Is a Combination of Formula and Breast Milk Best For Babies?

Researchers recently published a new study to the journal Pediatrics, revealing that for some babies, breast milk may not always be best option, as some underweight babies benefit from a dose of formula mixed with their mother's milk according to Counsel&Heal. 

The study found that feeding underweight babies formula along with breast milk immediately after birth may significantly increase the length of time that their mothers end up breastfeeding them.

Seventy-nine percent of babies who were given a combination of formula and breast milk in the first few days after their birth were still breastfeeding three months later, as opposed to only 42 percent of babies who were only given breast milk and were still being breastfed three months later.  

Researchers said that the findings suggest that "if mothers feel able to give their babies some formula milk alongside breast milk, they are more likely to breastfeed for longer."

"Formula use has the potential to be a slippery slope to breastfeeding discontinuation, but ELF is a different way to envision using it," said lead author Dr. Valerie Flaherman, an assistant professor of pediatrics and epidemiology and biostatistics at UCSF and a pediatrician at University of California San Francisco Benioff Children's Hospital, in a new release. "Rather than giving full bottles of formula that make it hard for the baby to return to the breast, early limited formula is a small amount of supplementation with a clear end point that alleviates some of the stress new mothers feel about producing enough milk."

He said the women do not immediately produce high volumes of milk after childbirth, rather secreting small amounts of colostrum, which contains high concentrations of nutrients and antibodies. During this time, babies often lose weight, causing new mothers to become concerned that their babies are not getting enough nutrients.

Forty underweight newborns who had lost more than 5 percent of their weight were studied between 24 and 48 hours of their birth, all randomly assigned to either early limited formula (ELF), which consisted of one third of an ounce of infant formula by syringe followed by breastfeeding, or breast milk alone. 

A week later, "all the babies in both groups were still breastfeeding, but only 10 percent of the ELF babies had been given formula in the last 24 hours compared with half the control group."

The American Academy of Pediatrics currently recommends that women breastfeed exclusively for the first six months of their baby's life, though researchers say that this latest study shows that for some newborns with early weight loss, a small amount of formula in addition to their mother's milk will help achieve the goal of long-term breastfeeding.  

"Many mothers develop concerns about their milk supply, which is the most common reason they stop breastfeeding in the first three months," Flaherman said. "But this study suggests that giving those babies a little early formula may ease those concerns and enable them to feel confident continuing to breastfeed."

Dr. James Taylor, medical director for the University of Washington Medical Center's Newborn Nursery, was involved in the study. 

"The results of this study are provocative and challenge conventional wisdom," he said. "It is crucial that we have more randomized controlled trials on interventions to increase breastfeeding rather than relying on heavily confounded observational studies or biased expert opinion." 

According to researchers, the findings need to be confirmed in larger studies that are more randomized.

"It will be important to see whether these results can be confirmed in future, larger studies and in other populations," said senior author Dr. Thomas Newman, a professor of pediatrics and epidemiology and biostatistics at UCSF and a pediatrician at UCSF Benioff Children's Hospital.