assistant professor of pediatrics and epidemiology and biostatistics at UCSF, and her team followed 40 newborns that had lost at least 5 percent of their birth weight by the time they were 36 hours old. The American Academy of Pediatrics (AAP) notes that it is normal for babies to lose weight during their first days as they become accustomed to feeding. However, if infants drop 10 percent of their birth weight, pediatricians become concerned that babies will be at risk for other heath problems.
For the small trial, Flaherman and her colleagues assigned half the babies a couple days of birth to receive two teaspoons of formula after each breast-feeding, via a syringe so as not to encourage “nipple confusion,” a condition in which a baby has trouble transitioning between breast and bottle. Mothers were instructed to discontinue the formula supplementation once their milk supply appeared, which generally takes two to five days. The other were exclusively breast-fed unless the doctor ordered formula.
When the babies were one week of age, 10% of the moms in the formula group were still using formula in some way as part of their feeding strategy compared with 47% of the group originally assigned to breast-feed but who added formula. And when the babies were three months old, 79% of the formula-group moms were exclusively breast-feeding, significantly more than the 42% of moms in the group originally instructed to breast-feed.
Flaherman suspects that adding a little formula early in the feeding process, then withdrawing it, helped moms feel more secure that their babies were getting enough to eat. That may have also given them the confidence to continue breast-feeding until it was exclusively how their babies were fed.
“Using that little bit of formula earlier really seems to have had a big effect on whether babies are getting formula at one week,” Flaherman says. “We wanted to try to find an early intervention we could do with these babies and moms to help them continue breast-feeding. I was surprised the effect was this big.”
The AAP recommends that moms breast-feed for 6 months at a minimum. In the United States however, most new mothers start by breast-feeding their infants but only 40 percent continue to 6 months. 20 percent make it to one year.
Some breast-feeding experts take issue with the study’s findings. They worry that the results may undermine the public-heath messages that breast milk alone is best for babies.
“This study goes against everything that’s been published for several years now from very reliable clinicians and researchers about the potential hazards of supplementing exclusively breast-feeding babies with formula,” says Dr. Kathleen Marinelli, an associate professor of pediatrics at the University of Connecticut School of Medicine and the chair-elect of the U.S. Breastfeeding Committee. “They’re flying in the face of years of research here and doing so rather glibly, stating that this is the new way to look at things.”
Tanya Lieberman, a lactation consultant who writes about scientific research for breast-feeding advocacy organization Best for Babes, says she’s “a little confused” by the results. “We know what works to increase breast-feeding exclusivity and duration and we’ve known it for 20 years. That includes no supplementation unless medically necessary.”
Lieberman believes the findings may have been affected by the attitude of the women who were open to the idea of adding formula to their breast-feeding routine.
She believes it’s possible that the mothers may have misunderstood how much milk newborns need. “Babies don’t need large volumes of milk in the first few days,” she says. “They are fine until their mother’s milk comes in.”
Flaherman, on the other hand, says the study’s results are not necessarily applicable to all babies. "This isn’t something we think all people should do,” she says. “It is just a potential tool for moms to consider using if they think it might be helpful.”
She also says that the ultimate goal of the study was to find a way to help more mothers breast-feed, and to do so for as long as possible to help their babies. “It’s kind of crazy that only 20% of people reach the recommended duration of breast-feeding,” says Flaherman. “Different approaches to supporting breast-feeding may work better for different people.”
If you’re interested in the idea of adding formula to your breast-feeding routine, it’s a good idea to talk with your pediatrician first. If you’re having trouble adjusting to breast-feeding, there are experts your doctor or pediatrician can recommend that can answer any questions you have. You may just decide that adding a little formula in the beginning is helpful as you and your baby adjust to breast-feeding and a new life together.