When it comes to infant formula, national and global health experts recognize that breast milk is the ideal source of nutrition for at least the first few months of life. But according to the World Health Organization (WHO), only 2 in 3 babies are breastfed for the recommended 6 months.1
“If there are no contraindications to breastfeeding or breast milk, there is no reason to use infant formula as long as the mother can breastfeed and/or provide breast milk,” said Lori Feldman-Winter, MD, MPH, president of the American Academy of Pediatrics (AAP) section on breastfeeding and a professor of pediatrics at Rowan University’s Cooper Medical School in Camden, New Jersey. “If for some reason the mother is unable to breastfeed or to give her baby breast milk, then infant formula is the recommended source of nutrition until the age of 1 year.”
If mothers choose not to breastfeed, even though they can, bottle feeding is a viable option, although Feldman-Winter called it “a recognized and significantly substandard way of feeding.”
Both AAP and WHO recommend exclusive breastfeeding for at least the first 6 months of life. Furthermore, breastfeeding is recommended until at least 1 year of age, but in conjunction with the introduction of complementary nutritious solid foods.1,2
Because there’s no apparent reason to switch from breastfeeding or using breast milk to bottle-feed, Feldman-Winter said, there really isn’t an official recommendation about the best time to make that move. “The only thing that can affect the timing is if a mother is for some reason unable to breastfeed or breastfeed, at which point infant feeding is recommended,” she said. “The longer the mother breastfeeds or provides her milk for the baby, the better the health outcomes.”
Pediatricians should base guidelines on the child’s overall health and nutrition and advise parents on nutritional options and best practices.
There’s no clinical evidence that one type of infant formula is better than another, Feldman-Winter said. “If and when infant formulas are introduced, it doesn’t really matter which formula is chosen, as long as it’s commercially available and compliant with the U.S. Department of Agriculture. [USDA] standards and has been reconstituted according to guidelines developed by the USDA, the Centers for Disease Control and Prevention [CDC]and AAP,” she said.
Bottle feeding should be done with responsive feeding practices, following the baby’s directions to avoid overfeeding, Feldman-Winter said. “Bottle feeding should follow AAP guidelines for responsive feeding, with bottles up to about 6 months, and the babies can transition to staged cup feeding depending on development,” she said. “If formula is fed, the formula should be mixed according to the manufacturer’s guidelines and not altered. Some babies prefer warm breast milk or formula to mimic the temperature of direct breastfeeding.”
The CDC agrees with AAP that breast milk is the healthiest option for both infants and mothers in the first few years of life, but the agency also recognizes that both mothers and infants can decide to stop breastfeeding at any time.3
According to the CDC, common reasons parents stop breastfeeding early include:
breast-feeding problems, difficulties with persistence, insufficient infant formula or weight gain, concerns about medications the mother is taking, challenges related to work or parental leave policies, lack of family or cultural support, and lack of support from caregivers and/or hospitals.
The timing of weaning, from breast milk to both formula and solid foods, is a personal decision, the CDC states. day to start, gradually increasing the frequency of replacements
Breastfeeding rates haven’t risen much in recent decades, but the push to expand the practice really took off in mid-2010. Then the Breast Is Best initiative launched a campaign to encourage hospitals to achieve a Baby-Friendly designation and support breastfeeding mothers. By the end of the campaign, the total percentage of breastfeeding grew by about 4% and exclusive breastfeeding from 39% to 61%.5
However, in the years since the campaign’s launch, some researchers and advocacy groups have questioned the ‘breast is best’ story, suggesting that good nutrition, not how it is provided, is critical.6
The Fed Is Best Foundation, a national nonprofit organization staffed by volunteer caregivers and parents, suggests that research findings indicate a rise in hospitalizations of exclusively breastfed infants due to nutritional complications from poor milk production or constitution. In 2018, an article in the Journal of Human Lactation questioned the Breast Is Best campaign, arguing that anxiety, depression, and mental health complications faced by mothers during the breastfeeding process should be considered when weighing the risks versus benefits of breastfeeding.
La Leche League International recommends that parents planning to switch from breastfeeding to bottle-feeding should wait until approximately the fourth week of breastfeeding.8 If supplementation is required, several types of manufactured formulas, including cow’s milk, soy-based, and hypoallergenic, are available to meet baby’s needs
Pediatricians should be sure that formulas offered to infants are USDA-approved and caution parents never to use homemade formulas or deviate from the manufacturer’s mixing guidelines.9
References
1. World Health Organization. Breastfeeding. Accessed February 15, 2022.
https://www.who.int/health-topics/breastfeeding#tab=tab_1
2. Recommendations and Benefits: Breastfeeding. Center for Disease Control and Prevention. Updated July 9, 2021. Accessed February 15, 2022.
https://www.cdc.gov/nutrition/infantandtoddlernutrition/breastfeeding/recommendations-benefits.html
3. Facts: Important Breastfeeding Indicators. Center for Disease Control and Prevention. Updated Aug 24, 2021. Accessed Feb 15, 2022.
https://www.cdc.gov/breastfeeding/data/facts.html
4. Weaning. Center for Disease Control and Prevention. Updated July 9, 2021. Accessed February 15, 2022.
https://www.cdc.gov/nutrition/infantandtoddlernutrition/breastfeeding/weaning.html
5. Feldman-Winter L, Ustinov J, Anastasio J, et al. Best fed begins: A nationwide quality improvement initiative to increase breastfeeding. pediatrics. 2017;140(1):e20163121. doi:10.1542/peds.2016-3121
6. About/FAQs. Fed is the best foundation. Accessed February 15, 2022. https://fedisbest.org/about/
7. McIntyre LM, Griffen AM, BrintzenhofeSzoc K. Borst is the best…unless it isn’t. J Hum Lact. 2018;34(3):575-580. doi:10.1177/0890334418774011
8. Introducing a bottle to a breastfed baby. LaLeche League International. August 2018. Accessed February 15, 2022.
https://www.llli.org/breastfeeding-info/introducing-a-bottle-to-a-breastfed-baby/
9. Nemours Kids Health. Bottle Feeding FAQs: Getting Started. Updated November 2021. Accessed February 2022.
https://kidshealth.org/en/parents/formulafeed-starting.html
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