Can a wee drop ‘o formula help breastfeeding?

The Pediatric Insider

© 2013 Roy Benaroch, MD

It’s a tiny little study, a simple one, but could it really be? Could offering newborns just a little bit of formula actually help support breastfeeding in the long run?

Researchers in California reported this month a study of 40 newborns, all of whom were recruited from families who had planned to nurse exclusively, and all of whom got off to a little bit of a rocky start. They had all lost > 5% of their birthweight after 1 day of life, which is not a disaster, but means that they weren’t getting super-good milk transfer yet. These 40 babies were randomized to either get 10 mL of formula (that’s 2 tsp) after nursing, or to continue exclusive breastfeeding.

By the end of their hospital stay, only 2 of the 20 early-formula babies were still getting formula (compared to 9 of the 19 control babies, whose parents had decided to go ahead and give formula on their own.) And: three months later, twice as many little-bit-of-early-formula babies were nursing, 80%, compared to only 40% of the families who had been randomized into the exclusive-breastfeeding group.

Small study, but those sure are impressive results.

To a practicing pediatrician, the outcomes of this study makes some sense. Though many babies nurse well, others seem to grow impatient waiting for mom’s milk to come in. These impatient babies can get cranky and upset, and mom get all sorts of conflicting information that only adds to their guilt and apprehension. A little wee drop o’ formula does seem to settle babies down, maybe enough for them to calmly nurse, and maybe enough to give mom the confidence to keep trying.

I realize that there are a lot of pediatricians and lactation counselors who won’t be very happy with this study—it flies in the face of our typical advice for nursing moms. But we’re here to be humble and learn, and this study might just have something to teach us about the best way to support breastfeeding.

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3 Comments on “Can a wee drop ‘o formula help breastfeeding?”

  1. Tara Says:

    Thank you for this post! I’m so grateful to see that you are considering this research as something reasonable to consider in the broader picture without jumping to conclusions in any particular direction. I wrote about it as well, with a similar perspective as you (albeit with a personal story thrown in), and got considerable pushback from LCs and other pediatricians — plus a lot of supportive, grateful comments from fellow breastfeeding moms.

    I’m a strong proponent of breastfeeding (I exclusively breastfed for 6 months and I’m still nursing my now-3-year-old at night, actually), but I feel the outright demonization of anything related to formula can be counter-productive, even in promoting breastfeeding. The study is admittedly small and not without considerable limitations, but I hope it will encourage other researchers to attempt to replicate it (and encourage ethics boards to approve such trials) so that we can have a stronger evidence base for what does and does not work in promoting breastfeeding — and to encourage dogmatic LCs and pediatricians to consider the fact that, at nearly every point in history, the medical/scientific consensus has been wrong about *something* (stomach sleeping, anyone?) and science is about continually seeking a closer version of what is true based on the evidence available.

    Liked by 1 person

  2. oldmdgirl Says:

    The dogmatism with which some people push breastfeeding is a huge turnoff to me. It’s like instead of religion people now have this. I breastfed for over a year, and my daughter never had formula, and I still feel that way! There is way too much shame surrounding the subject, and I have to think that is detrimental to health in its own way. I would really like to see a trial comparing outcomes among those told that breastfeeding is something you “get” to do vs. something you have to do or else you are a bad mommy.

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  3. Rachel Says:

    I wish there were more studies like this one and fewer of the ones that say that try to correlate long term health and other outcomes to breastfeeding. There are tons of studies that try to show the benefits but so few that actually try to create meaningful advice on how to breastfeed successfully in the face of problems.

    Oh, I totally agree with oldmdgirl – breastfeeding advocacy has gone way to far. I’ve been trying for a while to understand why some people care so deeply how someone else’s baby is fed. Studies or no – I can guarantee you that breastfeeding (or not) is not going to be a deciding factor in whether or not a kid thrives.

    Can’t we just decide that breastfeeding is dandy if it works and if it doesn’t (for whatever reason) – well, that’s dandy, too. There have got to be more important issues to spend money and time on.

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