Breastfeeding vs. Formula Feeding

Transcription

1 Breastfeeding vs. Formula Feeding Choosing whether to breastfeed or formula feed your babies is one of the first decisions expectant parents will make. Although there s no right or wrong choice, the American Academy of Pediatrics (AAP) joins other organizations such as the American Medical Association (AMA), the American Dietetic Association (ADA), and the World Health Organization (WHO) in recommending breastfeeding as the best for babies. Specifically, the AAP says babies should be breastfed exclusively for the first 6 months and that breastfeeding should continue until 12 months (and beyond) if both the mother and baby are willing. But breastfeeding (or nursing) may not be possible or preferable for all women. The decision to breastfeed or formula feed your baby should be based on your comfort level with breastfeeding as well as your lifestyle. Families with Multiples have even greater challenges when it comes to feeding time. Breast milk is seen by many as the ideal form of nutrition for newborns, and certainly, many mothers have breastfed twin, triplets, even quadruplets just fine. But for mothers who are unable to breastfeed or who decide not to, infant formula is a good alternative. If you feed your babies with a commercially prepared formula, be assured that your babies nutritional needs will be met. And with the tips found in this handout, you ll still bond with your babies just fine. After all, whether with breast milk or formula, feeding is an important time of connection between mother (or father) and babies. The decision to breastfeed or formula feed your baby is a very personal one. But here are some points you may want to consider as you decide which is best for you and your new additions. Contents of this Package: 1. Breastfeeding: Advantages & Challenges 2. Bottlefeeding: Advantages & Challenges 3. Bottle Feeding Basics 4. Positioning (tips from Mothers of twins!) 5. Photos (to show bottlefeeding two at a time) 6. Additional Resources and Sources Feeding PLUS: Handout from La Leche League Site from class 1

2 1a. Breastfeeding: The Advantages Nursing can be a wonderful experience for both mother and baby. It provides ideal nourishment and a special bonding experience that many nursing mothers cherish. Below are some of the many benefits of breastfeeding. Infection-Fighting. Antibodies passed from a nursing mother to her baby can help lower the occurrence of many conditions, including: Ear infections Diarrhea Respiratory infections Meningitis Other factors help to protect a breastfed baby from infection by contributing to the infant s immune system by increasing the barriers to infection and decreasing the growth of organisms like bacteria and viruses. Breastfeeding is particularly beneficial for premature babies and may also protect children against: Allergies Asthma Diabetes Obesity Sudden infant death syndrome (SIDS) As a group, formula-fed infants have more infections and more hospitalizations than do breastfed babies. Nutrition and Ease of Digestion. Often called the perfect food for a human baby s digestive system, breast milk s components - lactose, protein (whey and casein), and fat - are easily digested by a newborn s immature system. As a group, formula-fed infants have more difficulty with digestion than do breastfed infants. Breast milk tends to be more easily digested so that breastfed babies have fewer incidences of diarrhea or constipation. Breast milk also naturally contains all the vitamins and minerals that a newborn requires. The Food and Drug Administration (FDA) regulates formula companies to ensure that they provide all the known necessary nutrients in their formulas. Commercial formulas do a pretty good job of trying to duplicate the ingredients in breast milk - and are coming closer - but haven t matched their exact combination and composition. Why? Because some of breast milk s more complex substances are too difficult to manufacture and some have not yet been identified.

3 Free. Breast milk doesn t cost a cent*. And because of the immunities and antibodies passed onto them through their mothers breast milk, breastfed infants are sick less often than infants who receive formula. For example, researchers have determined that infants who are exclusively breastfed for 4 or more months have 40% fewer episodes of ear infections. That means they make fewer trips to the doctor s office, which equates to fewer co-pays and less money doled out for prescriptions and over-the-counter medications. Likewise, women who breastfeed are less likely to have to take time off from work to care for their sick babies. In a cost study published in the April 1999 issue of the journal Pediatrics, researchers determined that infants who were never breastfed would incur additional medical costs of $331 to $475 per year. * Remember, though, that you will need to buy a few good nursing bras, and you will be eating more, so you ll need to adjust your grocery budget accordingly. Different Tastes. A nursing mother will need 500 extra calories per day to produce breast milk, which means that she should eat a wide variety of well-balanced foods. This introduces breastfed babies to different tastes through their mothers breast milk, which has different flavors depending on what their mothers have eaten. Convenience. With no bottles to mix and sterilize and no last-minute runs to the store for more formula, breast milk is always fresh and available. And because breast milk is always the right temperature, there s no need to warm up bottles in the middle of the night. It s also easy for breastfeeding mothers to be active - and go out and about - with their babies and know that they ll have food available for whenever their little one is hungry. Obesity Prevention. Recent studies indicate that breastfeeding might help prevent childhood and adult obesity. According to the National Women s Health Information Center (part of the U.S. Department of Health and Human Services), babies who are breastfed tend to gain less unnecessary weight, which may help them be less overweight later. Smarter Babies. Recent studies suggest that children who were exclusively breastfed for 6 months have IQs 5 to 10 points higher than children who were formula fed. Skin-to-Skin Contact.* Many nursing mothers really enjoy the experience of bonding so closely with their babies. And the skin-to-skin contact can enhance the emotional connection between mother and infant. *Bottle feeding parents can do this too! Beneficial for Mom, Too. The ability to nourish a baby totally can also help a new mother feel confident in her ability to care for her baby. Breastfeeding also burns calories and helps shrink the uterus, so nursing moms may be able to return to their pre-pregnancy shape

4 and weight quicker. In addition, studies show that breastfeeding helps lower the risk of premenopausal breast cancer and also may help decrease the risk of uterine and ovarian cancer. 1b. Breastfeeding: The Challenges Although it is the best nutritional source for babies, breastfeeding does come with some concerns that many new mothers share. Whereas it s easy from the get-go for some, it can be challenging. Sometimes, both mother and baby need plenty of patience and persistence to get used to the routine of breastfeeding. But all the effort is often worth it in the long run - for both the mother and her baby. Common concerns of new moms, especially during the first few weeks and months, may include: Personal Comfort. Initially, as with any new skill, many moms feel uncomfortable with breastfeeding. But with adequate education, support, and practice, most moms overcome this. The bottom line is that breastfeeding shouldn t hurt. Latch-on pain is normal for the first week to 10 days, and should last less than a minute with each feeding. But if breastfeeding hurts throughout feedings, or if the nipples and/or breasts are sore, it s a good idea for breastfeeding mothers to seek the help of a lactation consultant, their doctor, and/or their child s doctor. Many times, it s just a matter of using the proper technique. Time and Frequency of Feedings. There s no question that breastfeeding does require a substantial time commitment from mothers. Then again, many things in parenting do. Some women may be concerned that nursing will make it hard for them to work, run errands, or travel because of a breastfeeding schedule or a need to pump breast milk during the day. And breastfed babies do need to eat more often than babies who are fed formula, because breast milk digests faster than formula. This means Mom may find herself in demand every 2 or 3 hours (maybe more, maybe less) in the first few weeks. This can be tiring, but once breastfeeding has been established (usually within about a month), other family members may be able to help out by giving the baby pumped breast milk if Mom needs a break or has to get back to work outside the home. And it s not long before babies feed less frequently and sleep through the night (usually around 3 months). Also, with a little organization and time management, it becomes easier to work out a schedule to breastfeed and/or pump. Limiting Caffeine. Caffeine intake should be kept to no more than 300 milligrams (about one to three cups of regular coffee) per day for breastfeeding women because it may cause problems such as restlessness and irritability in some babies. But many women are used to drinking less caffeine anyway because they kept their caffeine consumption

5 to a minimum during pregnancy. Women who enjoy caffeine, however, can still have a little by combining caffeinated and non-caffeinated drinks, and some might find they re satisfied just by trying similar-tasting non-caffeinated beverages. Maternal Medical Conditions, Medicines, and Breast Surgery. Medical conditions such as HIV or AIDS or those that involve chemotherapy or treatment with certain medications may make breastfeeding inadvisable. In these cases, a woman should check with her doctor or a lactation consultant if she s unsure whether she should breastfeed with a specific condition or while taking medications. But most moms are able to breastfeed even while on medications. Mothers who ve had breast surgery, such as a reduction, may have difficulty with supply if their milk ducts have been severed. In this situation, it s a good idea for a woman to talk to her doctor about her concerns, and to work with a lactation specialist. 2a. Formula Feeding: The Advantages Breastfeeding is considered the best nutritional option for babies by the major medical organizations, but not every mother chooses - or is able - to breastfeed. Commercially prepared infant formulas are a nutritious alternative to breast milk and even contain iron. Manufactured under sterile conditions, commercial formulas attempt to duplicate mother s milk using a complex combination of proteins, sugars, fats, and vitamins that would be virtually impossible to create at home. So, if you don t breastfeed your baby, it s important that you use only a commercially prepared formula and that you do not try to create your own. In addition to medical concerns that may prevent breastfeeding, here are a few other reasons women may choose to formula feed: Convenience. Either parent (or another caregiver) can feed the baby a bottle at any time (although this is also true for women who pump their breast milk). This allows the mother to share the feeding duties and helps her partner to feel more involved in the crucial feeding process and the bonding that often comes with it. (This is a particularly important point for families with multiples!) Flexibility. Once the bottles are made, a formula-feeding mother can leave her baby with a partner or caregiver and know that her little one s feedings are taken care of. There s no need to pump or to schedule work or other obligations and activities around the baby s feeding schedule. And formula-feeding moms don t need to find a private place to nurse in public. However, if Mom is out and about with baby, she will need to bring supplies for making bottles. Time and Frequency of Feedings. Because formula digests more slowly than breast milk, formula-fed babies usually need to eat less often than do breastfed babies. (About every 3-4 hours as newborns, as opposed to every 2-3 hours for breastfed babies.) Diet. Women who opt to formula feed don t have to worry about the things they eat or drink affecting their babies.

6 2b. Formula Feeding: The Challenges As with breastfeeding, there are some challenges to consider when deciding whether to formula feed. Organization and Preparation. Enough formula must be on hand at all times and bottles must be made. The powdered and condensed formulas must be prepared with sterile water (which needs to be boiled until the baby is at least 6 months old) or bottled sterilized baby water. Ready-to-feed formulas that can be poured directly into a bottle without any mixing or water tend to be expensive. Bottles and nipples need to be sterilized before the first use and then washed before every use after that (this is also true for breastfeeding women who give their babies bottles of pumped breast milk). Bottles and nipples can transmit bacteria if they aren t cleaned properly, as can formula if it isn t stored in sterile containers. Bottles left out of the refrigerator longer than 1 hour and any formula that a baby doesn t finish must be thrown out. And prepared bottles of formula should be stored in the refrigerator for no longer than 24 to 48 hours (check the formula s label for complete information). Bottles also may need to be warmed up before feeding the baby, although some babies actually prefer cold bottles to warm. Some parents pop bottles in the microwave for a few seconds; however, the microwave should never be used to warm a baby s bottle because it can create dangerous hot spots. Instead, run refrigerated bottles under warm water for a few minutes if the baby prefers a warm bottle to a cold one. Or the baby s bottles can be put in a pan of hot water (away from the heat of the stove) with the temperature tested by squirting a drop or two of formula on the inside of the wrist. Lack of Antibodies. None of the important antibodies found in breast milk is found in manufactured formula, which means that formula doesn t provide the baby with the added protection against infection and illness that breast milk does. Expense. Formula can be costly. Powdered formula is the least expensive, followed by concentrated, with ready-to-feed being the most expensive. And specialty formulas (i.e., soy and hypoallergenic) cost more - sometimes far more - than the basic formulas. During the first year of life, the cost of basic formula can run about $1,500 per baby. Can t Match the Complexity of Breast Milk. Manufactured formulas have yet to duplicate the complexity of breast milk, which changes as the baby s needs change. (Although most are now getting closer, including such ingredients as DHA in the formula.)

7 A Very Personal Decision Whatever nutritional option you choose, be sure to talk to your child s doctor about the choices available to help you make the decision that s best for both you and your baby. Updated and reviewed by: Barbara P. Homeier, MD Date reviewed: July 2005 Originally reviewed by: Neil Izenberg, MD Revised and edited by Vera C. Teschow, Bottle Feeding Basics How often should I feed my baby? As with breastfeeding, most experts agree that you shouldn t follow a rigid schedule in the early weeks, though you may be able to work out an approximate pattern for feeding within a month or two. Offer the bottle every two to three hours at first or as your baby seems hungry. Until the baby reaches about 10 pounds, she ll probably take one to three ounces per feeding. Don t force more than she seems ready to eat. Your pediatrician should advise you about suitable amounts for your baby as she grows. Do I need to sterilize the bottles? Before you first use new bottles, nipples, and rings, you should sterilize them by submerging them in a pot of boiling water for at least five minutes. Then allow them to dry on a clean towel. After that, a good cleaning in hot, soapy water, or a cycle through the dishwasher is sufficient. (You can find some handy bottle gear, such as dishwasher baskets for nipples, rings, and bottle caps, and special bottle drying racks, at most baby supply stores.) One caveat: If you have well water, repeated sterilization of the bottles may be best. Do I need to sterilize my drinking water for making formula? Though many parents do sterilize the water used to mix formula, especially in the newborn months, you don t need to unless your pediatrician recommends it due to your local water supply. However, if you use well water, you will likely be told to sterilize it or use bottled water for mixing formula. If you do choose to boil the water you use to mix formula, save yourself time by preparing enough for the whole day in the morning. What s the best way to warm a bottle? There s no health reason to feed a baby warmed milk but your baby may prefer it. When you re

8 ready to feed your baby, you can warm a bottle in a pan of hot--not boiling--water, or by running it under the tap; you can also buy a bottle warmer designed for this purpose. If your baby is accustomed to drinking bottles at room temperature or slightly cold, you save yourself the time and hassle of preheating bottles, especially when she s crying to be fed right now. Never use a microwave to heat a bottle of breast milk or formula; since a microwave oven heats unevenly, it can create hot pockets, leading to burns, and cause a breakdown of the nutrients. How can I make sure my baby is drinking comfortably? Like so much with babies, you ll need to listen and observe. If you hear a lot of noisy sucking sounds while she drinks, she may be taking in too much air. To help your baby swallow less air, hold her at a 45-degree angle. Also take care to tilt the bottle so that the nipple and neck are always filled with formula. Never prop a bottle. Besides not providing you or the baby with time for bonding and snuggling, it can cause the baby to choke. Bottlefeeding, like breastfeeding, can be a wonderful time for nurturing your baby by holding her close. Other Tips: Warm the refrigerated formula. Refrigerated formula doesn t necessarily have to be warmed up for your baby, but most infants prefer it at least at room temperature. The easiest way to warm refrigerated or frozen milk is to place the container in a pan of water on the stove at low heat and rotate it frequently. Microwave ovens should not be used for heating bottles; this can overheat the milk in the center of the container. Even if the bottle feels comfortably warm to your touch, the superheated milk in the center can scald your baby s mouth. Also, the bottle itself can explode if left in the microwave too long. If you warm a bottle or use it immediately after terminal heating, test it in advance to make sure it s not too hot for your baby. The easiest way to test the temperature is to shake a few drops on the inside of your wrist. Place your baby in a feeding position. Cradle her in a semi-upright position and support her head. Don t feed her lying down -- formula can flow into the middle ear, causing an infection. To prevent your baby from swallowing air as she sucks, tilt the bottle so that the formula fills the neck of the bottle and covers the nipple. Take note of your baby s intake. The pediatrician will probably ask you how much your baby has eaten, so be prepared to answer the question. Your newborn will probably take between two and four ounces per feeding during his first few weeks (during the first few days, he may take less than an ounce at feedings), and will probably be hungry every two to four hours. It s best to feed your baby on demand. Don t encourage your baby to finish the bottle if he s not interested. And if he s still sucking enthusiastically when the bottle is empty, offer him more. Burp your baby. Babies get fussy and cranky when they swallow air during feedings. This happens more often with bottlefed infants, though breastfed infants can also swallow air. To prevent a tummy full of air, burp your baby frequently -- after every two or three ounces of formula. If your baby doesn t burp after a

9 couple of minutes of trying, resume feeding. Here are the three best positions for burping: Over the shoulder: Drape your baby over your shoulder and firmly pat or rub her back. On the lap: Sit your baby upright, lean her weight forward against the heel of your hand, and firmly pat or rub her back. Lying down: Place baby stomach-down on your lap and firmly rub or pat her back. Source: Caring for Your Baby and Young Child: Birth to Age 5 (Bantam, 1998) This information is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child s condition. 4. Positioning (Mothers Discussion from Twinslist.org) Teresa: Let me preface this by noting that my twins are 4 months old/1.5 months corrected for prematurity. I used to feed both infants at once when they were a little bit smaller (4-6 lbs. or so) if they were hungry at the same time and neither could be stalled. Neither had great head control so I had to be creative. Some positions I have tried are: 1. Get bottles, pillows, and burp cloths ready on table next to glider rocker with ottoman (any chair with good back support and a foot stool to put your feet on). Prepare two regular bed size pillows -- one pillow for my lap (sitting on ottoman), one ready to place under my arm (sitting in chair). Place both babies on the pillow and lift them onto my lap. Sitting in the glider rocker, feet up on the ottoman, knees bent so that babies heads are elevated instead of flat, turn infant with least head control into cradle position. Angle other baby so that head is on knee nearest the other baby s head. With free arm, get the cloth diapers in position, and bottles. In this position I was able to manipulate both bottles with either hand (not always the most comfortable, but it worked) and I always used the cloth diaper to help prop the bottle for extra support if I needed to let go quickly to help the other baby. For burping, position cloth diapers first, move babies to shoulders and burp simultaneously. I couldn t really cross my arms effectively for burping (right arm burping baby on left shoulder and vice versa), so I usually used my thumb at the babies side for support and so I could burp with the palm of my hand. I never tried one at the shoulder and one on my lap tummy down, but I suppose it would have worked. 2. Baby with most head control at side in car seat (tilted slightly upright). I have the Snuggli seat inserts in the car seats. I unsnapped the head rest and used it as a bar across the seat. I would prop the bottle on the head rest and feed the other baby cradled in my arm or sitting in my lap (Indian style) with head on my knee. Burping

10 was same as above. I always needed lots of pillows for back support if I sat cross legged on my bed or floor when it came time for burping. 3. Currently, I try to stall one of them when both are hungry. I ve been dealing with a lot more spitting up than before and it gets difficult to manage when feeding them both. I suppose I ve been burned too much that I m afraid to try it. However, I recently was loaned a Boppy pillow (c-shape pillow) from the physical therapist, and I ve considered trying to use it to help when both are hungry at the same time. They re getting too big for me to try the rocking chair position, and they still don t have quite good enough head control for me to move to the high chairs yet... I could also try both car seats... I m hoping that eventually I ll be able to hold both in my lap, heads resting on my chest facing out. Heather: We bought a nursemate pillow (the kind that straps around you) for breastfeeding but my husband figured out that you could prop both babies up on it and give them both bottles and have both faces looking up into yours. We continued to use the pillow to feed both of them long after they quit breastfeeding. Now that bottles are long past for my kids I still have fond memories of watching him feed both of them this way. We also used the cloth chairs or the car seats to sit the babies in and then you can sit in between them and hold both bottles, but it s not as easy to burp them as using the nursemate pillow. Actually feeding both of them was easier than we thought because my son figured out how to hold his own bottle by about 4 months so you could let him solo for a few seconds while you reached for something or moved someone around. Michelle: I bottlefed the girls at the same time exclusively and found it much faster and easier than doing it separately. I sat on the couch and put each baby parallel to my legs with their head at the edge. I rarely used pillows under their heads, but couch pillows were the perfect size. When they were very small, they slept in our bed and I would prop myself up with pillows against the headboard and lay one on either side of me. This was *much* easier on my back than trying to lean over them in infant seats. My girls have never had an ear infection and I never had a problem with them eating relatively flat, but if yours are prone to them, their heads should always be propped up. When I was out I put one lengthwise on my lap and the other in the stroller beside me and held both of the bottles. If there was any chance of making it to the car I could feed them very easily by sitting between them in the back seat. I often ended up there when DH was driving too. I did not turn the car seats around until after one year, and consequently they were able to hold their own cups by then.

11 Carrie: I sometimes bottle fed both girls at the same time. I really had no choice -- it was either that or listen to the one not being feed scream bloody murder for her food:) -- plus it saved me some time to get other things done around the house, etc. I would sit on the couch and lay each baby s head on one of my legs (comfortably), and feed them that way, or put both of them on my lap and use a pillow for their heads - this way is a lot easier as you can look in their faces and talk/play with them as you re feeding them. It really is not as hard as I had of course imagined. [I remember thinking - HOW will I do this with two babies, HOW will I manage to do that with two babies - I sure we can all relate to that :) ] If one baby was calm and could wait to be fed after the other, I would feed one at a time just to spend one-on-one time and bond with each baby first, but if they couldn t wait...i did the above. Jocelyn: I bottle fed my twins together and found the bouncinettes to be the best thing. I would lay them both in bouncinettes, and sit between them on the floor with my back up against the couch, nappy over shoulder ready for burping later. I would then hold a bottle in each hand and when my arms got tired I would rest them on my knees. When they had both finished, I would then burp one at a time. Sitting on the floor I could talk to them while they were feeding and sit on a cushion and be comfortable at the same time. Only problem I had was if I got an itchy nose with no hand free to scratch. The bouncinettes were the best equipment we had as I could also leave them in them for a nap and later when starting to feed solids before they could sit in highchairs. I don t know if you can still buy them, they were the old fashioned types with mesh over a bouncy metal frame. which I made more comfortable with a padded cover and rolled up nappy under the backs of their knees so they didn t slide off. Wendy: For the first three months I found it very difficult to feed the babies simultaneously (breast or bottle). They were so tiny (4 and 5 lbs. at birth) and I was a first-time mom and not very comfortable with a newborn (I was sure I would cause a neck injury). Anyway, although it was more time-consuming I feed each baby separately, but always one right after the other even if it required waking a baby. When they were about four months, I found I could bottlefeed each baby simultaneously by sitting cross-legged with a baby resting on each leg. I also would put the babies in their infant carriers on the sofa and sit between them and feed. When one had to burp, I would prop the other baby s bottle with a rolled-up receiving blanket.

12 Many mothers I talked to about propping said they felt guilty about using bottles, and especially about propping them, but I found it was convenient and frequently necessary. If you stay with the babies, there is noting wrong with propping bottles. Don t waste your energy feeling guilty! Consider instead the extra time you will have to cuddle and play with your babies when they are not feeding. After all, you don t want them to associate your love exclusively with food! Carol: I didn t bottlefeed both boys until they were about 6-7 months old, so they were sitting in the car seat for meals, so they just got the bottle there. I would sit in front of the table, both car seats on the table, and hold the bottles for them. Not too long after that, they were able to hold the bottles on their own. At about 10.5 months, I switched them to Playtex sippy cups (after some trial & error -- to get them to suck hard enough to get anything out, I dipped the spout in apple juice). 5. Photos and Diagram for Bottle-Feeding Two at a Time 4 Feeding two at a time is an effective time saver, but try to ensure cuddling and facial connection as often as possible. Ideally, get lots of help for the first 6 weeks at least; 6 months is even better; the more feeders you have, the more cuddles each individual baby can get. (1) If you must be alone at a feed, both babies can be placed on a breast feeding pillow around the feeder s lap (2), or they can be propped up on any pillow facing the feeder (3) a great opportunity to make faces at your babies, or sing to them. The particularly skilled feeder can hold both babes cross-style (4), while others may prefer to hold one and feed the other in a chair (5). Both babies can be fed in their seats, tilted back slightly (6). Eventually, they will learn to hold the bottles themselves, and they can feed themselves while you cuddle them on your lap. (7)

13 6. Additional Sources and Resources: Websites: Kidshealth.com Babycentre.com Organizations: La Leche League Canada People: Dr. Jack Newman Lactation Consultants: Edith Kernerman (works w/ Newman) Anne-Marie Desjardins (also a registered nurse) Timea Szalay (mother of twins, also provides doula services) Books: The Parent s Guide to Raising Twins by Elizabeth Friedrich and Cherry Rowland When Breastfeeding is Not An Option by Peggy Robin Mothering Multiples by Karen Kerkhoff This Special Report was downloaded from the Members area at BabiesInBelly.com