Baby Formula, Inc.

The World Health Organization lists artificial baby formula as the fourth best option for feeding babies.  Breastfeeding, mother’s expressed milk, and donor milk should all be considered for feeding babies before formula.  Formula is necessary, however, because human milk banks don’t always have enough milk to meet demand.

The formula industry is a $25 billion dollar business.  Their competition, breast milk, is both superior and free.  There are regulations in place that formula companies are to follow in the marketing, education, and sales of their products but, many times, these international codes are violated.  This International Code of Marketing of Breast-Milk Substitutes exists to regulate how formula manufacturers promote sales of breast milk substitutes.  However, this code is not legally binding and relies upon individual governments to enforce fair and honest marketing practices.  Formula companies should adhere to internationally-endorsed ethical marketing practices.  In reality, many companies disregard these standards, or look for loopholes, in favor of entering new markets and making bigger profits.

The Code states that formula companies should not advertise or promote formula in any way; they should never distribute free samples; warnings should be on all labels, in the local language, indicating the superiority of breast milk and warnings of health complications with formula; formula company employees should not have contact with pregnant moms or mothers of young children (such as through online baby clubs); and no pictures of children, nor pictures or text that idealize formula, should be on packaging.

There are many formula companies who are not in compliance with this marketing code for breast milk! Not only is formula lacking in essential nutrients to grow healthy children, it poses a significant financial cost to families.  Once a mother has chosen to give formula, her milk supply begins to decline.  Weeks or months later when they realize they don’t have the money to purchase formula, or their baby doesn’t tolerate formula well, re-lactation is challenging at best.

Imagine the worldwide breastfeeding statistics if $25 billion could be spent to support and promote breast milk.  Rather than having formula companies undermine the greatest super food for babies, infants worldwide would be given the best chance at life and health.

Pitfalls of Infant Formula

Though there are many articles about the benefits of breastfeeding for babies, benefits for mothersuniqueness of breast milk, the importance of colostrum, and the amazing antibodies in breast milk it is also important to talk about the pitfalls of infant formula.

Here are 20 known and documented adverse health implications from infant formula:

    1. Cognitive Development
      Formula-fed infants have less advanced cognitive development.1 Preterm babies given formula have decreased cognitive abilities at five years of age.2
    2. IQ
      Formula-fed infants have lower mental development scores throughout adolescence, by as much as 10 points.3  4
    3. SIDS
      Formula feeding increases a baby’s risks of Sudden Infant Death Syndrome.5
    4. Allergies & Eczema
      Formula-fed infants have higher rates of allergic disease.6
    5. Asthma
      Babies who receive formula before 2 months of age have a four-fold increase than babies who are breastfed for at least four months.7
    6. Ear Infections
      Formula fed babies have 75% increase in incidence of otitis media (ear infections).8
    7. Respiratory Infections
      Formula-fed infants have higher rates of bronchitis, croup, and pneumonia.9
    8. Infectious Disease
      Formula feeding is associated with higher incidences of infectious diseases (including diarrhea, sepsis, and pneumonia) and hospitalizations for illnesses.10
    9. Necrotizing Enterocolitis
      Formula-feeding is associated with significantly higher rates of NEC.11 NEC is a serious illness that can be fatal, especially in premature infants.
    10. Gastrointestinal Illness
      Children and adults who were formula-fed have greater incidences of Chrohn’s disease, inflammatory bowel disease, ulcerative colitis, Celiac Disease, and other GI issues.12  Given that breast milk is essential for the proper development of a baby’s immature intestinal mucosa, it makes sense that coating his system with anything other than breast milk before his body is ready can cause gastrointestinal distress.
    11. Harmful bacteria
      Exclusively formula-fed babies are more likely to be colonized with pathogenic bacteria such as E-coli, Candida, and Clostridium.13
    12. Gross Motor Coordination
      Formula-fed infants are more likely to have gross motor coordination delays than babies who were exclusively breastfed at least four months.14
    13. Obesity
      Children who are formula-fed have increased rates of obesity throughout their lifetimes.15  This could be because breastfeeding has a cell programming effect in reducing overweight conditions, which formula-fed infants miss out on.  Formula-fed babies have higher insulin concentrations in their plasma which can begin fat deposition in the body at an early age. And breast milk contains the hormone leptin (which is not in formula) that helps regulate body weight.
    14. Diabetes
      Breastfeeding is protective against both Type I and Type II diabetes. Diabetes rates are higher among children and adults who were formula-fed.16
    15. Cancer
      Risks for several childhood cancers are greatly increased in formula-fed children: lymphoma, leukemia, and Hodgkin’s disease.17  Researchers have identified alpha-lactalbumin, a protein in breast milk, which causes the death of abnormal cells.  This human milk protein does not exist in formula.
    16. Diarrhea and Vomiting
      One of the leading causes of infant deaths around the world, the incidence of diarrheal disease is greatly increased in formula-fed infants. Exclusive breastfeeding for at least four months is highly protective.18
    17. Multiple Sclerosis
      The strongest link to MS is a person’s diet, especially in fatty acids.  Breast milk has the perfect makeup of essential fatty acids for humans and has not been replicated in formula.  In fact, formula destabilizes the normal development of myelin. There are higher incidences of MS in children and adults who were formula-fed.19
    18. Immunizations
      Children who are formula-fed show lower antibody responses to vaccines.  In fact, some formula-fed children show no antibody levels at all.20
    19. Neurotoxins
      Formula has much higher levels of manganese than breast milk and many times also contains MSG, toxic lead and silicon levels, nitrites, GMOs, and more. Formula is not sterile and has been recalled many times over the years.21
    20. Schizophrenia
      Exclusive formula-feeding, or breastfeeding less than two weeks, has been shown to be associated with an elevated risk of developing schizophrenia.22


{Note from Nursing Nurture:  One of the most controversial parenting topics is breastfeeding vs. formula feeding. Women love to hear the benefits of breastfeeding but if something is stated in the reverse it can cause great dissension. Mothers become polarized.  Some vehemently stand up for breastfeeding benefits while others say they “hate” the messenger.  

This article is not intended to upset mothers who formula-feed.  Nor is it meant to hurt them or make them feel guilty

Rather it is to help mothers have all the information and be able to make an informed decision.  Health care providers do not provide all of the negative impacts of formula and many mothers lament the fact that they were never told of the long-term, negative health implications for both mothers and babies from formula. Ultimately, all mothers must make what they feel to be the best decision for their situation.

Some mothers, when given all the information, will choose to breastfeed when they normally would not have.  Still others will persevere to find good lactation support, in spite of a health care system set up to fail those who need this additional help.  And, most importantly, understanding the pitfalls of formula may resonate so strongly with some breastfeeding mothers that they may choose to donate their breast milk.  By doing this, a day could come when no baby whose mother truly can’t produce enough milk is faced with having to give her child formula.}

Feeling Guilty for Not Breastfeeding

Mother Bottle Feeding a BabyOccasionally I receive notes from mothers who were unable to breastfeed for one reason or another and they read the material about breastfeeding on Nursing Nurture and feel hurt, sad, or battered…as if they have failed in parenting.  They wonder why I would post so many documented benefits to breastfeeding and harms to alternatives since many moms have had a difficult journey and this research and information only makes them feel worse.

It is absolutely not my intention to make a mom feel less of a mom, as if she has failed, or beaten up by reading the pages of Nursing Nurture.  There are many aspects to parenting, and feeding babies is just one.  How a mom feeds her baby does not have to impact the love she has for this new life she is blessed with, the bond she is able to forge, or the completeness she feels as a mother.

At the same time, while feeding babies is only one aspect of parenting, it is important.  And there is a lot of misinformation as well as lack of information in our culture.  Most medical professionals, who should know and encourage what is best, are not trained in breastfeeding while much of their education has received funding from formula companies.  And while there truly are some women who simply cannot produce enough milk to feed their babies, this number is quite low (1-5% of the population).  The vast majority can breastfeed, with proper support!!

Breast milk and formula are not two nearly-the-same choices to feed a baby. In fact, the World Health Organization lists options for feeding babies in this order:

  1. Breastfeeding at breast
  2. Mother’s expressed milk in cup, bottle, etc.
  3. Donor breast milk
  4. Formula

Most parents want to do what is best for their baby, or as close to it as possible.  In fact, I have never met a parent that wants their child to have the fourth best option in anything – whether it’s food, sports, clothing, friendships, or something else.  Yet, everyday, moms are having to settle for fourth best when it comes to feeding their babies.  There is a systemic problem:  many medical professionals either don’t support breastfeeding or don’t know how to give good support; IBCLC Lactation Consultants are not always available in a mother’s community; our culture tells moms it is more acceptable to pay 20-fold (or more) in formula feeding costs rather than seeing a lactation consultant and making breastfeeding work; and, there is not nearly enough donated human milk when a mother truly can’t breastfeed.

It seems to me that most mothers have gotten the message that “breast is best.”  Most mothers initiate breastfeeding.  But, by 6 months when babies should still be exclusively breastfed, the vast majority (78% in America) 1 have introduced formula. What has happened?  There’s a lack of support and help for breastfeeding mothers.  Our society doesn’t value qualified lactation help enough to cover it on most insurance policies either.  And our maternity leave laws barely allow time for mom and baby to establish a breastfeeding relationship, before mom is expected to return to work full-time. So moms are left to do what is natural and normal – but not always easy – all alone. And when they fail, and feel guilty, it seems easiest to hate the messenger.

It is not my intention to hurt any mom’s feelings or make her feel defeated.  On the contrary, I value motherhood and babies so much I have a passion to share breastfeeding research and help women become informed and supported.  Mothers have a right to feel sad, hurt, or mad when they learn the true uniqueness of breast milk and just how important it is.  Women should be outraged by a system that has failed them.  They should not beat themselves up and feel guilty. . . it is not their fault they didn’t succeed at breastfeeding.  It was a failure of the system to share information to make an informed choice as well as support her with breastfeeding problems and challenges.  Who is even responsible – in our current system – to provide breastfeeding support?  The obstetricians claim it is the pediatrician’s responsibility and the pediatrician sees babies – not mothers…and especially not mothers’ nipples.  Those women lucky enough to have a midwife will at least have someone who is usually supportive of breastfeeding, though not necessarily more knowledgeable than any other breastfeeding mother.

It is my hope that if you were not able to breastfeed your child, you wouldn’t feel guilty or as less of a mom because you have read this site.  Rather, that you would feel  empowered so that if there is a “next time” you can nurse your child with success and share this information with others so they may succeed as well. Not only that, it is my hope that we as a society would value breastfeeding so much that any baby who couldn’t receive his own mother’s milk would have plenty of donor milk to drink.

Uniqueness of Breast Milk

Mother breast feeding her sonThe uniqueness of breast milk is undeniable; it is an incredibly amazing and wonderful living substance!  Unable to be replicated in any laboratory, it is the “norm” for what a baby should eat.  But not only is human milk unique, all mammalian milk is specific to its kind and completely unique for its offspring.  For example, a mother polar bear’s milk has a fat content of 33% (compared to 3-5% in human milk) – perfect for a baby cub who must quickly put on weight – with an average 2100% growth rate in his first four months of life!  A mother goat and mother cow produce milk that is much higher in protein than human milk – exactly what these baby mammals need to quickly gain muscle and strength.1

Infants are born with immature immune and intestinal systems that need human milk to help them grow and mature while preparing them for food later in the first year of life.  A baby’s brain will triple in weight during the first two years so a mother’s milk is low in protein but highest of all milks in lactose – essential for appropriate brain development.  Human milk is also the only mammalian milk with higher concentrations of whey than casein – which helps a baby’s body quickly digest each serving so she will be awake sooner and ready for more cuddles and bonding that come through breastfeeding…as well as satisfying her hunger.

It seems that societies in developed countries are caught between knowledge and belief.  Everyone knows the rhetoric “Breast is Best,” yet our actions show most people don’t really believe there is much difference between formula and breast milk.  Nursing seems to be an ideal, a lofty goal, but a perfectly healthy and acceptable substitution is believed to be found in infant formula.  One need not look any farther than the CDC’s Breastfeeding Report Card which shows that while 81.1% of mothers initiated breastfeeding in 2016, only 22.3% of mothers were still exclusively breastfeeding at six months. 2

Artificial milk may be derived from a number of sources – cow’s milk, goat’s milk, soy beans or even almonds and rice. Various components are added and taken away and the milk is heated and treated to be digested by an infant. It is a very complex process to change the milk of one species (or plant!) to make it edible by another.  Not only are there multiple modes of contamination possible throughout this process (not to mention contamination that can occur later from dirty water or mixing formula for the baby), even the ingredients are so different the two substances really can’t even be compared.  Yes, both can be put in a baby’s body.  But only the norm – breast milk – was created uniquely for babies.  The variant – formula – is so vastly different that study after study consistently proves that these babies will not reach their intellectual potential.  Along with this, their physical health will suffer as a result, throughout their entire lives.

Nursing can be exhausting, difficult, and just plain hard – especially in the beginning, especially without support, especially with a preemie, an emergency c-section, a pediatrician who is not sold on breast milk, when you are surrounded with others who are not encouraging, multiples, sleep deprivation, pumping, cracked nipples, clogged ducts, a crying baby, no one to help, low supply, and so much more! But breastfeeding initiation rates are on the rise in the West.  It is not a lack of desire to breastfeed, but so many more times a lack of support, accurate information, and help.

Yes, breast milk is absolutely unique.  Yes, it is perfect for your baby.  And for mother.  Yes, it is best.  But it is also the norm.  With support and help it is something you, too, can give your precious baby!

How Breastfeeding Benefits Society

iStock_000020519032XSmallThat breastfeeding is healthy, saves lives, and has benefits for both mother and baby are well-known.  At the same time breastfeeding benefits society and our world in many profound ways:

  • Breastfeeding is the single greatest way to prevent childhood deaths due to illness around the world.
  • Babies who are able to begin breastfeeding within an hour after birth are more than three times as likely to survive as one breastfed a day later.
  • 830,000 childhood deaths could be prevented each year if breastfeeding were initiated for every baby following birth.1
  • Babies who are not exclusively breastfed have significantly higher rates of diarrhea, pneumonia, malnutrition, ear infections, allergies, asthma, eczema, gastrointestinal disorders, Multiple Sclerosis, childhood cancers, and much more.

And yet, worldwide, two out of every three children are not exclusively breastfed for the first six months of life.2

Did you know the formula industry is worth $25 billion?3  Imagine if that amount of money could be spent worldwide on breastfeeding.  Imagine if every woman received information about the incredible importance of breastfeeding her baby while pregnant, and then the support she needs after having her baby to successfully breastfeed.

Imagine if every healthcare worker were informed about the single greatest super-food in the world – breast milk – and helped to encourage and support women in their care not to give up.  Imagine if societies understood how having healthy babies and then, as these children grew, healthier adults would benefit their country’s economy.

This incredible economic impact cannot be overestimated.  In the US alone, human milk as part of the gross domestic product is valued at more than $110 billion/year, but two thirds of this amount is lost because moms are forced to wean their babies prematurely. 4  Millions upon millions of dollars would be saved annually on healthcare costs as formula feeding has lifelong negative health impacts.

But this would also require supporting women who breastfeed, including tearing down barriers to breastfeeding in public, having adequate maternity leave for all women, and then employer support of continued breastfeeding/pumping after returning to work.  It would pay for itself, of course, and then some.

Yes, the simple act of breastfeeding, the special and loving bond between a mother and her baby, does have a profound impact on society.  Let’s tear down the barriers and make sure everything in our culture that can be done to support breastfeeding mothers is done.

Breastfeeding Myths

dsc1Breastfeeding myths abound.  Here is a list of the most common along with the real facts:

Myth #1: Breastfeeding is easy.

Truth: Breastfeeding is natural but it is not always easy! Having experienced help to get your breastfeeding relationship off to a good start is very important. And finding support from other breastfeeding moms is a wonderful help and encouragement. If you are experiencing any pain or anxiety about breastfeeding, or if you just want to prepare for breastfeeding while pregnant, find a local IBCLC (International Board Certified Lactation Consultant) as well as try to plug into a local La Leche League (or other) breastfeeding support group.

Myth #2: Doctors and nurses know a lot about breastfeeding and are helpful resources.

Truth: Most doctors and nurses do not receive training in school about breastfeeding. Even if they do, it is quite limited.  Some may sincerely want to help you, but unless they have specific (additional) lactation training they are no more qualified than anyone else to assist you with breastfeeding. In addition to this, many are influenced by formula companies who fund research, encourage the use of their growth charts, and give free formula and coupons for doctors, nurses, and hospitals to give to unsuspecting moms. For qualified lactation support, seek out an IBCLC (International Board Certified Lactation Consultant) as well as a La Leche League group for mom-to-mom breastfeeding support.  Also, find a hospital or birthing center that has BFHI (Baby Friendly Hospital Initiative) status for the birth of your baby.  Staff at these locations are trained in practices that support and encourage breastfeeding.

Myth #3: If it’s hot outside, your baby needs water in addition to breast milk.

Truth: All your exclusively breastfed baby needs is breast milk. Breast milk is over 85% water. Your baby may need to nurse more frequently because he is hot and thirsty (just as you are!) but all he needs is your milk. In fact, milk is unique and specific to each mammalian species and breast milk is the perfect food for human babies!

Myth #4: Nursing on demand spoils your baby.

Truth: Inside your womb your baby was able to eat 24/7. Now that he’s out, he no longer has that luxury. But he does know when he’s hungry and if you follow his cues and feed him on demand you will have a baby that is happier and content because he is having his needs satisfied. Your baby is not being manipulative if he cries or lets you know he is hungry.  This isn’t spoiling, it is simply taking care of your baby’s needs.

Myth #5: There are no health benefits to non-nutritive sucking.

Truth: There are many health benefits to non-nurtritive sucking! Not only are breasts the original baby soother they are good for so much more than just active milk transfer. Breasts are a healthy pacifier, comforter, cuddle, and breastfeeding helps develop a normal face and jaw palate.

Myth #6: Breastfeeding moms have no idea if their baby is getting enough milk.

Truth: There are many signs your baby is feeding well and ways a mom can tell if her breastfed baby is getting enough milk. First, she should hear active sucking/gulping during breastfeeds. Her baby should nurse until he comes off the breast satisfied, or wanting the other side. After nursing he should be content (or asleep) for at least a few minutes before wanting to nurse again. He should show normal developmental signs, good skin tone, contentment, and grow out of his clothes appropriately. And, most importantly, what goes in must come out! If a baby is drinking sufficient breast milk he will have enough wet and dirty diapers.

Myth #7: Putting babies on a feeding schedule is best for them to develop a routine and learn proper sleep schedule.

Truth: A baby knows when he is hungry and it is best if mom follows her baby’s cues. All women are different as are all babies. A woman’s breast capacity varies not only from mom to mom, but between her own breasts. And the amount each baby takes in is different – each feed can even vary (just as we might be hungrier or eat more and then later want less to eat – there is no difference with babies and breast milk). Finally, your baby has not read the latest scheduling book about what he’s “supposed” to do. It is best to nurse on demand to establish your milk supply and grow your baby. Most babies nurse every 1-2 hours and this is normal. It is important to nurse at night and seeking to schedule his breastfeeding and sleep patterns could severely diminish a mother’s milk supply too.

Myth #8: I can’t nurse if I’m sick or taking an antibiotic.

Truth: You absolutely can! Your body is so amazing that if you are sick or have come into contact with bacteria, your body is making antibodies to put in your milk to protect your baby from these very same things! In addition, there are very few medications that are contraindicated for nursing. Almost every antibiotic or medicine you are prescribed from your doctor is compatible with nursing. There are many factors that affect how a medication can enter breast milk as well as how a baby’s body will be affected by a medication.  In general, most antibiotics, antidepressants, topical creams, and pills for acute and chronic illnesses are fine. Examples of drugs to be concerned with are some used to treat cancer and radiopharmaceuticals.

Myth #9: It’s normal for breastfeeding to hurt.

Truth: Breastfeeding should never hurt. If you are in pain, please seek qualified lactation support to find out why and help solve the problem. When you are beginning breastfeeding and the milk first comes in you might feel a tinge, or tingle, or “pain” just for a second while the milk lets down, but breastfeeding should not hurt. The vast majority of the time breastfeeding pain can be solved with altering positioning and latch of the baby to the breast.

Myth #10: Its too painful to nurse if I’ve had a c-section.

Truth: There are many ways to nurse a newborn after having a c-section. While you are in the hospital, ask to see a lactation consultant and have her help you find a position that is comfortable for you to nurse in. Many women have found nursing their babies while lying on their side to be effective so there is no pain/pressure on the incision.

Myth #11: I have to worry too much about my nutrition in order to nurse.

Truth: While some things you eat do affect your breast milk, your body will make good, healthy milk for your baby on just about any diet you eat. In fact, unless a mom is severely malnourished to the point of dying her milk will be healthier than any artificially manufactured formula.

Myth#12: Mothers with small breasts produce less milk.

Truth: Breast size does not equal breast capacity. Glandular tissue is necessary for milk, not fat tissue. Even women with small amounts of glandular tissue can make plenty of milk for their baby throughout a 24-hour period. Some moms will just need to feed more often than others. But, even if the mom has plenty of milk, some babies need to be fed more often than others so even large milk capacity in breasts doesn’t mean a mom will nurse less often. Just follow your babies cues and feed on demand and your breasts will be able to adequately and exclusively nourish your baby.

Myth #13: There’s not enough milk to nurse twins.

Truth: You have two breasts and two babies – there is plenty of milk! Your body makes milk according to how much is needed. With two babies nursing, your body gets the message to make more milk and will do so. If you will give attention in the early days to establishing a strong milk supply, and don’t supplement your babies, you will have plenty of milk to nurse twins.

Myth #14: Colostrum isn’t really milk so it doesn’t matter if I nurse much before my milk comes in.

Truth: Colostrum is breast milk and it is amazing and so important for your baby. No one has been able to replicate it, and if they could they would be able to charge a fortune. For the first 48 hours after birth, babies are not yet very hungry, but they need immunological protection from all the new things they are encountering outside their mother’s womb. Colostrum provides this protection. Additionally, lots of skin-to-skin and nursing in the first couple of days helps to establish a strong milk supply and allow mother’s milk to come in more quickly.

Myth #15: If I nurse my baby at night he’ll never learn good sleep habits.

Truth: All babies learn to sleep eventually. And they grow up so fast you will one day look back on the first couple of years of your baby’s life and wonder where it went. Nursing at night is important, too, because prolactin levels are higher. Prolactin is the hormone responsible for milk production so nursing at night helps you to establish your milk supplyBreastfeeding and sleep is a hot topic in our western culture these days, but babies are designed to need to nurse frequently in the early days – both night and day.  Sleeping through the night will come when they are bigger/older.

Myth #16: Moms who don’t nurse get more sleep.

Truth: Actually, the exact opposite is true. The latest research shows that nursing moms get more sleep than bottle-fed babies. How can this be? Well, first of all, even if you aren’t giving the bottle yourself, if your baby is eating your body needs to get the message and you should be pumping. If you choose to sleep during the feed and not pump your supply could begin to suffer. Additionally, your body will probably be uncomfortably full and you may be awake with engorgement. Or, if you hear your baby cry or stir your maternal instincts will kick in and you may wake up. Bottle feeding requires a more active state of alertness on your part as well. You have to get up, mix the formula, and give the bottle to your baby. Then the bottles need to be cleaned and sterilized. Contrast this with the semi-awake state you can be in to help your baby latch onto your breast and then you fall back asleep while your baby nurses. Not only does the research show that moms who breastfeed get an average of 40 minutes more sleep each night, but the quality of sleep is also better. Yet another reason to nurse your baby!

Myth #17: Formula is a perfectly safe/good alternative.

Truth: Formula is a man-made, synthetic concoction that is made by assimilating cow’s milk, goat’s milk, and/or soybeans, synthetic vitamins, and other factory-processed ingredients, heated to high temperatures, and canned for unwitting families to purchase for their precious baby. Breast milk is the norm, and it cannot be replicated. In fact, every alternative is so far from the norm that it is linked with lower IQs, sicker children, increased rates of cancer, asthma, allergies, diabetes, gastro-intestinal disorders, and more. Formula is not only not a good alternative, it is actually quite dangerous. Did you know that the World Health Organization states that formula is only the fourth best feeding option for babies? Breast milk at the breast, breast milk in a cup/bottle/etc., and donor breast milk are all considered better feeding options.

Myth #18: You only have milk every 2-3 hours.

Truth: You always have milk! It’s the law of supply and demand – the more the baby drinks the more your body will make. In fact, empty breasts make more milk. Therefore, the more you nurse, the more you have! Your body is so unique and in tune with milk-making that when your baby goes through a growth-spurt and needs additional milk it will get this message as your baby nurses more and increase the amount of milk it makes!

Myth #19: Breastfeeding keeps your baby weight around longer.

Truth: Breastfeeding helps moms to lose their baby weight quicker. Every time a new mom nurses, her uterus contracts and returns to its original size faster. On average, breastfeeding moms have returned to their pre-pregnancy weight by 6-9 months postpartum – just through nursing! Nursing allows moms to eat more and burn more calories, all while sitting and nursing her precious baby.

Myth #20: After the first year there’s no real benefit to continued nursing.

Truth: The World Health Organization states that babies should be exclusively breastfed for about the first six months and then complimentary foods introduced alongside breast milk. Breastfeeding should continue for up to two years or beyond! There are always health benefits that baby will get from breast milk. In fact, as your toddler grows and explores more and more of his world around him, breast milk is even more important to help protect him from the organisms he is exposed to in his environment.

Myth #21: Breastfed babies are picky eaters.

Truth: Breast milk changes flavor with mom’s diet so breastfed babies are actually exposed to a wide variety of flavors and tastes. Breastfeeding helps to prepare babies for the tastes of different and varied foods they will be exposed to in the future.  Breastfeeding allows babies to have various flavors and smells in their food every single day, preparing them for a wide variety of foods when solids are introduced!

Myth #22: Breastfed babies have many cavities from nighttime nursing.

Truth: Breastfeeding and bottle feeding require completely different tongue and palate movements. A breast nipple goes back farther in the baby’s mouth so milk does not sit around the teeth but is moved directly to the back of the mouth to be swallowed. In contrast, bottle-feeding is linked with increased cavities (no matter what is in the bottle) as the teat from the bottle does not go far into the baby’s mouth and the liquid can sit around the teeth overnight. Tongue tie and lip tie are also associated with cavities.  Breastfeeding is NOT associated with cavities.

Myth #23: Formula-fed babies are just as healthy as breastfed babies.

Truth: Breast milk gives your baby immunities. It contains immunoglobulins which allow a mother’s milk to specifically protect against whatever bacteria her baby is exposed to. In fact, not only are breastfed babies sick less and healthier overall while they are fed on breast milk, they are healthier over the course of their entire lives! Let’s put it another way, formula fed babies are sick more often and more severely than breastfed babies.

Myth #24: Formula-fed babies have the same IQs as breastfed babies.

Truth: Breastfed babies have higher IQs than formula-fed babies, 10 points higher on average per person! But, since breast milk is the norm, it is more accurate to say that formula-fed babies have lower IQs than breastfed counterparts.1 2 3 There are many other health benefits for babies as well!

Myth #25: Once my baby gets teeth he should be weaned.

Truth: Teeth have no bearing on breastfeeding. The sucking a baby does at the breast is not affected by his teeth and should not cause the mother any pain either. When a baby is latched and actively nursing the nipple is in the back of his mouth and his tongue is extended beyond his bottom teeth.  If there is any “damage” done by teeth while breastfeeding it would be to the underside of a baby’s tongue.  Teething and biting at the breast can sometimes occur during comfort feeding but there are many things a mom can do to make sure this doesn’t happen.  Breastfeeding should continue as long as is mutually beneficial for mom and baby. World-wide, weaning typically occurs between 2 1/2 – 7 years of age.

Myth #26: Supplementing with just one bottle while in the hospital does not hurt breastfeeding.

Truth: Whether a baby is supplemented with formula, water, herbal tea, glucose water, donor milk, or her milk is “fortified” all have an impact on the long-term breastfeeding relationship between mother and baby. There are many reasons given for this: mom needing sleep/recovery time, prevention of hypoglycemia or jaundice in baby, or because mom’s milk “hasn’t come in yet.” (Though none of these reasons are good indications for supplementing breast milk.) Actual research shows that supplemented babies are significantly less likely to be exclusively breastfed after hospital discharge; breastfeeding duration is shortened 4-fold; and, moms remember which brand of formula was used and most will then use that brand seeing it as an endorsement by the medical establishment.

Myth #27: Tongue tie is an uncommon condition and not worth worrying about.

Truth: If mom is experiencing any pain while nursing or if baby is having trouble latching and/or slow weight gain then your baby should be evaluated for tongue-tie and lip tie. With a trained practitioner, tongue tie is easy to diagnose, simple to resolve, and has immediate, positive results with no side effects. The younger your baby is when tongue-tie is diagnosed and resolved the easier it will be to continue breastfeeding. Early treatment, before your baby has learned – and become comfortable with a poor latch – means a lot less reteaching later.

Myth #28: Birthing practices do not affect breastfeeding.

Truth: Birthing practices have a huge impact on breastfeeding. Stress is strongly linked with delayed milk onset. 4 Cesarean sections and instrumental vaginal births typically delay skin-to-skin initiation and the first breastfeed, both of which have a high impact on breastfeeding duration. 5 Pain medications given to the mother affect the baby causing drowsiness and inability to suck well. 6 Some of these pain medications continue to impact the newborn for up to a month after birth!

Myth #29: Determination is no match for breastfeeding obstacles.

Truth: Maternal determination is a huge factor in overcoming breastfeeding obstacles and helping mothers meet their breastfeeding goals. Even in cases of emergency cesarean sections and other unplanned birthing interventions, premature births, multiples, etc. research shows over and over that maternal commitment goes a long way in overcoming strikes against mom or baby in breastfeeding and allowing the breastfeeding relationship to succeed. 7

Myth #30: Bigger babies are hungrier and need to be supplemented or start solids earlier.

Truth: A baby’s size does not impact when to start solids. In fact, from one to six months of age babies consume roughly the same amount of milk each day. Both the World Health Organization and American Pediatric Association state that babies should be exclusively breastfed for the first six months of life, with complimentary foods introduced alongside breastfeeding thereafter. Large or small, all a baby needs for the first six months is breast milk.

Myth #31: Babies can be allergic to their own mother’s milk.

Truth:  There has never been a single documented case of a baby allergic to his mother’s milk.  Mothers and babies share 50% of their genetic makeup; no antibody response to a mother’s breast milk has ever been reported. 8 Babies CAN be allergic to various foods a mother eats that can pass through her milk. Allergies occur in approximately 6% of children but breastfeeding when a baby has allergies not only can continue but can help lessen allergens and severe reactions.

Myth #32: A mother must wean her baby when she is acutely ill.

Truth: Whether a mother is sick with the common cold, influenza, food poisoning, or other illness – even if it requires antibiotics or other medications – is NOT an indication for weaning.  Breast milk is absolutely unique and amazing with its antibodies that are made specific to any germs or bacteria a mother comes into contact with.  Therefore, if a mother has the flu, her milk already has antibodies to protect her baby from this specific illness!  Food poisoning cannot pass through breast milk, nor can any other acute illness.  When mother is ill, it is best to drink plenty of liquids, practice good hygiene, and continue to breastfeed your baby as normal.

Myth #33: Maternal vaccines are contraindicated while breastfeeding.

Truth:  While maternal immunizations when a mother is breastfeeding are not ideal, every vaccine is considered safe with the exception of smallpox.  There are many well-documented health consequences associated with formula, even for a short duration.  Therefore, when a vaccine is necessary in a breastfeeding mother it should not be a cause of breastfeeding concern or reason for supplementation and/or early weaning.

Myth #34: A baby who is lactose intolerant should not drink breast milk.

Truth: While breast milk has the highest lactose amount of any mammalian milk, babies are not lactose intolerant.  Lactase – the enzyme that digests lactose – is produced in abundance in all babies regardless of ethnicity until at least the age of 2 1/2 and beyond.  As we age, the body can begin to have an insufficient amount of lactase, which is why it is common to hear of older children and adults who are lactose intolerant.  But primary lactose intolerance is so rare that the majority of medical practitioners will never see it in their lifetimes.  On the other hand, some babies will develop secondary lactase deficiency after using antibiotics, gastrointestinal illness, food allergies, and feeding mismanagement.  In these cases, breast milk (and proper lactation support) will bring the quickest healing to a baby.

Myth #35: A breastfeeding mother is extremely fertile 6 weeks after birth.
Truth: Exclusively breastfeeding mothers who nurse their babies on demand both day and night have a very effective form of birth control for six months following birth! The Lactational Amenorrhea Method is even more effective than the progestin-only birth control pill and various barrier methods.  Plus, it has the added bonus of not causing a hormonal disruption to your body or milk supply like many other birth control options.

Myth #36: Breastfeeding is an individual decision with no impact on society.
Truth: While it is up to each mother to decide if she is going to breastfeed her baby, choosing to not breastfeed does have tremendous societal implications. In the US alone, human milk as part of the Gross Domestic Product is valued at more than $110 billion/annually, but two thirds of this amount is lost because moms are forced to wean their babies prematurely. 9  Millions upon millions of dollars would be saved each year on healthcare costs as well.

Myth #37: It is too challenging for dads to bond with their breastfed babies.
Truth: There are MANY ways to interact with a new baby! Dads can hold their babies in skin-to-skin time, carry their babies in a sling, give baths, change diapers, burp them after feeds, practice baby massage, rock baby, sing to baby, and so much more. Breastfeeding is only one part of a baby’s life.  In fact, dads also play a vital role in this by supporting and encouraging breastfeeding, helping with positioning at the breast, etc.  Babies who are breastfed can and do have an amazing bond with their dads!

Myth #38: Exclusively breastfed babies need supplemental vitamins.
Truth: Breast milk has everything a baby needs for the first six months of life, with the possible exception of Vitamin D.  Some pediatricians may falsely encourage breastfed babies to have a multivitamin supplement since formula is “fortified with vitamins.” However, breast milk has the perfect balance of vitamins and minerals, the amounts it has are incredibly bio available for baby, and taking supplements actually inhibits the absorption of nutrients in breast milk.  Vitamin D is synthesized in the body by direct exposure to sunlight.  If baby is not receiving adequate amounts of sunshine each week, this is one vitamin supplement a breastfed baby would need.

Myth #39: Breastfeeding in public is too embarrassing.
Truth: Sadly, there are many in our society who want breastfeeding mothers to believe this lie.  The reality is that breastfeeding is natural and normal; babies need to eat all the time; and mothers and babies can and should go out together. If someone has a problem with breastfeeding in public then it should be their problem – not yours! A breastfeeding mother is just doing the most normal thing she can – feeding her baby.  It is important to normalize breastfeeding in everyone’s eyes…and the more people see it the more normal it will be.  There are many tips for breastfeeding mothers to nurse in public too.  A breastfeeding mother doesn’t need to be embarrassed for giving her baby the milk he was created to drink.

Myth #40: Nursing while pregnant is dangerous for my unborn baby.
Truth:  Research concludes there is not an increased risk of preterm labor while breastfeeding and the amount of oxytocin released while breastfeeding does not cause cervical effacement or dilation  While discussing breastfeeding during pregnancy with your health care provider is prudent, worldwide it is quite common for mothers to continue breastfeeding an older child after conception.

Smoking and Breastfeeding

Is it safe to smoke while breastfeeding?

Everyone knows that smoking cigarettes is hazardous to their health.  And while the risks of smoking during pregnancy are well documented with increased incidences of preterm birth, low birth weight, and increased risk of abortion or stillbirth, much less is publicized about smoking and breastfeeding. Many mothers who smoked in the past want to make changes now that they have a baby, but change can be hard and take time.

They understand the importance of breast milk for their babies but wonder if the benefits are negated if they still use nicotine.  The bottom line is that even though nicotine does pass into breast milk, and mothers should seek to stop smoking or at least use a nicotine patch, breastfeeding is still a better option than formula feeding, for a variety of reasons.

The CDC states the following:

“Mothers who smoke are encouraged to quit, however, breast milk remains the ideal food for a baby even if the mother smokes.  Although nicotine may be present in breast milk, adverse effects on the infant during breastfeeding have not been reported.  AAP [AmericanAcademy of Pediatrics] recognizes pregnancy and lactation as two ideal times to promote smoking cessation, but does not indicate that mothers who smoke should not breastfeed.”1

What are the various forms of nicotine?

  • Cigarettes – Smoking 17/day is proportional to the 21 mg nicotine patch.  The 14 mg and 7 mg patches have significantly less nicotine than cigarette smoking.
  • Patch – This is considered a safer option than smoking.  Nicotine amounts don’t have a sharp rise and decrease as with cigarettes or gum so timing breastfeeding is less important.
  • Inhaler – Dispenses low levels of nicotine and even habitual users will typically incur less nicotine than smoking a pack of cigarettes each day.  There is minimal transfer of nicotine to breast milk.
  • Gum – Maternal serum levels fluctuate as with smoking cigarettes.  The faster the gum is chewed the greater the peak levels of nicotine.
  • E-cigarette – Considered safer than smoking a cigarette. Peak blood nicotine levels similar to the nicotine inhaler and minimal in breast milk.2

How can I reduce the levels of nicotine my baby is exposed to?

Smoking (or using gum, inhaler, etc.) immediately following breastfeeding and then waiting a couple of hours before nursing again allows the nicotine in breast milk to decrease before each breastfeeding.  The half-life of nicotine is 95 minutes – that means it reaches its peak in the maternal blood stream at this time.  It takes 5 half-lives to clear a drug completely.  (You can read more about this on how medications affect baby.)

Smoking and then breastfeeding right afterwards greatly increases the amount of nicotine in breast milk.  However, if your baby wants to nurse after smoking it is better to breastfeed than give formula.

It is important to smoke away from your baby.  Smoking in a separate, well ventilated room can greatly reduce the amount of second hand smoke your baby is exposed to.  Decreasing the number of cigarettes a mother smokes or switching to a nicotine patch is also beneficial.

What effect does smoking have on a mother’s breast milk?

Smoking cigarettes can have a detrimental effect on a mother’s milk supply, milk ejection reflex, and a baby’s weight gain.3  In a mother with an ample supply of milk this may not be as much of a concern, but with a mother with smaller breasts or less glandular tissue (breast size does not equal breast milk capacity) this could mean the difference of being able to provide enough milk for her baby versus having to supplement.  Slow weight gain in a baby could lead to failure to thrive, a very serious diagnosis.  Babies of mothers who smoke should have their weight watched diligently to ensure adequate growth.

The fat content of breast milk in mothers who use nicotine is also lower.4  Fat in breast milk is something that is affected by maternal diet and mothers who smoke not only have lower fat content but the fat has nicotine in it.  Fat is important for infant growth and brain development.  But, just because nicotine affects the fat content of breast milk does not mean the alternative – formula – is superior; it’s not.

What are the infant concerns when a mother smokes?

Mother’s who smoke are less likely to breastfeed.  Those that do breastfeed are more likely to breastfeed for a shorter duration than mothers who don’t smoke.5  Breastfeeding has tremendous health benefits for mothers and benefits for babies so anything that decreases the duration of a mother-baby breastfeeding relationship is significant.

Maternal smoking also exposes a baby to the dangers of second-hand smoke.  This can cause increased allergies and respiratory illness as well as unsafe carbon monoxide levels.6

These infant concerns continue to exist when a mother formula feeds her baby while smoking.  In fact, formula feeding while smoking is even more harmful than breastfeeding and smoking.  A baby receives the vast majority of smoking side effects from second-hand smoke rather than nicotine in breast milk.  In fact, the nicotine that does pass through breast milk is easily outweighed by the living, changing, and unique qualities of breast milk that impart antibodies and immunities to a baby to help him fight disease, infection, and illness, as well as equipping his immune system to maturity so it will be strong and prepared to work to its full potential over the course of a lifetime.

A baby who is regularly exposed to second-hand smoke especially needs the benefits of breast milk!

So, while it is important for a mother to try to decrease or cease smoking, it is far better for a mother to smoke and breastfeed than to stop breastfeeding in order to continue smoking.

Mixed Feeding – Using Formula & Breast Milk

Mixed Feeding with Formula and Breast MilkMany mothers decide that while they want to provide breast milk to their baby, they won’t be able to provide enough milk for full or exclusive breastfeeding.  There are a variety of reasons for this: low milk supply, higher order multiples, early return to work or other separation from baby where mother is unable to pump adequate amounts, desire for others to help feed baby, etc.

Breast milk is unique and unlike any other mammalian milk or infant formula.  Any amount of breast milk a mother is able to provide her baby is a wonderful gift and should be celebrated.  There are many health benefits for both a mother and baby.  Even some breastfeeding will help with maternal-infant bonding and decrease feeding costs, visits to the doctor, time off work for illness, allergies, and health care costs both in the short and long term.

It is completely possible to have mixed feeds; here are 5 tips to help you succeed.

  1. Establish your milk supply
    During the first six weeks following birth a mother’s body is laying down prolactin receptors (hormones intimately involved with milk production) that will affect her milk supply for the duration of breastfeeding.  If her milk supply is built up strong in the beginning, it will be easier to decrease her supply and maintain lactation.  Conversely, if she never develops a strong supply in the initial weeks following birth, she may be forced to supplement which could further reduce her supply.  It is common for this cycle to continue until a mother is no longer producing any breast milk for her baby.
  2. Allow baby time to attach well to breastfeeding
    The sucking action at the breast as well as flow of milk is different at the breast and with a bottle.  To demonstrate this, try placing your clean index finger half-way in your mouth and notice what your tongue does.  Now, place that same finger all the way back in your mouth to where the hard and soft palates meet – just before you “gag” – and note your tongue movement.  Breastfeeding is similar to your finger being in the back of your mouth, and a baby’s tongue will extend down and out past his bottom gum line.  Alternatively, when a bottle teat is placed in a baby’s mouth his tongue bunches further back in his mouth.  A disorganized suck and/or nipple preference can develop if babies are introduced to an artificial teat (whether bottle or pacifier) before breastfeeding is well established.  Just as importantly, the flow of a bottle nipple is constant whereas a baby at the breast must suck-suck-suck to have a let-down which lasts a minute or two and then there’s a pause before another let-down. These subtle differences can cause confusion in babies until breastfeeding is well established.
  3. Slowly decrease the amount of breastfeeding sessions
    Once you have developed a strong milk supply, you may now choose to slowly introduce formula.  It is best to eliminate only one breastfeed every 2-3 days so that your body adjusts to making less milk.  Introducing formula more quickly and eliminating breastfeeding sessions more than one at a time could lead to engorgement, plugged ducts, mastitis, or even a breast abscess.
  4. Continue to nurse enough to maintain supply
    Watch your body closely and if you notice your milk supply diminishing more than you need it to, add in another breastfeeding session.  Every woman is different and even each breast on the same mother has different amounts of milk.  While one woman may easily maintain milk just nursing once or twice a day, another mother may need to nurse three or four times a day minimum to maintain a milk supply.  If your supply does begin to decrease, make sure to eliminate some of the formula feeds and increase breastfeeding sessions to help build up your supply.
  5. Have partner give bottles while mom breastfeeds
    Many moms who partially breastfeed find it easier of they are responsible for breastfeeding and then baby’s father, family, or friends give the formula feeds.  This is not a must, but it can make it easy for your baby to associate mom with breast milk. This is also a matter of convenience – breast milk doesn’t require mixing, heating, cleaning bottles, etc. so if mother is available to feed it just makes sense to feed baby in the most convenient way possible.

Whatever strategies you find that work for you and your situation, you have much to be proud of providing your breast milk for your baby.  Every drop is a gift and should be celebrated!

Tube Feeding Devices

There are a variety of tube feeding systems that allow mothers to supplement their babies while nursing at the breast.

Who Should Use an At-Breast Tube Feeding Device?

Tubing can be run to both breasts for tandem nursing or twin nursing. Photo courtesy of

Tubing can be run to both breasts for tandem nursing or twin nursing.
Photo courtesy of

These devices work well for babies who are able to latch effectively to the breast.  They are an excellent choice when a mother is attempting to increase her milk supply while breastfeeding her baby. They are also valuable when a mother must supplement but wants her baby to have the benefits of nursing – cuddling, bonding, skin-to-skin contact, proper oro-facial development, etc. Examples of situations where mothers have successfully used at-breast tube feeding systems include relactation, induced lactation, adoptive breastfeeding, nursing after breast surgery, in place of pumping to help increase low milk supply, when a baby is breastfeeding but must also have a supplement such as with PKU, in place of giving a supplement in a bottle, and more.

How Does a Tube Feeding Device Work?

This type of supplementation system consists of a container to hold the supplement (whether expressed milk, donor milk, or formula) and then thin tubing protruding from the container to the mother’s nipple. The tube is held in place by a nursing bra, nipple shield, band-aid, or hypoallergenic tape. Many moms prefer a band-aid as they can slip the tubing on and off and just leave the band-aid on their skin.  Care should be taken to ensure tube does not extend past the mother’s nipple so baby does not learn to suckle only the tube. The tube can be secured to the top, bottom, or either side of the areola – whatever garners the best result for baby. The tubing is typically inserted under the upper lip and enters the baby’s mouth along the roof of his mouth/palate.  However, some baby’s prefer the tubing to lie on the lower lip or along the tongue. Experimenting with what works best for you and your baby is key.

Baby Using Tube Feeding Device

Tubing can be secured to the breast with tape, if necessary.
Photo courtesy

The supplement can be initiated as soon as a baby begins to suckle at the breast, or the supplement could begin to flow after the breast has been drained. The tubing can be used in conjunction with a nipple shield.  For a baby with a weak suck, it is even possible to put the tubing from both sides on one breast so baby can receive an even larger quantity of supplementation while suckling at the breast. The flow of the supplement can be controlled by blocking and unblocking the flow of the tubing.

How Do You Clean the Tubing?

After each feeding, the tubing should be rinsed with cold water, then filled with warm, soapy water that is squeezed thoroughly throughout the tubing. This soapy water should then be rinsed well.  Once every day (24 hours) the tubing should be boiled for 20 minutes. 1

What are the Benefits of Supplementing with this Method?

As baby latches to breast, the tubing gently enters his mouth.

As baby latches to breast, the tubing gently enters his mouth.
Photo courtesy

At-breast tube feeding devices have many benefits:

  • Allows baby to continue nursing at the breast, rather than switching between bottle or other device which may lead to nipple confusion or breast refusal
  • Allows mother to breastfeed while supplementing with the added benefit of baby stimulating a mother’s milk supply while nursing
  • It is temporary aid to allow a mother to increase her milk supply while continuing to provide adequate nutrition to baby in a natural way
  • Mother can control rate of flow of supplement as well as starting the supplement later in the feed once breast has been emptied, or vice versa
  • A great option for mothers whose ultimate goal is to have baby nursing at breast
  • A great solution for mother’s who do not have enough breast milk to exclusively nurse but want their baby to experience full breastfeeding

When Should At-Breast Tube Feeding NOT be Used?

When a baby is not able to latch effectively to the breast, this type of nursing system is not very effective.  (In this case, working with a lactation consultant, it may be preferable to initially use finger feeding with the tube.) Babies can learn to suck the tubing, rather than the breast, in which case it does not help to stimulate a mother’s milk supply.  And when a baby is not able to generate sufficient suction at the breast, he will not be able to suck effectively enough to gain the nutritional benefit he needs.  If feeds take greater than 30 minutes, baby falls asleep during a feed, or if baby fails to gain adequate weight this type of feeding system is probably not the best option.2

Where Can You Obtain a Tube Feeding Device?

The supplement hangs in a pouch around mother's neck as baby nurses. Photo courtesy

The supplement hangs in a pouch around mother’s neck as baby nurses.
Photo courtesy

Two commercial tube feeding devices are sold in the US: SNS (Supplemental Nursing System) by Medela and Lact-Aid. Both can be purchased on-line and through many local doctors, hospitals, and lactation consultant offices.

The SNS by Medela has a firm feeding bottle, whereas the Lact-Aid has a soft plastic bag for the milk supplement.  The Lact-Aid requires a baby to suck against the flow of gravity as the tube exits from the top of the pouch. This may help to strengthen a baby’s suck, or it may be challenging for a baby with an already weak suck. 3

It is also possible to make your own at-breast tube feeding system. A gavage setup with a No. 5 feeding-tube or tubing from a butterfly needle can be used. 4