FFF Friday: “‘Any weight gain is good’ (is) another dangerous myth”

Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They are also not political statements – this is an arena for people to share their thoughts, and I hope we can all give them the space to do so.


The last FFF Friday of 2011 comes from Ella Blood, who is a frequent and valued contributor here at FFF and also on Bottle Babies. Her story highlights the point that not only is breast not best for every mother, the saying is also incorrect for some babies. As she says in her story, what happened to her daughter is a unique case – but all babies are unique in some way, and what makes us good parents is our willingness to be flexible and adjust to our children’s individual needs.

Happy Friday (and happy New Year), fearless ones,

The FFF

***
I was determined to breastfeed my daughter. From day one, she wouldn’t latch on; after 5 days in hospital we tried nipple shields, and she actually started to drink properly. We were told off by everyone, though, because nipple shields are almost as evil as formula, apparently. And then over the weeks we noticed that my daughter was putting on very little weight. But hey, any weight gain is good, right?

The nurses/ health visitors wouldn’t say the word ” formula” …The advice was “there’s something wrong with your breastfeeding, get rid of those nipple shields, spend days in bed with her, wake her up every three hours no matter what, force-feed her, top her up with expressed milk!” I was told to “concentrate solely on breastfeeding and not go out” ( a depressing prospect, but extreme lactivists will no doubt brand me selfish for admitting to feeling like this).

And here is what, to this day, still makes me furious, because it’s still happening: breastfeeding advocates, everywhere you look, tell you that WEIGHT DOESN’T MATTER, that any weight gain is good, that come on, you don’t want your baby to be obese anyway, and the charts are based on formula fed babies anyway so they don’t count, etc, etc…
A nursery nurse LIED THROUGH HER TEETH, telling me ” Okay, she’s dropping a few centiles but it’s already looking up so keep persevering”…that was at a time when my daughter had gained 2 oz ( 60 grams) in ten days.
That’s what really gets me, the whole ” Breastfeeding is so great that if your baby doesn’t put on weight it doesn’t matter, don’t bother with the scales” Seriously, that advice is EVERYWHERE, and the people who share it are not always fanatic breastfeeding advocates; they are decent, clever people who genuinely believe that myth. At the age of eight weeks, I found out that my daughter had a hole in the heart which would require open heart surgery. Turns out she was using up all the calories from breastmilk to breathe, therefore not putting on weight. Turns out waking her up every three hours was making her more tired and forcing her to deal with extra fluids she couldn’t handle. Turns out she wouldn’t latch on – hence nipple shields- because breastfeeding was just too bloody hard for her.
What she needed was high-calorie, prescription formula. Breast milk alone just wasn’t enough. I expressed up to six times a day and added formula powder for a few weeks, but that was really hard and punishing- and I didn’t get to spend any quality time with my daughter, which is important to all mums anyway, but even more so for me since I had found out, the hard way, just how precious she was.

So, I quickly moved on to the high calorie formula, which really helped with her weight gain. At the age of ten months she had her open heart surgery: A success, thank goodness. The surgeon did warn us that although it was a pretty straightforward procedure, there was a 2% chance of our daughter not making it. ( Interesting figure, considering that apparently “only” 2% of mothers can’t physically breastfeed. One chance out of 50. That number was never negligible to me or my husband…)

Needless to say, I’m very angry, and so was my doctor when she found out how rubbish the medical staff had been. One health visitor, just one, who was so pro-breastfeeding that she had exclusively pumped for her son, dared suggest formula- and that was after I asked about it. She actually hinted that she was glad I was mentioning it because she was, basically, as a professional, not supposed to! That goes to show that you can be very pro-breastfeeding and still realize that in some cases, formula is indeed a very good alternative. ( Other myth: all health visitors are rubbish and don’t know what they’re talking about…well, that one was very good )
Anyway, I appreciate that my daughter’s case is not typical and that some babies will put on little weight over a couple of weeks and actually be OK. But we have to stop saying that weight gain is meaningless.

When my daughter was “failing to thrive”, I was thinking it was because I couldn’t feed her properly. It was down to me. It’s meant to be natural, it’s meant to be that way, like that stupid ad suggests “all babies are meant to be breastfed”… There is a lot of controversy surrounding formula advertising; it’s been suggested that educated, mature women will fall for the whole formula con, and believe that formula is just as good, if not better than breastmilk.

Well, this educated mother here listened too hard to the breastfeeding propaganda and myths.

***

Start off the new year on the right foot: send your story to formulafeeders@gmail.com. It’s cathartic, I swear!

So there’s this nationwide nurse-in at Target….

This was supposed to be a post about a nurse-in provoked by an incident that occurred at a Texas Target, where a mother was apparently sitting unobtrusively in a corner (albeit on the floor) nursing her infant under a cover. The woman was asked to move to a dressing room, and when she refused, she was treated rather rudely by the Target staff. According to a letter from the mother herself which was posted on Best for Babes’ website:

“Briefly I will say that 2 female employees came and verbally asked me to move. The 2nd one told me that Target employees had been told/trained to interrupt nursing and to redirect mothers to the fitting rooms. Even after I informed the 2nd employee of my legal right to nurse in public she still suggested me moving closer to the jean display, turning to face another direction, and also turn my basket a certain way which would have put me practically underneath the jean display and totally barricaded me in. Employee #2 even hinted in a threatening way “you can get a ticket and be reported for indecent exposure” when nothing was being exposed and there was more boob showing from low cut shirts several shoppers were wearing that night. This does not include the other 3-4 employees besides the 2 verbal ones who were all watching and making a spectacle of my nursing by standing around pretending to do something and giving me mean looks and shaking their heads no back and forth. In a side note not a single non-employee customer ever saw the incident so I’m not sure why the employees were trying to act like I was offending “the public” and that it was their job to step in.”

When she contacted Target headquarters, they informed her that their rules were not necessarily one and the same with state laws. The mother approached Best for Babes, and through grassroots efforts, an international nurse-in was planned for Wednesday, Dec. 28th at 10am.

I heard this story and immediately thought, awesome. There have been cases where I thought a nurse-in was a misguided approach; a recently publicized situation in Washington D.C. springs to mind, when it was apparent that the issue was not breastfeeding in public, per say, but rather loitering in the hallways of a government building. I think that the power of this particular sort of protest is lost when used too often for the wrong things; I also believe that nursing moms deserve the same rights and privileges as everyone else – not less, but also not more. If the goal is to normalize nursing, let’s normalize it, not glorify it.

Yet, I have said many a time that if there were a way for a bottle-feeding mama to voice her support for a woman’s right to nurse in public, I’d champion whatever it was. This kind of seemed like “it”. I don’t know this mother from Adam; I don’t know if there was another side of the story; I don’t know if she’s telling the absolute truth about how it all went down. But I’ve seen enough scorn directed at women who are nursing in public to feel that this is a plausible scenario. So I think it’s at least worth encouraging bottle-feeding moms who do want to support the cause to go for it, and to let them know that they (hopefully) would be welcome to join their nursing sisters down at the local Target to make a statement.

I posted as much on Facebook, and boy, was it not the reaction I was expecting.

The first argument that popped up was that some readers felt a nurse-in was unwarranted. Many felt the issue was that this mother was parked on a floor feeding her baby; had she been accosted in, say, the cafe area, or on a bench, it would’ve been a different story. I wholeheartedly agree with this. Large retail chains need to follow some basic safety rules, and having someone sitting in aisle could be a fire hazard. It may be a stupid rule, but that’s not really the point. For example, a Target employee recently embarrassed me terribly by telling me rather loudly that “my child needed to sit down in the cart right now“. My son is shy as they come and not rowdy in the least; he had stood up for a split second to point at a shirt he wanted. I was pissed, and felt simultaneously ashamed and outraged. Who was this kid to tell me how to parent? was coupled with “What kind of parent am I that this kid has to tell me to abide by basic safety rules?”

But from what this woman has said, and Target’s response (or at least what the media has reported as Target’s response), I don’t think this had much to do with her sitting on the floor. My litmus test is imagining what would’ve gone down if she was feeding her baby a bottle on the floor… and somehow, I really can’t imagine the situation evolving in the same pattern. Maybe I’m wrong; maybe this is only because a bottle-feeding mom would know that it wasn’t anything to do with antiquated ideas about public indecency, so she would just think it was Target being asinine about regulations. In my gut, though, I feel that this was about breastfeeding, and if so…. that is not okay. And I think a statement should be made to show the world that mothers won’t take this sitting down (no pun intended).

Look. If we strip down all the mommy war bullshit, the sad fact remains that all mothers are disenfranchised, in one way or another. If we don’t stand up for each other, who will?

But, um, on the other hand…FFF Sara voiced something on the Facebook thread that gutted me (and I hope she doesn’t mind me re-posting it here):

I know that fff doesn’t want to contribute to the bf v. ff animosity that is so prevalent. And I respect that. But sometimes it feels so one sided to be a ff mama who supports bf rights. We have to explain and defend ourselves, our decisions, our reasons for ff all the time in a motherhood culture where “breast is best!” and “formula is poison” are constant refrains. And we need to make sure they know we support their right to bf lest we sound politically incorrect and disloyal to the sisterhood. Yet I so rarely see the bf community sticking up for the ff mama’s. Maybe when they stage a bottle in at a so called baby friendly hospital…maybe when they stop comparing ff to child abuse…maybe when they stop saying “formula should only be available by prescription only”….maybe when I can say I ff my kids without getting dirty looks from other mamas, without having to go into an explanation about my depression meds being contraindicated with bf, and wax pathetic about how I really wished I could nurse too just like the real mamas just so I can pass some kind of deserving of motherhood test that women with kids inflict on each other..maybe then I will begin to care more deeply about the plight of nursing mothers on the floor of Target…I wish that support was more mutual. And bf moms have so many advocates, groups,organizations,consultants. We ff mamas have you.

Touché. And ouch.

Reading that, I felt like an asshat. I realized I never should have posted about a nurse-in without explaining myself first. 

Guys, I know it seems like I am getting all riled up about breastfeeding moms when I should be focusing on the injustices that formula feeders are facing. Both types of feeding come with their own particularly noxious pile of crap. Breastfeeding moms get nasty looks when trying to feed their babies in public; bottle-feeding moms get nasty comments from physicians, the media, and the parenting literature. It shouldn’t be a battle over who has it worse. 

I know that many of us feel we don’t get the same solidarity or compassion from the bulk of the lactivist community. And you know what? We don’t. But I want to stand up for the women who do give us support; the ones who do stand up for us on a daily basis on breastfeeding blogs; the ones who frequent this blog and our Facebook page and Bottle Babies and offer positive commentary on a daily basis. I want to stand up for our breastfeeding friends who are being harassed for nursing in public, just like they stand up for us when people start hurling “breast is best” admonishments at grieving mothers. I don’t have blinders on; I realize that most of the women involved in this particular nurse-in probably don’t give a rat’s ass about me or any other formula feeding mom; I know that many probably think we perpetuate the same bottle-feeding culture which alienates them in the first place; many are the same folks who have berated us time and time again, who have pretended to support us and then belittled us behind our backs. 

I don’t care about them. I care about you guys. But I also care about creating a future where mothers do have each others’ backs. I know it’s probably futile and Pollyannic and all, but I can’t help myself. I hope you can at least trust that if I didn’t think that standing up for a breastfeeding mom’s right to nurse in public would make things better for all mothers, us included, I wouldn’t bother to bring up the protest in the first place.  

I take the credo of this blog very seriously. “Standing up for formula feeders” means that FFF is first and foremost a blog that supports and protects formula feeding or combo feeding mothers.  But the second half is important as well – “Without being a boob about it” means that I will fight for breastfeeding rights too, because I don’t want anyone feeling ashamed or marginalized, because of the way they feed their babies.  

That said, all I ever wanted to do here is spread the word about the nurse-in, in case that some non-breastfeeding moms would like to participate or show support. That’s it. It was never meant to be a huge issue, and certainly never meant to hurt any of you, or make you think my focus is blurry. Information on the protest can be found here; I would love to hear about how it goes if any of you do attempt to join the demonstration; otherwise, case closed, ok?

And just wait until I have an opportunity to stage the “bottle-in” that another reader jokingly referred to on Facebook. I’m chomping at the bit for that one.


 

FFF Friday: “I formula fed her and enjoyed her, and it was the best decision I ever made”

Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They are also not political statements – this is an arena for people to share their thoughts, and I hope we can all give them the space to do so.

I’ve saved Melissa’s FFF Friday entry for right before the holidays, because I feel like it is a perfectly packaged, lovely gift: beautifully written, honest, and with the exact message I’ve been trying to impart since day one of writing this blog (although she did it better in one attempt than I’ve done in 2.5 years of posts. In fact, her last sentence is almost word-for-word in the introduction to my book, but I kind of like how she said it better. Maybe I should have her write my foreword? ;) ). The story is also a primer on the variety of breastfeeding complications which can make nursing a challenge for some moms, which absolutely sucks for Melissa since she had to live through it all, but also gets me all fired up as a researcher. (Sorry, Melissa….!)

Merry Christmas, Happy Hannukah, and a very fearless New Year to you, fearless ones…

The FFF

***

When my oldest was born, I was a pretty young mother (18) and came from a staunch formula feeding family. Much to my mother’s chagrin, I planned on breastfeeding – in fact, I knew I’d breastfeed, it was that simple. However, I figured it came “naturally” (it’s natural, right? That’s what they tell us!) and did absolutely nothing in the way of preparation outside of reading a few websites and buying lanolin and a hand pump for times when I needed to be away from the baby. To everyone’s surprise, my baby was born four weeks early due to PROM. At 36 weeks, she was a hefty 8lb, 4oz, and as expected, her blood glucose levels were poor. Right after birth, she was taken to Special Care to be given glucose and formula, despite my stating that I wanted to nurse her right away.

When I finally got my hands on her at four hours old, she already had a full belly and was completely uninterested in nursing. The lactation consultants weren’t available as she was born over the Christmas holiday, and the nurses were cold and at times downright rude to me due to my young age. I actually had a nurse laugh in my face when I expressed frustration that my breasts were so floppy and hard to manage when trying to get her latched on (this would have been a key warning sign to a lactation consultant that something was amiss – but they weren’t there…) At five days old, despite nursing and pumping, I had no milk, no engorgement and she was jaundiced as a little Oompa Loompa and had lost almost a full pound. I was an emotional mess, she wasn’t latching or interested in eating, and my mother convinced me to go get some formula. And that was it. I pumped for two weeks (and despite pumping 8-10x a day, never gained anywhere near a normal supply.) I was frustrated and stopped at that point. I brought it up to my OB that I never had enough milk and he sort of shrugged it off, stating that I just had never gotten a good nursing pattern going.
When she was four months old, wracked with guilt and fighting severe postpartum depression and feelings of inadequacy that I couldn’t nurse my daughter, I relactated using galactogogues and frequent pumping. I again never gained a full supply, but we used an SNS to get most of her nutrition in, and a nipple shield to get her to latch. I continued pumping and nursing her for three months, until mastitis beat me into submission. I never enjoyed it, and it was stressful and at times I even felt downright resentful – but I was receiving the feedback from so many sources (mostly online, which as a young, isolated mother, was much of my support system and where I turned for advice) that real mothers nursed and that formula was inferior, so I did it.
When my twins were born, I was DETERMINED TO NURSE and swore that nothing would dissuade me. This was apparently a recipe for disaster. They were born full term, after 24 hours of labor, by C-section. My milk “came in” when they were two days old and I was thrilled. I wasn’t broken! However, it became clear that something wasn’t right pretty quickly. The hospital we went to didn’t have an LC on staff, but I knew that despite their latches looking fantastic and how alert they were, something was off. I was able to express milk, but despite a perfect latch, they didn’t seem able to get anything out. I was frustrated but resolved to get through it. We got an LLL-recommended LC up there and she reassured me that everything looked great. She noted that my breasts were not as heavy/hard as she’d expect for that stage, but assured me that it would come. So I kept nursing. They lost weight, but not enough to be concerning, and they didn’t get jaundiced because I would literally sit there and express milk into their mouths while they attemped to suck. This, unfortunately, meant I did almost nothing but feed them, and by the end of the hospital stay I was a basketcase.
We went home and things started to fall apart. Their latch still looked awesome, but my nipples looked like raw hamburger. The babies were hungry and I was losing my mind with worry. I took a 24 hour break from the whole thing, called another LC and made an appointment for the next day, and pumped so my husband could feed them and I could sleep (between pumping sessions, anyway.) This LC came and, bless her heart, she was able to figure out that the babies were getting almost no milk out on their own because they both had high “bubble” palates and tongue ties. I still have no idea how I was lucky enough to give birth to fraternal boy/girl twins who both had oral conditions that made nursing difficult… but there you have it. I decided to move forward and pump and bottlefeed expressed milk to avoid fighting their oral issues while nursing. And from there on, I did almost nothing but pump and obsess. Freezing milk, thawing milk, cleaning my pump, galactogogues, will my domperidone get here on time? Are they eating enough? I, again, never had a full supply, but it was almost enough for the first few weeks with the help of a combination of teas, fenugreek and a high dose of domperidone given to me by a local nursing mom. And when my milk ran out, this mom also donated some milk to me, which I was so grateful for. I was DETERMINED not to use formula, or to use as little as possible.
When they were 10 weeks old, I had a “delayed postpartum” hemmorhage that ended in a blood transfusion. When I told my primary care doctor at my follow-up appointment that I was on domperidone, he called me back a few hours later to let me know that there was a rare but documented link between that class of drug and excess menstrual/uterine bleeding. I was miserable, but I threw the pills out, because I knew that I was no use to my babies in a hospital bed. My supply almost immediately tanked. I stopped pumping about a week later, exhausted by the blood loss and defeated by the fact that I had literally made myself sick trying to give the babies breastmilk. We switched to formula and my husband put the pump parts in the trash – I was done having babies (so I thought!) and he wanted to remove my temptation to relactate again, because he knew the kind of special hell I’d put myself through with our oldest.
Three years later – surprise pregnancy! At this point I had gone from being a stay-at-home mom to working full-time at two jobs. From the start, I decided I would nurse in the hospital and what happened after that was up to fate and my breasts. After a difficult pregnancy, my youngest daughter was born by C-section a few days before my scheduled date, at 38 weeks. She was a big baby and very alert, her latch was fantastic, she had no oral issues and no issues getting colostrum out. I was thrilled, but again, made no promises or statements about continuing to nurse, because I knew where that had gotten me the last two times! She had no bottles or formula at all in the hospital, which I was proud of… but she was nursing constantly, and my milk, again, wasn’t coming in. I was blessed with a very easy C-section recovery, and we went home three days postpartum. Still no milk, and I had no pump and no intentions of buying or renting one, so we kept nursing and syringe fed her formula after feedings. Finally, at six days old, when my milk still wasn’t in and her diaper count was no longer passable, I sent my husband to the store for some bottles and more formula, and that was that. I was slightly sad, but I knew intellectually that something was physically wrong with my breasts that six days of nursing hadn’t produced a milk supply or breast changes. But I didn’t pursue it, I didn’t obsess over it. I formula fed her and enjoyed it, and enjoyed her, and it was the best decision I ever made.
When she was 11 months old, I went to the OB/GYN that had delivered my youngest after finding a breast lump. Thankfully, the lump was nothing, but after examining my breasts he asked me whether or not I had breastfed my children. When I told him that I had had major issues, he told me that he believed I had a condition called IGT, based on the spacing and shape of my breasts and the fact that he couldn’t feel much glandular tissue. I was floored and flabbergasted – how had several LCs missed this? (I believe the answer is that I am obese, and so my breasts are significantly larger due to fatty tissue than what LCs see in the typical IGT moms they help.) I went through a lot of emotions with this discovery – anger that no one had figured it out earlier despite so much contact with doctors and LCs over my nursing problems, relief that I had an “excuse” now for not breastfeeding, happiness that I had been flexible and willing to throw in the towel and enjoy my youngest instead of beating myself up over what she ate.
I’ll always agree that breastmilk is made for babies, and that breastfeeding has its benefits. I’m a breastfeeding supporter and believe in a woman’s right to nurse where she wants, when she needs to feed her baby. But for me, breastfeeding was a heartbreaking, painful experience, whereas formula was freedom and happiness and the ability to enjoy my babies. I look back on the early days of my first three children with regret and confusion. Was I really that determined to give them all-important breastmilk, to the detriment of enjoying their newness? That – not failing to breastfeed “right” – is my biggest regret. And if I do have another baby, I will formula feed from birth without apology. The shame I was made to feel – being told that I was “booby trapped,” inadequate, not doing enough to nurse successfully – as a young new mother is something that will never leave me, and it’s the biggest reason I am determined to normalize formula feeding by choice OR by necessity to the subset of society who feels that nursing is the yardstick with which to measure one’s motherhood.

***

All I want for Christmas is (my daughter to get her) two front teeth (because she’s driving me crazy with her night wakings). And also, a new crop of FFF Fridays to sink my own teeth into. Send them along to formulafeeders@gmail.com… thanks!

Walmart recalls formula after infant death: Is your baby at risk?

If you haven’t heard the news, you’re about to. I’m sure the Mommy-blogs will be buzzing in the morning about the terrible tragedy that occurred in Missouri, where 10-day-old Avery Cornett died from a bacterial infection. Avery was formula fed, and the family was using Enfamil Newborn which was purchased at their local Walmart. The authorities made it clear that the case is still under investigation; the bacterial infection could have been contracted from the water used to mix the formula (doubtful) or from the way the formula was handled (plausible, and this is not because of any fault of the parents; hardly anyone follows WHO protocol for formula feeding, because a. they are not informed about it and b. typically, it isn’t a problem) – not to mention some other non-formula-related exposure – and not necessarily the powder itself.

Not that these facts make it any less scary.

Look. There’s no doubt about it: it could turn out to be that the bacteria (a particularly dangerous type called Cronobacter sakazakii) was indeed in the powdered formula. This is even more gut-wrenching when you consider that the type of formula affected was one specifically marketed to newborns, who are most susceptible to bacterial infections.

Formula is a manufactured substance, and it is handled by humans in all stages of it’s “life”. This means it is prone to human error. There can be bug parts. There can be bacteria. It can happen.

These things also happen with other manufactured food substances, of course. It’s just that when a food is specifically designed for babies, you are dealing with a whole other can of worms. Sometimes literally…ahem, Similac….

I’ll be awaiting the verdict on whether or not the bacterium was in the powder or not; Enfamil claims that the batch (which has been recalled from all Walmart stores nationwide) was tested prior to its shipment to stores, but who knows. Ultimately, even if a tiny bit of the bacterium made its way into the powder, using extra-vigilant formula prep could reduce the risk of your baby getting sick. Bacteria has to grow and thrive; things like proper sterilization, using distilled or boiled/cooled water, and cleaning bottles, bottle brushes, nipples, etc extremely well can stunt that growth or murder the little buggers outright. This paper on Cronobacter sakazakii explains:

Though the contamination in infant formula has often been attributed to the dried powder, the origin could well be the environment in which the formula is prepared for feeding. Delays between reconstitution of the formula and the actual feeding may allow growth of the contaminants, particularly if the formula is kept warm. Naso-gastric feeding tubes may be left in place for long periods and initially low numbers of C. sakazakii in the formula could attach to feeding tube and reach levels capable of threatening infant health through biofilm growth on the internal bore of the tubes. As the biofilms grow, individual cells or lumps can slough off and re-enter the formula stream. The infant’s digestive tract is thus continuously inoculated with the bacteria. Infection is likely to be exacerbated by the weak immune system and lack of mature competing intestinal microflora in neonates.

For all the talk about the “risks” of formula, I’d say that this risk – the risk of contamination due to human error – is the only one most of us in the developed world truly should worry about. But please, for the love of all things, don’t let anyone berate you about this being yet another reason formula is dangerous, another reason we should all be breastfeeding. There can be risks to breastfeeding too, especially if you’re using women like us as a sample group. Women whose babies were starving due to insufficient milk; women who were withholding vital medications from themselves because they thought breastfeeding was more important than maternal health; women who suffer emotional trauma each time they attempt to bring a baby to their breast. These risks are small; most women who want to breastfeed will be able to do so without suffering any ill effects.

But most women will also be able to formula feed without facing the threat of bacterial contamination from powdered formula sold at Wal-Mart. We can’t mLinkLinkake decisions based on worst-case scenarios. If we did, none of us would be traveling for the holidays, and if the Los Angeles freeways and the cost of my plane ticket to Chicago are any indication, this isn’t the case.

Think of how many millions of babies drink formula every day. Now think about the last time you heard about a formula-related death due to bacterial contamination. Just as it would be ridiculous to use the story about a woman breastfeeding woman smothering her baby to death on a plane (or in the hospital) as an argument for formula feeding, it would be equally stupid to co-opt this tragedy in the name of lactivism. The real attention should be placed on what we could do to safeguard formula manufacturing from these egregious errors, and more importantly, on Avery and his parents, who must be suffering unimaginable grief.

The FFF Quick-and-Dirty Guide to Formula Feeding: Differences between formulas and bottles

I’ve promised quick and dirty, and instead I’ve delivered Ivory soap-flaked novellas, haven’t I?

Sorry about that. This “chapter” will be as short and to-the-point as I’m capable of.

Two issues I want to cover here: how to pick the right formula, and how to choose the right bottle, for your child. First the easy one….

1. Do different bottles really make a difference?

I’ve raised two primarily bottle-fed babies and yet standing in the bottle aisle still makes my head spin. There are just so many darn choices, and all of them are so… different. I am a sucker for a cool-looking design, so I went for a rather space-age looking set with my younger daughter. Come to find out that space age also means drippy and aggravating.

It really boggles the mind. Anti-colic, anti-gas, with vents and without, glass or BPA-free plastic… But just like there is no one-size-fits-all method of infant feeding, there’s no one-size-fits-all bottle. Even the one that gets the best reviews online may end up being wrong for your particular baby. That’s why it’s hard to say which bottles are the “best”; there was one interesting study conducted by one company which appeared to suggest that their bottles maintain vitamins and antioxidants better than others, but then again, nearly every big-name company claims to be “clinically proven” to lead to less colic or gas. I’d love to see a large-scale, independent study on what bottles really do offer the best health-related benefits, but I’m not aware of any at the moment.

But while we can’t say one is “best” across the board, bottles certainly do differ. Some babies prefer the shapes of certain nipples better, for example (and in fact if you are either combo-feeding or switching from the breast, studies suggest that babies prefer a nipple shape which resembles the mother’s own nipple – this is valuable info for parents of babies who do not transition well). Baby bottles also differ in how much air gets allowed into the bottle by the mechanics of the nipple (this is where all those discs, vents, rings, etc. come into play), which can definitely affect gassy or refluxy babies, at least according to moms I’ve talked to. (For the record, nothing helped my severely refluxy baby, and we tried every bottle on the market. I have a feeling these things make a difference for kids with mild reflux or who are getting gas/discomfort from feeding postures, awkward latches and so forth, but I’m not convinced a bottle can really “cure” a baby with clinical GERD.)

Other than that, bottles differ in how easy they are to clean. The more parts they have, the more aggravated you’ll be at the end of the day when you have 6 bottles to wash and just want to go watch Grey’s Anatomy.

Best advice? Don’t commit to any brand too soon. Before your baby is born, read the reviews online, and choose one to start with. ONLY BUY ONE OR TWO. Don’t make the same mistake I made with the space-age ones and fork out $50 for the 6-bottle set. (Most babies will like whatever they are first exposed to, so if you go for the cheapest BPA-free ones, more power to you.) If your baby likes the bottle you chose, go buy more. If not, try and figure out what he doesn’t like about it. Is the flow too fast? (If so, you may want to see if the company makes a slower nipple; that may solve the problem). Too big? Is the nipple too big for your baby’s mouth? Does it seem like he is swallowing a lot of air, or gulping? Or is the problem on your end – is it an awkward shape for you to hold, or is it drippy?

Sounds lame, but whatever your issue is, Google it. I guarantee you’ll stumble across Babycenter or Facebook threads discussing that very problem, complete with numerous rants and raves about bottles that address your specific concern. Buy one of the bottles you see recommended a lot, and hope for the best. It may take a few tries to find the one that works for you.

You may also want to check out my post on changing nipples and formulas as your baby grows.

2. What are the differences between formulas? Aren’t all formulas the same?

There’s this mythology out there that all formulas are the same. They are not.

Yes, all commercial formulas must meet certain nutritional standards, so all of them will nourish your child. Generics are fine, and there is no reason to pay full price for a name brand if you can get the same result from the cheaper version. But there are indeed differences between brands and types which, although sometimes small, can make a significant difference, especially to a sensitive child.

There are several categories of formula. The first are standard milk-based formulas. Within this category, some manufacturers have different formulas designed for age range – the differences in these is usually that the proteins are a little easier to digest in the newborn version, and there may be more or less of certain vitamins for different age ranges. There are also thickened formulas for reflux, which are just normal, milk-based formulas with added rice starch to help the liquid stay down; and organic versions, which typically use an organic milk source. Not all ingredients in these formulas are organic, however.

While still milk-based, the next category is comprised of “gentle” formulas marketed for babies with sensitive tummies. Depending on the brand, some are made with partially broken down proteins which are easier to digest. Recent studies have suggested that babies fed formulas with these types of protein – called partially hydrolyzed proteins – fare better in a few key ways.So they might be worth considering. You want to look for the words ‘partially hydrolyzed whey or casein” on the label – these are types of milk protein.

Next up, there’s soy formula. There is some question on whether giving babies so much soy protein is a good thing, so these are usually only recommended if a baby is truly lactose intolerant, or allergic to milk protein, or if the parents are vegan. My personal view is that like anything, these should be assessed with a risk/benefit analysis – if you can find another type of formula that works for your baby, it’s probably not worth the (incremental) risk of having her consume too much soy. But remember- this is a small, small risk, so if there are other immense benefits to using soy (for example, your child can’t tolerate milk-based formulas and you can’t afford the hypoallergenics), you can still choose it with confidence.

Then, we have hypoallergenic formulas which are made with completely hydrolyzed milk protein – meaning it’s broken down so much that even babies allergic to milk protein can tolerate it– or a prescription version for severely food allergic babies, made from amino acids rather than milk or soy proteins. These are seriously life-saving for babies with severe allergies or food intolerances, but they are quite expensive and smell pretty nasty (especially when you drip them all over your car. Not that I’d know from experience or anything…) so these should only be used if you really need them. They are also marketed for “colic symptoms”; unless the “colic” is caused by a food intolerance which is exacerbated by regular formula, they probably won’t do all that much for you. Then again, since no one really knows the cause of colic, I could be dead wrong about this. If colic is some sort of gastrointestinal issue, then a hypoallergenic (or “hydrolysate”) formula could feasibly make life easier for a stressed-out baby gastro system. It’s worth a shot. Usually, if these formulas are going to help, you’ll know withing 24-48 hours of trying them. It’s often a quick and dramatic change for the better.

Lastly there are specialty formulas – some for premature infants or infants who are having trouble gaining/maintaining weight (sometimes doctors will have parents use regular formulas and just mix up different ratios of formula to water or add other elements to make them more nutrient dense – which should ONLY be done with a doctor’s supervision), and lactose-free formulas for kids who are lactose-intolerant. Most children are reacting to the milk protein and not the lactose (although certainly not all – lactose intolerance does indeed occur in babies, it’s just not as common as milk protein allergy) and will not do any better on these formulas; they will need a hypoallergenic formula to make them more comfortable.

3. What’s the difference between ready-to-feed, concentrated, and powdered formula?

Formula can come in three forms: powder, ready-to-feed, and concentrated.

The most common and economical option is the powdered formula, where you mix specific amounts of powder with (safe) water to make the formula.

Ready-to-feed is exactly what it sounds like – the formula is ready to go as is, so all you need to do is pour it from the container into the bottle, or some companies make “nurser” bottles, where you just attach a nipple directly to the bottle the formula comes in. These are often used for newborns, due to their ease and safety – if there is no water or mixing involved, there is less chance for human error or contamination. I think if you can afford to use them, they are the best bet for the first few weeks. There’s a lot less to worry about when you’re using these, and what new parent couldn’t use a little break from all the worry?

The last kind of formula, concentrated, isn’t all that common these days, but it is kind of like condensed soup – it comes in liquid form, and you need to add water to make it drinkable.

There are actually some differences in the formula itself when in different forms – some sensitive or refluxy babies do better with ready-to-feed, for example, because it isn’t clumpy and tends to be smoother and creamier in consistency than the powdered version. Also, most powdered formulas contain anti-caking agents – often corn-derived – that certain babies might be sensitive to. But for most babies, the powdered version will work just fine, and it is certainly the most economical option.

Bottom line: formulas and bottles do differ by type, brand, etc. This doesn’t mean one is necessarily better than the other, but there are fundamental differences, so if you are having feeding problems, don’t despair. It may be a case of trial-and-error (and if you’re like me, there may be a lot of error) but eventually you will find a feeding system that makes the heavens open and the sun shine down. Well, maybe not that good, but at the very least, you’ll find a system that allows your baby to be comfortable and fed.

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