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Using infant formula when breastfeeding can happen by necessity or by choice.
For some nursing moms the need to use formula when breastfeeding can feel defeating. You may be worried that supplementing breastfeeding with formula can mean the end of breastfeeding.
Formula is not necessarily a bad thing. There are times when a breastfeeding mom needs to use some formula. Some families decide that combining breastfeeding and formula is what works best for them.
Whatever the reason is that you find yourself reading this blog post, by the time you are finished you will know when formula use is necessary and how to ensure that it doesn’t have to mean the end of breastfeeding.
BREASTFEEDING AND FORMULA: IMPORTANT CLARIFICATION OF TERMS
Any discussion about formula use when breastfeeding can be confusing because how breastfeeding is defined can vary from source to source.
So that we are all on the same page, this is how I generally define these terms.
- 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 includes bottle feeding formula or expressed breast milk.
- 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 but can include a bottle of expressed breast milk.
- “Just in case bottles” means there is no medical reason to give a bottle.
IS FORMULA REALLY THAT BAD?
There are different scenarios where a breastfed baby receives formula. I’ll go over those in a bit.
Exclusive breastfeeding for the first six months is considered optimum by the American Academy of Pediatrics (Source).
It is natural to be concerned if your breastfed baby receives formula. You may wonder how it will affect both your baby and breastfeeding.
REASONS FOR USING FORMULA WHILE BREASTFEEDING
There are different reasons a breastfeeding baby might receive formula.
Some reasons make sense, and some are just silly.
There are even reasons that formula is given that are harmful. That would include overfeeding so your baby will sleep longer. It is also harmful if anyone feeds your baby formula without your consent or even your knowledge.
- Your baby may have experienced low blood sugar in the hospital and his health care providers believed formula was needed to bring his blood sugar to a safe level.
- Your baby may have lost too much weight before your milk comes in.
- Your baby may not be gaining weight at an adequate rate while exclusively breastfeeding.
- You are a working mom and are unable to pump the amount of milk your baby needs while you are separated.
- An emergency comes up and you do not have a breast milk stash or you don’t have access to it.
- You have to take a medication that is contraindicated with breastfeeding and you don’t have an adequate breast milk stash.
- You may have made the decision to do mixed feeding.
- You have a medical condition that is contraindicated with breastfeeding.
- You may be considering having your partner, mother, or night nanny give a bottle of formula for the night feeds. This can result in a low milk supply.
- You want to combine breastfeeding and formula feeding because you believe this will work best for you. You should wait to attempt this until after your milk supply is well established – at 6-8 weeks.
SILLY OR HARMFUL REASONS TO USE FORMULA
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.
- You may feel unsure that your baby is getting enough from breastfeeding and you offer a bottle of formula “just in case.”
- Someone is pressuring you to let them feed the baby and you are unable to pump.
- A pump is not available.
- Mom has trouble with her let-down reflex when she tries pump.
- Any reason that pumping is problematic
- Someone else doesn’t have confidence the baby is getting enough from breastfeeding and offers formula. This could be your partner or a grandma.
- To let a mom rest or sleep. This can especially be harmful when her milk is coming in or she is establishing her milk supply
- Someone wants to prove that formula is just fine so they give the baby formula when mom is not around.
I had a co-worker whose mother-in-law watched her baby when mom when back to work. The mother-in-law had always been very vocal about thinking the whole breastfeeding thing was nonsense. She told my co-worker that she had fed her son formula and he turned out just fine.
My co-worker provided plenty of pumped milk when she dropped her baby off with her mother-in-law. At the end of the day when she picked him up her mother-in-law informed her that she had fed the baby formula to prove that he would be just fine and didn’t need to breastfeed.
THE PROBLEM WITH SUPPLEMENTING A BREASTFED BABY “JUST IN CASE”
I often hear from breastfeeding moms that they are going to give one bottle of formula a day. They may do it because they are worried about their supply. Or their partner is concerned about 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 with formula. This is a classic case of a slippery slope.
One bottle often turns into two, and so on. Before you know it, you are exclusively formula feeding or only token breastfeeding.
OTHER UNNECESSARY REASONS TO GIVE A BREASTFED BABY WITH FORMULA
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.
You may have heard that breastmilk changes as a baby gets older. You may wonder if it is better to give formula if the only pumped milk you have available was pumped when your baby was younger.
It is not!
Formula is the same for babies of every age; it doesn’t change. And don’t be fooled by the marketing by formula companies. Formula is never going to be better than breastmilk.
RISKS OF TOPPING OFF WITH FORMULA
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
Topping off is when a baby is offered formula after breastfeeding “in case the baby is not getting enough.” If the baby takes the formula it is thought that confirms the baby wasn’t getting enough from breastfeeding.
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 eat too much just like anyone. And it’s not true that a baby will just spit up if he takes too much. The excess milk can just push through the other end.
If a baby is repeatedly overfed, it can teach him that feeling overfull is normal.
If you know your milk supply is normal it is better to put your baby back to your breast if he is still looking hungry after breastfeeding.
WHAT IS THE BEST FORMULA?
Because you know “breast is best” if you do need to supplement with formula you will want to give your baby the best formula available.
The truth is that there are very few differences between most formulas.
The exceptions are specialized hypoallergenic formulas.
While the formula companies may give their formulas fancy names the ingredients that are important for growth and development are mandated by the FDA.
The one thing that sets some infant formulas apart are those that are organic. Organic formulas are made with pure cane sugar as opposed to high fructose corn syrup. They do not have any GMO’s and are made with organic ingredients.
OTHER INFANT FORMULA VARIETIES
- Cow’s milk based
- Soy based
- Plant-based soy-free
Always check if a formula is labeled for infants or toddlers. Infant formula should be used throughout the first year.
ARE HOMEMADE FORMULAS A GOOD OPTION?
I had a co-worker who was raised on a homemade formula. That is actually how the term was coined. Her doctor told her mother to feed her baby a combination of evaporated milk and corn syrup.
She even showed me the card it was written on.
My co-worker was a very smart person. The truth is that 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 feeding your baby a homemade formula.
You can not be sure that you have included all the things your baby needs in homemade formula.
While formula will never be as good as breastmil, there is a lot of science that goes into the ingredients.
Some moms have asked me whether goat’s milk is better than cow’s milk? I have yet to be convinced that a goat is any closer to humans than cows. I am open to research though.
FORMULA PREPARATION SAFETY
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 using water this temperature 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 the risk of bacteria in powdered formula. 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
IS IT OK TO MIX FORMULA WITH BREAST MILK?
Formula and breastmilk should not be mixed together if it can be avoided (Source).
There is something about the formula that decreases the valuable properties of breastmilk.
However, it will not always be possible to avoid mixing formula with breast milk. This is one of those “don’t stress about it” guidelines.
BEST WAY TO SUPPLEMENT WITH FORMULA
The best way to supplement breastfeeding with formula is to breastfeed first and then offer the formula by an SNS or bottle.
However, for the mom who has a very low milk supply, her baby may get frustrated if the milk is not flowing fast enough. In a case like this, it can work better to offer the formula first and breastfeed as dessert.
ALTERNATIVE TO USING FORMULA
There may be the option of using human donor milk.
Human donor milk has been donated by breastfeeding women to milk banks. The mothers and the milk goes through rigorous testing. The milk is pasteurized.
Human donor milk is an excellent option. However, it is admittedly an expensive option and there is not always enough available. Milk banks will give priority to premature and sick babies if their supply levels geet low.
You can find out if there is a milk bank near you on the Human Milk Milk Banking Association of North America site. Milk can also be shipped.
Because there is the potential for transmission of diseases and viruses through human milk it is not recommended to use milk donated by family or friends. It is definitely not recommended to use milk from someone you do not know personally.
FINAL THOUGHTS ON USING FORMULA WHILE BREASTFEEDING
Some breastfeeding moms will need to use formula. If this is your situation mama, please remember that the most important thing is that your baby is fed enough so he can grow properly.
If you are experiencing low milk supply I encourage you to work with a Lactation Consultant so that you can make as much milk as possible.
Breast milk is so valuable. Any amount of breast milk you give your baby is important.
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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.