Parents consider giving their babies formula for many reasons. In some cases it is medically necessary. At other times, mom may believe that her milk supply is low (and thus think that formula is needed) when her supply is actually fine. Sometimes it’s simply the parent’s choice. If you feel that your baby has a need for formula supplementation (or your baby’s doctor has suggested or recommended it) and you wish to continue breastfeeding, then contact a lactation consultant (preferably IBCLC) for guidance. A good lactation consultant can assess the need for supplementation and guide you in the use of supplements to support your own breastfeeding goals.
Keep in mind that formula (like a medication) comes with its own set of risks, and parents need to be aware of these so they can make an informed decision on its use. The use of formula can shorten the breastfeeding relationship, and comes with increased health risks for baby and mother (even in the US and other developed countries). Parents should look at their individual circumstances and decide whether the benefits of formula use outweigh the risks. Alternatives to formula include a mother’s own milk (the best choice when available– can be fed directly or expressed) or another mother’s milk (from a milk bank, private donor, family member, or friend).
Remember that breastfeeding does not have to be “all or nothing” – any amount of breastfeeding is beneficial to both mom and baby.
Following are some links to information on infant formula and alternatives.
Supplementing with Formula
- Feed The Baby: When Supplementing Saves Breastfeeding by Wendy Wisner, IBCLC
- Bottle-feeding Tips from Amy Peterson, BS, IBCLC, RLC
- Baby-led Bottle Feeding by Fleur Bickford BSc, RN, IBCLC
- Demystifying Medically Indicated Newborn Supplementation by Miranda Gallegos, IBCLC
- ABM Clinical Protocol #3: Hospital Guidelines for the Use of Supplementary Feedings in the Healthy Term Breastfed Neonate from the Academy of Breastfeeding Medicine
- Partial weaning and combination feeding @ KellyMom
- Weaning from formula supplements @ KellyMom
Safe Formula Feeding
- The do’s and don’ts of safe formula feeding by Teresa Pitman
- Infant milks: A simple guide to infant formula, follow-on formula and other infant milks by Dr Helen Crawley, from the First Steps Nutrition Trust.
- When It Has to be Formula: Optimizing the Health of Your Formula-Fed Baby by Dr. Linda Folden Palmer
- A guide to infant formula for parents who are bottle feeding from the Baby Friendly Initiative
- Guide to bottle feeding from the National Health Service, UK, and the UNICEF UK Baby Friendly Initiative
- Guidelines for the safe preparation, storage and handling of powdered infant formula from the World Health Organization
- Infant Formula: Evaluating the Safety of New Ingredients, Food and Nutrition Board, Institute of Medicine, 2004.
Infant Formula FAQs
- It’s Not Just About Breastfeeding by Danielle Rigg, JD CLC
- Baby-led Bottle Feeding by Fleur Bickford BSc, RN, IBCLC
- What no one tells you about formula feeding by Tipper Gallagher, BA, IBCLC, RLC. Information on choosing a formula, safe preparation, and bottle feeding.
- Information on infant formula and Infant Formula FAQs from the US Food & Drug Administration (FDA)
- Store brand or brand name formula? All infant formulas sold in the US are required to meet the same minimum safety and nutritional standards set by the FDA. Different formulas (whether store brand or name brand) have varying formulations, and these change constantly.
- Allergy prevention? Feeding with a hydrolysed infant formula (where milk proteins are broken down into smaller, potentially less allergy producing proteins) instead of ordinary cow’s milk formula may reduce allergies in babies and children, although further studies are needed to confirm this. Evidence suggests that using a soy formula instead of a cow’s milk formula does not reduce allergies in infants and children. There is no evidence to support feeding with a hydrolysed formula to prevent allergy in preference to exclusive breastfeeding.
- Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas (American Academy of Pediatrics Committee on Nutrition Policy Statement). Pediatrics. Vol. 121 No. 1 January 2008, pp. 183-191.
- Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003664.
- Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003741.
- Does the FDA approve infant formulas before they are marketed? No. The FDA does not approve infant formulas before they can be marketed. However, all infant formulas sold in the US are required to meet minimum safety and nutritional standards set by the FDA. Infant formula manufacturers are required to register with the FDA and provide the agency with a notification prior to marketing a new formula. If the FDA determines that an infant formula presents a risk to human health, the manufacturer of the formula must conduct a recall.
- Financial costs of not breastfeeding (including tools for estimating formula costs) @ KellyMom
- How do I report a problem or illness caused by an infant formula? In the US, see this FDA FAQ for more information.
- Infant Formula Recalls
Alternatives to Formula
- Human milk banking and other donor milk @ KellyMom
- Is it safe to use cow’s milk or other milks as a supplement to breastfeeding? @ KellyMom
- Supplementation of the Breastfed Baby: “Just One Bottle Won’t Hurt”—or Will It? by Marsha Walker, RN, IBCLC
- The Case for the Virgin Gut: Even the Occasional Bottle of Formula Has Its Risks by Ann Calandro, RNC, IBCLC
- Opinion adopted by the BIOHAZ Panel of the European Food Safety Authority related to the microbiological risks in infant formulae and follow-on formulae, 23 November 2004
- Breastfeeding and Public Health from the Massachusetts Breastfeeding Coalition
- The Scandal of Infant Formula by Sylvia Onusic
- Victora CG, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016 Jan 30;387(10017):475-90. doi: 10.1016/S0140-6736(15)01024-7.
- Bartick MC, Stuebe AM, Schwarz EB, Luongo C, Reinhold AG, Foster EM. Cost analysis of maternal disease associated with suboptimal breastfeeding. Obstet Gynecol. 2013 Jul;122(1):111-9. doi: 10.1097/AOG.0b013e318297a047.
- Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics. 2010 May;125(5):e1048-56. doi: 10.1542/peds.2009-1616.
- Stuebe A. The Risks of Not Breastfeeding for Mothers and Infants. Rev Obstet Gynecol. 2009 Fall; 2(4): 222–231.
- Commentary on formulas supplemented with DHA & ARA @ KellyMom
- American Academy of Pediatrics Committee on Nutrition. Use of Soy Protein-Based Formulas in Infant Feeding (Policy Statement). Pediatrics. Vol. 121 No. 5 May 2008, pp. 1062-1068.
“In term infants, although isolated soy protein-based formulas may be used to provide nutrition for normal growth and development, there are few indications for their use in place of cow milk-based formula. These indications include (a) for infants with galactosemia and hereditary lactase deficiency (rare) and (b) in situations in which a vegetarian diet is preferred. Soy protein-based formulas are not designed for or recommended for preterm infants.” Read the article for more recommendations and warnings.
- Vandenplas Y, et al. Safety of soya-based infant formulas in children. Br J Nutr. 2014 Apr 28;111(8):1340-60. doi: 10.1017/S0007114513003942.
- Jefferson WN, Patisaul HB, Williams CJ. Reproductive consequences of developmental phytoestrogen exposure. Reproduction. 2012 Mar;143(3):247-60. doi: 10.1530/REP-11-0369.
- Dinsdale EC, Ward WE. Early exposure to soy isoflavones and effects on reproductive health: a review of human and animal studies. Nutrients. 2010 Nov;2(11):1156-87. doi: 10.3390/nu2111156.
- Chen A, Rogan WJ. Isoflavones in soy infant formula: a review of evidence for endocrine and other activity in infants. Annu Rev Nutr. 2004;24:33-54.
- More journal articles on infant health and soy formula