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Breast Feed or Bottle Feed?

How you feed your newborn is the first nutrition decision you make for your child. These guidelines on breastfeeding and bottle feeding can help you know what's right for you and your baby.

Breast or Bottle?

The American Academy of Pediatrics (AAP) recommends that babies be breastfed exclusively for about the first 6 months. Following the introduction of solid foods, breastfeeding should continue through the first year of life and even beyond, if desired.

But breastfeeding isn't possible or preferable for all new moms. Deciding to breastfeed or bottle feed a baby is usually based on the mother's comfort level with breastfeeding and her lifestyle. In some cases, breastfeeding may not be recommended for a mom and her baby. If you have any questions about whether to breastfeed or formula feed, talk to your pediatrician.

Remember, your baby's nutritional and emotional needs will be met whether you choose to breastfeed or formula feed.

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About Breastfeeding

Breastfeeding your newborn has many advantages. Perhaps most important, breast milk is the perfect food for a baby's digestive system. It has the nutrients that a newborn needs, and all of its components — lactose, protein (whey and casein), and fat — are easily digested. Commercial formulas try to imitate breast milk, and come close, but cannot match its exact composition.

Also, breast milk has antibodies that help protect babies from many infectious illnesses, including diarrhea and respiratory infections. Studies suggest that breastfed babies are less likely to develop medical problems such as diabetes, high cholesterol, asthma, and allergies. Breastfeeding also may decrease the chances that a child will become overweight or obese.

Breastfeeding is great for moms too. It burns calories, so nursing moms get back in shape quicker. Breastfeeding also may protect mom from breast cancer and ovarian cancer.

Some moms find breastfeeding easier and quicker than formula feeding — it needs no preparation and you don't run out of breast milk in the middle of the night. Also, breastfeeding costs little. Nursing mothers do need to eat more and may want to buy nursing bras and pads, a breast pump, or other equipment. But these expenses are generally less than the cost of formula.

Breastfeeding meets a variety of emotional needs for both moms and babies — the skin-to-skin contact can enhance the emotional connection, and providing complete nourishment can help a new mother feel confident in her ability to care for her newborn.

Limitations of Breastfeeding

With all the good things known about breastfeeding, why doesn't every mother choose to breastfeed?

Breastfeeding requires a big commitment from a mother. Some new moms feel tied down by the demands of a nursing newborn. Because breast milk is easily digested, breastfed babies tend to eat more often than babies who are fed formula. This means mom may find herself in demand as often as every 2 or 3 hours in the first few weeks. This can be tiring, but it's not long before babies feed less frequently and sleep longer at night.

Some new mothers need to get back to work outside the home or separate from their babies from time to time for other reasons. Some of these moms opt for formula feeding so other caregivers can give the baby a bottle. Mothers who want to continue breastfeeding can use a breast pump to collect breast milk to be given in a bottle so their babies still get its benefits even when mom isn't available to breastfeed.

Other family members (dads most of all) may want to share in feeding the baby. When mom is breastfeeding, dad or siblings may want to stay close by. Helping mom get comfortable, or providing a burp cloth when needed, will let them be part of the experience.

When breastfeeding is established, other family members can help out by giving the baby pumped breast milk in a bottle when mom needs a break.

Sometimes a woman may feel embarrassed or worried about breastfeeding. These feelings usually disappear once a successful breastfeeding process is set. It's often helpful to seek advice from those who've gone through the experience. Most hospitals and birthing centers can provide in-depth instruction on breastfeeding techniques to new mothers.

Your pediatrician, nurse practitioner, or nurse can answer questions or put you in touch with a lactation consultant or a breastfeeding support group.

In some cases, a mother's health may affect her ability to breastfeed. For example, mothers undergoing chemotherapy for cancer and moms who are infected with human immunodeficiency virus (HIV, the virus that causes AIDS) should not breastfeed.

If you have a medical condition or take any medicines regularly, or if you or your baby gets sick, talk with your doctor about whether it's OK to breastfeed. If you have to stop nursing temporarily, continue to pump breast milk to maintain milk production.

In some situations, it may not possible to breastfeed, such as when a baby is sick or born prematurely. Mothers should talk with their baby's doctor about expressing and storing milk. Even if the infant cannot breastfeed, breast milk may be given via a feeding tube or bottle.

Sometimes mothers who have inverted nipples may have trouble breastfeeding, but with the help of a lactation consultant this usually can be overcome. Likewise, women who have had plastic surgery on their breasts should be able to successfully breastfeed. Talk with your doctor if you have any concerns.

Avoid using pacifiers or bottles until breastfeeding is established, usually after the first month of life. Introducing them before breastfeeding might cause "nipple confusion," and can lead to an infant giving up the breast.

About Formula Feeding

Commercially prepared infant formula is a nutritious alternative to breast milk. Bottle feeding can offer more freedom and flexibility for moms, and it makes it easier to know how much the baby is getting.

Because babies digest formula more slowly than breast milk, a baby who is getting formula may need fewer feedings than one who breastfeeds. Formula feeding also can make it easier to feed the baby in public, and lets the father and other family members help feed the baby, which can enhance bonding.

Limitations of Formula Feeding

Just as breastfeeding has its unique demands, so does bottle feeding. Bottle feeding requires organization and preparation, especially if you want to take your baby out. Also, formula can be pretty expensive.

It's important to make sure that you have enough formula on hand, and bottles that are clean and ready to be used.

Here are a few guidelines for formula feeding:

  • Carefully follow directions on the label when preparing formula.
  • Bottles left out of the refrigerator longer than 1 hour and any formula left in the bottle that a baby doesn't finish should be discarded.
  • Prepared bottles of formula should be stored in the refrigerator up to 24 hours and can be carefully warmed just before feeding. You don't have to warm formula, but most babies prefer it.
  • A bottle of formula can be warmed by holding it in running warm water or setting it in a pan of warm water. A bottle of formula (or breast milk) should never be warmed in a microwave. The bottle can heat unevenly and leave "hot spots" that can burn a baby's mouth.

How Often Do Newborns Eat?

Your newborn will nurse about 8 to 12 times per day during the first weeks of life. In the beginning, mothers may want to try nursing 10–15 minutes on each breast, then adjust the time as necessary.

Breastfeeding should be on demand (when your baby is hungry), which is generally every 1–3 hours. As newborns get older, they'll nurse less often and have longer stretches between feedings. Newborn babies who are getting formula will likely take about 2–3 ounces every 2–4 hours. Newborns should not go more than about 4–5 hours without feeding.

Signs that babies are hungry include:

  • moving their heads from side to side
  • opening their mouths
  • sticking out their tongues
  • placing their hands and fists to their mouths
  • puckering their lips as if to suck
  • nuzzling again their mothers' breasts
  • crying

A feeding schedule is not necessary; you and your baby will eventually establish your routine. Babies know (and will let their parents know) when they're hungry and when they've had enough. Watch for signs that your baby is full (slowing down, spitting out the bottle or unlatching from breast, closing the mouth, turning away from the breast or bottle) and stop the feeding when these signs appear.

As babies grow, they begin to eat more at each feeding and can go longer between feedings. There may be other times when your infant seems hungrier than usual. Continue to nurse or feed on demand. Nursing mothers need not worry — breastfeeding stimulates milk production and your supply of breast milk will adjust to your baby's demand for it.

Is My Newborn Getting Enough to Eat?

New moms often worry about whether their babies are getting enough to eat. It's important for all infants to be seen by their pediatrician 48 to 72 hours after a mother and newborn leave the hospital. During this visit, the baby will be weighed and examined, and feeding questions and concerns can be addressed.

You can be assured that your baby is getting enough to eat if he or she seems satisfied, produces about six to eight wet diapers a day, has regular bowel movements, sleeps well, is alert when awake, and is gaining weight. A baby who is fussing, crying, seems hungry, and does not appear satisfied after feeding may not be getting enough to eat. If you're concerned that your baby isn't getting enough to eat, call your doctor.

Many infants "spit up" a small amount after eating or during burping, but a baby should not vomit after feeding. Vomiting after every feeding might be a sign of an allergy, digestive problem, or other problem that needs medical attention. If you have concerns that your baby is spitting up too much, call your doctor.

Should Newborns Get Nutritional Supplements?

Breast milk has the right combination of vitamins and easily absorbed iron for newborns. A healthy infant being nursed by a healthy mother does not need any additional vitamins or nutritional supplements, with the exception of vitamin D.

The AAP recommends that all breastfed babies begin getting vitamin D supplements within the first few days of life, continuing until they get enough vitamin D-fortified formula or milk (after 1 year of age).

Iron-fortified formula contains the right blend of vitamins and minerals for a baby, so supplements usually aren't necessary. Infants drinking less than 1 liter, or about a quart, of formula a day may need a vitamin D supplement.

Water, juice, and other foods usually aren't necessary during a baby's first 6 months. Breast milk or formula provides everything babies need nutritionally until they start eating solid foods. Talk to your doctor if you have any questions about feeding your newborn.

Reviewed by: Mary L. Gavin, MD
Date reviewed: January 2018

Milk Allergy

People of any age can have a milk allergy, but it's more common in infants (affecting about 2% to 3% of babies). Many kids outgrow it, but some don't. 

When a baby is allergic to milk, it means that his or her immune system, which normally fights infections, overreacts to proteins in cow's milk (the basis for most commercial baby formulas). Every time the child has milk, the body thinks these proteins are harmful invaders and works very hard to fight them. This causes an allergic reaction in which chemicals like histamine are released in the body.

Babies often show their first symptoms of a milk allergy days to weeks after they're first given cow milk-based formula. Breastfed infants have a lower risk of having a milk allergy than those who are formula fed. If they are allergic, though, they can have symptoms if mom has dairy products in her diet.

A milk allergy is not the same thing as lactose intolerance, which is when the body has trouble digesting milk. 

Some babies with a milk allergy have an allergic reaction soon after having milk; others have problems hours or days later. If your baby has a milk allergy that causes symptoms soon after he or she has milk, keep two epinephrine auto-injectors on hand in case of a severe reaction (called anaphylaxis). An epinephrine auto-injector is an easy-to-use prescription medicine that comes in a container about the size of a large pen. Your doctor will show you how to use it. 

Symptoms of a Milk Allergy

In children who show symptoms shortly after they have milk, an allergic reaction can cause:

  • wheezing
  • trouble breathing
  • coughing
  • hoarseness
  • throat tightness
  • stomach upset
  • vomiting
  • diarrhea
  • itchy, watery, or swollen eyes
  • hives
  • red spots
  • swelling
  • a drop in blood pressure causing lightheadedness or loss of consciousness

A milk allergy can cause different symptoms at different times. Some reactions are mild and involve only one system of the body (like hives on the skin). But mild reactions in the past do not mean a child won't have a serious allergic reaction next time.

Children who do not have symptoms shortly after they have milk can have a different type of reaction that causes problems hours to days later, such as:

  • loose stools (possibly with blood)
  • vomiting or gagging
  • refusal to eat
  • irritability or colic
  • skin rashes, like eczema

If Your Child Has a Serious Reaction

If your child starts having serious allergic symptoms, like swelling of the mouth or throat or difficulty breathing, or symptoms involving two different parts of the body, like hives with vomiting:

  • Give the epinephrine auto-injector right away. Every second counts in an allergic reaction.
  • Then, call 911 or take your child to the emergency room. Your child needs to be under medical supervision because, even if the worst seems to have passed, a second wave of serious symptoms can happen.

Diagnosing a Milk Allergy

If you think your infant is allergic to milk, call your baby's doctor. He or she will ask you questions and talk to you about what's going on. After the doctor examines your baby, some stool tests and blood tests might be ordered. The doctor also may refer you to an allergist (a doctor who specializes in treating asthma and allergies).

The allergist may do skin testing. During skin testing, the doctor or nurse places a tiny bit of milk on the skin, then pricks the outer layer of skin or makes a small scratch on the skin. If your child reacts to the allergen, the skin will swell a little in that area.

If the allergist finds that your baby is at risk for a serious allergic reaction, epinephrine auto-injectors will be prescribed.

If You're Breastfeeding

If your breastfed infant has a milk allergy, it's important for you to avoid dairy products because the milk protein that causes allergic reactions can cross into your breast milk. Be sure to read food labels carefully. All food makers are required to clearly state whether a food contains milk or milk-based products — look for this in or next to the ingredient list on the packaging.

You may want to talk to your doctor or a dietician about finding alternative sources of calcium and other vital nutrients to replace what you were getting from dairy products.

If You're Formula Feeding

If you're formula feeding, your doctor may advise you to switch to an extensively hydrolyzed formula in which the proteins are broken down into particles so that the formula is less likely to trigger an allergic reaction. 

You also might see "partially hydrolyzed" formulas, but these aren't truly hypoallergenic and can lead to a significant allergic reaction.

Do not try to make your own formula. Commercial formulas are approved by the U.S. Food and Drug Administration (FDA) and created through a very specialized process that cannot be duplicated at home. Other types of milk that might be safe for an older child with a milk allergy (like rice milk, almond milk, or coconut milk) are not safe for infants. 

If you have any questions or concerns, talk with your child's doctor.

Reviewed by: Larissa Hirsch, MD
Date reviewed: September 2016

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