Inclusion and support for mothers and babies who can’t participate in breastfeeding
It is a wrap as we conclude the world breastfeeding week, but we are not leaving out mothers and babies who cannot participate in breastfeeding. Health experts have proven breast milk is the best nutritional choice for infants. However, breastfeeding may not be possible for all women. For moms who can’t breastfeed or who decide not to, infant formula is a healthy alternative. Formula provides babies with the nutrients they need to grow and thrive. Some mothers worry that if they don’t breastfeed, they won’t bond with their baby but the truth is loving mothers will always create a special bond with their children and feeding no matter how is a great time to strengthen that bond.
Bonding with your baby
Breastfeeding is a wonderful way to bond with your baby, but it isn’t the only way. At feeding time, hold your infant close to you and make eye contact. You can even hold your baby in a breastfeeding position while you bottle-feed them, with lots of skin-to-skin and eye-to-eye contact.
Remember, your relationship with your child isn’t based on whether you breastfeed or bottle-feed them. How you respond when they cry, how often you hold them, look at them, talk to them, play with them, and how you are as a parent matters more than how you feed them.
Reasons why you can’t breastfeed
In special cases, women may be advised not to breastfeed. These instances include when a woman is taking certain medications or drugs, when she has been diagnosed with a specific illness, or when other specific conditions apply:
- Certain medications are known to be dangerous to infants and can be passed to your infant in your breast milk. Women taking the following medicines should speak with their health care providers before considering breastfeeding:
- Antiretroviral medications (for HIV/AIDS treatment)
- Birth-control medications containing estrogen, until breastfeeding has been well established
- Cancer chemotherapy agents
- Illegal drugs
- Certain medications prescribed to treat migraines, such as ergot alkaloids
- Mood stabilizers, such as lithium and lamotrigine
- Sleep-aid medicines
- In addition, women who are undergoing radiation therapy should not breastfeed, although some therapies may require only a brief interruption of breastfeeding
- Medications that are safe during pregnancy may also be safe for you to continue while you are breastfeeding, although you should check with your health care provider to make sure they are safe before you breastfeed
- Contact your infant’s healthcare provider if you see any signs of a reaction to your breast milk in your infant, such as diarrhea, excessive crying, or sleepiness
- Women with certain illnesses and infections may be advised not to breastfeed because of the danger of passing the illness or infection to the breastfed infant.
If you have any of the following conditions, breastfeeding your infant is not advised. For more information, speak with your healthcare provider:
- Infection with HIV
- Infection with human T-cell lymphotropic virus type I or type II
- Untreated, active tuberculosis
2. In some additional situations, or if women or infants have certain health conditions, women may be advised not to breastfeed or may have difficulty breastfeeding:
- Women with certain chronic illnesses may be advised not to breastfeed, or will be advised to take steps to ensure their own health while breastfeeding. For example, women who have diabetes should monitor their blood sugar levels regularly, may need to reduce their insulin, and may need a snack containing carbohydrates before or during breastfeeding. Also, women who are underweight, including those with thyroid conditions or certain bowel diseases, may need to increase their calories to maintain their own health during breastfeeding
- Women who have had breast surgery in the past may face some difficulties with breastfeeding
- Women who actively use drugs or do not control their alcohol intake, or who have a history of these situations, also may be advised not to breastfeed
3. Infants who have galactosemia: a rare metabolic disorder in which the body cannot digest the sugar galactose — should not be breastfed. Galactosemia is detected by newborn screening, allowing proper treatment and diet to begin immediately. If not detected, the galactose builds up and becomes toxic for the infant, leading to liver problems, intellectual and developmental disabilities, and shock.
Other safe options available apart from mother’s breast milk
It is important to make this decision alongside with your healthcare provider, you can choose to:
- Feed your baby formula: It is a safe alternative for breast milk, providing all the nutrients your baby needs for the first six months of life. All infant formula has to meet high food and nutrition standards. Choose one that is the right age and stage for your baby and talk to your friends who formula feed.
- Use donor milk: Donor milk from breast milk banks is often used in hospital Neonatal Intensive Care Units (NICUs) to help feed premature or sick babies whose mother’s own milk isn’t available or isn’t quite enough. Some women use donated breast milk from other breastfeeding mothers they know or might connect with others through an informal breast milk sharing community. Your lead maternity care giver (midwife or obstetrician) can guide you.
What’s in Baby Formula?
A baby formula ingredient list can vary widely, but there are certain components that must be present. The Food and Drug Administration (FDA) requires minimum amounts of 29 different nutrients in baby formulas. At least, 9 of those have specified levels that cannot be exceeded for every 100 calorie-serving of formula. Note that baby formulas are designed to meet the highly complex nature of an infant’s biological needs. Because breast milk is the optimal source of nutrition for babies, baby formula exists to mimic its composition as closely as possible in both its physical and nutritional properties. This is precisely why it’s not safe or appropriate to substitute milk beverages, whether dairy or plant-based, in place of baby or toddler formula, or breast milk for babies. Milk beverages like these simply do not have the caloric density, nutrient composition, or carefully planned components to support a baby’s growth and development. It would, therefore, be dangerous to use them as a substitute.
There are also a variety of prebiotic oligosaccharides mixed into the powder formula or any other form of baby formula to mimic the gastrointestinal tract of breastfed babies. This includes stimulating the growth of bifidobacteria and lactobacillus.
There have long been three main types of baby formulas on the market: cow’s milk protein-based, soy protein-based especially for babies with galactosemia, and non-dairy specialized formulas like the hydrolyzed formula with broken-down proteins to increase digestibility. These ingredients have mixed in to resemble breast milk as much as possible.
Stick to baby formulas with the purpose of nourishing babies well. Here is a baby formula ingredient list, which tells you everything required when creating them:
- Protein
- Fat
- Linoleic Acid
- Fat-Soluble Vitamins A, D, E, K
- B Vitamins: B6, B12, Niacin, Thiamine, Riboflavin, Pantothenic Acid, Folic Acid
- Vitamin C
- Calcium
- Phosphorus
- Magnesium
- Iron
- Zinc
- Manganese
- Copper
- Iodine
- Selenium
- Sodium
- Potassium
- Chloride
- Only required to be added to non-milk based formulas: biotin, choline, inositol
These nutrients are either naturally found in the components used to make the formula (e.g., cows’ milk, soy, etc.). Or they are added through fortification to ensure the final product meets the required amounts per serving for babies and doesn’t exceed the regulatory maximums.
Extra ingredients
Some formulas have rice starch added, intended to help babies who are prone to reflux keep formulas down. Other formulas have been specifically made for premature and low birth weight babies, incorporating extra calories and nutrients to support catch-up growth. Some formulas are enhanced with extra ingredients such as the omega 3 fats docosahexaenoic acid (DHA) and arachidonic acid (ARA), which are found in breast milk and fatty foods. Research indictates that DHA and ARA can help with normal brain and vision development in babies, but other studies have found no significant impact at this age. Additionally, some baby formulas contain prebiotics and probiotics, but this is not required by the FDA. While these compounds have the potential to support digestion, immunity, and a healthy gut in general, research is ongoing around whether adding them to baby formulas is beneficial.
By Damilola Ilori
References
Centers for Disease Control and Prevention (CDC) (2022). Questions and Answers for Consumers Concerning Infant Formula. Food and Drug Administration (.gov) https://www.fda.gov/food/infant-formula-guidance-documents-regulatory-information/status-update-fdas-infant-formula-response-activities
Else Nutrition (2023). Signs Your Formula Doesn’t Agree with Your Baby (& What to Do!). Else Nutrition. https://babymilkbar.com/blogs/guides/signs-formula-doesnt-agree-with-baby
Food and Drug Administration (FDA) (Title 21: Code of Federal Regulations. Part 107 — Infant Formula). (.gov) https://www.fda.gov/food/resources-you-food/infant-formula
National Institutes of Health (NIH). (n.d.). Breastfeeding and Special Conditions. National Institutes of Health (.gov) https://www.nichd.nih.gov/health/topics/factsheets/breastfeeding
National Institutes of Health (NIH). (n.d.). Galactosemia. National Institutes of Health (.gov) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9313126/
Nemours KidsHealth. (2023). Breastfeeding vs. Bottle-Feeding. KidsHealth — The Nemours Foundation. https://my.clevelandclinic.org/health/articles/15274-benefits-of-breastfeeding
Ren, C. Y., & Ziegler, E. E. (2016). Early infant feeding and breast milk composition. Advances in Nutrition (Bethesda, Md.), 7(3), 613–623.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882692/