The decision whether to breastfeed or bottle feed is deeply personal to each parent. Moreover, there are many additional factors which may influence on the ability of an ability to breastfeed, including health, milk supply, needing to return to work quickly etc. This page will explore nutritional considerations for both breast and bottle feeding. If you have any questions or concerns following reading this article, we suggest you contact your doctor and your registered midwife / health visitor for further support.
Breastfeeding
Breastfeeding is a skill that takes time to get used to, both by the parents and the new-born. It needs to ideally be initiated within one hour of birth and infants should be exclusively breastfed for the first six months of their life, in order to achieve optimal growth. Breast milk meets all the nutritional requirements of new-born babies, containing, for instance, proteins that can be easily digested, keeping infants hydrated. In fact, no water or any other liquids need to be added to breast milk. Breast milk composition is dynamic, meaning that it is able to change in order to meet the infant’s needs, as they require different nutrient balances. Also, breast milk has unique biological particles useful to support babies’ immune system, which cannot be found in any other sources of food. Breastmilk from well nourished parents can provide all the nutrients the infant will need. However, this really illustrates the importance of ensuring parental nutrition beyond pregnancy, as breastfeeding parents who are not well nourished may have poorer nutrient quality in the milk, and be of higher risk of nutrient defiency.
Lastly, breastfeeding contributes to maintaining good health across the life span. For infants, breast feeding supports brain development and also supports gut maturation. This is because breastmilk is a source of the omega 3 fat, DHA, which is essential for healthy gut and brain health.
For example, adolescents and adults who were breastfed, are less likely to be overweight and obese, or to develop certain diseases, such as type 2 diabetes. Moreover, breastfed infants have been indicated to have higher IQ scores at school in later life, and breastfeeding parents were observed to have better cognitive at age 50, than those who had not breastfed. Breastfeeding also lowers risk of SIDS syndrome and leukaemia in the new-born.
During lactation period, breastfeeding parents can enjoy several benefits too, such as exclusive breastfeeding is associated with a natural birth-control method (although additional protective measures are recommended as this is not always a reliable method). Moreover, breastfeeding may also reduce the risk of ovarian and breast cancer, type 2 diabetes, and postpartum depression.
Diet and Breastfeeding
Lactation should be supported by a healthy diet and lifestyle. For instance, eating five portions of fruit and vegetables a day is highly recommended, as well as avoiding salt, sugar and processed foods. Also, starchy food should be integrated into a daily diet, as source of vitamins, fibres and especially energy. In addition, wholemeal grains should be preferred, as source of higher fibre content.
Protein must be included regularly in the everyday diet, such as meat, fish (two portions each week, trying to have one of them made by an oily fish, such as salmon), or eggs. Swordfish or shark should be limited due to the high mercury content. Eggs under the British Lion Code of practice are at low risk of salmonella, so they are safe to be eaten during all stages of breastfeeding.
Dairy is an important food group to include in the breastfeeding parents’ everyday diet, as it is a very good source of calcium. Also, if dairy alternatives are preferred, or required due to allergy, options which are calcium-fortified and unsweetened should be preferred to ensure daily intakes are met. Green leafy vegetables, almonds and tahini are also great plant based sources of calcium.
Plenty of water is highly recommended whilst breastfeeding, to ensure the parent remains hydrated. In addition, some supplements are essential during the lactation period, such as 10 mcg vitamin D.
Food to Avoid whilst Breastfeeding
Due to the caffeine level, coffee, tea, chocolate, energy drinks and soft drinks are better to be avoided, as caffeine is a stimulant which can make babies restless. It is advised to not exceed 300 mg of caffeine per day. Moreover, alcohol should be avoided at all times while breastfeeding, as it increases the risk of SIDS (sudden infant death syndrome).
Society and Breastfeeding
Globally, only 40% of infants under the age of six months are breastfed, and this can happen due to many reasons. For example, some medical reasons such as HIV, or if breastfeeding parents are taking some medications that can potentially harm their babies, such as cancer treatment drugs. Also, after mastectomy or radiation treatment for breast cancer, breastfeeding is not possible or recommended.
Moreover, there are also psychological reasons why some families choose not to breastfeed their babies. For example, returning to school or work after parental leave and having a fixed schedule, may not be compatible with regular pumping, which can be overwhelming for some parents. Also, some families might not have been educated about breastfeeding and its importance for the infant, therefore they may not feel well enough or have confidence in doing so. There also remains for some individuals concerns about showing breasts in public, and some parents concerns regarding modesty, perhaps due to religious reasons as well as feelings of discomfort and embarrassment, which could be due to Western sexualisation of women’s bodies or body image . For this reason, some people might choose bottle feeding instead of breastfeeding. However, a consideration here is that there is the option of using a breast pump and expressing breast milk.Expressing milk, for instance, could be a great option for not depriving the infant of breast milk, but avoiding breastfeeding. Expressing milk consists in squeezing milk out of the breast, so it can be stored and used whenever preferred. This choice could be considered if the breast feels uncomfortably full, if parents need to stay away from the new-born as the baby is in special care or because parents need to be back to work or also because the instant is not able to suck properly, but parents still want them to be fed with breastmilk.
Bottlefeeding
Breastfeeding is not always the first option for all the parents for plenty of reasons, such as medical conditions, social stress, or lack of time. Therefore, many parents choose to bottle-feed their new-borns. Baby formula is usually made from treated cow’s milk, to make it more suitable for infants’ needs and nutritional requirements. Labels should always be checked if adequate for every baby.There are two types of formula: dry powder that needs to be mixed with water and ready liquid formula. While ready liquid formula is convenient, it is also more expensive and must be utilised more rapidly once opened. Formula milk offers the nutrition that new-borns require to grow and develop. However, it does not provide the same health benefits to parents and their baby as breast milk. It cannot, for example, protect your infant against illnesses.
Parents sometimes have concerns about not giving enough formula to their babies. This can be monitored by noticing the baby’s weight gain and the amount of wet and dirty nappies. For example, a few days after the birth, six dirty nappies should be produced by an infant who is well nourished. If there are any concerns regarding a babies weight or bowel habits, it is important to contact a midwife / health visitor to discuss immediately.
Bottle-feeding can help supporting the development of a close relationship between the infant and parents, using formula milk, or expressed breastmilk instead of breastfeeding. Babies until twelve months of age should be having as a drink breastmilk or formula milk only. After six months, very small amounts of pasteurised whole cows’ milk could be used in food and meal preparation, but not given as a drink. After twelve months, cow’s milk can be fully introduced.
Cow’s Milk Allergy
Cow’s milk allergy is one of the most common food allergy among babies and young children. Its symptoms usually start in early weeks of life, and they can affect various part of the organism, such as the digestive tract or the skin. Cow’s milk allergy can be prevalent and problematic problematic in babies, as it is a particularly important source of energy, proteins, and nutrients helping their growth. For this reason, it has to be carefully replaced with a milk alternative with a similar nutritional profile.
Types of Formula
There are several types of formula milk with diverse characteristics which can be chosen in accordance with the infant’s needs.
First of all, first infant formula, which is suitable from birth, is based on whey protein which is thought to be easily digestable by babies. Secondly, goat’s milk formula, which is also suitable from birth, easily found in shops and pharmacies. This type of formula is not suitable for infants with cow’s milk allergy as the proteins contained are very similar. Thirdly, hungrier baby formula, which is suitable from birth under the advice of a midwife or health visitor. This type of formula is known to contain more casein protein than whey protein, which is more difficult to digest. There is also anti-reflux formula, which can be suitable from birth under the supervision of a doctor. It prevents reflux in babies and, although it can be easily found in shops and pharmacies, it is recommended to get it with a health professional’s advice only. Lactose-free formula is also suitable from birth under medical supervision. It is suitable for lactose-intolerant babies, who might find difficult to absorb lactose, which is a sugar naturally contained in dairy products and milk. The symptoms of lactose intolerance are diarrhoea, abdominal pain, and bloating. Another option is hypoallergenic formula, which can be also used from birth under medical supervision. It is prescribed if the infant has been diagnosed with cow’s milk allergy.
Soya formula is suitable from six months, under medical supervision. It is made from soya beans, so it is appropriate for babies with cow’s milk allergy. However, soy contains phytoestrogens, which are plant-based compounds naturally found in plants, which have a structure similar to human estrogens. Therefore, there are concerns about their consequences on babies’ reproductive systems. Moreover, sweetened soya milk products often contain glucose, which is likely to harm babies’ teeth.
Lastly, growing-up milk, which is suitable from twelve months, can be recommended under medical advice. It is can be used as an alternative to whole cow’s milk choice for toddlers over one year old.
Researcher: Rebecca Cerasa, BSc Dietetics London Metropolitan University
References:
Allergy UK, 2022, Cow’s Allergy, available at https://www.allergyuk.org/about allergy/allergy-in-childhood/cows-milk-allergy/
BDA, 2014, Suitable milks for children with cow’s milk allergy, available at https://www.nhs.uk/ipgmedia/National/British%20Dietetic%20Association/asse ts/CowsMilkAllergy-ChildrenFoodFactSheet.pdf
Brown Belfort M. (2017). The Science of Breastfeeding and Brain Development. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine, 12(8), 459–461. https://doi.org/10.1089/bfm.2017.0122
Fox, M., Siddarth, P., Oughli, H. A., Nguyen, S. A., Milillo, M. M., Aguilar, Y., Ercoli, L., & Lavretsky, H. (2021). Women who breastfeed exhibit cognitive benefits after age 50. Evolution, medicine, and public health, 9(1), 322–331. https://doi.org/10.1093/emph/eoab027
Innis S. M. (2014). Impact of maternal diet on human milk composition and neurological development of infants. The American journal of clinical nutrition, 99(3), 734S–41S. https://doi.org/10.3945/ajcn.113.072595
Lamberti L. M., 2011, Breastfeeding and the risk for diarrhoea morbidity and mortality, available at https://pubmed.ncbi.nlm.nih.gov/21501432/
Murray D., 2021, Why some women decide not to breastfeed?, available at https://www.verywellfamily.com/why-some-women-decide-not-to-breastfeed 431902#:~:text=Awkwardness%2C%20body%20image%20issues%2C%20stigma,al so%20make%20people%20feel%20uncomfortable.
NHS, 2018, Breastfeeding and diet, availale at
https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding and-lifestyle/diet/
NHS, 2019, Types of formula milk, available at
https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle feeding/types-of-formula/
NHS, 2019, Expressing and storing breast milk, available at
feeding/breastfeeding/expressing-breast-milk/
NHS, 2019, Types of formula, available at
https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle feeding/types-of-formula/
NHS, 2021, Guide to Bottle Feeding, available at
https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/advice/
Samuel, T. M., Zhou, Q., Giuffrida, F., Munblit, D., Verhasselt, V., & Thakkar, S. K. (2020). Nutritional and Non-nutritional Composition of Human Milk Is Modulated by Maternal, Infant, and Methodological Factors. Frontiers in nutrition, 7, 576133. https://doi.org/10.3389/fnut.2020.576133
Start For Life, 2020, Breastfeeding, available at
WHO, 2022, Breastfeeding, available at https://www.who.int/health topics/breastfeeding#tab=tab_1
Unicef, 2019, Responsive Bottle Feeding, available at
https://www.unicef.org.uk/babyfriendly/wpcontent/uploads/sites/2/2019/04/Infant-formula-and-responsive-bottle feeding.pdf
