FFF Friday: “Why I just didn’t even try.”

One of the reasons why I insist on supporting all formula feeders – regardless of their reasons for not breastfeeding – is because we can never know someone’s entire story. There are a myriad of complicated factors that play into our feeding decisions. The thing of it is, this isn’t like any other food or health-related decision. Feeding a child from your breast is not like spending your food budget on healthy choices/organic brands, or quitting smoking, or limiting television, or exercising. It’s not just a lifestyle choice. For some women, the act of nursing can be physically or emotionally painful – and frankly, that’s not anyone’s business but her own.

The woman who shares her story for today’s FFF Friday wants to remain anonymous, for obvious reasons. But I hope she knows how incredibly brave she is – and how incredibly considerate to tell the truth about her decision in the hopes that it can aid the cause of supporting all women, breastfeeding, formula feeding, or anywhere in between.


I was 14 when I was raped. Or maybe I was 15. I don’t really know…and to be honest that fact blows my mind, considering every other detail, like the way the forest smelt, the way my throat felt like it had a hot poker shoved down it and the way his eyes looked at me is embedded in my mind like little shards of glass. And wow how those shards have affected ever facet of my life since.  
Truly it doesn’t matter though what age I was. What does matter was that it was someone I trusted. Not a family member or even a family friend but my own boyfriend who I had said no to repeatedly. The fact that I was confused about even calling it rape for many years is important to, because it dramatically shaped the way I felt about my body, who touched it and what I considered trust for over 10 years.
It affected my relationships with almost everyone, but the worst type was the Boyfriend type. Some were understanding and gentle when I suddenly stopped in the middle of being intimate with them, screwed myself up into a ball and sobbed my way through a couple of hours or when everything was going fine and they would touch me in a slightly different way and I would go stiff and unresponsive. Some were impatient and they didn’t stick around. Some like my poor ex husband suffered in silence for years until he was too scared to even touch me. Yeah, so it was a catalyst to ruining my marriage too… when we get down to it. 
But this is a breastfeeding story, not a story about boyfriends.
I come from a place where breastfeeding rates are high. It’s the normal, responsible and practical thing to do. When friends and family did it, I thought it was the most natural thing in the world. When I thought about having babies in the future, I imagined holding that child in my arms and breastfeeding it. 
I felt that way right up until about the 6 month mark of my first pregnancy. At first it started out with feelings of dread. A person, using my body again… even more than it already is during pregnancy. Relying on only me and that’s it – it scared me. It filled me with dread. But I told myself that was nothing, that I’m sure most people feel that way briefly if they would care to admit it. I countered it with positive thoughts and used a sort visualization technique to make my brain realise how wonderful it would be. I read up on breastfeeding benefits, how truly wonderful our bond would be. Etc etc. 
Then I started waking at 2am in sweat after nightmares of a baby suckling blood from me. I tried the visualization stuff some more. Then I started having panic attacks during the day about it and I broke down in tears more than once about it, lets even go as far to say more than once a day about it. I tried talking to people who knew about my past about how I was feeling and they told me it would be fine, to just do it. Others had been through this before, they are fine. 
Then, I started to hate the baby growing inside me. I truly and utterly hated it. Oh god, I resented it. I hated the fact I would be made to feed this thing from my body, FROM MY BREASTS. My most sensitive part of my body, that had had so much damage done to them in the past, the part of my body that my partner had to be careful about touching in case it made me fly into one of my sobbing fits. Someone FEEDING from me? I couldn’t cope.  
I let the hate fester for a month or so. I felt I couldn’t discuss it with anyone because I got the ‘it will be fine’ talk or looked down at for feeling this way about my baby. . I couldn’t even discuss it with my partner or my best friend because I felt like such a failure. My mother doesn’t even know what had happened to me, neither did most of my family so there was no one to turn to there – not without opening a can of worms I didn’t want opened. I felt so ashamed, so guilty… but more than that I hated that creature for making me feel this way.
During the next visit with my midwife, I ended up breaking down. My blood pressure was sky high, I was obviously stressed beyond belief and she asked what was up. I told her I didn’t want the baby to come, that I really didn’t want to be a mother anymore. I was too scared to tell her why because I know how pro breastfeeding they all were but she got it out of me anyway. She looked at me carefully for a minute or two before taking my hand and saying the one thing that stuck with me since.
‘Then you will use formula, it’s a fine replacement and your baby will still thrive, be happy and healthy and more importantly, you will bond with him and love him more than anything you have ever loved before.’ She told me to let it go, to just look forward to holding the baby in my arms and the rest will happen. 
So, that’s how it happened. My hospital notes got changed to ‘will artificial feed’ and we did. My partner gave my baby his first feed and the love on his face said how privileged he felt doing so. When I held my baby in my arms and gave him a bottle I felt so at peace. I could touch his little face and stare into his big bright blue eyes and tell him just how much I loved him and how he was the best thing to ever happen to me… and oh how I meant it.

If you’d like to share your story with the FFF audience, please email me at formulafeeders@gmail.com.

Pregnant and considering bottle feeding? This one’s for you.

Yeah, maybe it was born from the unholy union of laziness and apathy, but you guys made my Q&A post yesterday well worth it.

A few of the questions came from pregnant peeps, which I thought was pretty awesome, and I decided to tackle these inquiries in this separate post. And keep the questions coming, y’all… I will answer them in the comments section unless they merit so much chitter chatter that I feel the need to post independently on the subject…


Q: I’m 18 weeks pregnant with my first and haven’t committed to a feeding method yet. I’ve moved from having no desire of any sort to breastfeed to being open-minded about the options. It is a challenge to find information that isn’t a thinly veiled agenda (on either side), one masquerading as objective data. I think I’ve read just about every argument/counter-argument as to why ‘breast is best’ or why formula isn’t poison. I’m curious now about real-life contrasts of FF babies and BF babies. Like, did you switch to formula early on with your baby or perhaps BF one child and FF the next? Were there any measurable differences in health or temperament that you felt could be attributed to feeding methods?

I don’t know if this is something you can address personally or is widely interesting enough to answer but I couldn’t turn away from a triple dog dare.

What I feel I really need right are a few good sources (books, articles, personal experiences) that I can reasonably trust are straight forward so I can make up my own mind without feeling as if I’ve just ‘sided’ with someone. Does that make sense? 🙂 (BTW – I found your blog through the Mainstream Parenting site and I’m glad I did! It has been a good resource so far.)  


A: Jessica, you’ve hit the really-difficult-to-hit-with-the-hammer-because-it’s-a-really-complicated-nail on the head. The best studies on breastfeeding would take sets of twins, raised by the same parents, in the same environments, and feed one breastmilk and one formula. But this would be unethical, so it ain’t gonna happen anytime soon. You’d need a lot of sets of twins to make it a decent study, too, because even in these conditions, a lot of “chance” factors might play in, capiche? Like, what if one twin was a better behaved baby, which meant that the parents had some deep-seated favoritism which resulted in more positive attention being placed on that twin… later on, the enhanced self-esteem and school performance of that twin could be attributed to breastfeeding, even if the feeding method had nothing at all to do with it. Or, since one twin was being breastfed, and the other bottle fed, one baby would be getting more skin-to-skin contact and bonding time than the other (which wouldn’t be the case if both were bottle fed or breastfed, as the feeding methods would be identical), and that could skew the results.

Point being… it’s really hard to compare formula fed babies to breastfed ones. This is true in ALL studies, because there are differences in the parents who breastfeed and those that don’t, when you look at the numbers of people necessary to carry out a legitimate study. My biggest complaint with these studies is that most don’t take into account all the social and emotional factors tied in with infant feeding. It’s just really impossible to know.

So, we’re left with purely anecdotal evidence, which really isn’t evidence at all. But for the hell of it, I can tell you this – I breastfed my son for a month. Or, I tried to – I had to pump for 3 out of those 4 weeks, because the little guy couldn’t latch, despite the help of multiple lactation consultants and a procedure to correct his tongue tie. Perhaps if the breastfeeding had worked out, the eventual diagnosis of his severe milk protein allergy would have been more devastating. But as things were, I was happy when it turned out he’d be better off on hypoallergenic formula. I was miserable. More importantly, he was miserable. He was sick to his stomach, constantly hungry (before we switched him to pumped milk in a bottle), with a terrible rash all over his body. When we got him on the right formula, he was a different kid. So yeah, if you looked at my child, he thrived on formula, and was miserable on breastmilk.

BUT. That is not a typical case. At the same time, it’s not the only case like this – read through the comments and FFF Friday posts and you might see a trend towards the conclusion that some kids do better formula feeding than breastfeeding – but then again, this is a blog for people who formula feed, and many of us have medical or emotional reasons for doing so. I strongly believe that happy mom (or dad) = happy baby. So if someone is miserable breastfeeding, no one is going to benefit from that. I think that is the fundamental difference that alienates me from some of the breastfeeding advocates – they encourage moms to keep going in the worst of circumstances, and in some cases, that is what is best – especially if breastfeeding is important to the mom. While I believe breastfeeding is best if its something you want to do and can do without going to extreme measures (which a lot of women can – don’t let this blog scare you!), I don’t believe it is so much better that it is worth vast amounts of pain or anxiety.

Back to your question though – I would tell you that this is a completely personal choice. Unfortunately, I don’t think it’s possible to find a completely accurate, unbiased answer. If you are even slightly considering breastfeeding, I would 100% go for it. Give yourself every opportunity to succeed. Take a class. Read some books. Read some of the blogs mentioned in last week’s FFF Friday post. Chat with those women. I have so many friends who breastfed, and many who had trouble in the beginning but loved it later. I think overall, if there aren’t problems, once you figure nursing out, it’s easier than formula feeding. And definitely cheaper!

But if you try it and it either doesn’t work or you hate it, switch to formula and don’t look back. Your baby will be healthy and happy because YOU are healthy and happy. Formula is a great option too, and thank god we have that option.

As for book and articles… I have some links listed in the “Factivist Finds” section that might be helpful… although I need to update the darn thing. I haven’t come across too many books that don’t shove the breastfeeding thing down your throat – I thought “Breastfeeding Sucks” was pretty good (and don’t be scared off by the title – it’s realistic about the challenges, but funny and helpful without being preachy). There’s only one formula feeding book out there, and it’s hard to find- called “When Breastfeeding Isn’t an Option” by Peggy Robin. I think it’s okay, but skews towards the anti-breastfeeding side, which I don’t like. I’m trying to write a book that talks about this all logically, but no one wants to publish it yet, because they think there is a “limited audience”. Blecch. Hopefully someone will take the chance and there will be another option for those considering formula feeding some day.

Good luck with it all, and feel free to come back here and ask me anything, anytime.

Q: I’m almost 26 weeks pregnant and plan on FFing. What I’m wondering, is how do you pick the right formula? Where do you start? Also, I’m all about generic food for me and hubby, but is it the same with formula? Do you have any guidelines or suggestions for new moms who are going to FF as far as what to buy and try? Thanks!!!


A: Choosing a formula is a bit like choosing a stroller- which I assume you’ve either already done or are about to do soon. There are a ton of options on the market; some have name recognition (like Bugaboo for strollers or Similac for formula), others have the “cool” factor (UppaBaby or Earth’s Best Organic), and others are far lower in price, with less bells and whistles – but just as safe and functional (Chicco or Target Brand).

All infant formulas currently on the market must adhere to certain nutritional and safety standards, as per the FDA. The rest of it is just designer bells and whistles. For example, if you want an organic formula, you’re limited to certain brand name options (although I’ve heard WalMart makes an organic formula – anyone here know it/tried it?), and there’s always some “new” type on the market promising less spit up, more DHA/ARA, or longer sleep at night (and for that last one – don’t believe the hype. Enfamil kind of lost me on that one. I’m a Similac girl anyway, but I thought that marketing this “restful” formula just made us formula feeders look more selfish than some people already thought we were. Plus it’s kind of creepy).

You get into tricky territory when it comes to the hypoallergenic or elemental formulas – but unless you’re unlucky enough to have a baby with food allergies, you probably won’t need to go there.

A lot of people end up sticking with whatever formula they were given in the hospital (if your hospital is still able to give out formula, that is) or received coupons for in the mail. Since the taste and makeup of the formulas is slightly different, there can also be some trial/error involved. I know some people (like my sister-in-law) who remained on the same formula from start to finish, and others (ahem, moi) who tried everything on the market before finding “the one”.

If I were you, I’d see if my hospital hands out sample bags – some still do, at least if you request them – because it’s usually the “premium” version of either Enfamil or Similac, and they give you a good amount to start. Just one less thing to think about. If your baby likes it, and seems to tolerate it well, then you can sign up on the formula company’s website and they will send you some great coupons, which usually makes the cost a bit less steep. When your supply of freebies runs out, you can make a decision – if you want to stay on the name brand stuff; try the generic; or if you want to try a more “specialty” version like Gentlease or something, if your baby is gassy or whatever. You can also ask your pediatrician, but most will just tell you it’s a personal choice. They may have an abundance of free samples of a certain kind though, and if they are willing to give some to you, that’s a pretty sweet deal.

Switching formulas doesn’t need to be a big production. You can do it slowly – like half and half of the old and new to “ease” your baby into it – or just do it cold turkey, as long as your kiddo isn’t prone to stomach issues. All milk-based formulas are pretty identical; if you are switching to soy or elemental for some reason, the transition might be a bit tougher, as these taste and metabolize differently.

In sum: 1)you can’t really go wrong in choosing a formula, because the worst that happens is you end up switching to another, either because your baby hates the taste, seems to have more stomach distress/spit up with the formula in question, or the cost becomes prohibitive; 2)generics are just fine, and a heckuva lot cheaper, and 3)don’t buy into the marketing – as long as the formula was made in the USA, it’s got the nutrients your child needs!

Q: I’d love to hear your thoughts on nipple confusion… I’m currently pregnant with my first, and we’re planning to combo feed. However, I’ve heard so much about nipple confusion from the lactivist side of things that I wonder if it’s worth breastfeeding at all. Not exactly the point that lactivists wanted to make, I’m sure…


A: This is the six million dollar question, Sara. I honestly don’t know what I believe. Because if I’m being entirely truthful… while I knew all about nipple confusion, when the doctors told me my growth-restricted baby was jaundiced and my milk had yet to come in, I gave the go-ahead for the nurses to give him a bottle. And after that, we never quite got the latching thing.

However, I think combo-feeding is the best of both worlds. I expect that if my son hadn’t had a tongue tie, he would’ve been able to latch, regardless of that bottle he had. Kids are resilient. I’ve heard friends say that they did bottles of pumped milk or formula from the beginning and didn’t have problems switching from bottle to breast.

If I were you (assuming that you would like to try breastfeeding) I’d take the time in the hospital after you deliver to establish breastfeeding. Focus on getting the latch going and your milk flowing. Then, as soon as you and the babe know the drill, go ahead and offer that bottle. I’ve heard some people do feedings at the beginning where they nurse first, then offer the bottle after the baby has fed from the breast, so that the kid can go from one to the other easily. I think the important thing is to establish breastfeeding first – but there’s no need to wait weeks or months before you start the bottle.

That being said – are you concerned with combo feeding in the hospital? I know from experience that after a long labor, sometimes being awoken every 2 hours to feed a baby who hasn’t quite figured out how to feed can be draining – and some women feel better letting the nurses feed the baby during the night so they can get some rest. That’s a perfectly legitimate desire (and one I share for my second birth, if it’s half as exhausting as my first labor was). If that is the case, then I would still take advantage of any help you can get establishing breastfeeding, but I’d also go ahead and allow some bottle feeding to occur. In my opinion, whatever is going to make breastfeeding a more viable option for you is a good thing. If you’re on the fence, and the fear of nipple confusion may stop you from trying at all, then of course you should say “fudge it” and combo feed from the start. It’s a no brainer. At least you’ll be giving yourself the chance to discover if you enjoy breastfeeding, which there’s a great chance you will.

Incidentally, I agree with you that discouraging combo-feeding is to the detriment of lactivism. Combo feeding is a way for breastfeeding to be mutually beneficial and enjoyable for mom, baby, and dad, who gets to take part in the feeding process. Good luck and let me know if I can help with anything!

Short and Sweet

I’m working on two research-heavy posts right now, but I’m getting that queasy feeling that comes when I neglect the blog for too long. It’s like I used to feel as a kid on Sundays, right around 3pm, knowing that I hadn’t even written one measly sentence of the book report that was due the next day.

So, I’m posting for the sake of posting today. Unfortunately, I’m brain dead. Can I throw the ball to you guys?

Here’s what we’re gonna do… why don’t you ask me something? It can be something formula-related (like an idea for a future post, or a quick inquiry into a specific subject) or personal. I’m an open book (report).

Ask away. I triple dog dare you.

FFF Friday: “I do believe in breastfeeding…but stress is not helping women be successful.”

A few months back, I stumbled upon a post about feminism and breastfeeding, by FFF Kathleen at amoment2think. It was love at first read…so I am more than a little excited to share a FFF Friday submission from this truly fearless mama. 

I hope you will take the time to check out the bloggers she references in her post. They are also personal favorites of mine – especially Accustomed Chaos, who stands up for breastfeeding without ever belittling formula feeders. It’s a tough thing to do, and these women do it well- so stop by their wonderful blogs and give ’em some love!


I have two purposes in writing this post. One: to share my story. Two: to share my message.

Story first.

My daughter was born after a relatively short labour, with minimal intervention. The only intervention I had was a injection of pain killers at about 5pm when they sent me home from the hospital, after a 4 hour wait in the WAITING ROOM of the hospital, because I wasn’t dilated enough to be admitted. We went back to the hospital at 9:00pm and she was born at 11:00pm. Other then the fact that I spend 90% of my labour with no health care support what-so-ever (as I said, I was IN THE WAITING ROOM) I count myself relatively lucky, in that I had a wonderful, healthy baby girl, without a 24 hour labour and hours on end of pushing.

They did all the right things (once I actually got admitted, about 45 minutes before she was born). She was put on my chest, skin to skin, within about 5 minutes of her being born. Within 20 minutes I was breastfeeding her. I had a supportive family and husband, a great family doctor, weekly visits to a lactation consultant, and everyone I knew breastfed. I had a one year maternity leave to look forward to. I live in a country that has about a 90% initiation rate for breastfeeding and the majority (54%) are still breastfeeding at 6 months. I sound like the definition of someone who should be successful in breastfeeding.

I wasn’t. Here is just some of the troubles I encountered and the extreme lengths I went to try and make it work:
  • stressful hospital stay- I don’t like hospitals and I felt very anxious sharing a room with a complete stranger after the overwhelming experience of giving birth. I am sure that isn’t out of the ordinary, but I get anxious most easily then most. I wanted to go home, they wouldn’t let me. I couldn’t sleep
  • poor breastfeeding support in the hospital. All very junior nurses that had no real experience, kind as they were. No lactation consultant
  • a tongue tied baby that didn’t have her tongue clipped until she was 8 weeks old because doctors hemmed and hawed, while my nipples were torn to shreds
  • a typical day schedule that looked like this: breastfeed for 45minutes or more, supplement with formula, pump for 20 minutes, sleep for 45 minutes, repeat ad nausea (feeding every 2 hours)
  • an alarm clock set all through the night to make sure that A got fed every 3 hours
  • a hospital grade breast pump I used round the clock for the better part of 3 months
  • use of supplemental nursing system and other ‘non bottle’ methods to supplement, in hopes of avoiding nipple confusion
  • use of switch nursing, cluster feeding, breast massage to try and increase supply and encourage A to get more milk
  • herbs, teas, galatagogues, maximum doses of prescription medication ect. ect. to try and get my supply up
  • stress, tears, fear, guilt. I wanted so bad to breastfeed and I was terrified of the harm that would be caused to her if I gave up and gave her 100% formula (I had read the studies). I was devastated when I was told I HAD to supplement with formula
  • a husband who was equally worried about the impact of not breastfeeding, He had also heard about the studies
  • a baby who was allergic to milk. Went on strict elimination diet to avoid all milk products. Despite the fact I live for milk and cheese
  • a lactation consultant who finally re-read my chart and saw that I have PCOS and admitted this might be a factor
  • a lactation consultant offers me experimental prescription (for diabetes) because someone else used it successfully to increase milk supply in PCOS patient
  • 3 1/2 months where I never pumped more then 2 oz of milk
  • a baby who, based on before and after feeding weighing at our weekly lactation consultant appointments, she never took more then 2 oz of milk a feed, often it was only 1 1/2 oz
  • a baby who weighed the same at 3 months as she did at 2 months (just over 9 lbs)
  • the final straw- thrush infection
  • an undiagnosed, but very likely in retrospect, postpartum depression sufferer
  • a disheartened mother eventually gives in, stops breastfeeding and gives the baby the bottle
  • Guilt. Tears. Fear.

To be honest, I was not sure I had done the right thing until I looked at a picture of my baby at 3 1/2 months (when I gave up) and at 4 1/2 months and saw the difference. She was not thriving at 3 1/2 months. But by 4 1/2 months she glowed and looked A LOT healthier. (Kinda want to show you a picture even though I have a no baby pictures on blogs rule. You would gasp!)

That is my story.

What is my message?

I am still pro- breastfeeding. I believe it is best. I do not believe that formula is bad or isn’t a good option. I do not believe that the ‘risks of formula’ are as dire as the studies suggest. (Correlation versus causation can be a tricky thing in studies) But I do believe in breastfeeding. I will try to breastfeed baby #2, if/when I am lucky enough to have a baby #2.


I believe that there are breastfeeding advocates that are hurting their cause. Because I, like many other women, would be on their side if they were a little more sensitive about it. If they didn’t make comments about women who formula feed being lazy, selfish or uninformed. If they weren’t so self-righteous and imply that breastfeeding is the definition of being a good mother. If they listened a little more. If they didn’t push the ‘risks of formula’ message as if the only reason we formula feed is because we are ignorant of the ‘risks.’ If they didn’t make so many women feel so stressed out about breastfeeding being ‘do or die’–literally, if you believe the studies. That stress is not helping women be successful. That stress may even be making it harder for them to make milk. I believe it made it harder for me to make enough milk.

But there is good news. There are some very good breastfeeding advocates out there. Women who are kind, supportive and not judgmental. Women who I would reach out to if I needed help breastfeeding baby #2. Women who I would stand behind their fight to get better support for women (from better hospital experiences, to better maternity leave, to pumping rights, to access to quality lactation consultants, to flexible work schedules)  and break down the still present anti-breastfeeding biases (like being made to feel uncomfortable breastfeeding in public or being told to stop breastfeeding a toddler). Women that push the message that breastfeeding is normal. Not easy. But normal. Not the magic bullet for a genius kid with a perfect immune system. Or the only way to have a good bond with your baby. But worth it and important none the less.

Here are some of my favorite pro-breastfeeding bloggers with a decidedly better approach to breastfeeding advocacy:

Accustomed Chaos

Sorta Crunchy

What other ones do you know about?

If we can promote these kind, supportive and intelligent women, maybe their positive approach will take the lead, over the un-kind, judgmental and hurtful approaches that others are taking. Because we do need change and a heck of a lot more support. Sometimes, when all you hear is the negative and the unkind, it is good to know and think about the positive and the kind out there.


Hey all – it’s the FFF here again. In the spirit of Kathleen’s post, I’d like to invite anyone who has breastfed, or considers themselves a breastfeeding advocate, to come on here and guest blog. Let’s stop the insanity and learn how to support each other – the first step to doing that is dialogue, don’t you think?

Oh yeah- and if this post doesn’t inspire you to write your own FFF Friday story, I don’t know what will. Send ’em if you got ’em: formulafeeders@gmail.com.

Hyping hydrolysates: All about hypoallergenic formulas

I want to admit my bias towards hydolysates up front:  I think they are magical. My son has been on hypoallergenic formula since he was about 3 months old, and the difference between FC on breastmilk/regular formula/soy formula and the hypoallergenic formula we ultimately switched him to was astounding. It was like the kid had received a spontaneous lobotomy. He was miserable for the first 10 weeks of his life, with terrible skin rashes, gas, stomach issues, and a personality that can best be described as the Grinch meets Chairman Mao; within 24 hours of switching him to hypoallergenic formula, he could have starred as the “after”  in a Harvey Karp instructional video. FC was truly the happiest baby on the block, thanks to Alimentum.

Still, I was concerned about the long-term safety of such a space-age, highly processed formula. The stuff smelled like regurgitated potatoes. (Although for some reason, FC loved it; up until a month ago, we still used a scoop of the stuff to flavor his hemp milk because he so adores the taste. But then again, he likes kiwi as well, and hates chocolate. I’m blaming FH’s taste genes.) And the whole “pre-digested” thing kind of skeeved me out. So, I did a little research, and the following is what I’ve found. Needless to say, I am by no means a doctor or have any background in science; this is just what I’ve gleaned from a layman’s perspective (with the slight advantage of a journalism background that focused on health issues), so take it all with a grain of salt. Or a grain of pre-digested protein. Your choice.

First, a definition: What are hydrolysates?

Basically, in kids who are allergic or sensitive to milk protein, the lower the molecular weight of a protein, the better. Casein hydrolysates like Similac Alimentum or Enfamil Nutramigen contain tiny, broken-down versions of milk protein, making it easier for milk-sensitive babies to digest. There’s another level of hypoallergenic-ness (yes, I made up that word, sue me) which you find in amino-acid based formula (Neocate); for some babies, even the infinitesimal amount of milk product in the hydrolysates is problematic. Since Neocate is only available by prescription, and the majority of kids with food sensitivities have success with the over-the-counter hydrolysates, we’re going to focus on these.

What are the nutritional differences?

Comparing nutritional labels, there doesn’t seem to be much difference between your average milk-based formula and a casein hydrolysate one. But a 2003 study in the American Journal of Clinical Nutrition did find that “the iron status of infants fed (casein hydrolysate formula) was lower than that of all other groups. The amounts of amino acids provided by hydrolysate formulas appear excessive compared with regular formula, which is reflected by high serum urea nitrogen… and high plasma amino acid concentrations.” The study authors suggest, in their conclusion, that a “reduced and more balanced amino acid content of hydrolysate formulas may be beneficial.” I’m not sure if the formula companies have changed the recipe since 2003, but I will look into it and get back to you.

The International Society of Infant Food Manufacturers has a good run down of the nutritional issues surrounding hydrolysates, but I’m well aware that there’s a bias against the formula organizations, so do with this what you will. They claim that “on the whole, available data suggest that there is no evidence that feeding (hydrolysate formula) impairs the growth and biochemical parameters of term infants. There is also no evidence of differences between infants fed (hydrolysates) and an adapted cow’s milk formula and/or human milk on growth parameters and biochemical parameters, except on indices of protein metabolism.”

What’s the deal on allergies?

A 2008 clinical report from the AAP suggested that hydrolysates may actually have a preventative effect against allergies:

The documented benefits of nutritional intervention that may prevent or delay the onset of atopic disease are largely limited to infants at high risk of developing allergy (ie, infants with at least 1 first-degree relative [parent or sibling] with allergic disease). Current evidence does not support a major role for maternal dietary restrictions during pregnancy or lactation. There is evidence that breastfeeding for at least 4 months, compared with feeding formula made with intact cow milk protein, prevents or delays the occurrence of atopic dermatitis, cow milk allergy, and wheezing in early childhood. In studies of infants at high risk of atopy and who are not exclusively breastfed for 4 to 6 months, there is modest evidence that the onset of atopic disease may be delayed or prevented by the use of hydrolyzed formulas compared with formula made with intact cow milk protein, particularly for atopic dermatitis.

It’s not clear in this synopsis, but reading through the entire study, it seems that both breastfeeding and use of hydrolysate formulas confer equal benefits in this particular case. Obviously, if you have a history of allergies and are able to breastfeed, it’s a no-brainer – why feed your kid expensive and atrociously smelly formula? But for those of us whose kids are unable to tolerate breastmilk due to severe allergies, or who cannot breastfeed for any other reason, but have a family history of allergies, the hydrolysates might be worth the cash.

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