Giving some formula during baby's first days may boost breast-feeding rates

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Health professionals have been pushing for mothers to breast-feed longer due to the benefits it can provide for both the woman and her baby. In order to boost breast-feeding rates, some hospitals have even ended free giveaways of infant formulas, over concerns they could deter moms from breast-feeding their babies exclusively. A new study, however, shows that giving small amounts of formula during the first few days to infants who have lost a lot of weight may lead to an increases in breast-feeding duration.

"Until now, we haven't explored if it is possible to identify babies who might benefit from early formula use. This study provides the first evidence that early limited formula can provide important benefits to some newborns," lead author Dr. Valerie Flaherman, an assistant professor of pediatrics and epidemiology and biostatistics at UCSF and a pediatrician at UCSF Benioff Children's Hospital, said in a press release. "Based on our 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."

The study appeared online in Pediatrics on May 13.

The World Health Organization encourages breast-feeding as a natural way of giving babies the nutrients they need for healthy lives. Breast milk can provide antibodies that protect infants from common illnesses like diarrhea and pneumonia, which are the two main cause of childhood death worldwide.

Breast-feeding also provides a natural form of birth control for mothers, and is 98 percent effective for the first six months. Lower breast and ovarian cancer rates have been linked to breast-feeding, as have increased weight loss after pregnancy and lower obesity rates for mothers.

Breast-feeding has also been thought to reduce risk for childhood obesity, but a recent study published in the New England Journal of Medicine in January and another in JAMA in March discredited that link.

Because of the benefits, the WHO recommends breast-feeding exclusively for the first six months of life. After six months, food can compliment breast milk until the child reaches two years old. The WHO advises that breast-feeding begin within an hour after birth, and should be available as the child sees fit.

Only 45 percent of U.S. mothers in 2008 were breast-feeding at six months, according to the Centers for Disease Control and Prevention. Although it was a 10-point increase from 2000, experts said that rates needed to be much higher.

Women don't produce large quantities of milk right after giving birth, but they do produce small amounts of colostrum, which contains high concentrations of nutrients and antibodies for the baby. Because they aren't providing much milk, babies often lose weight, and new moms sometimes feel the babies are hungry or fussy.

"Many mothers develop concerns about their milk supply, which is the most common reason they stop breast-feeding in the first three months," said Flaherman. "But this study suggests that giving those babies a little early formula may ease those concerns and enable them to feel confident continuing to breast-feed."

Forty full-term newborns between 24 to 48 hours old who had lost more than 5 percent of their birth weight were enrolled in the study. The babies either received early limited formula (ELF) -- which was made up of one-third of an ounce of infant formula delivered via syringe following each breast-feeding -- or were fed using breast milk exclusively. The babies were only given a small amount of formula in order to not stop them from drinking breast milk as their primary source of nutrition, and were given the milk in a syringe to stop nipple confusion, in which babies develop a preference for bottle nipples instead of their mother's. Formula was stopped two to five days after birth when the mother started producing regular milk.

After one week, all the babies were still breast-feeding. But, only 10 percent of the ELF babies had received formula in the last 24 hours, compared with 47 percent of the control group.

After three months, 79 percent of the ELF babies were still breast-feeding exclusively, compared to only 42 percent of the babies who had been breast-fed exclusively during the study. Ninety-five percent of ELF babies were breast-feeding at some level, compared to 68 percent of the other group.

Some experts were skeptical of the study's results and were worried this would encourage mothers to think that their breast milk wasn't enough to feed their child. Hospitals around the U.S. have been enacting initiatives to cut down on formula use. Massachusetts reported in June 2012 that all 49 birth facilities in the state had decided to stop giving away infant formula gift bags to new moms. As of September 2012, formula in NYC hospitals was locked away to encourage mothers to try breast-feeding first.

"This study goes against everything that's been published for several years now from very reliable clinicians and researchers about the potential hazards of supplementing exclusively breast-feeding babies with formula," Dr. Kathleen Marinelli, an associate professor of pediatrics at the University of Connecticut School of Medicine and the chair-elect of the U.S. Breastfeeding Committee, told TIME.com. She was not involved in the study."They're flying in the face of years of research here and doing so rather glibly, stating that this is the new way to look at things."

Others took the studies results as an invitation to explore other methods that may help mothers continue to breast-feed.

"The results of this study are provocative and challenge conventional wisdom," said Dr. James Taylor, medical director for the University of Washington Medical Center's Newborn Nursery who did not participate in the study, said in a press release. "It is crucial that we have more randomized controlled trials on interventions to increase breast-feeding rather than relying on heavily confounded observational studies or biased expert opinion."

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