Breastfeeding and Formula Supplementation: What are the risks?

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Breastfeeding and Risk of Formula Supplementation.

The maxim, “breastfeeding is the way to go!” was drummed in early in my pediatric training and it remains a scientific fact to date. Recently the World Health Organization (WHO) conducted surveys and monitored growth for years on exclusively breast fed newborns in stable home environments from six racial backgrounds in six different geographic regions of the world to get an idea of how a normal human ought to develop in the first 2-years of life. The finding which shows that we all grow in a consistent manner regardless of racial background when exclusively breastfed corroborates the importance of breastfeeding. Baby friendly hospital initiatives gaining traction in some valley newborn nurseries draw their antecedents from these initiatives by the WHO.

There are various reasons why a newborn infant may not handle the transition to establishing normal breastfeeding after birth as well as anticipated. These situations often call for formula supplementation informed by medical reasons. This recommendation frequently meets resistance and understandably so from mothers who want to exclusively breastfeed their newborns. Their concerns are often premised on the fact, that formula supplementation would hamper subsequent establishment of successful breastfeeding.

In the May 2013 of Pediatrics, a publication of the American Academy of Pediatrics, Dr. Flaherman et al set out to address this question for the first time and find out what effects if any the early administration of small formula volumes would have on newborn breastfeeding rates between the first week and the third month of life. 40 exclusively breastfed newborns who had met the medical criteria for early formula supplementation were randomly assigned to a study arm and a control arm. The researchers used a randomized control trial (RCT) model to study the effects of formula supplementation on these newborns. RCT type studies are widely ranked high on the hierarchy of medical evidence and scientific scrutiny.  Their findings show that longer term breastfeeding rates were better than anticipated at the first week of life and at 3 month in infants who were allowed early formula supplementation for medical reasons.

This is the first study of its kind to address this concern and indeed shows that our collective fears and concerns about potential adverse effects of early formula supplementation of maternal breastfeeding efforts may be exaggerated and not actually inimical to successful long term breastfeeding rates. There are caveats however, since the infants were supplemented with formula fed by syringe and not a bottle and nipple perhaps to avoid the hobgoblin of nipple confusion is one key outlier not adjusted for in this study. The small size of the study participants also limits the statistical power and applicability to the general population.

We laud the efforts of all mothers and acknowledge the challenge of exclusively breastfeeding a newborn. We champion this cause at our practice and support variations of it. Ultimately the overarching goal must remain optimal nutrition for the newborn to support healthy growth and development.

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