Formula: Should you offer formula for nighttime feeds?

Many of my friends have told me if I give my baby a formula feeding before bed it will help him sleep through the night. So far this experiment has been a disaster, with crying, screaming and constipation. Should I rely on just breastfeeding for my four month old or am I just trying the wrong formulas?

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Kathy Kuhn

Kathy Kuhn is a registered nurse who has been working with breastfeeding families since 1981. She has been an International Board Certified... Read more

It would be best to rely exclusively on breastfeeding. Formula feeding is known to carry numerous risks to the infant.

The potential risks are possible with all formulas, so switching the brand will not reduce these risks, and a different formula may not be tolerated any better by your baby than the one you are using now.

Formula feeding increases the risk of ear infections, respiratory infections, childhood cancers, allergies, reflux, sudden infant death syndrome (SIDS), juvenile diabetes, infectious diarrhea and many other diseases. (Cunningham A., et al 1991) (Walker, M. 1993)

Studies seem to suggest that the problems associated with formula feeding are what we call "dose related." That means the more formula a baby gets the more likely they are to have the associated problems. In your case, however, your baby is already showing signs of a sensitivity to formula and that may mean he is more vulnerable to the associated risks than your friend's baby. Also, because he is not tolerating the formula it may increase sleep disruptions.

Your breasts were designed to sustain your baby's entire need for milk. In addition to the risks already mentioned, providing formula on a regular basis will decrease your milk supply. Your milk supply is regulated by how much breastmilk your baby takes from the breast. If the baby is getting formula he will take less breastmilk, which will reduce your supply.

Normal infant sleep patterns vary widely, so try to resist the urge to compare your baby with other babies. Parents who attribute longer sleep stretches to formula feeding may or may not be correct in their assessment of the situation. There are too many factors involved to easily sort out what has encouraged longer sleep or if a longer sleep stretch than would have occurred anyway has actually transpired. .

Most babies have an evening fussy spell during which they want to breastfeeding very frequently. This is called a cluster feeding. The baby's fussiness combined with an apparent need for frequent feeding routinely causes parents to assume that the baby is "unsatisfied" with breastfeedings or "not getting enough" during this fussy time. This is normal newborn behavior -- not an indication of low milk supply or any breastfeeding problem. Parents who haven't been taught about this normal behavior and strategies to deal with it frequently respond by giving a bottle of formula. Because the baby has very little control over the flow rate of the formula bottle, this causes a rapid pattern of sucking and swallowing that gives the appearance that the baby is "gulping the bottle down hungrily." This of course. only reinforces the parent's fear that the baby wasn't getting enough at the breast. Often the baby falls asleep after being offered a bottle, which also gives the parents the wrong impression that the bottle was just what the baby needed. What may have occurred is that the baby has come to the natural conclusion of the fussy spell. Most parents give the bottle as a last resort, which means the fussiness has been going on for awhile and may be drawing to its natural conclusion - often a long stretch of sleep. Additionally, some babies may respond to the bottle by withdrawing because the fast, difficult to control flow has caused stress for the baby who must struggle to breath with the fast flow. In response to this stress many babies fall asleep, further giving some parents the impression that the bottle has encouraged sleepiness. It is easy to see why some parents may mistakenly encourage you to give a bottle of formula to induce sleep.

Studies point to numerous benefits of nighttime breastfeedings, so in addition to the risks of formula, encouraging longer stretches of sleep may not be in your baby's best interest.

Many mothers find one of the nicest advantages to breastfeeding is that they can do night feedings in the side lying position and continue to get a good nights rest while meeting the infant's needs. Bottle feedings can not safely be done in this way.

Your baby seems to be signaling you that the formula is not right for him, follow his cues and continue to enjoy your exclusive breastfeeding relationship. You are giving your baby the very best by breastfeeding, adding formula to his feeding routine may only create problems for both you and your baby.

Thanks for helping me to clear up a common concern.

References:

  • Cunningham, A. Jelliffe, B. , Jelliffe, E, "Breastfeeding and Health in the 1980's: a global epidemiologic review." Journal of Pediatrics 118: 659-6, 1991
  • McKenna, et al, "Infant-Parent Co-Sleeping in an Evolutionary Perspective: Implications for understanding Infant Sleep Development and the Sudden Infant Death Syndrome" Sleep, Vol 16, No 3 1993.
  • McKenna, J. & Mosko, S. "Evolution and infant sleep: an experimental study of infant-parent co-sleeping and its implications for SIDS" ,Acta Paediatr, 1993, 389, 31-36.
  • Walker, M. "A fresh look at the risks of artificial feeding infant feeding". Journal of Human Lactation Vol 9. 97-107, 1993.
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