This post is Part 2 in my Spilled Milk series, providing a balanced profiling of different milk options based on objective, medically and scientifically based sources. As mentioned in my first post, which was about breastmilk, I will mostly be compiling research with regards to what these choices are, and will leave the rest to my readers to decide for themselves.
Note that at the end of this series, I will be creating a handy little chart comparing all the options for you!
In my last entry, I covered what I consider to be objective key information about breastmilk. Now I’d like to talk about the “alternative”: formula. Often demonized for being an “inferior choice”, formula can be a taboo subject. For many moms, myself included, particularly in this Baby Friendly Initiative age, pulling out a formula bottle can make us feel like lesser parents, lazy cop-outs — a feeling that is often reinforced by other moms and even doctors/nurses/lactation consultants who (unsolicited or not) provide input on our feeding choices.
If you have read my blog at all, you will know that my son was “exclusively breastfed/fed breastmilk” for the first 6 months of his life save occasional formula “emergencies.” After crossing the 6 month mark, and in the face of supply issues from months of full-time work and other related factors, our son became mixed/”complementarily” fed (60-70% breast, 30-40% formula, and 3 solid meals a day). However, to this day, though I almost never judge other moms for their feeding choices, I do continue to feel occasional fears of judgment, and “failure” (failing my own wishes and expectations) when I pull out a scoop of S26 Gold.
As such, I do hope that, through the course of both my writing and your reading this, some level of enlightenment and peace is reached over the case for formula feeding, and we can all stop judging and shaming each other.
All that said, here’s what we’ll look at today:
- History of Infant Formula
- Common Criticisms of Formula Feeding (What’s true and what isn’t?)
- Pros of Formula Feeding
- [Optional Reading] My Two Cents
#1 History: In the old days (dating way back BC even), wet nurses were the popular substitute in the case of lactation failure or an absent mother. In addition, historical records show that some babies even received animal milk as a substitute — plus pap (a semi-solid breadcrumb based mush), gruel (boiled cereal in milk), or panada (bread cooked in broth) for infants not thriving on the milk. The most common animal milk to use back then was cow’s. However, in the late 1700’s, scientists began to analyze the chemical differences between different milks, and so began the journey towards creating specialized infant milk substitutes designed to mimic (“as closely as possible”) the benefits and composition of human milk. Here is a helpful screencap (from the National Academy of Sciences) with a year-by-year history of infant formula:
In the late 19th century, formula grew in popularity particularly in response to incredibly high infant mortality rates. The medical industry encouraged mothers to turn to system, schedule, and science in their baby feeding habits. This lasted well into the 50’s in the West, and even further to the 70’s in the East. That’s why, for most of us in our current generation (babies born in the 80’s-early 90’s), our parents come from a time when everyone was formula fed. This was “en vogue,” and what many “modern”, middle-class families did.
In the 50’s, tides shifted more in favor of breast milk in the West, and a couple of decades later the East followed. In 1956, the La Leche League was founded by 7 concerned citizens after the breastfeeding rate in the US dropped to nearly 20%. The group published its first book in 1963 called The Womanly Art of Breastfeeding, and a year later they were incorporated into La Leche League International Inc (LLLI).
In 1990, the breastfeeding rate dropped again to about 50% this time (after decades of consistent improvement between +3-6% year after year), UNICEF and the World Health Organization authored the “Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding.” It was signed by 10 UN Agencies and 32 countries. In conjunction with the Declaration, the Baby-friendly Hospital Initiative (BFHI) was launched. The BFHI was designed to encourage mothers to exclusively breastfeed for at least the first 6 months of life. If your hospital doesn’t allow pumps, bottles, etc, and has a strict no-supplementation-except-in-emergencies policy against formula, glucose water, and the like; then your hospital likely signed on to the BFHI too. See the entire BFHI paper here.
As a result of the movement pushing for a return to breastfeeding, in many places, formula suddenly became the choice of the poor, whilst breastmilk became a luxury for the privileged. Women with time, education, access to good doctors/consultants/healthy food/etc, were more able to breastfeed successfully; and women without the time, resources, and support had to “resort to formula.” But suffice to say, there was a definite shift in perception following the Inncoenti Declaration.
Formula is commonly composed of a cow, or soy milk base, with adjusted protein, fat, and carbohydrates components to more closely mirror the proportions in human milk. As formula was further developed, and more research on breastmilk was done, formula was (and continues to be) modified to include elements that mimicked other benefits of breastmilk. “For example, iron was added in 1959 to reduce the risk of iron deficiency in formula-fed infants, and long-chain polyunsaturated fatty acids were recently added in an effort to improve infant visual and cognitive development.”1
Most formulas, base milk aside, are composed of similar elements. Here is an example of what’s in Wyeth’s S26 Gold formula (also known as “Promil” in many markets) (according to their site): (You can see the full nutritional information here as well)
|Oligofructose (OF)||A prebiotic that may support gut health and promote softer stools|
|Sucrose-free||May assist in weaning to unsweetened solid foods and help support healthy eating habits|
|Taurine||Help support overall mental and physical development|
|Inositol||Supports importan biological functions in tissues and cells|
|Choline||Helps support overall mental functioning|
|Selenium||An important antioxidant|
|5 Nucleotides||Support body’s natural defenses (only for infant formula targeting infants less than 1 year of age)|
As research continues to tell us more about the benefits and breakdown of formula, companies iterate to include these elements in their milk.
#3 Common Criticisms of Formula & Formula Feeding (What’s true and what isn’t?):
If you’re a parent who’s used the internet to look up “baby milk” even just once, you will have come across these 5 common criticisms of formula and formula-feeding. I would like to take a moment now to unpack each and see which hold weight and which don’t.
- “Formula is just an expensive junk food version of breast milk.”
- So this statement is one of the more popular ones on all-natural mommy blogs in particular. But is it true? Well, in some ways…yes.
- First: It’s true that formula is more expensive than breastfeeding (one comes out of you, and the other you get from the store). But that doesn’t take into account the money you spend on maintaining your milk supply when you are nursing (read: a lot. Because you need tons of water, and food to maintain a healthy supply, and many moms also pay added big bucks in lactation consultations, pediatric visits, and more to achieve alpha breastfeeder status). It also doesn’t consider potential welfare and subsidies made by some governments for mothers who need formula to feed their babies.
- Second: to call formula “junk food” may seem a bit harsh, but it is admittedly processed milk. However, you would typically characterize junk food as several things, including but not limited to: high in added sugars, high in saturated fat, and high in sodium. Formula is none of those things. Formula is (especially these days), very carefully created using elements that are themselves naturally occurring, to make a milk that mimics mothers’ as closely as possible. To those who try to hammer this idea down parents’ throats, I say: take your hyperboles and polemic elsewhere. “Processing” food is not always a bad thing. For example, the milks we find on our shelves in groceries are almost always pasteurized. The delicious cheese we eat, the soy milk you put in that chai latte; these all undergo processes of some sort and are not inherently bad for us. It is only in the abuse and/or misuse of these perishables that they can be considered dangerous.
- So this statement is one of the more popular ones on all-natural mommy blogs in particular. But is it true? Well, in some ways…yes.
- “Formula is full of chemicals that are going to kill our babies.”
- There is no concrete evidence that links formula itself to any increases in infant mortality. There has been a correlation in recent years to the increasing infant mortality rate and formula-feeding, however, meta research and deeper literature analysis shows that this correlation could simply be owed to the fact that (in the locations researched) poorer women misuse formula when feeding their children (mixing too much water with too little formula and causing complications, sometimes even death). Thus, there is no concrete evidence to show that it is the formula itself rather than a lack of proper support, supply, and education.
- “Formula makes your baby more susceptible to problems with cancer, obesity, allergies, and asthma as they grow older.”
- As with #2, correlations but not causations have been found across multiple studies stating formula-fed babies are more likely to experience health complications when older. For every 5 medical journal entries you find boldly stating the correlation between formula-feeding and childhood obesity, for example, you will find at least another 2 saying the jury’s still out on that one. If you ask me personally, I would say this: The entire generation above me on both maternal and paternal sides received little to no breast milk but what made more of a difference in their childhood weight gain and growth was the amount of healthy food they were served growing up, and the amount of time spent active. In any case, the present truth of the matter is that the effects of generations of exclusively formula feeding are only being realized now, and at the same time, those effects will never be the same effects our own children experience because formula itself is constantly changing and “becoming better.” Instead of worrying too much about what you can’t know, just do the best you can do with what you do/can know.
- “Formula-feeding dilutes integral bonding time between mothers and babies that cause psychological and/or developmental issues in the future.”
- I disagree with this in particular. There are many other ways (not just breastfeeding) that can build a bond between parent and child. Again, I know many formula fed babies and formula-feeding mothers, and they don’t seem to love each other any less. The experience may be different, but who is to say the love and bond are not as fierce?
- “Formula-feeding doesn’t allow mother to receive important biological benefits of breast feeding/direct latching.”
- This is actually true. For example, direct latching in the early weeks helps contract your uterus and shrink it to healthy size. This is an important postpartum step and skipping it can have negative effects. Research has seen a correlation between skipping breast feeding and experiencing higher risk of ovarian cancer, uterine complications, and more. If you are planning to formula-feed from birth, talk to your doctor about what the implications are or could be on your body and go from there.
#4 The Pros of Formula Feeding:
- You will always know how much your baby is getting — no worries of “is it enough?” “is he dehydrated?”
- In the early days, it can be incredibly nerve-wracking (and actually dangerous/life-threatening) when baby is new to the world and not getting enough to drink. Formula feeding allows you to immediately measure and organize your baby’s drinking schedule and habits to ensure he/she is receiving the optimal amount of nutrition from the get-go.
- You have the flexibility to go back to work quickly.
- Many women don’t have the luxury of staying home for months on end and nursing directly. And more women still don’t even have the luxury of being able to pump at work or during the day. As such, formula is their next bet. Formula-feeding gives you the flexibility not to have to worry about missing a pump, or a feed, and rest assured that your baby is still getting the sustenance he/she needs.
- Your co-parent can have a more equitable share of chores from the very start.
- Formula feeding will allow you to equitable split of responsibilities with your partner from the beginning, and thus grant you both sleeping time in accordance to what you’ve agreed upon. This also allows your baby to bond well with daddy and vice versa! A nice little plus of equitable responsibility in those early days.
#5 [OPTIONAL READING] My Two Cents
This bit is “optional” because I know I promised objective commentary and you’ve basically gotten that above. But I did want to close with my own thoughts on the matter. If you are interested, do read on.
After all of this research on formula and breast milk, I do believe my initial opinion remains: breast milk is still best for babies and breast fed comes second only to best fed. I know that I’ve said that the research is still unreliable on the subject, and it’s true. Results and methods for data collection remain inconsistent, and it may be decades yet before we see really if there is causative truth to the correlations between health issues and formula feeding, for example. However, infant formula is still a man-made concoction created to mimic human milk characteristics, whereas breast milk is the real thing. If you are in any position at all to breastfeed, I encourage you to try it. But if you find that it is too difficult, detrimental to your health (and your child’s), or just not for you (for financial, medical, etc reasons). Then by all means, go the formula route and do not feel guilty about it. But in any situation, the ideal for me would always be to at least give the breast a try, and if it doesn’t work do the next best thing: proudly give your baby formula and rest happy in the fact that you are constantly doing your best for your child, and you are a super-parent no matter what anybody says.
Now I have two more special notes to leave before signing off:
- To breastmilk evangelists out there: people give up on breastfeeding, or choose formula-feeding for many different reasons. While your position on the matter might be valid in some respects, please approach formula-feeding mothers with love and kindness. You never know the battles people are fighting.
- To formula companies: Do continue to iterate and improve on your milks. Don’t shy away from research that will help you make your product better and safer and ultimately more sustainable.
And there it is. The end of my profile on the two main infant milk options. Coming up soon: notes on other milks too! Goat, soy, cow: what’s best to come next as babies enter the toddler years??
- Fomon SJ. 1993. Nutrition of Normal Infants. St. Louis: Mosby-Year Book.
- Beaudry M, Dufour R, Marcoux S. 1995. Relation between infant feeding and infections during the first six months of life. J Pediatr 126:191–197. [PubMed]
- Pro Formula Feeding
- Anti Formula Feeding
- Baby Formula Has No Place In A Sustainable Future (The Guardian)
- How to Win Any Breastfeeding Argument (The Alpha Parent)
- Babies should be breastfed exclusively for 6 months (The Healthy Baby Code)