This piece first published in The Natural Parent Magazine, Issue 9, 2012

Note: If you see a formula advert on here, please comment and let me know the full brand.  I have blocked formula companies but they now have categorized their products not only under the baby food category but the more general “food” category meaning I need to block them one by one.  I do NOT endorse any formula adverts and would like to block them all asap.  While I believe I have covered all North American companies, I know there are those elsewhere that I am unaware of.  Thank you for your cooperation!

If you read Evolutionary Parenting regularly, it should be clear that I am an advocate of breastfeeding (even though it’s taken on a bit of a bad name these days).  The degree to which I support it has actually caused controversy with people getting upset over the perceived slight to mums who do not breastfeed for one reason or another.  However my focus is not on moms who make this choice, but the system that forces many of them into that choice.  I believe mothers should have options.  You can’t breastfeed?  Pump.  Can’t pump?  You should have the option of expressed breastmilk from someone else.  To me, formula should be a last resort that only select few women have to go to or truly choose to go to.  Breastfeeding is the biological norm that babies expect, and for mothers who hoped to breastfeed and couldn’t for whatever reason (there are so many booby traps, it’s hard to count), there are ways to mimic this relationship.  Even if breastfeeding wasn’t your choice, there are considerations one should at least look into when bottle-feeding.

All Bottle-feeding Isn’t Equal

One of the things that gets lost in translation is that “bottle-feeding” can be either the use of formula or bottle fed breastmilk and some babies are exclusively fed this way.  This type of bottle-feeding ranks second on the WHO list of best ways to feed your baby (only behind breast milk from the breast) and thus many of the concerns that breastfeeding advocates speak about simply do not apply.  From a health perspective, most of the “benefits” of breastmilk exist for these bottle-fed babies who are receiving breastmilk in the bottle.  Compared to formula, expressed breastmilk still contains antibodies and other immunological components that help babies, especially with respect to more serious illnesses like cancer[1][2][3] and infectious diseases[4].  In fact, if 90% of babies in the US were exclusively breastfed—from a breast or bottle—for the first six months, it would save over 900 lives per year (nearly all infants under 1)[5].

What pumping may not offer health-wise is immediate assistance when an infant presents with an illness.  When a breastfed infant latches to the nipple, it is hypothesized that small amounts of the baby’s saliva enters the breast, providing information to mum’s immune system about what antibodies are needed at that moment[6].  This means if mum has not already passed these specific antibodies on to her child via breastmilk (either expressed or from the breast), her body can start to create them for her child and pass them on as soon as they are available.  If a child does not latch, this type of immunity can take longer to receive as mum will have to come into contact with the illness herself to create the antibodies and we know that this does occur via moms smelling and kissing and touching their babies, but may not be as fast if the hypothesized saliva mechanisms is, in fact, real.

These health reasons should force you to at least consider donated breastmilk or pumping if you decide you don’t want to or can’t breastfeed from the breast, but it also should remind the rest of us that just because you’re seeing a bottle, doesn’t mean you’re seeing formula.  However, there are still some factors that are relevant to all bottle-feeding babies that mums should take note of.  What I share below are three of the scientific risks relevant to bottle-feeding and how you can overcome them to get your child closer to what they biologically expect (and in the case of bottle-feeding breastmilk, incredibly close).  [Of note: If you live in a place where you can get donated milk from breast milk banks, please be aware that milk is generally pasteurized, meaning is has lost a lot of the health benefits, but still remains superior to formula.]

[Note: As stated above, breastfeeding is and should be considered the biological normal feeding method for an infant with all other outcomes considered with that in mind.  However, research papers do not always use this language and in an effort to be consistent with what is reported, for those who go and read the original sources cited, I have used the language used in the research papers.  However, please keep in mind that breastfeeding = normal.  Any risks or benefits should be seen relative to that normal behaviour.]

Bonding

Research finding:  Studies has shown that infants who breastfeed from the breast are more likely to have bonded with their mother than those who bottle-feed[7].  In fact, not only is it bonding, but babies who bottle-feed are more likely to be neglected or abused when controlling for myriad other socio-economic and family factors[8].  Within the realm of bonding, researchers have identified two main components (though there may be more) that are at play with breastfeeding versus bottle-feeding: oxytocin[9] and eye contact[5].

What You Can Do:  Oxytocin is triggered in part from the skin-to-skin contact, a fact that all bottle-feeding mums can take advantage of.  A mother who is regularly bottle-feeding should be cognizant of the importance of skin-to-skin contact and how that releases oxytocin in both mum and baby which leads to mutual feelings of love and comfort.  This means if she takes the time to ensure she is getting enough skin-to-skin contact, the bonding process can be made much easier.  One simple way to do this would be to mimic breastfeeding at home with the bottle by removing your shirt and holding your infant close.  Eye-to-eye contact is a normal part of breastfeeding for many mums, but is sometimes conspicuously absent when a baby is fed by bottle (seems odd, I know, but it has been found).  It may be that the infant being literally attached to a breastfeeding mum provides a cue to mum to continue to check on and look at her infant, but regardless, eye contact is key as it is related to the ability to empathize and love another individual[10].  This means that if you’re bottle-feeding your infant, you should make sure to take the time to look at them.  Dedicate at least one feeding a day where you don’t do other things while feeding, but sit and truly stare at your infant.  Even better, combine the skin-to-skin with eye contact and give your baby the experience they are biologically expecting.

Intelligence

Research finding:  Multiple studies have reported finding that breastfed babies showed greater cognitive development later on (for a review see [11]).  While many studies focused on IQ or cognitive development during preschool years, this finding also held with academic success in elementary school years[12].  This early evidence suggested that pumping would lead to the same effects as breastfeeding, but more recent research has cast these findings in doubt.  It turns out it may not just the breast (v. formula) that has the effect on intelligence, but also feeding on demand[13].  There is a confound in that breastfed babies are far less likely to be fed on a schedule and bottle-fed babies are far more likely to be fed on a schedule.  So on top of or instead of breastfeeding per se (more research is needed to know if feeding on demand replaces breastfeeding in the link to intelligence or adds to it), feeding your child on demand (bottle or breast) is related to higher cognitive development and intelligence.

What You Can Do:  Well, really this one is simple – feed your child when he or she is hungry and that’s it.  It can be a pain, it can be far more often that you’d expect, but this is what your baby needs.  With respect to cognitive development, infants need lots of energy for brain development.  Their little brains are growing at an astronomical rate and when you leave a brain without energy to call upon, it simply won’t develop to the best of its capacity.  If you think of how alert and capable you are when you’re hungry, you now have an idea of how your infant is functioning; only your infant has to grow his or her brain, along with using it.  So ditch the schedule and when your infant cries out for food, get a bottle ready and feed away.

Weight Problems

Research Finding:  Much research has focused on the distinction between breastfeeding and formula-fed infants with strong findings supporting a link between the risk of being overweight and the use of formula (for a review, see [14]), presumed to be due to the nutritional differences between the two feeding types.  However, there is research that finds a distinction based on bottle-feeding (which also includes short – < 3 months – durations of breastfeeding) too[15].

What Can You Do?  Two factors seem to be at play.  One is the nutritional differences between formula and breastmilk and there is nothing that can be done about this except to suggest that parents look to donated or expressed breastmilk instead of formula if that’s possible (if not, the risk of obesity is still far higher from a sedentary life later so make sure you’re active and leave it at that).  The second, however, has to do with the composition of breastmilk from the breast with breastfeeding offering babies foremilk first, which is much lighter and has a higher composition of water in it and is used to quench thirst, then hindmilk, which is thicker and contains more fat and protein (though still considerably less than formula which is why breastfed babies need to eat more often) to still the infant’s hunger.  If infants do not get foremilk, or it is blended with hind milk, they can overeat in an attempt to quench thirst, even when hunger has been satiated.  Luckily, if you are pumping, you can actually pump to separate out the fore-and hind-milk (this can also be helpful for mums who have too much foremilk, leading to weight-gain problems).  Lactation consultants should be able to help you figure out how to do this, or if not, there is a great document from the Children’s Hospital of Philadelphia on how to pump fore- and hind-milk separately to give your baby a good mix[16].  There is one other consideration that mums should be aware of and that is, once again, scheduled versus on-demand feeding.  Scheduled feedings can also lead to greater risk of overweight as infants are forced to overeat to ensure they do not go hungry later.  It is basically teaching an infant to override or ignore his or her internal check on when he or she is full which can lead to problems eating later on in life as well.

Conclusions

Bottle-feeding has become a standard part of parenting in Western society both for mums who have to return to work and are expressing for their babies, those who receive donor milk from other mums, and those who are using formula.  While expressed breastmilk is superior to formula in the health department, bottle-feeding has certain limitations regardless what’s inside given it is not what babies are biologically expecting.  When parents read the research on bottle-feeding, they often become quite defensive because of the implications of the findings, and while I understand that, the fact remains that the more a mother knows, the better she can do for her child.  In the case of breast- versus bottle-feeding, some of these limitations can be overcome with some extra work on behalf of mum, meaning some of these findings don’t have to be true for any parent who bottle-feeds.  Instead of getting angry at the findings, try to make sure you don’t become one of these statistics by doing all you can to ensure your child gets as close to what he or she expects as possible.  The suggestions herein should help you on a path in which both mum and baby benefit.

Addendum:  It was brought to my attention that I forgot to mention one more factor many bottle-fed babies don’t have is pacing.  Bottle-feeding can mean the baby gets too much, too quickly whereas breastfeeding allows the baby to regulate how much he or she gets while feeding.  A great resource on information and how-to’s can be found here.  Read it and add that to ways to make bottle-feeding more normal and natural for babe!

Many mums are unable to physically feed their baby for various reasons, and as such there is always ample need for a mother’s breastmilk to help those mums who can’t breastfeed their child on their own. 

If you live in Australia, it seems that there are 4 milk banks: Mothers’ Milk Bank in northern New South Wales (www.mothersmilkbank.com.au), the PREM Bank in Perth, Western Australia (www.kemh.health.wa.gov.au/services/PREM_Bank/index.htm), the Mercy Health Breastmilk Bank in Victoria (www.mercyhealthbreastmilkbank.com.au) and a new one just opened in the last few weeks at the Royal Brisbane and Women’s Hospital in Brisbane, Queensland (http://www.rbwhfoundation.com.au).

If you live in New Zealand, there is currently no milk bank, but there is a non-profit group, Mothers Milk NZ, working towards the development of a national milk bank. 

If you live in Canada, there are now two milk banks.  The first is run by Women’s Hospital in Vancouver, BC.  Although located on the west coast, women from all over the country can both utilize and donate to it.  For more information, please go to http://www.bcwomens.ca/Services/PregnancyBirthNewborns/HospitalCare/Breastfeeding.htm#Milkbank for a list of FAQs and contact information.  The second is in Toronto, ON, and is a partnership amongst three hospitals in Toronto.  They accept donations from all over and will cover the cost of shipping milk to the bank.  For more information, please go to http://www.milkbankontario.ca/ for all the information you need!

If you live in the United States, several states have milk banks which you can contact to see if they have milk you can purchase.  I don’t know how each of them sets their standards or if they mail milk out-of-state (if you live in a state without a milk bank), but a list of all the milk banks in the US, with contact information, can be found here: http://www.hmbana.org/milk-bank-locations.

If you live in the United Kingdom, you have 17 milk banks (go you!) and the primary site with information and how to donate is found at http://www.ukamb.org/.  And as an aside, I love their motto – EVERY DROP COUNTS.  (Yes, it does.)

And of course, no matter where you live there are the always-wonderful Human Milk 4 Human Babies and Eats on Feets networks which are (nearly) global.  Here you will be able to network with other mums who may live in your area and have breastmilk for you.  This is not a regulated endeavor and is running solely on the goodwill of mothers everywhere. 

Good luck and happy feeding!

 


[1] Shu XO, Linet MS, Steinbuch M, Wen WQ, Buckley JD, Neglia JP, et al. Breast-feeding and risk of childhood acute leukemia.  Journal of the National Cancer Institute 1999; 91: 1765-1772.

[2] Davis MK, Savitz DA, Graubard AI.  Infant feeding and childhood cancer.  The Lancet 1988; 332: 365-368.

[3] Kwan ML, Buffler PA, Abrams B, Kiley VA.  Breastfeeding and the risk of childhood leukemia: a meta-analysis.  Public Health Reports 2004; 119: 521-535.

[4] Duijts L, Jaddoe VWV, Hofman A, & Moll HA.  Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy.  Pediatrics 2010; 126: e18-e25.

[5] Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States:  a pediatric cost analysis. Pediatrics2010; 125: 1048-56.

[6] Vickers MC. Breast milk production: The anatomy of breastfeeding. Accessed from <http://www.breastfeed.com/how-to/basics/breast-milk-production> on April 27, 2011.

[7] Else-Quest NM, Hyde JS, Clark R. Breastfeeding, bonding, and the mother-infant relationship. Merrill-Palmer Quarterly, 49, 495-517.

[8] Strathern L, Mamun AA, Najman JM, O’Callaghan MJ.  Does breastfeeding protect against substantiated child abuse and neglect? A 15-year cohort study.  Pediatrics 2009; 123: 483-493.

[9] Uvnas-Moberg K. The Oxytocin Factor: Tapping the Hormone of Calm, Love, and Healing (2003). Da Capo Press: Cambridge, MA.

[10] Dadds MR, Allen JL, Oliver BR, Faulkner N, Legge K, Moul C, Woolgar M, Scott S.  Love, eye contact and the developmental origins of empathy v. psychopathy.  The British Journal of Psychiatry 2012; 200: 191-196.

[11] Horta BL, Bahl R, Martines JC, Victora CG. Evidence on the long-term effects of breastfeeding: Systematic reviews and meta-analyses.  World Health Organization 2007.

[12] Oddy WH, Li J, Whitehouse AJO, Zubrick SR, & Malacova E. Breastfeeding duration and academic achievement at 10 years. Pediatrics 2011; 127: e137-e145.

[13] Iacovou M, Sevilla A.  Infant feeding: the effects of scheduled vs. on-demand feeding on mothers’ wellbeing and children’s cognitive development.  European Journal of Public Health 2012. DOI: 10.1093/eurpub/cks012.

[14] Harder T, Bergmann R, Kallischnigg G, Plagemann A.  Duration of breastfeeding and risk of overweight: a meta-analysis.  American Journal of Epidemiology 2005; 162: 397-403.

[15] Bergmann KE, Bergmann RL, von Kries R, Bohm O, Richter R, Dudenhausen JW, Wahn U.  Early determinants of childhood overweight and adiposity in a birth cohort study: role of breast-feeding.  International Journal of Obesity 2003; 27: 162-172.

[16] http://www.chop.edu/export/download/pdfs/articles/pfe/separating-milk-help-baby-grow.pdf

[Photo: GETTY from the Telegraph UK]