A Little Formula in Baby’s First Week Doesn’t Impact Early Breastfeeding Success, Doctors Say

Moms who plan to breastfeed their baby are typically advised not to throw formula into the feeding mix. But if a newborn’s weight is dropping in those first few days of life, researchers say introducing formula may actually do more help than harm. The new study features findings from researchers at the University of California, San Francisco (UCSF) and was published in JAMA Pediatrics.

Researchers say the outcome depends on breastfeeding duration goals, and needs to be balanced against the risks that newborns face in the first days of life when their weight is dropping. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding until baby is six months old, and continuing breastfeeding until one year while transitioning to solids. But according to the Centers of Disease Control and Prevention (CDC), just over one-third of infants in the US are breastfeeding at 12 months. Which is why the general belief that infant formula is deterrent to breastfeeding success actually depends more on the mom and baby at hand.

Researchers tracked long-term feeding habits of 164 babies born at the UCSF Benioff Children’s Hospitals and Penn State Children’s Hospital. The infants had been breastfed between one-to-three days old, and their weight loss had been in the 75th percentile or above for their age. Half of the mothers added syringe-fed formula after each breastfeeding, which stopped when the mother’s milk came in at two-to-five days after delivery. The other half had continued to breastfeed exclusively.

The study’s authors found when babies in the supplemented group were six months old, they were as likely to breastfeed as those who had exclusively breastfed. The difference was noticed when infants were 12 months old. At this point, 30 percent of the supplemented group were still breastfeeding, compared to 48 percent of infants in the non-supplemented group. The difference between the two groups was less when researchers accounted for married status and longer breastfeeding duration goals—both of which were associated with long-term breastfeeding.

“The results suggest that using early, limited formula may not have a negative impact on infants, but it may alter maternal attitudes toward breastfeeding,” says first author Valerie Flaherman, MD, a pediatrician at UCSF Benioff Children’s Hospitals and associate professor in the UCSF departments of pediatrics, and epidemiology and biostatistics.

But it’s also important to take into consideration the benefits of introducing formula when baby isn’t gaining weight. An earlier study of the same 164 infants, also led by Flaherman, found that the supplemented newborns may have been at lower risk for hyperbilirubinemia, a condition that leads to jaundice and may be caused by inadequate nutrition. Of the five infants readmitted to the hospital at one-month-old, four were in the non-supplemented group. “Our study’s results show that early, limited formula may have significant benefits as well as risks for subsequent breastfeeding duration,” says Flaherman.

The takeaway? The effects of introducing formula to a newborn is really a case-by-case basis. “Counseling that implies all formula is harmful would be inaccurate and may be detrimental to long-term breastfeeding success,” explains Flaherman. But she also stresses that if formula is used in the first few days after birth to prevent hyperbilirubinemia or dehydration, “it should be discontinued as soon as possible, since ongoing use at one week of age indicates a mother is at high risk of early breastfeeding cessation.”

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