I don’t know why I didn’t do this earlier. I think I thought I had it covered with the pros and cons of breastfeeding with insufficient supply, and my how-to post Walking the line with combination feeding , but I remember feeling so down about combination feeding because everything I read, written by somewhat inflexible lactivists, was about how artifical breast milk, formula, was going to undo any good that breastmilk was doing. That simply is not true. There is no evidence to support this in the majority of situations, and I’ve found most claims otherwise to be wholly conjecture. Exclusive breastfeeding is best (because it’s what is normal), but if you can’t for mental or physical reasons and can provide some breast milk without undue trauma, then that is what is best. There are a few select areas where I’ve read the research and I agree it does indicate that early introduction of formula removes some protective effect that exclusive breastfeeding provides (and I’m not going to link it here because if you are reading this you probably don’t need something else depressing you!), but by and large if you must combination feed the formula isn’t somehow counteracting the benefits of human milk.
The biggest reason:
It’s what babies expect. Babies expect the breast externally and internally expect breast milk.
Let’s talk about internally first. To use a food based analogy that I think won’t be offensive (unlike the ones comparing formula to Slimfast, Ensure or McDonalds) People are meant to be omnivores. Lots of research supports us, as cave people, eating eggs, fish, fruit, greens and some grains. But some people are vegans. What you get from animal products are bioavailable molecules like cholesterols, fats, proteins and carbohydrates that are most similar to our own. You can live, and some live quite well, as a vegan. Eating a balanced vegan diet with no animal products your body will manufacture cholesterols from plant oils, will take the vegetable based fats, amino acids, proteins and carbohydrates and create whatever chemicals the body needs. It’s simply easier for our body to do this with animal products. And so with breast milk and formula. With some human milk in the diet a baby will have easy access to easily converted human fats, proteins and carbohydrates. With formula the child’s body can make what it needs from the building blocks available. That said, the more available the better, but the big benefit of combination feeding here is that a combination fed baby will use the most easily digestible, the most bioavailable fats, proteins and carbohydrates first, before using the building blocks from artificial milk. So what benefits are we looking at here? Myelination of nerve sheathes, presence of bioavailable cholesterol, promotion of appropriate gut flora though the presence of human milk fatty acids such as lauric acid (also found in coconuts), mother’s immunities (some research suggests as little as 2 ounces per day aids with this), reduced constipation and the majority of the other benefits of breastfeeding can be obtained by having some human milk daily. Of all I’ve read there are only two, possibly three, benefits of breastfeeding that are known to be reduced or changed in any way by the early (pre six-month) introduction of artificial milk. So next time someone touts the benefits of breastfeeding know that if your baby is getting any human milk per day that you have a stake in those benefits as well.
Now externally, babies expect closeness, expect skin to skin, expect the oral development from sucking on the breast. Babies expect the problem solving skills they learn at the breast, how is best to get milk out of this thing? Much of this can be replicated with bottle feeding and thoughtful parenting because what babies expect most is care and love.
Now to shift back to modern life people may find benefit in combination feeding while separated from baby, especially if expressing is impossible or impractical. People may find benefit, because we now lack the extended family structure that used to be available to aid with child upbringing-something that causes a fair amount of pressure I believe, of having some time away from a baby. These are all personal choices and unique to your family and situation. I’m inclined to believe that if it keeps breastmilk coming for longer then it is better than having pressure build up to an untimely end of breastfeeding. But for those who find combination feeding an unwanted necessity there are positives to focus on.
But how much is enough? There’s no real research on that. Some studies indicate that two ounces (50ml) per day contains all the immunological necessities, but that study was done on toddlers in combination with solids, not breast milk and formula in younger infants. As it’s the only real volume based piece of research available that is the number I’ve clung to in the past. I’ve told it to other people as well and having something concrete to fixate on has enabled many of them to keep going and meet their alternate goals. Two ounces per day is a more relaxing goal than some unknown amount. If your output varies from day to day you aren’t feeling as much despair as it goes from 12 to 10 to five, you are feeling happy about keeping it above two. And more is obviously better, but when more isn’t an option, having an achieveable limit to aim for can be a mental lifesaver.