When Is Latest to Introduce Formula to Baby
How to Feed a Combination of Chest Milk and Formula
New mothers hear and then much nearly the advantages of breastfeeding over formula feeding that it can seem like a revelation to realize that you tin practice both at the same fourth dimension.
Credit... Caroline Tompkins for The New York Times
This guide was originally published on May v, 2019 in NYT Parenting.
When I was a new female parent, I heard then much about the advantages of breastfeeding over formula feeding that it felt like my only options were either breast milk or formula. And then much so that information technology seemed similar a revelation when I finally realized I could practice both at the same fourth dimension.
I was not lone in this realization, of course. Many women successfully combination feed — a practice that involves giving babies formula in add-on to breast milk. According to the Centers for Disease Command and Prevention, 1 out of three breastfeeding mothers in the United States supplements her breast milk with formula by the time her baby reaches 6 months of historic period.
Many women detect that their babies switch between chest and bottle and between chest milk and formula with ease. For others, there are hiccups forth the way.
To help you get started combination feeding and manage any potential bug, I reviewed the published information 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 Academy in Montreal.
[Read our guide on breastfeeding during the first two weeks of life ]
Introduce a bottle early on, but non also early.
The sugariness spot for introducing bottles for total term babies is ordinarily "between ii and 6 weeks of age," said Rosenfeld. If you practice it earlier you and your baby are "in a groove with breastfeeding," she warned, your baby may learn to prefer the faster, easier flow from the bottle and lose involvement in the breast.
But even more important than age, according to Dr. Neifert, is whether "your baby is latching well, getting full feeds at the breast and gaining well." Some babies become the hang of nursing sooner than others.
Once your baby is nursing effectively and gaining weight, even so, don't await too much longer before introducing the canteen because the infant might reject it. Babies' sucking reflexes typically start fading at around 6 to 8 weeks, so it'due south best to introduce a canteen before this reflex has faded so your baby reflexively sucks on the bottle nipple.
Kickoff slowly, utilize the correct nipple, relax and enlist assist.
Start by offering bottles filled with only a half ounce or so (of breastmilk or formula).
If your baby has been exclusively breastfed, Rosenfeld recommended starting with a wide, tedious flow nipple that mimics the shape and period of your own nipples, decreasing the chance that your babe volition find it easier to get milk from a bottle than the breast.
A infant older than iii months, withal, may get frustrated with a slow flow bottle, peculiarly if mom'southward breasts have a fast period, Rosenfeld warned. In that instance, she recommended trying a faster flow nipple.
To ensure that baby is happy, relaxed and not also hungry, offer a bottle i to two hours after your baby'south last feeding. Crying is a late sign of hunger, and a hungry infant is hands frustrated.
If you are the first to offer the canteen, your baby may pass up and insist on nursing. (She knows who has the skilful stuff, after all.) Instead, ask your partner or another familiar caregiver to offer the commencement few bottles, if you can. This will non only help your baby get used to bottle feeding, but volition help plant a feeding relationship with your partner (if you take ane), also.
Whomever is giving the bottle should effort to relax and follow your baby'south cues. Babies sense stress and may reject a canteen if the person offering information technology seems broken-hearted.
Do non force your baby to bottle feed.
If your babe refuses the bottle at first, do not force him to potable. Await and effort once again later, an hour or two after their next feeding. Some studies have linked early on overfeeding with an increased chance of later obesity.
"For about healthy, full-term infants, parents can expect to their infant rather than the clock for hunger cues," according to a webpage from the American University of Pediatrics. "This is called feeding on need, or responsive feeding."
When bottle feeding, sentry for signs your baby has had enough: turning away, pushing away the canteen, spitting out milk, chewing on the nipple, gagging or falling comatose. (This video from the A.A.P. describes these signs in detail.)
Different breast milk, leftover formula in a bottle your infant has drunk from cannot be saved. Check out this A.A.P. guide to safely preparing formula.
When dealing with canteen refusal, be patient.
Rarely, a breastfed baby will prove shockingly tenacious in refusing to take milk from a bottle. If subsequently trying all of the above techniques your baby is nevertheless rejecting the canteen, or if your baby begins refusing the bottle after taking it previously, you lot tin likewise effort:
Distracting the baby. Endeavour giving the bottle when your baby is calm and a little distracted, for example, by offering a bottle while taking a walk outside.
Heating things up. Effort warming the milk and the bottle nipple, to make the experience more similar to feeding at your breast.
Offering a gustation. Using a syringe, try dribbling a petty milk into your baby'due south oral cavity and so giving her the bottle. This helps trigger her drive to suck on the canteen.
Using music equally a feeding cue. Rosenfeld recommended playing the same music while nursing and bottle feeding. This cues your baby that information technology's fourth dimension to eat.
Bypassing the bottle. If your baby is 6 months or older, try circumventing the bottle and weaning direct onto a loving cup.
Prevent uncomfortable engorgement, leaking and chock-full ducts.
When you lot start introducing formula, your chest milk production will take a few days to suit to the reduced demand. In the acting, your breasts may become uncomfortably engorged, which can lead to embarrassing leakage, clogged ducts or even mastitis — a painful infection of the chest tissue.
Thus experts generally advise introducing formula slowly, gradually replacing breastfeeding sessions with formula feeding.
One method is to replace one nursing session per week with a formula feeding session. First by giving your baby one canteen of formula at around the same fourth dimension each day. This will railroad train your trunk to stop producing milk at that time.
Another way to start introducing formula, according to the National Childbirth Trust, a nonprofit based in Great britain, is the "peak information technology off" method, which involves giving a minor corporeality of formula (one-half an ounce to an ounce) subsequently a nursing session. The extra nourishment will make your baby feel more total, extending the time until your next nursing session and gradually reducing the amount of milk yous produce at that time.
If your breasts still get engorged, "you can relieve some of the force per unit area by pumping or hand expressing a little milk, but only until y'all feel relief," said Dr. Neifert. She warned against "draining your breasts completely, every bit that signals to your breasts to continue to produce milk."
[How to keep pumping when you return to work ]
Maintain your milk supply while giving formula.
If you wish to maintain your milk supply while giving formula, you may need to breastfeed or pump frequently, up to 8 to 12 times per day. The verbal number of times will depend on your breasts' storage capacity and the age of your babe.
According to the North.C.T., if your baby is older — around 8 or ix months — you can commonly maintain your breastmilk supply alongside formula feeding, every bit long as you breastfeed every twenty-four hours.
The Section of Agriculture has tips for maintaining your milk supply while introducing formula.
Choose an fe-fortified formula.
For healthy, total term babies who are partially breastfed, the A.A.P. recommends a moo-cow'southward milk-based formula that is fe-fortified. (Low-iron formulas raise your infant's risk of anemia.)
Infants younger than 1 year should never receive regular cow'due south milk or any other milk in place of formula or breast milk. Cow'southward milk does not contain the proper balance of nutrients your growing infant needs.
A few babies, such equally those with lactose intolerance, astringent reflux or milk allergies may demand a special formula. Talk with your baby's pediatrician if yous think your infant needs i.
If you need more help choosing a formula, consult The Wirecutter's Guide to the Best Babe Formula. (The Wirecutter is a New York Times company that does rigorous production reviews.)
Understand that bottle feeding and breastfeeding identify different demands on your baby.
To breastfeed finer, babies must open their mouth wide, latch on to the breast and then coordinate a suck, consume and jiff sequence. Bottle feeding, past contrast, provides a continuous flow of milk; instead of working to extract the milk, babies merely demand to intermission the flow of milk in order to exhale.
Considering of these differences, some babies will develop a stiff preference for the bottle or, less often, for the chest.
Nipple defoliation. Women sometimes receive dire warnings that artificial nipples, including pacifiers, can lead to nipple confusion — or an inability to latch on to the breast and effectively extract milk.
" … these concerns [over nipple defoliation] can cause pregnant stress for new mothers who are struggling with breastfeeding," Dr. Chad Hayes, M.D., a pediatrician practicing in Charleston, S.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's sucking patterns later on introducing a canteen or a dummy [pacifier]. Her baby may struggle and cry, find it hard to latch on, or simply nurse ineffectively at the breast."
Fortunately, according to Dr. Hayes, these fears are overblown. A recent meta-analysis of randomized controlled trials, for instance, plant that among full-term babies, bottle feeding and pacifier apply had no apparent affect on the elapsing of breastfeeding. After reviewing the inquiry, Hayes concluded that "nipple defoliation doesn't seem to play a huge part in baby feeding."
(Amidst preterm babies who, for health reasons, often need to start on bottles earlier breastfeeding is established, bottle 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 babe fussing at the breast or refusing to latch is menstruation preference.
Menses preference occurs when your infant can notwithstanding breastfeed finer but prefers the fast, piece of cake flow of milk from a bottle. Babies who prefer bottles may fuss, cry or push you away when you try to nurse. Some babies may temporarily reject to nurse at all, going on a nursing strike.
If this happens, La Leche League recommended paw expressing a bit before trying to latch your baby onto your chest. This helps to reduce engorgement and to get the milk flowing, and then that your baby is rewarded with milk immediately afterwards latching. The Australian Breastfeeding Association also offers several tips for treatment breast refusal.
If your baby is still resisting breastfeeding, Rosenfeld recommended taking a bottle holiday for at least a calendar week. When yous 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 just slightly reclined, property the bottle horizontally then your baby has to suck to extract milk from the bottle, and assuasive for frequent pauses between gulps of milk.
If you are having persistent bug getting your baby to latch or to breastfeed finer, seek exterior help. The U.s. Lactation Consultant Association website tin can help you find a board-certified lactation consultant most yous.
Feel good about your choice.
The A.A.P. recommends that women breastfeed exclusively for nearly the commencement six months of life, and then continue breastfeeding while giving solid foods for at to the lowest degree a year.
Exclusive breastfeeding for six months — without boosted solids or formula — provides the strongest protection confronting gastrointestinal and respiratory infections during infancy. But fractional breastfeeding does still provide some protections against diarrhea, ear infections, Sudden Infant Death Syndrome and respiratory infections like pneumonia.
Note though, that "this protection against infection lasts only as long equally you are breastfeeding," said Dr. Kramer.
Some studies also advise that breastfeeding can confer additional lifelong protection confronting obesity, eczema, asthma and allergies, likewise equally a slight boost in I.Q., though many of the studies showing these long-term benefits "accept major methodological issues," according to the A.A.P.
Women sometimes hear that simply ane drop of formula will change a baby's microbiome — the mélange of bacteria, fungi, and other microscopic bugs that line the skin and gastrointestinal system. Such changes, they are warned, may have lifelong consequences for their babies' immune and metabolic health.
While formula-fed babies do take a dissimilar residual of leaner in their gut microbiome, said Dr. Kramer, "we notwithstanding do 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 likewise warn that using formula tin can "shorten the breastfeeding relationship."
Just this depends on your situation. I and many of my mom friends found 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 cause your breasts to get engorged with milk, which can atomic number 82 to clogged milk ducts. You may notice a hard, crimson and tender lump on your breast that feels warm to the touch. A clogged duct volition often occur only in one breast.
To help clear the duct, nurse and pump frequently to keep your breast from becoming full of milk. Massaging your chest and applying warm compresses while nursing or pumping may besides help the duct clear and ease discomfort.
If yous besides develop shivers, chills or other influenza-like symptoms, you may have mastitis, a serious infection of the breast tissue. Mastitis tin come up on of a sudden and cause you to feel weak and achy. If you recollect you may accept mastitis, contact your doctor right away; you may need antibiotics.
Amy Kiefer, Ph.D., is a freelance scientific discipline writer and mother of three who blogs on pregnancy and breastfeeding for Expecting Science.
Source: https://www.nytimes.com/article/combination-breast-bottle-feeding.html
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