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Breastfeeding vs. Baby Formula:
A Guide for Parents

Every parent wants to provide their new baby with the healthiest possible start in life. The decision of whether to breastfeed or bottle-feed is an easy choice for some, but some new moms grapple with the pros and cons. While the American Academy of Pediatrics (AAP) recommends breastfeeding for at least the first six months of life, this decision is not always straightforward.

You may wonder if breastfeeding is an option when you have a full-time career. You may feel pressure from family or friends to choose breastfeeding or bottle-feeding. Some new parents would prefer to bottle-feed but worry about the cost. Others feel uncomfortable with breastfeeding. Some mothers have medical issues that exclude breastfeeding as an option.

Your baby’s feeding method is a private decision that only you can make after carefully weighing what will work best for you and your family. Whether you choose to breastfeed or bottle-feed, you can raise a healthy, happy baby. Nourishment from the breast or the bottle combined with love will set your bundle of joy on track to enjoy good health for many years to come.

What to Know About Breastfeeding

The AAP recommends breastfeeding exclusively for the first six months. Solid food can be introduced at six months and combined with breastfeeding until the baby reaches twelve months of age. After the first year, breastfeeding can be continued according to the preferences of the mother and the baby.

Composition of Breastmilk

Breastmilk contains the ideal proportions of the nutrients your baby needs to grow and develop. The breastmilk you produce changes during the first two weeks following your baby’s birth.

Colostrum

Colostrum is the first milk you produce. It is thick yellow milk that is often referred to as “liquid gold.” It is rich in nutrients and immune factors that protect your baby from infections and promote healthy digestion.

Transitional Milk

Within two to five days following birth, the thick yellow colostrum will transition to bluish-white milk, and your breasts may become full and warm. This transition takes place over the next ten to fifteen days to meet your baby’s changing needs.

Mature Milk

Your mature milk will come in next and continue to change over time to provide all the nutrients your growing baby needs.

Human milk is uniquely designed to promote the health and growth of human babies. It contains a combination of water, protein, carbohydrates, oligosaccharides, and minerals customized for your baby’s needs. The lactose content is lower than in cow’s milk. Mother’s milk contains immune factors and is relatively low in protein but high in fatty acids, such as DHA, that aid in brain development.

Breastfeeding Your Baby

Breastfeeding provides special bonding opportunities at each mealtime. It is a natural way to feed your baby, but this does not mean you will instinctively know what to do. The following tips will make your breastfeeding experience successful and pleasurable for both of you:

1

Start with clean hands. You will need to use your hands to help your baby latch on, especially in the beginning, so wash your hands prior to each feeding.

2

Achieve a proper latch. The pigmented tissue surrounding the nipple is called the areola. A properly latched baby’s mouth will cover most or all of the areola. To accomplish this, touch the baby’s lips with your nipple until your baby opens his mouth widely. Quickly pull the baby to your breast, so the latch occurs while the mouth is still wide open.

3

Understand the let-down reflex. When your baby first starts suckling, the milk flows very slowly until it “lets down.” The milk will then flow quickly. You may feel a tingling sensation in your breasts, and the baby may begin swallowing loudly and quickly.

4

Feed your baby on demand. A newborn infant needs an average of eight to twelve feedings per day or a feeding every two to three hours around the clock. This will decrease as your baby grows older. Over time, you will become familiar with your baby’s hunger cues.

5

Ensure your baby is getting enough milk. Look for these signs:

  1. Satisfaction after feedings
  2. Consistent weight gain after the first week
  3. Six to eight wet diapers daily
  4. Two to five stools daily at first, decreasing to two or less per day over time
6

Protect your milk supply. The more your baby breastfeeds, the more you will produce. If you regularly spend time away from the baby, use a breast pump during your absence at the same frequency the baby would feed to maintain your milk supply.

Benefits of Breastfeeding

Breastfeeding has multiple benefits for you and your baby.

Benefits for Your Baby

Breastfed babies enjoy physical and psychological benefits:

  • Warmth and closeness that strengthens bonding
  • Easy digestion
  • Ideal infant nutrition and antibodies for a healthy immune system

According to the Centers for Disease Control and Prevention, breastmilk has protective properties that decrease your baby’s risk of developing many dangerous and chronic conditions, including the following:

  • Ear infections
  • Pneumonia
  • Obesity
  • Sudden infant death syndrome
  • Eczema
  • Some cancers
  • Diarrhea
  • Meningitis
  • Diabetes
  • Asthma
  • Colitis
  • Necrotizing enterocolitis (NEC)

Benefits for Mothers

Women who breastfeed seldom do it for their own benefit, but breastfeeding does afford many benefits for the mom:

  1. Convenience. Once established, breastfeeding is convenient. It is free and readily available.
  2. Hormonal benefits. Breastfeeding releases hormones that promote maternal fulfillment. Prolactin and oxytocin promote relaxation and feelings of nurturing, love, and attachment. Oxytocin also triggers uterine contractions that help return the uterus to its normal size and decrease post-partum bleeding.
  3. Calorie burn. Breastfeeding burns extra calories and helps some women lose their pregnancy weight.
  4. Delay of menses. Breastfeeding delays the return of menstruation in some women.
  5. Health benefits. Mothers who breastfeed experience reduced rates of breast cancer, ovarian cancer, Type 2 diabetes, rheumatoid arthritis, and cardiovascular disease later in life.

Breastfeeding Challenges

Breastfeeding is not without its difficulties. While these challenges can be overcome in many cases, just 43 percent of American women still breastfeed after six months, and only 13 percent breastfeed exclusively at that point.

Breastfeeding challenges can occur at any time, but they are most common while breastfeeding is being established.

Low Milk Supply

Before supplementing with formula, try increasing the number of breastfeeding sessions, and make sure each breast is being emptied. Supplementing with formula will cause your baby to nurse less and further reduce your milk supply. Birth control pills may decrease your milk supply. Supplements containing fenugreek can help increase it.

Engorgement

Breasts that are too full of milk are engorged. Engorged breasts are hard, enlarged, warm, and painful. This is common during the first week after your milk comes in while the body is adapting to your baby’s needs. Engorgement can also happen when you are away from your baby and feedings are delayed.

Engorged breasts can be relieved by emptying the breast through feeding, pumping, or hand expressing. Pumping breast milk while you are away will prevent engorgement. Allowing engorgement to occur can reduce your milk supply.

Sore Nipples

Sore nipples most often occur during the first week of breastfeeding. Some rawness and discomfort are normal as your nipples adjust to suckling. Cracked or bleeding nipples cause severe pain when the baby latches on.

This is usually caused by improper latching. Correcting this will promote healing. A hydrogel pad can prevent a bleeding nipple from sticking to your bra. A few drops of breastmilk applied to the nipples may speed healing. They will heal in a few days, making breastfeeding much less painful, so don’t give up.

Lack of Community Support

Support from family, work, and the public makes breastfeeding easier to establish and maintain.

Well-meaning family members may pressure you to bottle-feed because they think it would be easier for you or they want to assist with feeding. It is okay to firmly but kindly assert that you have made your decision and need their support. After breastfeeding is established, you can allow family members to bottle-feed the baby expressed milk.

Federal law requires employers to provide breastfeeding women with a private area other than a bathroom to pump breastmilk as often as needed. Making arrangements before your baby is born can make this easier.

Federal law gives you the right to breastfeed in public when your baby is hungry. You can practice techniques while you are at home, such as using blankets to cover up. Talking to other breastfeeding moms, even online, can help you find ideas to breastfeed comfortably in public.

Diet and Lifestyle Challenges

Breastfeeding requires sacrifices that can be challenging. It is time-consuming in the beginning. Breastfeeding mothers must avoid harmful substances like alcohol, caffeine, some medications, and even some foods. Just remember, your temporary sacrifices are bringing about a lifetime of benefits for both of you.

When to Contact a Lactation Consultant

Lactation consultants are supportive and knowledgeable. Contacting a lactation consultant at the first sign of issues can help you resolve them more quickly. Lactation consultants provide the following assistance:

  • Assistance in increasing your milk supply
  • Treatment for sore nipples and engorgement
  • Education
  • Troubleshooting
  • Identification of medical issues
  • Encouragement

Medical Conditions That Make Breastfeeding Unsafe

While breastmilk is usually the ideal food for your baby, these medical conditions make breastmilk hazardous to your baby:

  • Galactosemia—a metabolic disorder that makes a baby intolerant to lactose, including the lactose in breastmilk
  • HIV in the mother
  • T-cell lymphotropic virus Type 1 or 2 in the mother—leukemia-causing viruses
  • Maternal drug use
  • Ebola in the mother

Tips for Breastfeeding

The following tips will help you establish a breastfeeding routine that is convenient and rewarding.

  • Allow the baby to empty each breast before switching sides. Offer both breasts at every feeding.
  • Continue taking prenatal vitamins.
  • Do not attempt a calorie-restricted diet during breastfeeding.
  • Don’t give up! It gets easier after just a couple of weeks.
  • Get support if needed. The National Breastfeeding Helpline can be reached at (800)994-9662.

What to Know About Formula Feeding

If breastfeeding is not the best choice for you and your baby, iron-fortified commercially available formula is the next best option. Formula does not have the immune factors breast milk has, but it does contain optimal proportions of milk proteins, calories, fat, vitamins, and minerals needed for growth and development. Vitamin D supplementation may be needed until your baby consumes at least 32 ounces of formula daily.

Types of Formula

There are a few types of formula available to meet the varying needs of infants. They are specially formulated by experts to safely nourish your baby. It is very important that you only use commercially available formulas.

Homemade formulas lack important nutrients and could be unsafe. Speak with your pediatrician if you are unable to find a commercially available formula you feel good about. The different types include the following:

  1. Cow’s milk-based formula: Regular cow’s milk is unsuitable for infants. It is modified to be closer to human milk when used to create infant formula.
  2. Soy-based formulas: These are used for lactose-intolerant infants.
  3. Special formulas: These are available by prescription and are often used for premature infants or infants with rare disorders.
  4. Hydrolyzed formulas: These are easier to digest. They are used for babies with allergies.
  5. Low-iron formulas: These are not recommended.

All formulas must meet the Food and Drug Administration’s strict standards before being commercially offered. Generic formulas may be less expensive than name brands while offering the same benefits.

Formula comes in powdered, liquid concentrate, and ready-to-use cans. Ready-to-use cans are the most expensive.

Benefits of Formula Feeding

Formula feeding is convenient and offers greater flexibility than breastfeeding.

Conveniences

Formula feeding allows mothers to share infant feeding responsibilities with other caregivers and family members. This provides bonding opportunities for family members and helps them feel more involved with the baby’s care.

Bottle-feeding eliminates the discomfort of feeding in public. It spares working mothers the stress of seeking accommodations at work and pumping during the workday.

Formula is less digestible than breastmilk, resulting in your baby staying full longer and needing less frequent feedings.

Diet and Lifestyle

Moms who bottle-feed can eat their favorite foods, drink coffee, consume alcohol, and take medications without having to worry about how they might impact their baby.

Challenges of Formula Feeding

While formula feeding is a nutritionally sound alternative to breastfeeding, it does have disadvantages.

  1. Lack of antibodies and some nutrients: Breastmilk is complex and includes nutrients and antibodies for which a substitute cannot be manufactured. Breastmilk changes as your baby develops to specifically match his or her needs. Scientists have yet to create a product that mimics breastmilk.
  2. Some inconveniences: Formula-feeding requires you to maintain a stock of feeding equipment and formula. You will need storage space and will have to carry supplies with you when you go out. Middle-of-the-night feedings can be more taxing, as you will have to take the time to prepare the bottle while your hungry infant waits.
  3. Expense: Formula is expensive, and if your baby needs a soy-based or other specialty formula, the cost can be significantly high.
  4. Gastrointestinal effects: Formula causes more gas and firmer bowel movements in some babies.

Necrotizing Enterocolitis (NEC)

NEC is an intestinal disease that causes inflammation and death of intestinal tissue, which infects infants during the first few weeks of life. Premature infants are the most vulnerable. The condition comes on suddenly after the infant appears to be healthy.

NEC is treated by keeping the stomach empty and administering antibiotics. Surgery is performed in severe cases. Some babies recover without complications, but others are left with chronic health issues, and one-third do not survive.

Exclusive breastfeeding is the most effective preventative measure, with studies showing an 80 percent reduction in occurrences when infants are exclusively breastfed rather than formula-fed. Several studies have found a link between cow’s-milk-based formula and NEC. This is perhaps the most significant disadvantage of formula feeding.

Tips for Formula Feeding

Feeding time is a perfect opportunity to enjoy closeness with your little one and strengthen your bond. These tips will help you make the most of feeding time:

  • Hold your baby close during feeding. Skin-to-skin contact and eye contact mimic the conditions in breastfeeding and help you and your baby bond.
  • Never prop the bottle or leave it in the baby’s mouth. Your baby could choke, consume too much, or develop tooth decay later.
  • Feed only formula in the bottle. Do not add cereal. This creates a choking hazard.
  • Let the baby decide how much to eat. It is okay if the baby does not finish the bottle.
  • The WIC program offers assistance that can cover a portion of your formula expense.

While breastfeeding is best, many loving parents choose formula feeding for personal, valid reasons and raise healthy babies. Whatever method you choose, administer every feeding with love and treasure every moment with your precious baby. Most importantly, reach out to your health care provider or other supportive professionals at the first sign of an issue. Your baby is counting on you.