How Much Milk Does a Breastfed Baby Drink
How to Feed a Combination of Breast Milk and Formula
New mothers hear so much almost the advantages of breastfeeding over formula feeding that it can seem like a revelation to realize that y'all can practice both at the same time.
Credit... Caroline Tompkins for The New York Times
This guide was originally published on May 5, 2019 in NYT Parenting.
When I was a new mother, I heard and then much most the advantages of breastfeeding over formula feeding that it felt like my but options were either breast milk or formula. And then much so that it seemed like a revelation when I finally realized I could do both at the same time.
I was not alone in this realization, of grade. Many women successfully combination feed — a practice that involves giving babies formula in addition to chest milk. Co-ordinate to the Centers for Disease Control and Prevention, one out of three breastfeeding mothers in the United states of america supplements her breast milk with formula by the time her baby reaches 6 months of age.
Many women find that their babies switch betwixt chest and canteen and betwixt chest milk and formula with ease. For others, there are hiccups along the manner.
To help you get started combination feeding and manage any potential problems, I reviewed the published data and spoke with several experts, including Dr. Marianne Neifert, M.D., a pediatrician practicing in Denver; Freda Rosenfeld, a board-certified lactation consultant based in Brooklyn, N.Y.; and Dr. Michael Kramer, M.D., a professor of pediatrics at McGill University in Montreal.
[Read our guide on breastfeeding during the start two weeks of life ]
Introduce a bottle early on, merely not too early.
The sweet spot for introducing bottles for full term babies is usually "between 2 and 6 weeks of age," said Rosenfeld. If you practice it earlier yous and your babe are "in a groove with breastfeeding," she warned, your babe may learn to prefer the faster, easier flow from the bottle and lose involvement in the breast.
But even more important than historic period, according to Dr. Neifert, is whether "your babe is latching well, getting total feeds at the breast and gaining well." Some babies go the hang of nursing sooner than others.
In one case your babe is nursing effectively and gaining weight, nevertheless, don't wait too much longer earlier introducing the bottle because the baby might reject it. Babies' sucking reflexes typically kickoff fading at around vi to 8 weeks, so it'south best to introduce a bottle earlier this reflex has faded and then your infant reflexively sucks on the bottle nipple.
Beginning slowly, utilize the correct nipple, relax and enlist aid.
Get-go by offering bottles filled with just a one-half ounce or so (of breastmilk or formula).
If your baby has been exclusively breastfed, Rosenfeld recommended starting with a wide, dull flow nipple that mimics the shape and period of your own nipples, decreasing the take chances that your baby will find it easier to go milk from a bottle than the breast.
A baby older than 3 months, however, may become frustrated with a tedious flow bottle, especially if mom's breasts have a fast flow, Rosenfeld warned. In that example, she recommended trying a faster flow nipple.
To ensure that babe is happy, relaxed and not too hungry, offer a bottle one to ii hours later your babe's last feeding. Crying is a late sign of hunger, and a hungry baby is hands frustrated.
If you are the first to offer the bottle, your baby may turn down and insist on nursing. (She knows who has the good stuff, after all.) Instead, ask your partner or another familiar caregiver to offer the first few bottles, if yous tin can. This will non merely help your baby get used to bottle feeding, merely will help establish a feeding relationship with your partner (if y'all take 1), likewise.
Whomever is giving the canteen should try to relax and follow your baby'due south cues. Babies sense stress and may reject a bottle if the person offering it seems anxious.
Do not force your baby to canteen feed.
If your baby refuses the bottle at first, do not strength him to potable. Expect and try again afterwards, an 60 minutes or two subsequently their next feeding. Some studies have linked early on overfeeding with an increased chance of later obesity.
"For nearly healthy, full-term infants, parents can look to their baby rather than the clock for hunger cues," according to a webpage from the American Academy of Pediatrics. "This is called feeding on demand, or responsive feeding."
When canteen feeding, picket for signs your babe has had enough: turning abroad, pushing away the bottle, spitting out milk, chewing on the nipple, gagging or falling comatose. (This video from the A.A.P. describes these signs in item.)
Unlike breast milk, leftover formula in a bottle your infant has drunkard from cannot exist saved. Bank check out this A.A.P. guide to safely preparing formula.
When dealing with bottle refusal, exist patient.
Rarely, a breastfed baby volition prove shockingly tenacious in refusing to take milk from a canteen. If after trying all of the to a higher place techniques your baby is even so rejecting the bottle, or if your baby begins refusing the bottle afterward taking it previously, you lot can also try:
Distracting the baby. Try giving the bottle when your infant is at-home and a lilliputian distracted, for example, past offering a bottle while taking a walk outside.
Heating things upwardly. Try warming the milk and the bottle nipple, to brand the feel more similar to feeding at your breast.
Offer a gustation. Using a syringe, try dribbling a lilliputian milk into your baby'south mouth and then giving her the canteen. This helps trigger her drive to suck on the canteen.
Using music as a feeding cue. Rosenfeld recommended playing the aforementioned music while nursing and canteen feeding. This cues your infant that it'south fourth dimension to eat.
Bypassing the bottle. If your baby is 6 months or older, try circumventing the bottle and weaning directly onto a cup.
Prevent uncomfortable engorgement, leaking and clogged ducts.
When you start introducing formula, your chest milk production will take a few days to adjust to the reduced demand. In the interim, your breasts may go uncomfortably engorged, which can lead to embarrassing leakage, chock-full ducts or even mastitis — a painful infection of the breast tissue.
Thus experts mostly suggest introducing formula slowly, gradually replacing breastfeeding sessions with formula feeding.
One method is to supercede i nursing session per week with a formula feeding session. Outset by giving your baby i bottle of formula at around the same time each twenty-four hour period. This will railroad train your body to stop producing milk at that time.
Another fashion to commencement introducing formula, according to the National Childbirth Trust, a nonprofit based in Britain, is the "top it off" method, which involves giving a small amount of formula (half an ounce to an ounce) later on a nursing session. The extra nourishment will make your baby experience more full, extending the time until your adjacent nursing session and gradually reducing the amount of milk y'all produce at that fourth dimension.
If your breasts nonetheless become engorged, "you can save some of the pressure by pumping or hand expressing a piffling milk, but only until you experience relief," said Dr. Neifert. She warned against "draining your breasts completely, as that signals to your breasts to continue to produce milk."
[How to go on pumping when you lot return to work ]
Maintain your milk supply while giving formula.
If y'all wish to maintain your milk supply while giving formula, you may need to breastfeed or pump frequently, up to eight to 12 times per day. The exact number of times will depend on your breasts' storage capacity and the age of your baby.
According to the Due north.C.T., if your baby is older — effectually 8 or 9 months — you lot can usually maintain your breastmilk supply alongside formula feeding, as long as y'all breastfeed every day.
The Department of Agronomics has tips for maintaining your milk supply while introducing formula.
Choose an iron-fortified formula.
For good for you, full term babies who are partially breastfed, the A.A.P. recommends a moo-cow's milk-based formula that is atomic number 26-fortified. (Low-iron formulas heighten your baby's risk of anemia.)
Infants younger than one year should never receive regular moo-cow'southward milk or any other milk in place of formula or breast milk. Moo-cow's milk does non contain the proper balance of nutrients your growing baby needs.
A few babies, such every bit those with lactose intolerance, severe reflux or milk allergies may need a special formula. Talk with your babe's pediatrician if y'all recollect your baby needs one.
If you need more than help choosing a formula, consult The Wirecutter'southward Guide to the Best Babe Formula. (The Wirecutter is a New York Times company that does rigorous production reviews.)
Sympathize that bottle feeding and breastfeeding place unlike demands on your babe.
To breastfeed effectively, babies must open up their rima oris wide, latch on to the breast and then coordinate a suck, consume and jiff sequence. Bottle feeding, past contrast, provides a continuous period of milk; instead of working to extract the milk, babies simply demand to pause the menstruum of milk in order to breathe.
Because of these differences, some babies volition develop a potent preference for the canteen or, less often, for the breast.
Nipple confusion. Women sometimes receive dire warnings that artificial nipples, including pacifiers, can atomic number 82 to nipple defoliation — or an inability to latch on to the breast and effectively excerpt milk.
" … these concerns [over nipple confusion] can cause meaning stress for new mothers who are struggling with breastfeeding," Dr. Chad Hayes, M.D., a pediatrician practicing in Charleston, Due south.C., wrote on his blog.
For example, La Leche League, a nonprofit focused on breastfeeding advocacy, warns that many mothers have "noticed a change in her baby'southward sucking patterns later on introducing a bottle or a dummy [pacifier]. Her baby may struggle and cry, find it difficult to latch on, or only nurse ineffectively at the breast."
Fortunately, according to Dr. Hayes, these fears are overblown. A contempo meta-assay of randomized controlled trials, for case, plant that amidst full-term babies, bottle feeding and pacifier use had no credible affect on the elapsing of breastfeeding. Later reviewing the research, Hayes concluded that "nipple defoliation doesn't seem to play a huge role in infant feeding."
(Among preterm babies who, for health reasons, oftentimes need to offset on bottles before breastfeeding is established, canteen feeding has been linked with a slightly shorter duration of exclusive breastfeeding.)
Flow preference. While true nipple confusion is rare, a more than common cause of a baby fussing at the chest or refusing to latch is menstruation preference.
Menstruum preference occurs when your baby can still breastfeed finer merely prefers the fast, easy flow of milk from a bottle. Babies who prefer bottles may fuss, cry or push you away when you effort to nurse. Some babies may temporarily refuse to nurse at all, going on a nursing strike.
If this happens, La Leche League recommended hand expressing a bit before trying to latch your baby onto your chest. This helps to reduce engorgement and to get the milk flowing, so that your baby is rewarded with milk immediately subsequently latching. The Australian Breastfeeding Association besides offers several tips for treatment breast refusal.
If your baby is however resisting breastfeeding, Rosenfeld recommended taking a canteen holiday for at least a week. When y'all reintroduce the bottle, you tin can try paced bottle feeding, a method of giving bottles designed to emulate breastfeeding. It involves sitting your baby upright or only slightly reclined, belongings the bottle horizontally and so your infant has to suck to extract milk from the canteen, and allowing for frequent pauses between gulps of milk.
If you are having persistent problems getting your baby to latch or to breastfeed effectively, seek outside aid. The Usa Lactation Consultant Clan website can help you find a lath-certified lactation consultant most you.
Feel expert about your choice.
The A.A.P. recommends that women breastfeed exclusively for about the first 6 months of life, and then continue breastfeeding while giving solid foods for at to the lowest degree a yr.
Exclusive breastfeeding for half dozen months — without boosted solids or formula — provides the strongest protection against gastrointestinal and respiratory infections during infancy. But partial breastfeeding does still provide some protections against diarrhea, ear infections, Sudden Babe Death Syndrome and respiratory infections like pneumonia.
Note though, that "this protection against infection lasts only every bit long as you are breastfeeding," said Dr. Kramer.
Some studies also suggest that breastfeeding can confer additional lifelong protection against obesity, eczema, asthma and allergies, likewise as a slight heave in I.Q., though many of the studies showing these long-term benefits "have major methodological bug," according to the A.A.P.
Women sometimes hear that just i drib of formula will alter a babe's microbiome — the mélange of leaner, fungi, and other microscopic bugs that line the pare and gastrointestinal organization. Such changes, they are warned, may have lifelong consequences for their babies' immune and metabolic health.
While formula-fed babies do have a different residuum of bacteria in their gut microbiome, said Dr. Kramer, "we still practice non know how this relates to later health." And, Dr. Kramer added, many things, such as antibiotics, how they were born and the types of foods they eat, can also alter the microbiome.
Some popular breastfeeding websites also warn that using formula tin can "shorten the breastfeeding human relationship."
Just this depends on your state of affairs. I and many of my mom friends institute that giving some formula helped u.s. sustain breastfeeding by lessening its logistical, physical and emotional demands.
When to Worry
Cutting down on breastfeeding may crusade your breasts to become engorged with milk, which can atomic number 82 to chock-full milk ducts. You may detect a difficult, red and tender lump on your breast that feels warm to the touch. A clogged duct will often occur merely in one chest.
To help clear the duct, nurse and pump frequently to keep your breast from becoming full of milk. Massaging your breast and applying warm compresses while nursing or pumping may likewise help the duct clear and ease discomfort.
If you also develop shivers, chills or other flu-similar symptoms, you may have mastitis, a serious infection of the breast tissue. Mastitis can come on suddenly and crusade you lot to feel weak and achy. If yous think you may accept mastitis, contact your doctor correct abroad; you lot may need antibiotics.
Amy Kiefer, Ph.D., is a freelance scientific discipline writer and mother of iii who blogs on pregnancy and breastfeeding for Expecting Science.
Source: https://www.nytimes.com/article/combination-breast-bottle-feeding.html
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