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I took a few weeks off for the holidays to be with my family. While I consider this blog to be my newest baby, my human family is the most important thing to me in the world. My kids are all grown up adults now, with jobs and lives of their own. All those moments when we get to be together as a family are cherished. Now it’s time to get back to nurturing my blog and trying to make it grow.
Breastfeeding and Formula
A Lactation Consultant talking about formula can be like acknowledging the elephant in the room. It is often done in hushed tones because you’re not sure if it even should be talked about. However, for many moms, for many reasons, it’s a reality, which means it must be talked about.
I am going to assume that you didn’t come to this blog because you plan to, or are, exclusively formula feeding. Formula is not necessarily a bad thing. There are times when a breastfeeding mom needs to use some formula. She may choose to do a combination of breastfeeding and formula. There are also times, sadly, when someone gives a baby formula against mom’s wishes.
Is Formula a Bad Thing?
You, or someone else, may have given your baby some formula and you are wondering if that is a bad thing. You may be mixed feeding and are wondering if that’s a bad thing. You may be thinking you need to supplement so your baby will gain enough weight and wonder what kind of impact that will have on breastfeeding.
You may be thinking about having your partner, mother or night nanny give a bottle of formula for the night feeds, and you are hoping for some reassurance that it won’t mess up breastfeeding for you. That last one I can answer pretty quickly. Yea, that’s gonna be a bad thing, in most cases.
As with everything I discuss, most things just depend on the entire story.
Definition of terms
The story can get muddied because a lot of names today can be confusing. To clarify what I am talking about, this is what these terms mean to me:
- Breastfeeding is exclusive breastfeeding
- Formula feeding is exclusive formula feeding
- Mixed feeding is any combination of both. It is best to establish a good milk supply before doing this. That usually takes 4-6 weeks of exclusive breastfeeding.
- Token breastfeeding is breastfeeding 1-2x/day and formula feeding the rest of the time
- Bottle feeding can mean any of the above because you can put breastmilk in a bottle
- Supplementing can mean combining direct breastfeeding with bottles, either with breastmilk, human donor milk, or formula. Therefore, it needs to be specified what is being put in the bottle
- Topping off is when a baby is offered a bottle after breastfeeding and usually refers to formula
- Just in case bottles mean there is no medical reason to give a bottle
Why and When Give Formula?
There are different reasons to give a breastfeeding baby formula. Some reasons make sense, and some are just silly. There are even reasons that are harmful. That would include overfeeding or anyone feeding your baby formula without your consent or even your knowledge. You might read that and think, how could that happen? Oh, the stories I could tell.
Some people may read my list and come up with a situation where they believe it was very justified to give formula. I don’t know the specifics of everyone’s case. For the most part, though, these are valid vs. silly reasons:
When it’s good to use formula (these assume that Human Donor Milk is not an option)
- Baby with low blood sugar after birth
- Baby losing too much weight and mom’s milk is not in yet
- Baby separated from mom
- When breastfeeding is contraindicated due to a medical condition in baby or mom
- Mom with a documented low milk supply
When it’s bad to use formula
- To “see” if a baby will take some more after breastfeeding (Just in case reason)
- To let a mom rest, when her milk is coming in, or she is establishing her milk supply
- Because someone else (dad, partner, grandma, whoever) wants to give a bottle and mom doesn’t want to or is unable to pump (pump is not available, mom doesn’t let down to the pump, or any reason that pumping is problematic)
- Just in case bottles – I hear all the time from breastfeeding moms that they are only going to give one bottle of formula a day, or they are worried about their supply, or their partner is concerned whether the baby is getting enough. If there is no documented problem with supply and the baby is gaining enough weight, then the baby should not be supplemented. One bottle often turns into two, and so on. Before you know it, you are exclusively formula feeding or only token breastfeeding.
- Some moms think there might be something in formula that is not in breastmilk and they want to make sure their baby has the best of everything. There are things in formula that are not in breastmilk, but it’s nothing good.
- Moms have heard that breastmilk changes as a baby gets older and all they have available to give the baby is milk they pumped when the baby was younger, and they think it might be better to give formula. It is not! Formula is the same for babies of every age; it doesn’t change. And don’t be fooled by their marketing. It is never going to be better than breastmilk.
- Topping off usually happens when a mom or the other parent, or grandma, doesn’t believe that breastfeeding is enough. Topping off is different than supplementing. Supplementing is when a baby needs more food due to an inadequate milk supply
- Just because a baby takes more food, doesn’t necessarily mean that he needs more food. Do you ever eat when you don’t need to? Do you ever eat too much, and feel uncomfortably full? Babies can do that also. It’s not true that a baby will always spit up if he takes too much. It can just push through the other end. If a baby is repeatedly overfed, it can teach him that feeling of overfull is normal. If you know your milk supply is normal, then it would be better just to put your baby back to your breast if he is still looking hungry after breastfeeding.
Which Is the “Best” Formula?
When a breastfeeding mom needs to supplement with formula, she will want to give her baby the best formula available. Unless a baby needs a specialized formula; one basic formula is the same as another basic formula. The formula companies will give them fancy names, but the ingredients that are important for growth and development are mandated by the FDA. Formulas like The Honest Co. Organic Non-GMO Premium Infant Formula with Iron, 40 Ounce and Baby’s Only Organic LactoRelief with DHA & ARA Toddler Formula are organic and do not have any GMO’s and are made with pure cane sugar as opposed to high fructose corn syrup.
My mentor was raised on a homemade formula. That is actually how the term was coined. This is how her doctor told her to feed her baby. It was made up of evaporated milk and corn syrup. She showed me the card it was written on.
My mentor is a very bright woman. A baby can not only survive on substandard food, but they could even thrive on it. But we know how much better they can do on food that is intended for human babies. I don’t recommend a homemade formula. You just don’t know if you are going to get all the essential things into it. While formula will never be breastmilk or even close, there is a lot of science that goes into the ingredients. As for whether goat’s milk is better than cow’s milk? I have yet to be convinced that a goat is any closer to human than cows. I am open to research though.
If you are not using ready to feed, it is important that you mix formula safely. There is a guide written by the World Health Organization with step by step instructions.
The instructions call for boiling water and adding the powdered formula when the water is no cooler than 70 degrees Centigrade. This is 158 degrees Fahrenheit. The reason for this is so that the hot water will kill any bacteria in the powdered formula. It has nothing to do with whether bottled water is used. The formula companies are unable to eliminate this risk. If you are unable or unwilling to do this, you should use ready to feed or concentrated formula.
These recommendations are supported by the Centers for Disease Control
Mixing formula and breastmilk
Formula and breastmilk should not be mixed together, if possible (source). There is something about the formula that decreases the valuable properties of breastmilk.
One Final Thought
Some breastfeeding moms need to use formula for different reasons. If this is your situation, the most import thing is that your baby is fed enough so he can grow properly. If you don’t have enough breastmilk is for that to happen then work with a Lactation Consultant so that you can achieve as good a milk supply as possible for you. Breastmilk is the best food for your baby. However, food is better than not enough food.
Andrea Tran RN, MA, IBCLC
Andrea has been working with new families as an RN for over 35 years and a Lactation Consultant for over 25 years.
She has her MA in Health and Wellness with a focus in Lactation.