Do Infants Need Formula Plus Breast Milk?

I try to breastfeed my newborn as much as possible, but I’m afraid she’s not getting enough milk. Should I incorporate formula into my baby’s diet? Is it healthy to feed my baby both breast milk and formula?

– October 21, 2013

Breast milk is the absolute best food you can give your baby during the first year of life. It provides all of an infant’s nutritional needs and transfers from mother to baby antibodies that protect against a long list of infectious diseases. Over time, breastfed babies are less likely to develop such chronic conditions as diabetes, high cholesterol, asthma, and allergies. And breastfed babies are less likely to become overweight children than their bottle-fed counterparts.

I discussed your question with Sandy Newmark, M.D. a pediatrician at the Osher Center for Integrative Medicine in San Francisco. He emphasizes that breast milk alone is a complete food for an infant until it is time to introduce solid foods. However, Dr. Newmark says that if you need to start formula for personal reasons, like returning to work, for example, then it is definitely fine to feed your baby both breast milk and formula.

I did come across an interesting study suggesting giving newborns very small amounts of formula for a limited time in an effort to lengthen the amount of time they’re breastfed. This was a small, randomized controlled study with 40 full-term infants. All the babies had lost at least five percent of their birth weight within their first 36 hours of life. In the study, half of the babies were given 10 milliliters (a little more than two teaspoons) of formula via a syringe after breastfeeding during the first few days after birth. The other 20 infants received no formula. The idea was to ease anxiety among new mothers who worried that their babies weren’t getting enough breast milk. (This concern is one of the most common reasons why women stop nursing.) In the study, the formula was discontinued once the mothers’ milk came in. Giving the babies the formula via syringe instead of in bottles was aimed at ensuring that they didn’t learn to prefer bottles to the breast.

Three months later, 79 per cent of the babies who had received formula for a few days were exclusively breastfeeding, compared to only 42 per cent of those in the control group.

Despite this encouraging news, the study generated a fair amount of negative feedback. Critics maintained that instead of adding a little formula, new mothers should be reassured that some weight loss is normal after birth, as is fussiness among newborns. The study was published online May 13, 2013 by Pediatrics.

Pediatricians recommend breastfeeding babies for at least a year and breastfeeding exclusively (no solid food) for at least six months, and that message seems to be getting through. Data from the Centers for Disease Control and Prevention released on July 31, 2013, show that breastfeeding rates have been rising. Overall, the CDC said that babies who started breastfeeding at birth increased from 71 percent in 2000 to 77 percent in 2010. The percentage of babies breastfeeding at six months increased from 35 percent in 2000 to 49 percent in 2010 and the percentage still breastfeeding at 12 months rose from 16 to 27 percent during that same time period.

Andrew Weil, M.D.

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