BREASTFEEDING AND BOTTLE FEEDING

One of the first decisions new parents must make is how to feed their baby. We join such medical organizations as the American Academy of Pediatrics and the World Health Organization in recommending breast milk as the ideal form of infant nutrition. For those women who are unable to breastfeed, or who choose not to, today's formulas provide a good alternative in terms of how easy they are for babies to digest and the nutrients they provide.

Making a decision to breast-feed or bottle-feed your baby is a personal one, but there are some points you should consider to help you decide which option is best for you and your baby. Your child's doctor or a lactation consultant can provide excellent guidance.

Feeding your baby, whether by breast or by bottle, is an important time of connection between mother and baby. Breast-feeding mothers seem to particularly value the 'skin to skin' warmth of a nursing baby. But no matter the feeding method, it should be a time that is unhurried and quiet.

Below are some issues you might want to consider as you decide which option is best for you and your baby. Once you do make the decision, you'll most likely have a number of questions. How should you get started? How much - and how often - should your baby eat? KidsHealth addresses these questions as well


Breast-feeding

Fights infection. Antibodies passed from mother help protect baby from some conditions, such as ear infections, diarrhea, allergies, pertussis (whooping cough), and coughs due to pneumonia and other respiratory infections. As a group, breast-fed babies tend to have fewer infections than babies fed formula.
Promotes digestion. Enzymes and other substances in breast milk make digestion somewhat easier and aid in the absorption of nutrients. Manufactured formulas do a fairly good job of imitating breast milk, but some of breast milk's more complex substances are too difficult to manufacture, and some have not yet been identified.
Cost-free. Breast milk is free (but nursing mothers will find that they need to take in an additional 500 or more calories per day).
Convenient. There are no bottles to mix and sterilize, no last-minute runs to the store for more formula, and it's always fresh and available.
Prevents obesity. A recent study indicates that breast-feeding may help prevent childhood obesity.
Bacteria-free. Breast milk is free of bacteria (but the bottles used for expressed breast milk may not be).
Perfect temperature. Breast milk is always the right temperature when the infant ****s it directly from the breast.
Unsafe with some medical conditions. Maternal medical conditions, such as HIV or AIDS or some types of hepatitis, or those that involve chemotherapy or treatment with certain medications (such as some antiseizure medicines to treat epilepsy) may make breast-feeding inadvisable because the disease or components of the medicine may be transmitted to the baby through breast milk. (Check with your child's doctor or lactation consultant before taking any medication, though.)
Difficult with breast surgery. Women who have had major breast surgery, such as breast reduction, may have difficulty breast-feeding because their breasts may not produce enough milk or the ducts through which the milk travels in the breast may have been severed. (Women can use a Supplementary Nursing System (SNS) or a nursing trainer - a small tube attached to the nipple that provides additional formula or donor breast milk to the baby.)
Limit caffeine. Caffeine intake should be limited to 300 milligrams (about 3 cups of coffee) per day because this stimulant may cause problems for some babies.
Frequent feedings. Breast-fed babies usually need to eat more often.
Personal discomfort. Some women feel uncomfortable with the idea of breast feeding, but with adequate education and support, most women can overcome any initial inhibitions or concerns they may have. Some mothers may find it difficult to work, run errands, or travel because of a breast-feeding schedule or a need to express breast milk during the day. Any physical discomfort associated with breast feeding, such as sore nipples (see below), are usually easily handled by observing proper technique and the advice of doctors, lactation counselors, and other experienced breast feeders

Bottle-feeding

Convenient. Either parent (or another caregiver) can feed the baby at any time (and expressed breast milk also can be given in these circumstances).
Flexible. A mother who bottle-feeds has a bit more flexibility in regard to separation from their babies (to go to work, run errands, or go on a trip) without disrupting the feeding schedule. For those times when baby can't come along, expressed and stored breast milk can also be used.
Lacks antibodies. None of the important antibodies that are found in breast milk is found in manufactured formula.
Expensive. Formula can be expensive (powdered formula is less expensive than premixed, liquid formula, though), and extra care must be taken when mixing formula to ensure your baby gets the right amount of nutrients.
Not bacteria-free. Bottles, nipples, and formula may transmit bacteria if not cleaned properly or stored in sterile containers.
Longer preparation time. Formula must be prepared and bottles must be warmed (but not too hot!) before feeding.
May produce gas and constipation. Bottle-feeding may cause more gas or firmer bowel movements.
Can't match complexity. Manufactured formulas have yet to duplicate the complexity of breast milk, which changes as the baby's needs change.


How to Breast-feed Your Infant
Arrange for your baby to room with you in the hospital so that you can nurse your baby whenever he's hungry, and let the nurses know that you're going to breast-feed so that they don't give your baby a bottle.

Your milk may take a few days to come in, especially if you have received larger amounts of pain medication or anesthetics for a ******l birth or a caesarean section (C-section). In the meantime, your baby will benefit from your colostrum (the pre-milk in your breasts during late pregnancy and the first few days following delivery). Colostrum contains many concentrated protective properties, including immune system-boosting and antibacterial substances.

Try to nurse your baby as soon as possible after birth. Let your baby breast-feed at one breast until he no longer seems interested in eating, then switch him to the other side. Before switching, you may want to try burping your baby. Often, the movement alone can be enough to cause a baby to burp, but if this doesn't happen, you can try again when your baby's finished with the second breast.

A lactation consultant or hospital nurse (or perhaps someone from La Leche League) should be available to help you find a comfortable position and help your baby latch on properly. Latching on, which refers to the suction created by your baby's mouth at your nipple, is an important key to successful nursing. It may take a few times before getting it right, but it's important that your baby nurses with a wide-open mouth and takes as much as possible of your areola (the dark-colored area of the breast) in his mouth (not just the tip of the nipple, to help avoid sore nipples).

If your baby is sleepy from a difficult birth, you may have to wake him up to nurse - this will help ensure that your baby's getting enough to eat and that your milk supply is increasing. (This also will lessen the likelihood of uncomfortable engorgement of your breasts.) Follow your baby's cues - many newborns seem to nurse almost constantly during the first few weeks of life.

When feeding your baby, keep the distractions to a minimum. Sit in a quiet room and in a chair that provides you with enough support to keep your baby comfortable and facing your breast. It may take a few days or weeks for you to find the feeding positions that work best for you and your baby. A nursing or feeding pillow (or some cushions) may help. Or if you're recovering from a C-section, consider the football hold (feeding or nursing your baby while he's tucked under your arm and supported by a pillow), rather than lying across your stomach and putting pressure on your incision.

To make nighttime feedings easier, you may want to consider letting your baby sleep in a crib or bassinet in your room for the first few months. The exception: babies should never sleep in the same room with people who are smoking, because of a higher risk of SIDS (sudden infant death syndrome) associated with this sleeping situation.

If your baby sleeps in another room, keep that room dark for nighttime nursings and keep stimulation to a minimum. This will help your baby to realize that nighttime is for sleeping - not playing - and will encourage him to return to sleep.

Avoid supplementing (unless your child's doctor recommends it) your breast milk with formula until your milk supply has had a chance to develop and stabilize; early supplements can lead to nipple confusion for your baby and a reduction in your milk supply. Most lactation professionals recommend that parents wait at least 3 weeks before offering pacifiers or artificial nipples of any kind. Many of the health benefits of breast-feeding come from the first 2 months of feeding.

How to Bottle-feed Your Infant
The first thing you'll need to do if you decide to bottle-feed your baby is to decide which formula to use. There are many brands on the market, including cow's milk-based formulas, formulas with added iron, soy-based formulas, and specialized formulas for infants born prematurely or those with certain medical conditions. Ask your child's doctor which type would be best for your infant.

Formula comes in ready-to-feed (which is a ready-to-eat liquid), concentrates (which are liquids that require diluting with water), and powders (which require mixing with water). Follow the instructions on the label when preparing your baby's bottles, and always refrigerate any bottles you fill for later feedings to prevent bacteria from growing. Throw away mixed formula after 24 hours.

There are many different types of bottles and nipples available - you may need to try a few different brands before you find the combination that works best for you and your baby. Check nipples regularly for signs of wear, and replace them often.

Feed your baby when he seems hungry, and listen to his cues. Mix your baby's formula in 2- or 3-ounce (56- to 85-gram) servings for the first few weeks, and gradually increase the amount as you become familiar with your baby's eating patterns and appetite.

Always hold your baby during feeding times. Don't leave a baby unattended feeding from a 'propped' bottle. Mealtimes provide a great opportunity for snuggling and bonding with your baby.

Never put your baby to bed with a bottle - it's a choking hazard, and formula pooling in your baby's mouth can lead to tooth decay in older babies and toddlers. Also, don't give your baby juice in a bottle unless your child's doctor says it's OK.

Common Feeding Questions
Whether you've decided to breast-feed or bottle-feed, it's likely that you'll have a few questions or concerns about feeding your baby.

Is My Baby Eating Enough?
Babies grow at different rates, and at times you may wonder whether your baby is getting enough nutrients to develop properly. To help determine whether your baby is eating enough, follow the schedule of regular postnatal checkups so that your baby can be weighed and measured. Also, you probably will be changing at least 4 to 6 wet diapers each day (or 6 to 8, if you use cloth diapers) - this can be a good indicator that your baby is getting enough to eat. If you see yellowish crystals in a wet diaper, contact your baby's doctor - these can signal inadequate fluid intake or dehydration.

Each baby is different, but on average, a newborn consumes about 1.5 to 2 ounces every 2 to 3 hours.


Does My Baby Have an Allergy?
Some bottle-fed babies may be sensitive to the cow's-milk protein in their formula. If your baby suddenly becomes fussy or colicky, your baby's doctor may suggest switching to a soy-based formula or a special hypoallergenic preparation.

A breast-fed baby may have an allergic or sensitivity reaction after the mother consumes certain foods or drinks. If you think your baby has had such a reaction, call your baby's doctor and avoid eating or drinking anything your baby cannot tolerate.

When Should I Introduce Solid Foods?
Wait until your baby is 4 to 6 months old before introducing solids. Feeding solids earlier than this can increase the chances of your baby developing food allergies. Watch for signs of readiness, such as your baby's tongue-thrust reflex subsiding and your baby beginning to reach for other people's food. Always start with baby cereal on a spoon for 1 to 2 months before advancing to fruits and vegetables. And don't add cereal to your baby's bottle unless your child's doctor instructs you to do so.

Don't expect your baby to eat a lot at this stage. Solid foods are more for recreation and practice than for nutrition during the first year of your baby's life - almost all the nutrition your baby receives should be from breast milk, commercially prepared formula, or a combination of the two.

Is It Safe to Microwave My Baby's Bottles?
The microwave can create dangerous 'hot spots' in bottles of formula or breast milk. If you use a microwave for this purpose, make sure the formula or breast milk in the bottle is well-mixed after microwaving, and that the bottle and contents are not overheated. In the case of breast milk, microwaving will also change the composition of the milk, destroying some of its protective properties. Instead, warm your baby's bottles in a pan of hot water and test the temperature by squirting a drop or two on your hand before feeding your baby.

Reviewed by: Neil Izenberg, MD
Date reviewed: January 2001