Academic Journal
Main Category: Pediatrics / Children's Health
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Article Date: 14 May 2013 - 0:00 PDT Current ratings for:
Giving Babies Formula In Early Days May Help Prolong Breastfeeding For Some
In a bid to promote breastfeeding, hospitals push to reduce formula feeding in infants in the days following their birth. But in a new study, the first to carry out a randomized trial, researchers show that giving small amounts of formula to newborns who lose a lot of weight in their first few days of life, can actually help prolong breastfeeding in the long term.
Lead author Valerie J. Flaherman of the University of California - San Francisco (UCSF), and colleagues, write about their findings in the 13 May online issue of the journal Pediatrics.
Because of its perfectly balanced nutritients for healthy growth and wide-ranging protective benefits, such as reducing infection and allergy risk, breastfeeding is widely promoted by public health bodies.
For example, the American Academy of Pediatrics recommends that for maximum health benefits, infants should breastfeed exclusively for the first six months of their lives, as long as mother and baby are in good health.
In a press statement, Flaherman, an assistant professor of pediatrics and epidemiology and biostatistics at UCSF and a pediatrician at the University's Benioff Children's Hospital, says until now, there hasn't been much investigation of whether it is possible to pick out the infants who might benefit from early formula use.
"This study provides the first evidence that early limited formula (ELF) can provide important benefits to some newborns," she adds, explaining that based on these findings, "clinicians may wish to consider recommending the temporary use of small amounts of formula to new moms whose babies are experiencing significant early weight loss."
While using formula can be a "slippery slope" to stopping breastfeeding altogether, ELF can be seen as a different way to use it, says Flaherman.
The point of ELF is to supplement breastfeeding with small amounts of formula, to alleviate the stress that not having enough milk can produce in new mothers.
This is a different approach to giving babies full bottles of formula that then make it hard for them to return to the breast.
In the first few days after birth, the mother's breasts tend to produce small amounts of colostrum, which contains high levels of nutrients and antibodies for the baby. Sometimes, this means milk production is delayed for a few days, and in the meantime the baby has lost weight, and may appear fretful and hungry, which naturally distresses to the mother.
"Many mothers develop concerns about their milk supply, which is the most common reason they stop breastfeeding in the first three months," says Flaherman.
But this study suggests giving just small supplements of formula may alleviate that concern and help mothers carry on breastfeeding.
For the trial, Flaherman and colleagues recruited 40 full-term newborns. The infants were between 1 and 2 days old and had lost more than 5% of their birth weight.
They randomly assigned the babies to one of two groups: an ELF group and a breastfeeding only group.
In the ELF group, the babies received one-third of an ounce of infant formula by syringe after each breastfeed, while in the breastfeeding only group (the controls), the babies received no supplementation and were assigned to be fed only via the breast.
The idea of the intervention was to cause minimum interference with breastfeeding, which occurred up to 12 times a day. ELF was in small amounts, at the end of each breastfeeding session.
They used a syringe so as not cause confusion about nipples: sometimes when babies are given a bottle as well as the breast, they can end up preferring the bottle nipple.
ELF was stopped as soon as the mother were producing enough mature milk: this was between 2 and 5 days after birth.
One week after birth, all the babies in both groups were still breastfeeding. But in the ELF group, only 10% of the babies had been given formula in the previous 24 hours compared to 47% of the breastfeeding only group.
Three months after birth, 79% of the ELF babies were still breastfeeding exclusively, compared to 42% of the controls.
Also at the three-month assessment, researchers found that 98% of the ELF babies were breastfeeding to some extent, compared to only 68% of the controls.
Although the results seem impressive, the authors point out this is the first study of its kind, with a small number of participants, and now needs to be confirmed with larger trials in other populations.
James Taylor, medical director for the University of Washington Medical Center's Newborn Nursery, was not involved with the research. He says the results are "provocative and challenge conventional wisdom".
"It is crucial that we have more randomized controlled trials on interventions to increase breastfeeding rather than relying on heavily confounded observational studies or biased expert opinion," he urges.
A recent report from the US Centers for Disease Control and Prevention (CDC) shows that more American mothers are breastfeeding, and a record number are still breastfeeding at six months.
Written by Catharine Paddock PhD
Copyright: Medical News Today
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Main source: University of California - San Francisco. Please use one of the following formats to cite this article in your essay, paper or report:
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19 May. 2013.
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posted by PJ on 15 May 2013 at 6:18 am
JC - I did work with a qualified lactation consultant. I was taught what a proper latch was and was not. My baby was hungry all the time. He nursed for 20 minutes on each side, went back for another round, slept for 45 minutes and was hungry and crying again. According to the (highly qualified and highly educated) pediatrician, it takes time for milk production to catch up to baby's needs (this was also touched on by the child birth educator, the lactation expert whose class I took, all of the breast feeding books I read and the nurse in the hospital). For the record, I am college educated, employed full-time in healthcare, and was determined to be successful breastfeeding both of my children; I was. There is no significant harm that was done to either of my boys associated with the use of formula supplementation for the first several weeks.
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posted by Desiree on 15 May 2013 at 4:38 am
Just to follow up with one of the other comments. I feel like moms do not give their bodies enough credit. I also had big babies, two were 10 1/2 pounds, and my littlest was 9 pounds, 10 ounces.
Nurses at the hospitals told there was no way I would be able to satisfy their appetite with just breastmilk. To which I said of course you can. My body knows how much milk I need to make and it will. I never needed to supplement, and on top of that I had a huge oversupply issue.
I also feel like the study was not very accurate, but in very rare instances (I even cringe to say this) it has helped. In my 4 years of helping moms there has only been 1 time that I felt it was beneficial. Because generally you give any amount of formula and moms are confused about whether they can produce enough to sustain their babies.
Please women do yourself a favor and do not stress about how much baby is getting. There are some key things to look at and know. After the first 5 days: is baby satisfied after a feeding? Is baby gaining weight? Is baby pooping 4 times a day or more, a quarter size or more? Is baby having plenty of wet diapers a day? Does baby have alert times? All of these things can be factored into if your baby is getting enough to eat. If there is any question feed the baby.
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posted by JC on 14 May 2013 at 6:01 pm
There are so many flaws in this study.
1) This study had a total of 40 babies. 40 babies is a very small study group.
2) It doesn't state if they consider age, economic status, first time mother or multip, vaginal or C-section.
3) One coauthor has served as a paid consultant for Abbott Nutrition, Mead-Johnson, Nestle SA, and Pfizer Consumer Products. Hmmm - really..
4) 5% weight loss in not 'a large weight loss'. The Academy of Pediatrics state 5-7% weight loss is normal. To add on to the weight loss there was a study published a few months ago which stated mothers who received large doses of IV fluids had infants with larger weight loss. As I already mentioned this study didn't state how long these mothers were in labor and how much fluid they got.
5) The mothers who were in the exclusive breastfeeding group received a presentation on ways to soothe fussy babies - the best way to soothe a fussy baby is to allow them to nurse so if these parents were rocking, swaddling, holding these babies instead of realizing they are giving signs that they want to eat of course breastfeeding will be harder.
6) Numerous studies discuss the health difference between babies that are EXCLUSIVELY breastfeed versus formula or combine feeding. Maybe this study needs to extend out and keep health tabs on these 40 babies for the next 5 years.
LaLeche Nazis be damned --------
Breastmilk has more calories then formula by far and bleeding and/or damaged nipple is a sign of a poor latch - poor latch causes mother's pain but it also means the baby is transferring less milk as well. I wish that you had the ability to work with a qualified lactation consultant who would have assisted you with your difficulties. If our bodies couldn't produce enough milk for a baby weighing 10 pounds then it also wouldn't be able to produce enough milk for a mother of twins weighing 5 pounds a piece.
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posted by PJ on 14 May 2013 at 5:40 am
I can tell you first hand, having had two large (10 pound) babies with appetites, a little formula supplementation goes a long way. With my first, I was exhausted, in pain (c-section) and had a newborn who was starving. My milk did not have enough calories to support his needs. I arrived at the two week check up appointment in tears because all I had done for two weeks was nurse him until I bled. When the pediatrician said, "give yourself a break and give him a little formula after you nurse him", I was shocked. It was completely against everything those militant lactation consultants told me - the horrors of nipple confusion and the bad mother I would be to feed my child (gasp) processed formula milk-like foodstuff.
Sooooooo glad I listened to the pediatrician. There was no nipple confusion whatsoever, my babied were comfortably full, and I was able to rest and heal. Simply put, it was the best advice I got....and yes, I left the hospital after baby #2 with formula samples in hand. I also breast fed both boys till they were 14 months old.
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posted by Adam on 13 May 2013 at 10:30 pm
Breast-feeding is accepted to action absolute antitoxin bloom allowances for babies, abbreviation their accident of infections and allergies and accouterment a antithesis of nutrients to advice them abound into able and advantageous toddlers.
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