Leading health organisations recommend exclusive breastfeeding for the first six months and then for breastfeeding to continue alongside complementary foods for two years and beyond.
Exclusive breastfeeding means only breastmilk is given, with no other liquids or solids – not even water.
Most women want to breastfeed. For example, in Australia, 96% of women start out breastfeeding.
Despite this strong desire to breastfeed, the rates of breastfeeding and exclusive breastfeeding drop month by month postnatally.
Indeed, breastfeeding can be tricky to get the hang of and many women experience breastfeeding challenges. This is why we need to do better to help more mothers achieve their breastfeeding goals, whatever they might be.
As an International Board Certified Lactation Consultant (IBCLC), I find it really irritating when I discover useless research like this recently published piece:  The Effect of Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota: A Randomized Clinical Trial.
In this study, the researchers aimed to determine whether supplementing newborns with small amounts of formula after each breastfeed, before a mother’s milk comes in, affects breastfeeding duration, hospital readmission or intestinal microbiota.
Naturally, I checked the end of the paper and, sure enough, it had been funded by a formula company. Of course!
Regardless of who funds it, though, what is the point of such a study? Using formula is not the way to help women breastfeed. The solution is better breastfeeding support.
Let’s address some of the things the paper claimed.
Here are 4 things you should know:
#1: ‘Exclusive’ Breastfeeding Was Not Exclusive
It was reported no differences were found between the intestinal microbiota of the babies in the ‘continued exclusive breastfeeding’ (control) group and those in the ‘early life formula’ (intervention) group.
However, ‘continued exclusive breastfeeding’ in this study was far from being exclusive. In fact, by one week of age, almost 40% of babies in the control group received some formula.
Comparing fecal samples from mixed fed babies with those from other mixed fed babies really doesn’t tell us anything.
To obtain a clear picture about the effect of infant feeding on intestinal microbiota, fecal samples from genuinely exclusively breastfed babies would have to be compared with those from mixed fed or fully formula fed babies.
#2: No Differences Found In Rates Of Breastfeeding
This study found no significant differences in the rates of breastfeeding at one week and one month between the control group and the intervention group. Therefore, what was the point of subjecting babies to early formula supplementation when there was no clear medical need?
Also, there’s plenty of other research which indicates formula supplementation in hospital actually reduces breastfeeding duration.
#3: It’s Normal For Babies To Lose Weight After Birth
In this study, babies in the intervention group whose weight loss was ≥75th percentile for age were supplemented with 10mL of formula after every breastfeed, starting between 24 and 72 hours before a mother’s milk came in.
However, it’s normal for a baby to lose weight in the first few days after being born and, for many women, their milk won’t have come in by 24-72 hours. These things certainly don’t indicate a medical need for supplementation.
Also, in this study, the criteria used to determine when the babies received supplementation didn’t take into account the range of normal, or the importance of individual evaluation.
This paper reported four babies in the control group and no babies in the intervention group were readmitted to the hospital in the first week. This outcome was not statistically significant.
Regardless of that, there was no evidence in the paper to suggest exclusive breastfeeding was in any way to blame for the hospital readmissions in the control group. And, even if there were, it wouldn’t necessarily highlight the need for early formula supplementation; it would suggest the need for proper breastfeeding support.
#4: Early Formula Supplementation Can Negatively Affect A Mother’s Breastmilk Supply
Breastmilk production works on the basis of ‘supply to match need’. The need is typically determined by the baby. When a mother breastfeeds in response to her baby’s cues, the amount of breastmilk she makes is likely to match her baby’s needs.
Early and frequent breastmilk removal from a mother’s breasts is important to help establish a good supply. If formula is given after breastfeeds, this can result in the baby feeling fuller and not giving cues to feed as often.
If this happens in the first few days after a baby is born, it could result in a mother’s milk supply not reaching its full potential.
Of course, if there were a medical need for formula feeding, it would be important to use that method.
Interestingly, studies have shown as newborns’ weight loss increases, they show feeding cues at shorter intervals. Responsive feeding would therefore become more frequent and would result in increased milk intake and therefore increased production.
It has also been shown that the frequency of feeds on the first two days after birth correlates positively with a baby’s breastmilk intake on days 3 and 5. This would be much less likely to occur if early formula supplementation were given, as it was in this study.
So, overall, this was a really pointless industry-funded study. End of story.
