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“My baby needed more than just breastmilk”
“Breastmilk wasn’t filling him so we had to give formula”
“Baby was big/hungry and not satisfied on breastmilk alone, big babies sometimes need more than exclusive breastfeeding”
“My baby isn’t getting what she needs as she wants to feed constantly every evening”
“Baby wasn’t gaining enough weight and needed something more”

These are phrases many of us are used to reading online, and I have long pondered – what is the magic “more”?

Firstly let’s think about it logically – human infants are born perfectly designed to consume human milk; just like calves are to drink cow’s milk and piglets are to drink sow’s milk.  For this to be “inadequate” for some infants would make no sense, because before the days you could buy a tin it was the only option.  Secondly the volume of breastmilk isn’t limited to x oz per feed, if baby is hungrier they can drink more and mum makes more!  As the vast majority can (with the right support)  make enough milk for twins, even the hungriest baby can have their fill.

Standard breastmilk substitutes contain around 20 cals per oz, breastmilk contains on average 22.  Fat levels in substitutes are at around 3.5 g per 100ml, compared to an average of 4.2 in breastmilk.  Protein levels in a standard formula are approximately the same as breastmilk, around 1.3g per 100ml.

Breastmilk is often compared to a “healthy salad”, because of how easily it is digested and how the baby feels after feeding; in contrast substitutes are often compared to a “roast dinner”, because baby may zonk out for a long period.  This is partly because it’s easy to inadvertently overfeed with a bottle, but also because milk of another species is much harder to digest – whilst both contain protein, one is human and one is bovine.   In terms of nutrients to grow, breastmilk is no “lighter lunch” than the typical alternative.

So if substitutes offer nothing “more” than breastmilk (and lack all the immunological propertes of breastmilk), why do some parents feel their baby needs them?

I suspect there are several or more answers to this question.  Firstly, formula frequently matches what many mums perceive as a more sated infant, based on cultural expectations.  Many mothers only know infants who are fed substitutes and so their behaviour is held as the norm.   Breastmilk is digested in 1 1/2 – 2 hours, whereas formula can take 3-4 hours; if baby wants feeding every couple of hours or more, mums are often concerned her baby is hungry or “not as settled as they should be”.  The truth is breastmilk is digested at a normal rate – it’s non breastfed infants who often take a longer than normal time to digest, resulting in longer than normal feed spacings.  Nothing to do with “being more content” and all to do with working hard to digest foreign milk!

Some infants struggle so much to digest it results in cconstipation or colic – resulting in less sleep all round – the opposite of the desired result; and for a small proportion of infants the supplement makes absolutely no difference at all to sleep, settling, or frequency of feeding – but a big difference to their gut.

If the sitution in society were reversed and the majority of mums were breastfeeding every couple of hours – a baby suddenly going a long time between feeds would be the cause for concern, not the reverse.  I wonder if the advice then would be to supplement with breastmilk? 😉

It also comes down to ineffective breastfeeding support and education – most babies have fussy periods (previously called growth spurts) where they want to feed much more frequently for a few days, and many in the early weeks cluster feed (lots of feeds back to back early evening) but as a lot of mums are never even told about this, they understandably believe they aren’t making enough milk to satisfy baby, or that for some reason it wasn’t filling enough.  I for one fell into this group with my first and was quite gobsmacked when I read about it online that despite spending 9 months convincing me “breast was best”, nobody had bothered to let me know about that part!

It could also be down to less than great positioning and attachment – baby may not be actually drinking well and so in that case genuinely may need more milk; but that’s because the amount of milk being consumed is too small – not a quality issue.   With good support this can be quickly and easily overcome in the vast majority of cases.

Perhaps the visual aspect also plays a part? we are most used to bovine milk- skimmed is thin and watery, down to full fat which is rich and creamy.  Expressed breastmilk because of the type of protein and fats appears an almost blue colour, and is thinner in consistency than full fat milk; in contrast a bottle of formula appears much more as we expect a richy creamy milk to look.  A good (formula feeding) friend of mine once commented when my first was tiny, that my expressed milk “didn’t look very creamy or rich, was it filling enough?” (First baby didn’t sleep long periods and so the implication was obviously my uncreamy milk!)

Because non breastfed infants often gain more weight than breastfed after the early months, due to either wrong re-constitiuting of powder or overfeeding – perhaps this adds to the feeling formula offers something “more”?

As long as mum is consuming somewhere around the recommended calories per day (1500-1800) and not drastically below, diet has little impact on fat and calorie content of breastmilk.   It can vary mum to mum, feed to feed – but only volume of milk consumed has been correlated with growth.

Lastly the whole “big baby” statement makes so little sense if you think about it.  Those mums who do exclusively breastfeed for 6 months, do so not only when their baby is tiny, but when it is four or five months old too!  Even the chunkiest of newborns or young babies are smaller than this – so why would breastmilk be unable to sustain them when it  can do so fine with older bigger babies?  for those who become chunky – breastmilk made them so, how would it do that if so lacking?

So if anyone does work out what the magic more is, do let me know.


11 Comments

Penny in TX · December 8, 2010 at 11:19 pm

After my first child (9#6 and 24.5″) was born, my midwife told me, “he’s a big baby, so you should expect to nurse him a lot.” So I did. I later learned that when people had smaller babies, she told them, “your baby is a little smaller, so expect to nurse her a lot.” Basically, regardless of the size of the baby, she told the parents to expect the baby to need to nurse a lot. As a result, no one was surprised that the baby needed to nurse every 1.5 hours! We live in a bottle feeding culture and frankly hardly anyone has the least idea of what normal infant feeding behavior is.

    Maria · December 9, 2010 at 11:33 am

    Just had to reply, what a wonderful midwife, that did make me laugh

      EA · December 9, 2010 at 11:37 pm

      I thought the same thing 🙂

Emily Cross · December 9, 2010 at 8:55 am

It would appear that formula isn’t the magic milk cure all, baby rice is.

I have frequently read on a well known Mum forum women stating that they have had to put their bottle fed baby on baby rice from 9 weeks to keep them satisfied. Apparently the poor babies wanted feeding every 2-3 hours, had doubled their birth weight well before 3 months, from the first spoonful of baby rice they were instantly happier more content babies, smiling the whole time, cried when the bowl was empty. Their HV didn’t approve, but that’s OK because Mums always know best, right????

Holly Lyne · December 9, 2010 at 10:06 am

Great article and love the comments above! Lol!

Claire Cohen · December 9, 2010 at 10:47 am

Great article and I especially agree with Penny that it seems that so few people understand what normal infant feeding behaviour is. I think the sooner that changes, the more women will breastfeed sucessfully.

Anon · December 9, 2010 at 12:25 pm

And what about the baby that loses 17% of their birth weight by 5 days old despite VERY frequent feeding and mum’s milk still not coming in? Is that mother doing wrong by following medical advice and giving her baby formula? Or should she have stood her guns despite that meaning baby would need to be admitted to special care?

I so wish mothers could just worry about their own decisions and leave others to theirs.
BTW i’m not anti bf – very much the reverse.

Sam · December 9, 2010 at 12:31 pm

The last line is something I think quite often.

My baby was small at birth (6lb 11oz) but I breastfed her exclusively for 27 weeks (then started BLW and continued to nurse). I had people with 2 or 3 week old babies saying they ‘couldn’t fill them’ or they had a ‘big, hungry baby’… when their ‘big’ newborn was still about half the size (if that!) of my exclusively breastfed 5 or 6 month old.

Sam · December 9, 2010 at 12:44 pm

In regards to how much a baby loses after birth, there are so many things wrong with that.

First of all, the scales can be calibrated wrong, meaning it looks like there is significant weight loss when there might not be.
Second of all, it is normal for babies to lose some weight. Unless the baby is looking gaunt, dehydrated, crying a *lot*, or not pooing or weeing, there is no need to worry prematurely. If the baby is feeding often then a repeat weighing should be done 5 to 7 days later, because in most cases even with more than 10% lost, the baby will start gaining after day 5. (Anecdotally my daughter was 6lb 11oz at birth and supposedly lost 11oz in the first 4 or 5 days, but at the next weigh-in she had gained about an ounce a day from day 5 onwards).

Third, if there IS a worry that the baby is not gaining enough, ‘medical advice’ ought to be helping the mother to make sure the baby is positioned properly and attaching well, so that it is drinking effectively. She needs to know to fee often, an not let the baby sleep too long between feeds (as some newborns are sleepy). Other factors should be checked out such as tongue-tie or low tone (which can affect ability to suckle). And then milk should be expressed and fe through syringe or off a spoon, but only a small amount alongside continuing to feed.
Ultimately though, advice to supplement with formula should only be a very last resort, and only for those whose babies not only have ‘lots weight’, but are showing signs of taking nothing in.
More important than weight is, are they feeding often? Are they pooing and weeing ok? Are they awake and alert at times? Is the Fontonelle depressed? Are they crying (weakly) often? If the first 3 are ‘yes’ and the last two are ‘no’, then it is very unlikely they need supplementary feeding, just help to make sure the latch is OK an they are feeding effectively.

Charlie · December 9, 2010 at 1:40 pm

Hi
To be fair anon this situation is a lil different to the one I describe above. If mum’s milk hasn’t come in, it’s not a case of something “more”? I blogged about this here: http://www.analyticalarmadillo.co.uk/2010/09/is-my-breastfed-baby-getting-enough.html

If milk is very delayed – due to say a stressful section, retained placenta or suchlike, a supplement may sometimes be required. Ideally donated breastmilk from a bank but if not there are some situations an alternative supplement may be required (some mothers may choose formula, some may go for “informal milk sharing”.
Support should of course also be in place to help mum establish feeding and remove the supplement as supply develops 🙂

Alison · December 9, 2010 at 5:14 pm

I just wanted to add to the weight loss issue too. If the baby is born in Hospital, as most are around here, and the mother recieved IV fluids, then the baby’s birth weight will be increased due to water retention. This means that their true birthweight may very well be 2-3 oz lower than the scales said. A big difference percentage wise when the baby is only around 8 lbs.

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