A Personal Decision
Choosing whether to breastfeed or formula feed your baby is one
of the first decisions expectant parents will make. The American
Academy of Pediatrics (AAP) joins other organizations such as the
American Medical Association (AMA), the American Dietetic
Association (ADA), and the World Health Organization (WHO) in
recommending breastfeeding as the best for babies. Breastfeeding
helps defend against infections, prevent allergies, and protect
against a number of chronic conditions.
The AAP says babies should be breastfed exclusively for the
first 6 months. Beyond that, the AAP encourages breastfeeding until
at least 12 months, and longer if both the mother and baby are
Although experts believe breast milk is the best nutritional
choice for infants, breastfeeding may not be possible for all
women. For many women, the decision to breastfeed or formula feed
is based on their comfort level, lifestyle, and specific medical
considerations that they might have.
For mothers who are unable to breastfeed or who decide not to,
infant formula is a good alternative. Some women feel guilty if
they don't breastfeed. But if you feed your baby with a
commercially prepared formula, be assured that your baby's
nutritional needs will be met. And you'll still bond with your
baby just fine. After all, whether with breast milk or formula,
feeding is an important time of connection between mother and
The decision to breastfeed or formula feed your baby is a very
personal one. But here are some points you may want to consider as
you decide which is best for you and your new addition.
Breastfeeding: The Advantages
Nursing can be a wonderful experience for both mother and baby.
It provides ideal nourishment and a special bonding experience that
many nursing mothers cherish.
Here are some of the many benefits of breastfeeding:
Antibodies passed from a nursing mother to her baby can help lower
the occurrence of many conditions, including:
Other factors help to protect a breastfed baby from infection by
contributing to the infant's immune system by increasing the
barriers to infection and decreasing the growth of organisms like
bacteria and viruses.
Breastfeeding is particularly beneficial for premature babies
and also may protect children against:
As a group, breastfed babies have fewer infections and
hospitalizations than formula-fed infants.
Nutrition and ease of digestion.
Often called the "perfect food" for a human baby's
digestive system, breast milk's components - lactose, protein
(whey and casein), and fat - are easily digested by a newborn's
As a group, breastfed infants have less difficulty with
digestion than do formula-fed infants. Breast milk tends to be more
easily digested so that breastfed babies have fewer incidences of
diarrhea or constipation.
Breast milk also naturally contains many of the vitamins and
minerals that a newborn requires. A healthy mother does not need
any additional vitamins or nutritional supplements, with the
exception of vitamin D. Breast milk does contain some vitamin D,
and vitamin D is produced by the body when the skin is exposed to
sunlight. However, sun exposure increases the risk of skin damage,
so parents are advised to minimize exposure. As a result, the AAP
recommends that all breastfed babies begin receiving vitamin D
supplements during the first 2 months and continuing until the
infant consumes enough vitamin D-fortified formula or milk (after 1
year of age).
The U.S. Food and Drug Administration (FDA) regulates formula
companies to ensure that they provide all the known necessary
nutrients (including vitamin D) in their formulas. Commercial
formulas do a pretty good job of trying to duplicate the
ingredients in breast milk - and are coming closer - but
haven't matched their exact combination and composition. Why?
Because some of breast milk's more complex substances are too
difficult to manufacture and some have not yet been identified.
Breast milk doesn't cost a cent, while the cost of formula
quickly adds up. And because of the immunities and antibodies
passed onto them through their mothers' breast milk, breastfed
infants are sick less often than infants who receive formula. For
example, researchers have determined that infants who are breastfed
exclusively have fewer episodes of ear infections. That may mean
they make fewer trips to the doctor's office, which equates to
fewer co-pays and less money doled out for prescriptions and
Likewise, women who breastfeed are less likely to have to take
time off from work to care for their sick babies.
A nursing mother will usually need 500 extra calories per day,
which means that she should eat a wide variety of well-balanced
foods. This introduces breastfed babies to different tastes through
their mothers' breast milk, which has different flavors
depending on what their mothers have eaten.
With no last-minute runs to the store for more formula, breast milk
is always fresh and available. And when women breastfeed,
there's no need to warm up bottles in the middle of the night.
It's also easy for breastfeeding mothers to be active - and go
out and about - with their babies and know that they'll have
food available for whenever their little one is hungry.
Some studies have found that breastfeeding may help prevent
Some studies suggest that children who were exclusively breastfed
have slightly higher IQs than children who were formula fed.
Many nursing mothers really enjoy the experience of bonding so
closely with their babies. And the skin-to-skin contact can enhance
the emotional connection between mother and infant.
Beneficial for mom, too.
The ability to nourish a baby totally can also help a new mother
feel confident in her ability to care for her baby. Breastfeeding
also burns calories and helps shrink the uterus, so nursing moms
may be able to return to their pre-pregnancy shape and weight
quicker. In addition, studies show that breastfeeding helps lower
the risk of breast cancer, high blood pressure, diabetes, and
cardiovascular disease, and also may help decrease the risk of
uterine and ovarian cancer. In one long-term study of the National
Institutes of Health Women's Health Initiative, women who breastfed
for at least 7 to 12 months after giving birth had a lower
risk of cardiovascular disease.
Breastfeeding: The Challenges
Although it is the best nutritional source for babies,
breastfeeding does come with some concerns that many new mothers
share. Whereas it's easy from the get-go for some, it can be
challenging. Sometimes, both mother and baby need plenty of
patience and persistence to get used to the routine of
breastfeeding. But all the effort is often worth it in the long run
- for both the mother and her baby.
Common concerns of new moms, especially during the first few
weeks and months, may include:
Initially, as with any new skill, many moms feel uncomfortable with
breastfeeding. But with adequate education, support, and practice,
most moms overcome this. The bottom line is that breastfeeding
pain is normal for the first week to 10 days, and should last less
than a minute with each feeding. But if breastfeeding hurts
throughout feedings, or if the nipples and/or breasts are sore,
it's a good idea for breastfeeding mothers to seek the help of
a lactation consultant or their doctor. Many times, it's just a
matter of using the proper technique, but sometimes pain can mean
that something else is going on, like an infection.
Time and frequency of feedings.
There's no question that breastfeeding does require a
substantial time commitment from mothers. Then again, many things
in parenting do. Some women may be concerned that nursing will make
it hard for them to work, run errands, or travel because of a
breastfeeding schedule or a need to pump breast milk during the
And breastfed babies do need to eat more often than babies who
are fed formula, because breast milk digests faster than formula.
This means Mom may find herself in demand every 2 or 3 hours (maybe
more, maybe less) in the first few weeks.
This can be tiring, but once breastfeeding has been established
(usually in about a month), other family members may be able to
help out by giving the baby pumped breast milk if Mom needs a break
or is going back to work outside the home. And it's not long
before babies feed less frequently and sleep through the night
(usually around 3 months). Also, with a little organization and
time management, it becomes easier to work out a schedule to
breastfeed and/or pump.
Women who are breastfeeding need to be careful about what they eat
and drink, since things can be passed to the baby through the
breast milk. Just like during pregnancy, breastfeeding women should
avoid fish that are high in mercury, and limit lower mercury fish
intake. If a woman has alcohol, a small amount can be passed to the
baby through breast milk. She should wait to breastfeed at least 2
hours after a single alcoholic drink in order to avoid passing any
alcohol to the baby. Caffeine intake should be kept to no more than
300 milligrams (about one to three cups of regular coffee) per day
for breastfeeding women because it may cause problems such as
restlessness and irritability in some babies. Some infants are
sensitive enough to caffeine to have problems even with smaller
amounts of caffeine.
Maternal medical conditions, medicines, and breast
Medical conditions such as
HIV or AIDS
or those that involve chemotherapy or treatment with certain
medications may make breastfeeding unsafe. A woman should check
with her doctor or a lactation consultant if she's unsure if
she should breastfeed with a specific condition. Women should
always check with the doctor about the safety of taking medications
while breastfeeding, including over-the-counter and herbal
Mothers who've had breast surgery, such as a reduction, may
have difficulty with supply if their milk ducts have been severed.
In this situation, a woman should to talk to her doctor about her
concerns and work with a lactation specialist.
Formula Feeding: The Advantages
Breastfeeding is considered the best nutritional option for
babies by the major medical organizations, but it's not right
for every mother. Commercially prepared infant formulas are a
nutritious alternative to breast milk, and even contain some
vitamins and nutrients that breastfed babies need to get from
Manufactured under sterile conditions, commercial formulas
attempt to duplicate mother's milk using a complex combination
of proteins, sugars, fats, and vitamins that would be virtually
impossible to create at home. So, if you don't breastfeed your
baby, it's important that you use only a commercially prepared
formula and that you do not try to create your own.
In addition to medical concerns that may prevent breastfeeding,
for some women, breastfeeding may be too difficult or
Here are a few other reasons women may choose to formula
Either parent (or another caregiver) can feed the baby a bottle at
any time (although this is also true for women who pump their
breast milk). This allows the mother to share the feeding duties
and helps her partner to feel more involved in the crucial feeding
process and the bonding that often comes with it.
Once the bottles are made, a formula-feeding mother can leave her
baby with a partner or caregiver and know that her little one's
feedings are taken care of. There's no need to pump or to
schedule work or other obligations and activities around the
baby's feeding schedule. And formula-feeding moms don't
need to find a private place to nurse in public. However, if Mom is
out and about with baby, she will need to bring supplies for making
Time and frequency of feedings.
Because formula digests slower than breast milk, formula-fed babies
usually need to eat less often than do breastfed babies.
Women who opt to formula feed don't have to worry about the
things they eat or drink that could affect their babies.
Formula Feeding: The Challenges
As with breastfeeding, there are some challenges to consider
when deciding whether to formula feed.
Organization and preparation.
Enough formula must be on hand at all times and bottles must be
prepared. The powdered and condensed formulas must be prepared with
sterile water (which needs to be boiled until the baby is at least
6 months old). Ready-to-feed formulas that can be poured directly
into a bottle without any mixing or water tend to be expensive.
Bottles and nipples need to be sterilized before the first use
and then washed after every use after that (this is also true for
breastfeeding women who give their babies bottles of pumped breast
milk). Bottles and nipples can transmit bacteria if they aren't
cleaned properly, as can formula if it isn't stored in sterile
Bottles left out of the refrigerator longer than 1 hour and any
formula that a baby doesn't finish must be thrown out. And
prepared bottles of formula should be stored in the refrigerator
for no longer than 24 to 48 hours (check the formula's label
for complete information).
Some parents warm bottles up before feeding the baby, although
this often isn't necessary. The microwave should never be used
to warm a baby's bottle because it can create dangerous
Instead, run refrigerated bottles under warm water for a few
minutes if the baby prefers a warm bottle to a cold one. Or the
baby's bottles can be put in a pan of hot water (away from the
heat of the stove) with the temperature tested by squirting a drop
or two of formula on the inside of the wrist.
Lack of antibodies.
None of the important antibodies found in breast milk are found in
manufactured formula, which means that formula doesn't provide
the baby with the added protection against infection and illness
that breast milk does.
Formula can be costly. Powdered formula is the least expensive,
followed by concentrated, with ready-to-feed being the most
expensive. And specialty formulas (i.e., soy and hypoallergenic)
cost more - sometimes far more - than the basic formulas. During
the first year of life, the cost of basic formula can run about
Possibility of producing gas and constipation.
Formula-fed babies may have more gas and firmer bowel movements
than breastfed babies.
Can't match the complexity of breast milk.
Manufactured formulas have yet to duplicate the complexity of
breast milk, which changes as the baby's needs change.
Whatever nutritional option you choose, be sure to talk to your
doctor about the choices available to help you make the decision
that's best for both you and your baby.
Larissa Hirsch, MD
Date reviewed: November 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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