Choosing whether to breastfeed or formula feed their baby is one of the biggest decisions expectant and new parents will make.
A number of health organizations — including the American Academy of Pediatrics (AAP), the American Medical Association (AMA), and the World Health Organization (WHO) — recommend breastfeeding as the best choice for babies. Breastfeeding helps defend against infections, prevent allergies, and protect against a number of chronic conditions.
The AAP recommends that babies be breastfed exclusively for the first 6 months. Beyond that, breastfeeding is encouraged until at least 12 months, and longer if both the mother and baby are willing.
Although experts believe breast milk is the best nutritional choice for infants, breastfeeding may not be possible for all women. For many, the decision to breastfeed or formula feed is based on their comfort level, lifestyle, and specific medical situations.
For mothers who are unable to breastfeed or who decide not to, infant formula is a healthy alternative. Formula provides babies with the nutrients they need to grow and thrive.
Some mothers worry that if they don't breastfeed, they won't bond with their baby. But the truth is, loving mothers will always create a special bond with their children. And feeding — no matter how — is a great time to strengthen that bond.
The decision to breastfeed or formula feed your baby is a personal one. Weighing the pros and cons of each method can help you decide what is best for you and your baby.
All About Breastfeeding
Nursing can be a wonderful experience for both mother and baby. It provides ideal nourishment and a special bonding experience that many mothers cherish.
Here are some of the many benefits of breastfeeding:
Fighting infections and other conditions. Breastfed babies have fewer infections and hospitalizations than formula-fed infants. During breastfeeding, antibodies and other germ-fighting factors pass from a mother to her baby and strengthen the immune system. This helps lower a baby's chances of getting many infections, including:
Breastfeeding also may protect babies against:
Breastfeeding is particularly beneficial for premature babies.
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.
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 bouts of diarrhea or constipation.
Breast milk also naturally contains many of the vitamins and minerals that a newborn requires. One exception is vitamin D — the AAP recommends that all breastfed babies begin receiving vitamin D supplements during the first 2 months and continuing until a baby 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 they provide all the necessary nutrients (including vitamin D) in their formulas. Still, commercial formulas can't completely match breast milk's exact composition. Why? Because milk is a living substance made by each mother for her individual infant, a process that can't be duplicated in a factory.
Free. Breast milk doesn't cost a cent, while the cost of formula quickly adds up. And unless you're pumping breast milk and giving it to your baby, there's no need for bottles, nipples, and other supplies that can be costly. Since breastfed babies are less likely to be sick, that may mean they make fewer trips to the doctor's office, so fewer co-pays and less money are paid for prescriptions and over-the-counter medicines.
Different tastes. Nursing mothers usually need 500 extra calories per day, which means they 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. By tasting the foods of their "culture," breastfed infants more easily accept solid foods.
Convenience. With no last-minute runs to the store for more formula, breast milk is always fresh and available whether you're home or out and about. And when women breastfeed, there's no need to wash bottles and nipples or warm up bottles in the middle of the night.
Smarter babies. Some studies suggest that children who were exclusively breastfed have slightly higher IQs than children who were formula fed.
"Skin-to-skin" contact. 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 totally nourish a baby can 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. Also, 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.
Breastfeeding can be easy from the get-go for some mothers, but take a while to get used to for others. Moms and babies need plenty of patience to get used to the routine of breastfeeding.
Common concerns of new moms, especially during the first few weeks and months, may include:
Personal comfort. Initially, many moms feel uncomfortable with breastfeeding. But with proper education, support, and practice, most moms overcome this.
Latch-on 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 their nipples and/or breasts are sore, it's a good idea for breastfeeding mothers to get help from 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. Breastfeeding requires a big time commitment from mothers, especially in the beginning, when babies feed often. A breastfeeding schedule or the need to pump breast milk during the day can make it harder for some moms to work, run errands, or travel.
And breastfed babies do need to eat more often than babies who take 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.
Diet. Women who are breastfeeding need to be aware of what they eat and drink, since these can be passed to the baby through the breast milk. Just like during pregnancy, breastfeeding women should not eat fish that are high in mercury and limit consumption of lower mercury fish.
If a mom drinks alcohol, a small amount can pass to the baby through breast milk. She should wait at least 2 hours after a single alcoholic drink to breastfeed 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) or less per day because it can cause problems like restlessness and irritability in some babies.
Maternal medical conditions, medicines, and breast surgery. Medical conditions such as HIV or AIDS or those that involve chemotherapy or treatment with certain medicines can 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 medicines while breastfeeding, including over-the-counter and herbal medicines.
Mothers who've had breast surgery, such as a reduction, may have difficulty with their milk 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.
All About Formula Feeding
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 supplements.
Manufactured under sterile conditions, commercial formulas attempt to duplicate mother's milk using a complex combination of proteins, sugars, fats, and vitamins that aren't possible to create at home. So if you don't breastfeed your baby, it's important to use only commercially prepared formula and not try to make your own.
Besides medical concerns that may prevent breastfeeding, for some women, breastfeeding may be too difficult or stressful. Here are other reasons women may choose to formula feed:
Convenience. 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 mom 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.
Flexibility. 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.
Time and frequency of feedings. Because formula is less digestible than breast milk, formula-fed babies usually need to eat less often than breastfed babies.
Diet. 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 Challenges
As with breastfeeding, there are some challenges to consider when deciding whether to formula feed.
Lack of antibodies. None of the antibodies found in breast milk are in manufactured formula. So formula can't provide a baby with the added protection against infection and illness that breast milk does.
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.
Planning and organization. Unlike breast milk — which is always available, unlimited, and served at the right temperature — formula feeding your baby requires planning and organization to make sure that you have what you need when you need it. Parents must buy formula and make sure it's always on hand to avoid late-night runs to the store.
And it's important to always have the necessary supplies (like bottles and nipples) clean, easily accessible, and ready to go — otherwise, you will have a very hungry, very fussy baby to answer to. With 8-10 feedings in a 24-hour period, parents can quickly get overwhelmed if they're not prepared and organized.
Expense. Formula can be costly. Powdered formula is the least expensive, followed by concentrated, with ready-to-feed being the most expensive. And specialty formulas (such as 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 $1,500.
Possibility of producing gas and constipation. Formula-fed babies may have more gas and firmer bowel movements than breastfed babies.
Making a Choice
Deciding how you will feed your baby is not an easy decision to make. You'll really only know the right choice for your family once your baby comes.
Many women decide on one method before the birth and then change their minds once their baby is born, or in the weeks or months after. And many women decide to breastfeed and supplement with formula because they find that is the best choice for their family and their lifestyle.
While you're weighing the pros and cons, talk to your doctor or lactation consultant. These health care providers can give you more information about the options available and help you make the best decision for your family.
Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: February 2015