Breast Milk or Infant Formula?

This information has been reviewed and adapted for use in South Carolina by Janis G. Hunter, HGIC Nutrition Specialist, and Katherine L. Cason, Professor, Food Science and Human Nutrition Department, Clemson University. (New 10/08.)

HGIC 4101

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Both breast milk and infant formula will help your baby grow. However, breast milk is the best first food for babies,according to the American Academy of Pediatrics and the American Dietetic Association. Breast milk offers your baby a natural defense against infections and allergies. Colostrum, the milk produced during the first few days, is especially full of infection-fighting antibodies.

The American Academy of Pediatrics, the American Dietetic Association and other health organizations recommend exclusive breastfeeding, or nursing, for the first six months of a baby’s life. These experts recommend adding complementary foods when the baby is ready and continuing to breastfeed for at least the first 12 months.

In the United States, only 15% of white mothers, 13% of Hispanic mothers and 10% of African-American mothers follow the recommendation to exclusively breastfeed their babies for at least six months. Of all the new mothers in South Carolina:

  • less than 57% breastfeed their babies at all.
  • only 27.3% are still breastfeeding when the baby is six months old.
  • only 13.6% are exclusively breastfeeding when the baby is six months old.

Source: 2003 National Immunization Survey.

Breastfeeding

Advantages to Baby: Breast milk is the best first food for babies because it:

  • provides sugars, fats, protein and vitamins in an easily digestible form that is just right for your baby.
  • causes premature babies to do better than premature babies who are fed formula.
  • gives more self-control over when and how much is eaten, which may be important for setting a long-term appetite regulation pattern.
  • leads to normal weight gain and may decrease the risk for obesity later in life.
  • may help keep baby from getting sick and is a natural defense against allergies, asthma, eczema and infections. Breastfed babies have five times fewer gastrointestinal illnesses, three times fewer respiratory illnesses, and half as many ear infections as formula-fed infants.
  • aids in eye and brain development.
  • is good for the jaw (sucking on the breast).
  • helps future teeth grow straight.
  • passes along the flavors of the foods the mother eats and may help in baby’s acceptance of a greater variety of food when solids are started.

Note: Your baby may need an iron supplement when they are around four to six months old, because their prenatal store of iron becomes depleted at that age. This extra iron could come from a vitamin/mineral supplement or from foods, such as iron-fortified infant cereal. Also, infants living in cold climates may need a vitamin D supplement in the winter.

Advantages to Mother: Breastfeeding also is best for mothers and offers these benefits.

  • There is no infant formula to buy, measure and mix, which makes your life easier and saves you money and time.
  • Nursing your baby helps you develop an emotional closeness with them and self-confidence in your ability to care for them.
  • You can rest every few hours while you feed your baby.
  • You can breastfeed while lying down.
  • Night feedings are easier, because you don’t have to prepare and warm a bottle of formula.
  • There are no bottles to sterilize. An exception is when you pump breast milk and bottle it for your baby to drink while you are away during the day, such as at work.
  • You recover from childbirth faster, with your uterus contracting and returning to its original size in less time. Breastfeeding, especially when you don’t supplement with formula, delays the return of normal ovulation and menstrual cycles. However, talk with your doctor or nurse about birth control choices during this time.
  • You burn extra calories, allowing you to return to your pre-pregnancy weight.
  • It appears to improve your long-term health, including a lower risk of breast cancer and osteoporosis.

Caution: Breastfeeding is not advised in a few circumstances. A woman who is HIV-positive could pass the HIV infection to her baby through breast milk. A mother on chemotherapy and one who has untreated tuberculosis should not breastfeed either.

Cigarette smoke, alcoholic beverages, prescription drugs, street drugs, over-the-counter medications, and some herbal supplements can pass through your breast milk and may cause problems for your baby. They also can affect milk production and the let-down reflex.

Advantages to Society: Breastfeeding benefits society in several ways, also.

  • It reduces health care costs. Breastfed infants typically need fewer sick care visits, prescriptions and hospitalizations.
  • It contributes to a more productive workforce, since breastfeeding mothers miss less work, and their babies are sick less often.
  • It is better for the environment, because it produces less trash and plastic waste than using bottle supplies and formula.

Getting Started: When preparing to breastfeed, mothers may find these tips beneficial.

  • Ideally breastfeeding should begin within an hour after the baby’s birth. However, it may need to be delayed a while if you are exhausted from delivery, groggy from medication, in pain from cramping or have delivery complications. To make you more comfortable, put your nipple as far back in your baby’s mouth as possible.
  • Be patient, because it takes time for you and your baby to learn how to breastfeed.
  • Air dry your nipples to prevent cracking and soreness.
  • Breastfeed frequently and regularly. This may be as often as every two hours and at least eight times in a 24-hour period. Most mothers and babies find a feeding style and schedule unique to them.
  • Allow time for your milk supply to become established and the baby to get used to a regular breast feeding routine. This takes at least three or four weeks. After that time, breastfeeding doesn’t have to be “all or nothing. ” You may find that breastfeeding once or twice a day, with bottle feedings in between, suits your schedule better than breastfeeding exclusively.
  • Your milk supply is a matter of “supply and demand.” As your growing baby demands more milk, your body produces more.
  • Your baby should have at least six wet diapers a day.

Health Tips for Moms: It is very important for breastfeeding moms to take care of themselves by getting plenty of rest, eating nutritious foods, and drinking plenty of liquids.

  • Eat a healthy diet and rink plenty of fluids, including water. For help choosing the right foods, refer to HGIC 4118, Pregnancy & Breastfeeding. “MyPyramid Plan for Moms,” found on the www.MyPyramid.gov website has additional information.
  • Making breast milk requires a lot of water, so drink 8 ounces (1 cup) of water each time you nurse. Drinking excess water will not cause you to make more milk than you should. Every day try to have 8 to 10 cups of fluid, including milk and 100% juices. Soft drinks are not good choices, since they are high in sugar and usually contain caffeine.
  • Limit caffeine and avoid cigarettes and alcoholic beverages. These pass through breast milk to your baby. If you must smoke, don’t do it within two hours of breastfeeding.
  • Right now your most important job is taking care of your new baby and yourself. Sleep when your baby sleeps, get as much rest as you can, and ask for help with other children, housework and cooking.

Handling & Storing Pumped Breast Milk

At Room Temperature: Pumped breast milk can be stored safely for these maximum time limits at the following room temperatures:  four hours at 86°F to 100°F; four to six hours at 79°F; 10 hours at 66°F to 72°F, and 24 hours at 60°F.

Discard unused breast milk left in the bottle after feeding. Don’t thaw pumped breast milk at room temperature.

In the Refrigerator: Store pumped breast milk in the refrigerator in dated containers (e.g. sterilized bottles or disposable plastic nursing bags). It will keep for up to eight days at 32°F to 39°F.

Thaw frozen milk in the refrigerator. Do not refreeze it once it has thawed.

In the Freezer: To avoid waste, freeze milk in small amounts. Always date the container.

The length of time that pumped breast milk may be kept in the freezer varies with each type of freezer: up to two weeks in the freezer compartment of a refrigerator; three to four months in a self-contained freezer (e.g. bottom, top mount side-by-side, or stand alone freezer), and six to 12 months in a deep freezer, which has a constant 0°F temperature.

Pumped breast milk may separate when stored, so shake it gently before feeding it to your baby.

Iron-Fortified Infant Formula

The Food and Drug Administration (FDA) makes sure that the infant formula you buy at the store is safe and has all the nutrients your baby needs.

If you choose to feed your baby an iron-fortified infant formula, ask your doctor or health care provider to recommend one. Babies can drink formula made from cow’s milk or soybeans. Homemade formula may not contain all the nutrients needed to keep your baby healthy.

Formula is available in powder, liquid concentrate, and ready-to-feed. Powder is the cheapest form, and ready-to-feed is the most expensive.

Preparation & Storage: Follow these tips to prepare and store infant formula safely.

  • Sterilize bottles and nipples in a dishwasher or in a pot of boiling water for five minutes.
  • Before adding water to powder formula or liquid concentrate, boil the water a minute or two and cool.
  • Mix powder formula and liquid concentrate with the exact amount of water stated on the label. Too much water keeps your baby from getting enough to eat, and too little water can upset your baby’s stomach or hurt their kidneys.
  • After you mix formula with water, store it in the refrigerator until you use it, preferably within 24 hours. Never leave formula at room temperature.
  • Cover an opened can of formula (liquid concentrate or ready-to-feed), store in the refrigerator, and use within 48 hours after opening.
  • Some babies will drink a bottle straight from the refrigerator. However, if your baby prefers warm formula, right before feeding time, heat the bottle in one of these three ways: use a bottle warmer according to directions; hold the bottle under a stream of warm tap water, or put it in a pan of warm water (that has been removed from the stovetop) for about five minutes.
  • Gently shake the bottle, and then sprinkle several drops of formula (or milk) on the back of your hand, not your wrist, to test the temperature and ensure it’s not too hot for feeding. It should be slightly warm to the touch, and you should barely feel the temperature on your skin.
  • Never heat a bottle of formula in a microwave oven, because it doesn’t heat evenly and could burn your baby’s mouth.
  • Discard unused formula left in the bottle after feeding.

Avoid Regular Cow’s Milk

For proper growth and development during the first year of life, your baby needs the balanced nutrition in infant formula. When your baby is a year old, you can stop feeding formula and start giving them whole milk, or regular cow ’s milk. If you are breastfeeding, you can continue feeding breast milk to your baby as long as you want.

Regular cow’s milk doesn’t offer the same nutritional advantages as human milk or infant formula. Also, cow ’s milk is hard for your baby to digest, may cause them to have a stomachache, an allergic reaction and low blood iron. It is unsafe to serve raw (unpasteurized) milk to an infant.

Generally a 1-year-old child should not be given reduced-fat (1% or 2%) or fat-free milk and milk products, because they don’t contain enough fat and calories for a growing baby. Your baby’s doctor will tell you when it is time to switch to lower fat milk, usually not until after age two.

In 2008 the American Academy of Pediatrics began recommending the use of reduced-fat milk (2%) for some children. They specified children between 12 months and two years of age for whom overweight or obesity is a concern or who have a family history of obesity or cardiovascular disease.

Giving Water to Your Baby

Do not feed sugar water to your baby unless your doctor or health care provider tells you to do so. Breast milk and formula provide the amount of water that your baby needs to replace water loss and to grow. Therefore, a healthy baby does not need any extra water, except in hot weather.

Your baby will need extra fluids when solid foods begin to replace some of the breast milk or formula in their diet.

Bottle Do’s & Don’ts

Use bottles for breast milk, formula and water only. Do not feed your baby Kool-Aid®, tea, soft drinks or cereal in bottles. Kool-Aid® and soft drinks contain lots of sugar and no nutrients. Solid foods, such as cereals, should be fed with a spoon.

Feeding Time

Whether you breastfeed or give your baby infant formula, you and your baby should be happy and comfortable. The warmth and security felt during feeding time can soothe a cranky, frightened, or tired baby.

Mealtime is more than just the time to feed your baby. It is an opportunity to get to know your baby and learn to read their cues. Your baby will communicate with you even before they can talk. For example, when they are hungry, they will cry, nuzzle, make sucking motions and fuss.

Fussiness during feeding can be a sign that your baby is still hungry or has gas. When your baby has finished nursing, they usually will be happy and content. When full they will usually stop sucking, spit out the nipple, or fall asleep.

At feeding time, you and your baby are learning about each other. Relax, talk to them, and hold them close. Showing love through cuddling and comforting is very important for your baby’s health.

When the time comes to wean your baby from the breast, usually around 12 months of age, do it gradually and with love. Substitute one feeding at a time with a different kind of loving care, such as reading a story or going for a walk with your child.

For More Information

If you have more questions, contact your doctor, health care provider, a certified lactation educator, or any of these reliable sources of information.

  • Clemson Extension, Home & Garden Information Center. HGIC 4118, Pregnancy & Breastfeeding.
  • USDA’s MyPyramid for Pregnancy and Breastfeeding. http://www.mypyramid.gov/mypyramidmoms/index.html
  • La Leche League International, a group that helps mothers. Call 1-800-La Leche (525-3243) or write: La Leche League, 1400 N. Meacham Road, Schaumburg, IL 60173-4808.
  • The National Women’s Health Information Center’s Breastfeeding Helpline (English and Spanish) staffed with La Leche League International trained peer counselors. Call 1-800-994-9662 toll-free Monday through Friday, 9 a.m. to 6 p.m. EST. Information also is available on the internet at www.4woman.gov/breastfeeding and at www.womenshealth.gov/breastfeeding.
  • The University of Florida Extension’s publication FCS2166, Emotional and Physical Preparation for Breast Feeding (2006), gives details on how to get started breastfeeding. Authors: Garret D. Evans and Caroline E. Danda. http://edis.ifas.ufl.edu/FY004
  • The University of Maine Extension’s Bulletin #4150, Help for Breastfeeding Moms,contains information such as: why your baby cries; what you should do if you think you baby has colic, and solving problems with tender nipples. Author: Katherine Musgrave. www.umext.maine.edu/onlinepubs/htmpubs/4150.htm
  • Gerber’s Breastfeeding Help on the internet at www.gerber.com/bf/help/index.html. Topics include: benefits of breastfeeding; getting started; nutrition for mom; tips and help; returning to work; special situations, and weaning.
  • DHHS Centers for Disease Control and Prevention. Breastfeeding. http://www.cdc.gov/breastfeeding/index.htm
  • The FDA at its toll-free number, 1-888-SAFE-FOOD (723-3366) or on the internet at www.fda.gov/.

Sources:

  1. U.S. Department of Health and Human Services. Food and Drug Administration (FDA). Feeding Your Baby With Breast Milk or Formula. www.fda.gov
  2. Clemson University Nutrition Information Resource Center. Breastfeeding. http://virtual.clemson.edu/groups/NIRC/pdf/nursing.pdf
  3. Haliena, Rita. Why is Breastfeeding Good for Your Baby? Clemson University Department of Food Science and Human Nutrition and EFNEP. Nutrition Information & Resource Center (NIRC). Nourishing News (08/03).
  4. Gerber. Breastfeeding Help. www.gerber.com.
  5. South Carolina Department of Health and Environmental Control. Moving South Carolina Towards a Healthy Weight: Promoting Healthy Lifestyles and Healthy Communities 2005. Breastfeeding (3-13). www.scdhec.gov/health/chcdp/obesity/plan.htm
  6. Hedstrom, Nellie. Feeding Your Baby, Bulletin #4061.The University of Maine Cooperative Extension.
  7. National Center for Nutrition and Dietetics of the American Dietetic Association. Breast-feeding Basics—and Beyond.
  8. Daniels, Stephen R., Frank R. Greer, and the Committee on Nutrition. Lipid Screening and Cardiovascular Health in Childhood. Pediatrics, Vol. 122 No.1 July 2008, 198-208.
  9. Hanula, Gail. Building Baby’s Brain: Is Breast Milk Best? University of Georgia College of Family and Consumer Sciences.
  10. Evans, Garret D., and Caroline E. Danda. Emotional and Physical Preparation for Breast Feeding (FCS2166). University of Florida IFAS Extension. 2006. http://edis.ifas.ufl.edu/FY004
  11. Breastfeeding Made Easier at Home and Work. www.womenshealth.gov
  12. The National Women’s Health Information Center. Benefits of Breastfeeding. www.4woman.gov/breastfeeding
  13. Duyff, Roberta Larson. American Dietetic Association Complete Food and Nutrition Guide, 3rd Edition. 2006
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