New parents have countless decisions to make when it comes to caring for their new child. When it comes to feeding an infant, there are only two options – breastmilk or formula. While some parents can easily make that decision, others fret over which is the right choice for their child. Cultural opinions, parental leave and even formula recalls can all factor in which path they choose for their family.
Experts encourage parents to opt for breastfeeding, if possible, because of the benefits. But Registered Dietitian Beth Leonberg, DHSc, an associate clinical professor emerita in Drexel University’s College of Nursing and Health Professions, board certified specialist in pediatric nutrition with decades of experience and author of “Infant Feeding Guidelines for WIC,” adds that mothers need to be supported in that decision.
Leonberg spoke with the Drexel News Blog about the differences between breastmilk and formula and what parents should consider when deciding how to feed their infant.
There are only two ways to feed an infant – breastmilk or formula – for the first six months. What are the similarities and differences between the two options?
Universally, every authoritative health care organization around the world recommends that newborns be breastfed, that the optimal feeding for all babies is breastmilk. That includes babies that are born prematurely and babies that are born at term. Preferably it is the mother’s own milk, but in some instances where that can’t happen, then donor milk would be the second choice.
Breastmilk is preferred over formula because it contains over a thousand bioactive compounds that contribute to what we know to be much better outcomes in the long term for kids who are breastfed. There is lower risk for all kinds of acute childhood diseases, like ear infections, and chronic diseases, like diabetes and cancer. For all of them, the risks are lower when a baby is breastfed as opposed to formula-fed.
Infant formula was developed and marketed as an innovation in the 1940s and was very popular for decades. But over the last 20-30 years, we’ve come to understand the importance of breastmilk. So, we are encouraging people to breastfeed whenever possible, for as long as possible. But infant formula is an appropriate substitute, and it is the appropriate substitute if a baby cannot be breastfed, for whatever reason.
In the United States, we do have manufacturing guidelines that infant formulas have to meet those specifications. And so, generally speaking, formulas are designed to provide similar nutrients as breastmilk, and promote appropriate weight gain, growth and development.
Why would a parent choose one option over the other?
I think the biggest reason that people might opt not to breastfeed is perceived convenience. Or a sort of a cultural perception that it’s that it’s odd, or there’s some sort of sexualization of the breast, as opposed to, using it as a form for feeding the baby. I think those are the main reasons that people opt not to.
Certainly, in this country, because people have to go back to work, oftentimes as soon as maybe six weeks, or up to a few months after the baby is born. It requires the mom to pump and store breastmilk in order for the baby to continue to receive breastmilk while the mom is at work. That requires some effort, in terms of making arrangements to do it at work, or to transport the milk, or to have whoever is feeding the baby use the stored breastmilk. I think those are the primary reasons why people do it.
In the past, we were concerned that infant formula was marketed in the hospital – it used to be that it was given to moms when they were discharged from the hospital. That’s no longer allowed. But it was very convenient to open a can, a bottle, or mix up a powder and so that’s why people might choose to do that.
There are a few medical conditions that might prevent somebody from breastfeeding, certainly somebody who’s had breast surgery. If they’ve had a mastectomy, or they’ve just had some type of breast surgery, it can sometimes interfere with breastmilk production. Otherwise, there’s very few medical contraindications to breastfeeding.
What should parents know, or what are some things that they should keep in mind when deciding which way to go, whether they’re going to breastfeed or formula feed?
We encourage parents to think about what’s best for the baby, and the long-term health of the baby, and that’s clearly breastfeeding.
As healthcare providers, our job is to support parents in breastfeeding, so that they can make that choice and not have formula feeding be more convenient or easier.
Breastfeeding does take work, it does take effort. For some moms and babies, it goes very smoothly. For others, it’s more difficult and it’s more fraught. It’s really important that moms get the appropriate support that they need. That’s where lactation consultants, breastfeeding counselors or peer counselors (there’s lots of different options), can really help to support the mom so that they maintain breastfeeding, as opposed to opting to go to formula.
Last time we spoke in 2022, there was a nationwide formula shortage because the FDA shut down a formula plant and there were pandemic-related supply chain issues. What is different about the recent recall of ByHeart formula?
At that point in time, the shortage was the issue. Because ByHeart is such a small manufacturer, there’s no shortage right now. It’s not really an issue the way that it was back then. The majority of people are still able to access the formula they’ve been using. It would just impact the people who are using ByHeart that are affected right now.
The one thing that has changed over the last few years is that there are more of these smaller companies that have come into the market that were not there previously – ByHeart is one of them.
Do you have any recommendations for parents who may be impacted by this ByHeart recall?
ByHeart has taken a different approach to making formula. They have a patented protein that they promote, as well as prebiotics. They use whole milk as opposed to skim milk with added other fats. They’ve taken more of a whole foods approach to creating the formula. The other formulas that are most similar to that are probably Bobbie and Kendamil. Those are two manufacturers that are new to the market and are more similar to ByHeart.
I would say that for any parent the data is not extensive to show that ByHeart or Bobbie is going to be better for your baby. So, really, any other equivalent kind of formula in the short term is fine.
The issue is that botulism is a risk for infant formula manufacturing for all companies. And that was part of the issue before in 2022. That was a large company, so that affected a lot of people. This is a smaller company. The manufacturing facilities are tightly regulated and inspected, but infant formula cannot be sterile – it just can’t. So, as long as you’re using infant formula, there is a risk that there could be contamination of some type.
Is there not a similar kind of risk with breastfeeding?
Breastmilk is also not sterile, but there’s no risk of botulism. It contains organisms as well, but most of those are organisms come from the mom. Breastmilk is made from the mother’s blood – so whatever’s in the mom is going to potentially be in the breastmilk. But botulism and botulism spores are what we’re concerned about in the infant formula, or other types of bacteria. Those are not something that we have to worry about with breastmilk.
Is there anything else you think is important to mention about infant feeding, breastmilk, formula or this ByHeart recall issue?
If parents have questions, they should seek out healthcare providers, like their primary care doctor or through the WIC program, if they’re WIC participants, as opposed to just relying on social media, as their source of information. That’s how they can get the best advice about what would be an appropriate substitution for their child.
Reporters interested in speaking with Leonberg should contact Annie Korp at 215-571-4244 or amk522@drexel.edu.
