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A little bit of formula can help with breastfeeding, new study finds

As part of efforts to promote exclusive breastfeeding, many hospitals are reducing their use of baby formula for newborns. But - as is being widely reported today - a new study published online in Pediatrics suggests that a strict no-formula approach in the early days of breastfeeding may sometimes amount to throwing the baby out with the bathwater.

The study focused on a problem that often derails moms' early efforts to breastfeed: Early weight loss among newborns may prompt some mothers to switch from breastfeeding to formula-feeding because they worry that their babies aren't getting enough to eat. Using a little bit of formula in a carefully controlled way may help these moms to stick with breastfeeding in the long run, the study found.

Here's the back story: In the first three days after birth, instead of making milk, women produce small amounts of a fluid called colostrum. Colostrum is really good for babies, but there isn't much of it, so it's normal for babies to lose some weight before full-scale milk production begins. But if a baby loses more than five percent of his or her birth weight, doctors and moms can both get worried - especially if the mother's milk is a bit slow to come in, or if the baby seems especially hungry or fussy.

Stanford/Packard Children's pediatrician Janelle Aby, MD, who collaborated on the new study with a team of scientists at the University of California-San Francisco, told the San Francisco Chronicle:

In the first three days or so, the key complaint we hear is 'I'm concerned I don't have enough milk. I'm worried my baby is starving,' " said [Alby]. "Then we do daily weighs and it's dropping and dropping, and that's very stressful. Some moms, they get to a place where they can't take it anymore and they give the baby formula."

Yet giving formula at this point can derail breastfeeding completely - with a tummy full of formula, the baby may not be hungry enough to nurse. And using a bottle in the early days can cause "nipple confusion," in which the baby finds the bottle easier to drink from and subsequently won't take the breast.

The research team thought there might be a possible middle ground. They wondered if they could use just a little bit of judiciously delivered formula to help boost breastfeeding efforts. They taught mothers whose babies had lost at least five percent of their birth weight to supplement breastfeeding with small amounts of formula fed by syringe. The idea was to give hungry babies a little boost without feeding so much formula that they'd stop wanting to nurse. Using a syringe prevented nipple confusion. And once the moms' milk came in, the formula supplements stopped.

The strategy worked: Women who used the formula-supplementation scheme were more likely to be breastfeeding their babies at 3 months of age than moms in a control group who were told to handle their babies' early weight loss with breastfeeding only.

In the Chronicle story, lead researcher Valerie Flaherman, MD, explained how the findings should be interpreted:

"This study does not mean that all babies should get formula or that formula is better than breast-feeding. It's my strong belief that most babies do not need formula," said Flaherman, a pediatrician at UCSF Benioff Children's Hospital. "But it does raise the possibility that some babies may benefit from a little bit of carefully managed formula."

An editorial (.pdf) accompanying the new study says that more investigation is needed before rolling out this formula-supplementation technique on a widespread basis, cautioning, for instance, that scientists should study how the technique compares to established methods for helping new mothers increase their milk supply, and that the research does not address the needs of babies born prematurely.

Previously: A ban on baby-formula freebiesStanford expert discusses breastfeeding techniques, Breastfeeding: "Not only a lifestyle choice"and More breastfeeding support needed in hospitals
Photo by Ginny Washburne

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