Breastfeeding vs. Formula Feeding

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 willing.

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 baby.

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

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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:

Infection-fighting. Antibodies passed from a nursing mother to her baby can help lower the occurrence of many conditions, including

* ear infections
* diarrhea
* respiratory infections
* meningitis

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:

* allergies
* asthma
* diabetes
* obesity
* sudden infant death syndrome (SIDS)

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 immature system.

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.
Free. 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 over-the-counter
medications.

Likewise, women who breastfeed are less likely to have to take time off from work to care for their sick babies.

Different tastes. 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.

Convenience. 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.

Obesity prevention. Some studies have found that breastfeeding may help prevent obesity.

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 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:

Personal comfort. 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 shouldn't hurt.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 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 day.

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.
Diet. 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 surgery. 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 medicines.

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 supplements.

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 stressful.

Here are a few 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 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.

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. However, if Mom is out and
about with baby, she will need to bring supplies for making bottles.

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.

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: The Challenges

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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 containers.

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 "hot spots."

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.

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 (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 $1,500.

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.

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