Is Your Baby Getting Enough Milk? Breast Feeding Success May be Formula Based
Recommendations for infant feeding and care made by the American Academy of Pediatrics state that healthy mothers should exclusively feed their newborns with breast milk the first six months of life. Conventional medical wisdom has it that in order to ensure that babies remain breast fed they must not be fed formula due to the infant may develop a preference for artificial milk delivered via a rubber nipple and thereby refuse suckling from a breast.
However, one of the obstacles to breast feeding is a new mother’s fear that her breasts are not producing enough milk as she watches her newborn infant initially lose weight rather than gain weight. This early weight loss often leads to abandonment of the breast for bottle fed formula to ensure that her infant is getting enough nourishment.
Following childbirth, new mothers do not begin to lactate significantly until several days later. Rather, during the first few days the human breast secretes small amounts of early milk called colostrum that possesses nutrients and protective antibodies to kick start the infant’s immune system. Mature milk in greater quantities arrives later, but sometimes too late for the mom who has decided her baby is in need of more nourishment sooner and turns to the bottle.
"Many mothers develop concerns about their milk supply, which is the most common reason they stop breastfeeding in the first three months," says author Valerie Flaherman, MD, MPH, an assistant professor of pediatrics and epidemiology and biostatistics at UCSF and a pediatrician at UCSF Benioff Children's Hospital. Dr. Flaherman is the lead author of a paper to be published soon in the journal Pediatrics that reports that providing limited amounts of formula during the first few days of birth actually increases the odds that an infant will continue to be breastfed.
"Based on our findings, clinicians may wish to consider recommending the temporary use of small amounts of formula to new moms whose babies are experiencing significant early weight loss," states Dr. Flaherman in a news release.
The study tests the hypothesis that providing formula in a method referred to as “early limited formula” (ELF) to an infant, can actually be beneficial to mothers who want to breastfeed their babies for the first 6 months of life as recommended by health officials.
In the study, 40 full-term newborns 1 -2 days old who had lost at least five percent of their birth weight were randomly assigned to either a test group or a control group. The test group infants were provided with the ELF method which consisted of syringe feeding 1/3 of an ounce of formula to an infant immediately following a breast feeding session by the mother. The reason for syringe feeding over bottle feeding was to prevent the infant from developing nipple confusion and thereby risk breast rejection. Once the mother began to produce mature milk 2 to 5 days following birth, the syringe feeding was discontinued. The control group was exclusively breast fed without supplemental formula.
What the study revealed was that:
• After the first week, only 10% of the ELF test group infants had received supplemental formula from their mothers within the past 24 hours compared to 47% of the infants from the control group.
• After the first 3 months, 79% of the ELF test group infants were still breastfeeding, compared to only 42% of the control group infants who did not receive early limited formula. Furthermore, 95 percent of the babies who received limited formula in the first few days were breastfeeding at least part of the time at three months, compared with 68 percent of the babies from the control group.
The authors of the study concluded that initiating early limited formula treatment during the first week of birth in infants with early weight loss may prove to be a successful coping strategy for mothers wanting to breast feed but are at risk of discontinuing nursing if they feel their baby is not being adequately nourished. Furthermore, early limited feeding may also prove to increase the rate of longer-term breast feeding without the use of supplemental formula during the first 6 months of life.
The authors note that additional larger scale studies are needed to confirm the results of their initial study.
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Reference: “Effect of Early Limited Formula on Duration and Exclusivity of Breastfeeding in At-Risk Infants: An RCT” Published online May 13, 2013 (doi: 10.1542/peds.2012-2809); Valerie J. Flaherman, MD, MPH et al.