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# Tiny bit of formula promotes breast-feeding

##### A tiny bit of formula encourages nursing in small-scale trial

##### Erin Allday

##### Published 12:02 am, Monday, May 13, 2013

- BOTTLES09_19593.JPG Glass baby bottles, long considered an anachronism, are making such a comeback that parents can't get their hands on them. 16 mo old Lucina Lippman from Berkeley holds a new glass bottle with organic formula.

  Photo: Lance Iversen, The Chronicle

  BOTTLES09_19593.JPG Glass baby bottles, long considered an...

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Giving a little bit of formula - the equivalent of a single bottle over several days - to a newborn who's losing too much weight after birth might actually increase the likelihood that the baby will be breast-feeding three months later, according to a small Bay Area study.

In a climate of aggressive public health policy trying to cut down on formula use and encourage new moms to give infants only breast milk, the study results are likely to be controversial, and they may seem counterintuitive, the authors said.

But for a select group of new mothers who are eager to breast-feed, small doses of formula, given for a short and carefully monitored time, may alleviate some of the stress associated with breast-feeding and, in turn, give them confidence to stick with it, said Dr. Valerie Flaherman, lead author of the study, published Monday in the journal Pediatrics.

"This study does not mean that all babies should get formula or that formula is better than breast-feeding. It's my strong belief that most babies do not need formula," said Flaherman, a pediatrician at UCSF Benioff Children's Hospital. "But it does raise the possibility that some babies may benefit from a little bit of carefully managed formula."

Breast-feeding is widely supported by doctors and public health authorities, and groups like the World Health Organization and the U.S. Centers for Disease Control and Prevention recommend that women breast-feed babies for at least one year, and give infants nothing but breast milk for the first six months.

Babies who are breast-fed have lower risks of developing infections and allergies in their infancy, and the longer they're breast-fed, the greater the health benefits, studies have shown. Increasingly, U.S. hospitals have been developing policies to discourage any formula use for new mothers and babies, and to make sure mothers have at least attempted to breast-feed before they go home.

### Many give up

But in the United States, while roughly three-quarters of mothers attempt to breast-feed, only 30 percent of them are breast-feeding exclusively at three months, and less than a quarter are breast-feeding at all by the time the baby is a year old.

The reasons women stop breast-feeding are varied and complicated and not always well understood. One possibility that the study authors wanted to address was the idea that for babies who are struggling to gain or maintain weight, mothers may worry about not producing enough milk and turn to formula use.

"In the first three days or so, the key complaint we hear is 'I'm concerned I don't have enough milk. I'm worried my baby is starving,' " said Dr. Janelle Aby, a pediatrician at Packard Children's Hospital at Stanford and an author of the study. "Then we do daily weighs and it's dropping and dropping, and that's very stressful. Some moms, they get to a place where they can't take it anymore and they give the baby formula."

### Bottle-feeding effects

But using formula can create a feeding cycle that makes breast-feeding more difficult. Babies who finish an entire bottle of formula, for example, may adapt to feeding in longer cycles, instead of every two to three hours for breast-feeding. Babies may also experience nipple confusion, where they get used to the rubber nipple of a bottle and not their mother's breast.

The study authors said they all are proponents of exclusive breast-feeding, and that the idea behind their study was to find creative ways to help women breast-feed longer.

The study of 40 infants was a small trial, and it will need to be replicated in follow-up research among larger, more diverse groups of mothers, the authors said. All of the infants had lost at least 5 percent but less than 10 percent of their birth weight in the first 36 hours of life, which is considered a high drop in weight, but not dangerously so.

The infants - who were all born at either UCSF or Stanford - were randomly assigned to a group that would receive formula supplementation or a group that would breast-feed without formula. Mothers in the first group were instructed to keep breast-feeding, about eight to 12 times a day, and give their infants about two teaspoons of formula from a syringe after each feeding.

### First few days

The formula supplementation lasted only for the first few days after birth, when mothers aren't yet producing regular breast milk. Once they produced milk, the mothers in the study were told to stop using any formula.

All of the infants in both groups were still breast-feeding after one week. By the end of that week, only 10 percent of infants in the formula group were still using formula. But among infants assigned to the exclusive breast-feeding group, nearly half were using formula.

### Distinct results

At three months, 79 percent of the babies in the formula group and 42 percent of babies in the control group were breast-feeding exclusively.

The results, while promising as an option for helping some women stick with breast-feeding, are probably not applicable to all new mothers in the United States. And lactation experts not involved in the study said they were wary that mothers might get the message that formula is always an acceptable alternative to breast milk.

"Just looking over the study very cursorily, you could get the impression that it's OK to give your kid a little formula. But without the specific need for supplementation, and without a specific plan, that's probably not going to be true," said Dr. David Lee, medical director of the lactation support program at California Pacific Medical Center, who was not involved in the study.

### Bay Area difference

The study authors agreed that their results may not apply across the country, and they noted that Bay Area women in general are much more eager to breast-feed than women in other parts of the country. At UCSF, 98 percent of women who give birth there leave the hospital at least having started to breast-feed.

Suggesting any amount of formula supplementation, if only a couple of teaspoons at a time, to women who aren't interested in breast-feeding in the first place may only discourage them further, the authors said. But their study at least suggests that formula may be a viable option - even for women who are inclined to dismiss it, said Aby at Stanford.

"Formula is kind of demonized," Aby said. "I certainly don't want all of our kids raised on formula, and I do think breast milk is a lot better.

"But we have this dichotomy where we want people to breast-feed, but when that's not successful, people just switch over to bottle-feeding the baby with formula," she said. "We need to get away from the dichotomous thinking. Hopefully this opens a dialogue."

Erin Allday is a San Francisco Chronicle staff writer. E-mail: eallday@sfchronicle.com

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Tiny bit of formula promotes breast-feeding
Giving a little bit of formula - the equivalent of a single bottle over several days - to a newborn who's losing too much weight after birth might actually increase the likelihood that the baby will be breast-feeding three months later, according to a small Bay Area study. In a climate of...

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