a pediatrician on formula: why supported + empowered feeding is "best"
By Marissa Burg, MD
Breast, bottle, or a combo of both. How you feed your newborn is one of the first important decisions you'll make as a parent. You may have a clear preference now while babe's still cookin' and waiting for his big moment. However, parents often overlook the fact that breastfeeding isn't a one woman show. Once your baby arrives, he or she may have other plans.
What I've learned over the years is that parenthood will teach you the same lesson in a million ways. For example, my own feeding experience was all about letting go (something I'm still working on by the way...). Consult your doctor, do your research, talk to other moms to make an informed decision around your feeding choices. Then be prepared to pivot if the journey doesn't go as planned.
While there are certainly medical advantages to feeding your baby breastmilk (aka "liquid gold" or "nature's perfect food" as some call it), breast isn't always "best" for every mama and babe. Not only that, this type of language can be harmful to new mothers who are at their most vulnerable: their body is still healing, they're dealing with crazy hormone fluctuations, and not to mention the lack of sleep.
As a pediatrician and fellow mama, I'm here to tell you that nobody — not your friend, sister, and especially that stranger on the internet — can decide what's right for you, your baby, and your family. It's a decision you get to make as a little family unit, without guilt or fear of judgement. So whether it's breastmilk, baby formula, or some mix of both, I hope you feel empowered by your decision and supported by those around you. I certainly didn't in the beginning so I thought I'd share a little bit of my story...
my feeding journey
As a pediatrician, I never thought much about my own feeding choices before having my first child. I knew all about the benefits of breastmilk for infants (e.g., ideal nutrition, easily digested, protective antibodies, reduced risk for certain diseases), and I romanticized the idea of my daughter and I locking eyes, her sweet suckles, the quiet moments of bonding.
I excitedly bought everything I could possibly need, and then I spent the first month of my daughter's life in shock and disappointment when breastfeeding would not work for us. No matter what we tried, whether it was a new nipple shield, latch adjustment, or pump cushion, it was just not a possibility for her and I. I felt ashamed when she still hadn't gained weight by a month old, embarrassed to talk about it even with my lactation consultants and colleagues at work, and miserable from the pain of constant feeding/pumping attempts and lack of sleep.
I knew as a pediatrician that breastfeeding doesn't always work for everyone, and despite my best efforts to tell myself what I would tell my own patients — that breastfeeding shouldn't cost you your mental health, formula is highly nutritious — I couldn't stop feeling this way. Until my mom reminded me that I was a formula-fed infant who turned out just fine. It was then I gave myself permission to make the switch and life instantly turned around for me. After this huge, draining weight had been lifted, I could finally enjoy my baby and being a new mother!
I hope this inspires you to take control of you and your babe's feeding journey and not let guilt or expectations get in the way. If breastfeeding ends up not working out for you or your circumstances, please know that you are making the best choice for you, and there are also some amazing perks to formula that aren't always talked about...
6 formula benefits
1. It will help your baby grow + thrive.
Formula is highly nutritious for infants. The content in terms of calories, protein, and vitamins is regulated to be very similar to breastmilk, with the exception of added iron to prevent anemia and vitamin D to keep their tiny bones strong. These both need to be added as supplements to the diets of breastfed infants.
2. It can save you time.
Maybe you don't want to put in the work of a another full time job in addition to being a mom and employee. Breastfeeding is conservatively estimated to take 1,800 hours of a mother's time in a year. This is very close to a 40 hour work week with 3 weeks of vacation (1,960 hours a year). In comparison, formula feeding took about an hour a day for me, or just 365 hours per year.
3. It gives you back some of your freedom.
After sharing your body with another human throughout your entire pregnancy, this may come as a relief — especially if nursing/pumping was causing you pain and discomfort as it was for me. Formula feeding will also allow your partner and loved ones to help you with feedings. They'll get their own bonding time with babe and you get a much-needed break. Win-win!
4. It's convenient.
Of course, having babe's food source with you at all times comes in super handy. But many parents don't realize that formula feeding can be really convenient, too. All I needed was powdered formula in a container and a bottle of water and I could go anywhere with my baby. There was no longer a need to lug around my pump and all its parts (e.g., flanges, pumping bra, cooler, ice packs) or find the time and a private space to pump. It also made it easier to go places without my baby — returning to work was certainly less of a hassle and required way less planning compared to when I was pumping.
5. You know how much your baby is eating.
If you've ever had a newborn, you know that it's normal for them drop 7% to 10% of their birth weight in the first 10 days. After that, they should steadily gain about an ounce a day during the first month. However, if your baby is not gaining weight like my daughter initially, bottle feeding can help you track exactly how much babe is getting. Some newborns may also struggle with weight gain and stomach problems due to an allergy to dairy or soy. They can be fed alternative formulas specially made for babies with food sensitivities. A breastfeeding mom would have to change her diet to help improve her baby's symptoms.
6. Babe may stay fuller for longer between feedings.
Babies digest formula more slowly than breastmilk. This often means that you and babe will both enjoy sleeping longer stretches of time. This was definitely the case for both of my children as soon as I made the switch.
the formula shortage
While formula does have its many benefits, abundant availability is currently not one of them. As of now (August 2022), the national formula shortage is starting to ease compared to a few months back but things still have not returned to normal. A large American plant that had been closed has finally reopened and overseas formula products have been approved by the FDA and are now being sold in the U.S. Things are looking up but the issue is still ongoing. Here are some tips to help parents cope in the meantime:
1. Try a different brand.
It is perfectly safe to use a generic version instead of a name brand formula as they are equivalent (and less expensive!). Or you can switch to another name brand or a different version of the brand your baby is used to. Your pediatrician will often have free formula samples in their office that you can try out, too.
2. Don't dilute.
It is not safe to dilute your baby's formula with extra water or to make your own. It is also not safe to feed your newborn toddler formula, goat's milk, or start solid foods before they are 4-6 months old.
3. Ask your pediatrician.
The American Academy of Pediatrics released updated recommendations in response to the formula shortage. For example, they say if in a pinch whole cow's milk may be an option to use on a temporary basis for babies over 6 months old. I recommend you talk to your child's pediatrician about the safety of cow's milk and other alternatives to baby formula before making any switch. And please let them know if you're struggling to find an available formula that works for your baby, and they can help point you in the right direction.
From well-intentioned opinions on what's "best" for your baby to the ongoing formula crisis, it is certainly not an easy time to raise a child. It's also important to remember the big picture. There is so. much. more. to parenthood than what's right in front of you. You and babe still have a lot of growing to do, starting with owning your parenting choices and feeling confident in your new mama skin. You got this.
Dr. Burg is Mom to Scarlett and Hunter and a Board Certified Pediatrician at Amherst Pediatric Associates in New York. She is also an Associate Clinical Professor at SUNY Buffalo Medical School and cares for newborns at three local hospitals. She received her medical degree at The University of Buffalo School of Medicine and completed her Pediatrics residency at Women and Children's Hospital of Buffalo.