Nipple Confused? Here’s some “supplementary” info

When FC was a wee little sprout, he looked a bit like my grandma did when she had hepatitis. (An image that haunts me to this day – her eyes turned yellow. Yellow. Can you imagine what that did to my 5-year-old brain?) Yep, little FC was jaundiced, and since he wouldn’t latch after the first day in the hospital, we were given “permission” to supplement with a bit of formula.

Needless to say, this caused a lot of consternation for pro-breastfeeding Fearless Husband and me, but the prospect of not being released from the hospital was an incredibly persuasive argument in favor of formula. My PPD had already kicked in, and the cold, stale smell, white walls, and constant buzzing of machinery seemed unbearably eerie to me; I honestly believed that if I stayed there a moment longer, I would start screaming and never stop. (I’m thinking I may sign out against medical orders this time after 24 hours, as long as FC#2 gets the okay from our fabulous pediatrician. The idea of spending 48 hours in that hospital again is far scarier to me than the birth itself. I’d almost barter a med-free birth for the ability to be knocked out for the “recovery” period. And I’m a big fan of the epidural.)

So, we ended up letting the nurse feed FC a tiny bottle of formula. As I watched him guzzle the liquid down as if it were manna from heaven, my heart started thumping around my chest. The latching had been hard enough; what if he got nipple confusion now? I vowed that this would be the last bottle he’d take, at least until we had breastfeeding down, my supply leveled off, and he conquered the whole latch thing.

Cut to a week later, when one of our many lactation consultants encouraged me to exclusively pump as a solution to our problem (i.e., a child who couldn’t latch well, and who was incredibly hungry at this point). This was a life-saving suggestion, for both mother and baby – I finally felt that my breasts could do something productive, and my son started gaining weight like a champ. On MY MILK, no less!

But as the days went on, I started having trouble keeping up with FC. He was a voracious eater (I still think it’s because he was growth-restricted, and making up for lost calories on the outside, even though I have no medical evidence to back me up), and barely slept – my pumping schedule was every 2 hours, and took 40 minutes (20 minutes per breast) to get enough milk, which meant the most I could sleep was 90 minutes at any given time (and that was if my husband got up to give FC a bottle while I pumped – and I say if, because my husband, while lovely and amazing in so many ways, is a horse’s ass about waking up in the wee hours of the night –  otherwise, I had to factor in a 30 minute feeding/burping in that time slot, as well). Between my postpartum issues and sleep deprivation, I was drowning. I convinced myself that one small bottle of formula a night wouldn’t hurt my baby, and we started supplementing. I could barely admit it to myself – when asked, I’d say we “occasionally” supplemented with formula, but very rarely, when in reality it was a nightly ritual. A ritual that ended up allowing me to give him breastmilk for the rest of the day, however, and even get “ahead” of him every now and then – that was the best feeling ever, seeing a nice, full bottle of expressed breastmilk in the fridge, knowing that it could hold my child over until I pumped again….I started fearing the formula a bit less every day, especially as nipple confusion was no longer an issue. FC was clearly confused from day one. Somehow, the instinctual knowledge all babies are supposed to have about suckling human breasts never made it to my son’s developing brain. Maybe he was out of the house when the intra-utero UPS tried to deliver that essential piece. Or perhaps our bottle-feeding culture has seeped into the collective consciousness?

I digress. The point is, while FC was still getting breastmilk, I supplemented with one bottle of formula a night. And I strongly believe that supplementing can be a girl’s best friend, especially if she has supply issues, needs to pump exclusively, or has to work full time where pumping is simply not convenient (like, say, in service industries like restaurants or Starbucks, where facilities other than a restroom are not physically available, and taking an additional 40 minutes of break time per shift can result in lost tips). Supplementing, or “combo feeding”, can allow you to keep breastfeeding while taking some of the pressure off. There’s a ton of conflicting advice out there on supplementation, though, so for those who are considering going in this direction, confusion probably abounds.

I’ve scoured the internet for the past few days, and everything I read seems to contradict the thing I read before it. Parenting Magazine’s August issue had a big feature on combo-feeding; it was pretty solid advice, so if you can get your hot little hands on a copy, I’d highly suggest it. It quotes Dr. Marianne Neifert, who is a great example of a strong breastfeeding advocate who still acknowledges that supply issues and breastfeeding setbacks are real, and not something mythical, like unicorns or the Tooth Fairy.

One of the more interesting things Dr. Neifert says in her book, Great Expectations: The Essential Guide to Breastfeeding, is that while many lactation professionals prefer alternate suppplemental feeding methods, like feeding baby with a cup, spoon, finger or supplemental nursing system (SNS), rather than a bottle), especially if breastfeeding hasn’t been successfully established, “cup feeding is the only alternative method that has been studied, and research shows no significant benefit of cup feeding over bottle-feeding in maintaing breastfeeding beyond hospital discharge”. She also explains that the babies who most often get nipple confusion are the ones who are not latching correctly or have mothers with compromised milk supplies. The logic here is clear – these babies aren’t getting what they need easily, and then a bottle comes along, and gives it to them with far less work involved on their parts. This information can be taken two ways: first, it kind of sucks, as the kids who could benefit the most from supplementing are the same ones with whom doing so could complicate the breastfeeding relationship in the future. On the other hand, it’s encouraging for moms who want to supplement just for their own sanity, or because work makes exclusive breastfeeding difficult.

Let’s clarify this a bit. If you are having breastfeeding problems like I was, then yes – nipple confusion is more of a concern. I don’t regret my decision to allow supplementation in the hospital, though, because ultimately, I believe the end results would have been the same. Dr. Neifert suggests that even babies who do develop nipple confusion can bounce back with a little effort of the mother’s part; I just heard from a chat room friend that her baby, who hadn’t latched for nearly 6 weeks, suddenly just started breastfeeding like a champ. We tried and tried, but it just never happened for us; I don’t think FC would have latched better if he hadn’t had that one measly bottle in the hospital. And according to this 1985 study from the official journal of the AAP, I’m probably right – the researchers found that “It thus appears that formula supplementation in the hospital is a marker, rather than a cause, of breast-feeding difficulty.”  Kids are resilient, you know? But I am not a lactation consultant, so if you are truly concerned about causing further problems for yourself, I would call a reputable LC, pronto – don’t wait, because the earlier you get help, the better – and hold off on the supplementing until you feel secure about it. You don’t want to be blaming formula for your breastfeeding failure somewhere down the line. Trust me.

Lecture over… let’s move on to those without problems. Say your kiddo is latching like a champ – when can you start introducing formula? The issue here is establishing your supply. The more your baby nurses, the more milk your body (ideally) will produce, so if she is sucking on a bottle instead of your breasts, your supply might not meet her growing needs.

It comes down to your reasons for supplementing – is it because you need to go back to work? If this is the case, you might want to wait a month (see reference to BabyCenter’s advice below) before introducing formula; when you do start, just do one small – and I mean SMALL, like 2oz – bottle a day. This will get him used to the bottle and the taste of the formula. Now, I know some people might disagree with me on this one, and say to wait until the last possible moment to start supplementing, but I see a few inherent problems in this. Some babies get nipple confusion in the other direction – breastfed babies won’t take a bottle (I think FFF Megan has some firsthand experience with this, no?) If you’re going back to work after 12 weeks of maternity leave, things are gonna be relatively stressful as is; the last thing you want to be worrying about is if your baby will starve at daycare because he won’t take a bottle. If you’re concerned about supply, you could pump during that one formula-feeding session and store the milk you express; not only will you be giving your body the message that it needs to maintain its supply, but you’ll be getting a headstart on your milk stash for when you go back to work.

What if you just want to give one bottle of formula a night, so you can get a little sleep? Well, if you’re doing this because you think formula fed babies sleep better, think again. I wish that old wives’ tale was true, but, sadly, no. Also, if you’re pumping, be aware that some studies show that morning milk may keep babies up at night – so if you’re EPing, use freshly expressed evening milk before bed; or the evening bottle would be a good one to supplement with formula, if you’re heading in that direction. However, if you’re not co-sleeping (which usually makes for a situation where breastfeeding is easier than formula feeding, since all you have to do is roll over and let your baby latch on), and your husband can get up, go down the hall, and feed your little one once a night with a bottle of formula, then I do think it can allot you a little more sleep. If you’re going this route, according to BabyCenter’s medical advisory board, the best time to start is when your baby is around a month old.

(One small tip here – if you do want to use a bottle of formula at night, keep your supplies in your master or closest upstairs bathroom. We used to keep a jug of distilled water (recommended for the early months by our pediatrician), a can of formula, and a bottle, on our master bathroom vanity. That way, all we had to do is mix the stuff up and give it to FC, who was asleep in his cocoon sleeper next to our bed. As we got better at everything, we would pre-measure the water in the bottles, so all we had to do was add the appropriate scoops of formula. Done and done.)

I know many of you have asked for specific information on supplementing, but I can’t really give much, as most of the information I’ve found is incredibly biased (it all starts with the caveats about breastfeeding being best, and how you should avoid formula at all costs, etc, etc). Plus, I am not a physician, and I don’t think it’s appropriate for me to be doling out information that could potentially affect someone’s health. I will post some links at the end of this which offer advice without being too judgmental (those are hard to find, unfortunately), and hopefully these can answer more specific questions.

I think the important thing to remember is this: some breastmilk is better than none. If you are committed to exclusive breastfeeding, well, then you may not want to supplement – that’s kind of a no brainer, if you ask me. But if you are struggling, or just feel like combo-feeding might be a better option for you, I have to wonder if it’s really necessary to wait the requisite month before starting formula. Because if you only need your supply to be sufficient enough to feed your child for a few meals a day, what’s the problem with establishing that kind of supply right off the bat? I’d imagine that if you establish the supply of an exclusive breastfeeder, but are planning to supplement heavily with formula for whatever reason, you’d be setting yourself up for some pretty intense engorgement. (I suppose the argument could be that perhaps you wouldn’t have made up your mind about these things in the early days; maybe you’ll find that breastfeeding is easier than you expected, and decide to punt the supplementation altogether. I’m talking about the women who KNOW they are going to supplement, for their own personal reasons – why not help them do so? Otherwise, they might be less likely to breastfeed at all, which I assume is counterproductive to breastfeeding advocacy efforts.) I’m genuinely curious about this – if there are any lactation consultants, scientists or pediatricians out there who have an answer for me, please post it – I’d love to know the answer. I feel like there has to be a rational explanation, otherwise, why are we freaking women out about supplementing if supplementing is going to allow them to breastfeed, with the alternative being no breastfeeding at all?

Any answers? First one to give me one gets a big gold star.

***

Some good resources for supplementing info:

Supplementing With Formula (BabyCenter.com)

Formula Feeding FAQs: Supplementing (KidsHealth.org)

Yes, You Can Supplement: Breastfeeding with Bottles (Parenting.com)

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.


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22 thoughts on “Nipple Confused? Here’s some “supplementary” info

  1. I think you've put together a nice summary of many of these issue, so kudos!

    If you'd like to learn more, you might want to check out a new book called “Balancing Breast and Bottle” which touches a bit more on many of these issues. I haven't had the chance to read it, but I've seen excerpts and heard some good reviews. http://www.amazon.com/Balancing-Breast-Bottle-Reaching-Breastfeeding/dp/0982337957

    A few other comments:

    Personally I'm very much the Marianne Neifert camp, that supplementing with a bottle (as opposed to cup feeding etc.) is absolutely fine. Sometimes I think all the “breastfeeding gadgets” just make things more complicated for moms who are struggling.

    Out of curiosity, it sounds like you were pumping with a single-sided pump, did I read that correctly? Did your LCs suggest a double electric pump (or renting a hospital-grade one) given that you were exclusively pumping and had some supply issues? Exclusive pumping is already a huge undertaking, so pumping for 40 minute sessions sounds like a Hurculean task.

    Also, on the jaundice issue, there's a lot of confusion within the medical community on the need to supplement with formula. The Academy of Breastfeeding Medicine (a group of MDs that work on evidence-based protocols for managing breastfeeding issues) recently put out a protocol on jaundice which might be worth reading as you prepare for your next baby (if you're considering breastfeeding) http://www.bfmed.org/Resources/Protocols.aspx. Obviously there's no one course of treatment for every baby, but many doctors give that blanket recommendation that all jaundiced babies must receive formula supplements, which is simply not the case.

    -Kate

  2. @Kate,

    Thanks for your comment and advice. Yeah, at the beginning I was using an electric single pump, which was great in that I could pump in the car (while my husband was driving, of course, since it wasn't a hands-free situation!!), but I figured out pretty quickly that this wasn't gonna cut it. So eventually, I did switch to a hospital grade Medela, which was truly a godsend. I also invested in one of those hands-free bras, which I strongly recommend to anyone pumping for a significant period of time. This allowed me to get online while I pumped, turning it from a chore to a relatively relaxing experience, at least at the times where my husband was around to take care of FC (b/c even hands free, I couldn't handle him while I was pumping – those stupid tubes would pop out or the cups would slip everytime I moved too much. Errrg). Unfortunately, once I figured out all the tricks to EPing, it was around the same time we discovered his MSPI and switched to formula altogether.

    As for the jaundice issue – I've looked into that issue, and you're absolutely right that the medical community is at odds on this one. And whichever “side” of the debate you fall on, ultimately it just causes frustration for moms (and I'm sure for LCs as well) who are being told one thing in their breastfeeding classes or by certain doctors, and then hearing something completely different in the hospital. It's so hard to know what/who to believe/trust in your already fragile state…I just wish the medical community could take one unified stand on this one and stick to it!

  3. After reading this I feel a little annoyed that we weren't ever told about there being a debate about formula/BM with jaundice. Kellen was extremely yellow, and we almost had to leave him at the hospital because of his jaundice. Not once did someone say that formula *might* help. It might have been my “no formula” on my birth plan… though it also said “no vacuum” and I am happy to say that intervention likely saved my son. After we took him home, we were once again having to consider Billi lights… so I guess in my case, breastfeeding zealotry might have worked against us.

    And I second the putting the water in the bottle before you go to bed so that you just have to add the formula. WAY easier. They also have little compartment things so you can pre-measure formula and pour it right in. Anything to make 3 a.m. easier because formula sure as heck didn't make Kellen STTN. Not even close.

  4. I found it so interesting that the need to supplement in the hospital doesn't cause problems, but is a sign. I always heard it was because of supplementing that problems started. We had to supplement because of latch problems and jaundice etc. We were given a little SNS tube though. It never got easier though.

    The bit about formula fed babies sleeping better is a lie I can vouch for as well. When we were BF he was up all night, but once we switched to formula it was the traditional every 2 hours. He went through phases where he slept well (growth spurts) and phases of frequent waking. For the most part, he has rarely slept through the night and always wakes at least once for a bottle.

  5. I have often wondered if that tiny bottle of formula my baby had in the hospital caused us to have bf problems. Of course, the reason she needed it is because we couldn't get her to latch. Even with several nurses, the pediatrician, and many LCs helping us! So obviously, it was already a problem before the bottle was given. For some reason I didn't see it that way until I read your post. Thank you! One less thing to feel guilty about!

  6. Thank you for this post. I am doing better with breastfeeding this time, but struggling with a baby who does mini-feeds. She's never spent more than 10 minutes at the breast, and she's eating every 2 hours at almost 8 weeks old. It's kind of killing my nipples and more so, it's kind of hurting my time with my other child. I have noticed, however, that if she gets to eat a ton during the day, I can get an 8-4 sleep out of her, but that includes a large bottle of breastmilk each evening, somewhere between 5 and 7 (since her feeding schedule is nowhere near consistent). The pumping to get that bottle is what's really becoming tough – with another child, I find I can't always get to pump. Moreover, with my daughter eating so frequently, my breasts are often tapped out, and that's with the hospital grade pump.

    So just yesterday I introduced a little formula. Sure, she gave me the stink eye about it, but after sipping a bit and playing a bit after, she was hungry and sucked it down. So I think that I may make that evening bottle formula on the days I can't pump. Sure, it might damage my supply to the point where I can no longer feed her breastmilk in the evenings, but that's ok. I think combo feeding is honestly a mother's dream, particularly for those that struggle with breastfeeding or have other issues that make it difficult. Like I said, I do plan to keep pumping, and I hope that my breastfeeding her before bed and pumping after will help me get enough to keep giving her breastmilk in those bottles, but having the formula option is such a tremendous stress relief to me, and I think that's more important than a child getting exclusively breastmilk.

  7. Seems to me this “virgin gut” nonsense is more purity policing. You want a baby with a real virgin gut? NEVER FEED IT ANYTHING!

    Good grief people and their magical thinking.

    Thanks for this little guide, FFF. Hopefully, I will need it someday.

  8. oh I wanted to let you know that most insurance companies will not pay if you sign yourself out early…just so you know. I was forced to stay in the hospital for 48 hours just because of my GBS+ status. If I would have signed myself out early then insurance would not have covered anything. That is why I am going with a homebirth this next time…I can't stand to be in the hospital that long…mainly when everyone is happy and healthy.

  9. Thank you for this post! I too had been searching for information online about supplementing / combo feeding. It is very difficult to find info that is non judgmental and actually provides real tips and advice. We had to figure out our own system that works for us.

    I totally agree that it would make much more sense to have unbiased info about combo feeding readily available. I believe it would encourage more women to breastfeed longer if they knew there were alternatives to exclusive breastfeeding.

    My son was born 3 weeks early and had problems latching on. At the beginning he was nursing constantly (an average of 16 times a day for 40 – 60 minutes a feed) and I was going nuts. I had a bad case of the baby blues (I hate that term as it makes it sound like it is not a big deal) and was exhausted. I had to use a nipple shield and we would wrestle to get him on that. I hated nursing, especially during the wee hours of the night.

    After 3 weeks of this, he still had not re-gained his birth weight (only 7 lbs) and I had had enough. We saw a LC and she said my supply was fine, and that I just had to keep it up and eventually it would get better. Although she was a very nice lady and probably was right, I just could not wait any longer for it to get better. The cost of exclusive breastfeeding was my sanity and that was to high a price to pay. That same day we bought a pump and we gave our son a small bottle of formula. He drank it but knew the difference (looked at us like 'what is this??'). Luckily he had no problems with the bottle (I think that may be in part because of me already using a nipple shield, he was used to different things from birth). I pumped to try to get a bottle of breast milk for one feeding to allow my husband to give him one over night. At that time we used formula to fill him up when I noticed that he was not satisfied after nursing and it worked!

    After a few weeks and many tries latching on directly to me, he finally got it and we stopped using the shield. He started gaining weight, and started to feed about 12 times a day around that time, which was a definite improvement.

    Now at 3 months old he is gaining weight at a normal level and eating about 8 or 9 times a day for about 20 minutes a feed. He still gets his bottle of breast milk each night and we use formula when I am away or to make things convenient if we are out with him (I do not nurse in public). He gets about a bottle of formula every few days on average. In terms of supply, if I am gone for an afternoon for example, I try to pump to keep the pressure off me, get a little extra stored milk and keep my body on its regular schedule.

    He definitely prefers the breast milk but the formula has allowed me to keep nursing. I would have given up long ago if it was not for this extra option. Some may say I could have pumped more and avoided formula altogether but for me pumping is such a stressor. Sometimes getting enough for that night's bottle puts me on edge all day. I have had to choose between sleeping and pumping and many times I chose sleep! I want to spend time with my son, my spouse, my friends and family and I want sleep… is that too much to ask?

    As you said, some breast milk is better than none. Why can't we be happy with mothers providing the most breast milk they can instead of putting all this pressure on breastfeeding exclusively? Surely the benefits of breast milk do not disappear if some formula is consumed?

    I enjoy reading your blog, keep up the good work!

  10. Where were you 10 years ago when I was pregnant with my first child who screamed practically all night long with hunger the first month and then with colick for another 6? If only I had the courage to give her a supplemental bottle the first couple weeks – maybe I wouldn't have thought about running away. I eventually did give her the bottle but the guilt, the guilt! I was prepared with baby #2 and #3 – gave them a bottle of formula at night every night from the day we got home. Anyhow, I am not at all surprised about a lack of empirical evidence @ nipple confusion – it sounds like an old wive's tale that is apparently a midwive's tale, no? Here we are confusing the symptom with the cause yet again! And also, come on, can you imagine researchers trying to pin down “nipple confusion” – honestly, is it failure to put nipple in mouth, failure to suck, a hint of dissatisfaction on the baby's lips? It's not like the baby's going to tell us “hey, I'm just really confused.” By the way, congrats on the pregnancy!

  11. Yup, we had the “reverse nipple confusion” over here!

    And even when she *sort of* figured out the bottle, she totally balked when I tried to supplement with formula around five months.

    I wrestle with the combo feeding idea. You touched on this, but my fear is that if I wait too long to try supplementing, it will backfire again. On the other hand, what if I start right away and regret it because maybe I'll enjoy nursing more this time and want to do it exclusively?

    I don't know. I guess I'll just see what feels right at the time.

  12. I seriously think that those serious about breastfeeding-at-all-costs-advocacy should make shirts that say “Save the Virginal Gut.” (It's what the link @Anonymous posted as “unbiased” information to add to the FFF's links- HA!)

  13. Ooops, sorry – just to clarify that last, that post is a response to Anonymous's link, not to FFF's post. 😉 I've also now gone through my post and tidied up the links, which were in a bit of a mess – sorry about that!

  14. @Kate: I love your handle “Lactivista”. Very cool!

    @FFF: You ask, if you're going to end up supplementing anyway, why not start at the beginning? You may scoff at the conventional wisdom, which is that supplementing usually leads to a downward spiral of breastmilk supply which means more formula, which means less breastmilk supply, until you're all dried up. But this is exactly what has happened in every case I've seen or heard about (including my own as an infant, and my kids' half-brother), where a mother starts supplementing. So the short answer to that is that if you're going to supplement eventually, but you want the baby to get the most breastmilk possible, you should start that downward spiral as late as possible.

  15. @ Alan – I was fed a combination of formula and breastmilk my first year pretty much out of the canal. So as far as anecdotes are concerned, you can consider “knowing” your first case where that didn't happen.

  16. @ Alan – No offense, but you're explanation of supplementing is very simplistic. Just because a mother continues to supplement with formula, her milk doesn't necessarily dry up. It's a bit like weaning, you start by replacing one nursing session with a bottle of formula and your milk supply will adjust. In most women it won't dry up, because bf continues except for that one session. Your supply will probably dip a little, but that's ok because the baby is receiving formula for that feeding. Then you can replace another session (if you want/need to) a few days or weeks later and let your body adjust again. As long as you don't go cold turkey on bf most mothers are fine. How do you think women work during the day and nurse at night? Or nurse a toddler that only bf twice a day? There is also a simple way to make sure supply doesn't drop and that's pumping to make up for the lost bf time. Then you can start a little stockpile and need less formula. Combo feeding is wonderful – it helps women breastfeed longer, and lets dads and other family members enjoy the bonding that feeding a baby brings.

  17. @Alan, please count me as another whose supply did not decrease.

    Since I started to supplement with formula and pumped breast milk my supply has increased as my child's daily needs have increased. I believe it is all how you manage it (like Jenny said, no cold turkey).

  18. Sometimes supplements ARE necessary. And sometimes that means formula, in the real-world context where western women make “choices”. But the increased risks associated with formula are real, too. And it seems that the earlier the formula is given, the bigger the risk is. So the single bottle of formula before hospital discharge of newborn is perhaps the riskiest of all.

    With regard to the mum who wants to mix feed, when can she start doing so? Well, I'd have loads of queries about whether or not she is making an informed, free choice. But that's a digression. Let's assume that for some reason it is. (I can't imagine a reason, but let's leave that). The milk supply is generally established about six weeks, and changes from being hormone-driven to depending on efficient breast emptying around 3 months.

    So if she wants to mix feed, her milk supply is best protected if she can wait till three months. Earlier than that means that her milk supply is likely to be compromised.

    Having said which, there are changes in the baby's gut around six months which ready the baby for exposure to other foodstuffs, and reduce the risk of allergies etc associated with the use of formula or other foodstuffs. So therefore, it would be better for baby if mum waited till then to introduce the formula.

    By around 9 months, most mums find that their supply is fairly robust. So using formula as a complementary foodstuff seems to have little impact on milk supply at this point, although it could also be a part of a process of weaning from the breast, and transitioning to a fully weaned baby at a year.

    By a year, babies who need a milk feed can be given ordinary cow's milk, even though they are still well short of the 2 years plus of breastfeeding that WHO recommend.

    So when is the best time to introduce formula? The answer has to be: never.

    But when does your baby need a supplement? That might be the first day of life.

    Will it impact you and your baby? Possibly. There are increases in risk. Relative to the risk of starvation, of course Formula is a reasonable choice. Deciding what risks to take, and which to avoid although there are costs entailed in avoiding these risks, is part of parenting.

  19. Explain the risks, please, and cite peer-reviewed medical journal studies with complete documentation as to how those studies were conducted. Then let's analyze the risks. Until then, I'm assuming you're referring to the same junk science that every other scare-mongering militant lactivist refers to. You accuse us of not knowing the science–I encourage you to please learn what you're really talking about. In developed countries, these supposed risks are so overblown, it should be criminal.

  20. “Let's assume that for some reason [making a decision to combo feed is an informed, free-choice]. (I can't imagine a reason, but let's leave that).” – Anon

    Actually, let's not leave it at that since it's an insanely ignorant comment.

    It's a good thing FFF exists so that you can imagine those reasons. Dozens are cited in the archives.

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