Breast Feeding / Formula / Milk FAQs

• The other evening while nursing my 3 month old girl bit me - once on both breasts. Can you help? NEW!
  
• Any suggestions on how to assist in getting her to drink more - and increase her calories - either by bottle or by a cup? NEW!
  
• Is it safe to breast feed most of the time and formula feed some of the time? NEW!
  
• I want to wean my daughter, but she will not take formula. What can I do to wean her since she won't take formula?
• My one year old will not drink milk, however I am still nursing her. Will she get enough calcium from breast milk?
• I read that I shouldn't breastfeed my baby together with the meal in which I give a vitamin supplement with iron, because some studies show that calcium binds with iron, decreasing availability to the body. What is your opinion?
• My son is eight months old and breastfed. He is a vegetarian and a healthy eater. Can I give him soymilk instead of cow's milk and when should I introduce it. He will not take a bottle.
• Can my Mother give my 3 month old apple juice when the breastmilk bottles run out?
• I have a 5-month-old daughter who is exclusively breastfed. If I give her iron supplements when is the absolute latest I can keep her on breast milk alone?
• Our baby boy is 15 days old. We worry about over feeding him, and would like to know how much is too much food for a baby his age?
• What do you recommend feeding for the first four months if I cannot breastfeed?
• What is the best natural formula?

The other evening while nursing my 3 month old girl bit me - once on both breasts. Both times I quickly followed the bite with a firm "No Biting!" to which she gave me a wide grin. After the grin I figured she was playing and did not continue nursing her. Can you help?

You did very well! When an infant bites mom's breast, the best response is to stop the feeding immediately (put your finger in her mouth to break the suction) and sternly say "No!", as you did. You may need to do this repeatedly, but eventually she will learn that this behavior is not desired.
 

We adopted our daughter from China 2 1/2 months ago when she was 10 months old. She is now 13 months. When we first adopted her she was slow to take a bottle from us, but soon (within a few days) was drinking 4-5 bottles of formula (6-8 oz each). She became ill with diarrhea after about three weeks with us and at that time she refused to drink or eat and got mildly dehydrated requiring IV fluids. She was rehydrated, and gradually started to drink formula again and eat better.

Starting about one month ago, her desire and interest in drinking formula has gradually declined, to the point she now only consumes 10-15 oz of formula a day (3- 4oz three to four times a day). She eats other solids reasonably well and eats a variety of foods, however she will not drink fluids of any other type (no juice, water, milk) and will not drink from a sippy cup or other vessel. We are worried that she is not getting enough fluids and may get dehydrated again. We are also worried her overall nutrition will suffer, as she does not seem to be gaining weight.

Any suggestions on how to assist in getting her to drink more - and increase her calories-- either by bottle or by a cup? Her pediatrician is giving her a trial of medication in case this may be related to GERD (reflux).

One way to determine if your daughter is dehydrated is to pay close attention to her urine. If her diaper is infrequently wet, if the urine is dark yellow and has a strong odor, those are all signs of dehydration. However, if she has six or more wet diapers a day, if the urine is pale yellow, and without much odor, you can feel that she is fine. Most foods are largely water, so even without drinking, you can get plenty of fluids. Offer lots of fruits, vegetables, yogurts, puddings, healthy frozen yogurts or ice creams, soups, etc. that are mostly fluid to help keep her well hydrated. Simultaneously continue to offer, in a non-pressured way, fluids in a bottle or, preferably, a sippy cup. She will eventually begin to drink again. Your daughter is at an age where she can sense if this has become an 'issue'. So while you know it's very important for her to drink, you want to encourage it without it becoming a power struggle. Subtle, gentle ways of offering drinks will work best. If she still isn't taking fluids, and she can't get enough from food, then you may want to ask your pediatrician to recommend a dietitian or occupational therapist that can help. It's not unusual for weight gain to drop off after the age of one, so her lack of weight gain, in the short term, shouldn't be a problem. Just keep track of it. If the trend continues, make efforts to get higher calorie foods into her diet.
 

I have a 1-month-old baby and am trying to do the right thing and breast-feed him. But sometimes I find it inconvenient. Is it safe to breast feed most of the time and formula feed some of the time? Will switching back and forth cause upset stomach or any other side effects in my child?

Supplementing breast milk with formula is often the only way a mom can continue to nurse. Mixing formula feedings into your one-month's old diet is absolutely fine. It's great that you have waited one month. That will have allowed your milk supply to become well established. Adding a formula at this point is perfect. Your baby is still young enough that he most likely hasn't become too opinionated about demanding only mom's milk, as some older babies often do who haven't had early exposure to formula. He will learn that he can satisfy his hunger not only from you, but also from formula, and whomever else feeds him. It may be a good idea to allow your husband or another caregiver to give the formula so that your baby adapts to others as well. At first your baby may experience some stomach upset, but not necessarily, as his digestive system adapts to this new food. Once you have established him on a mix of formula and breast milk, and he gets the formula on a regular basis, his digestive system will remain accustomed to the mix. Earth's Best supports you in your efforts to nurse as much as is possible, but we also recognize, that there are times it's inconvenient, or perhaps impossible. In that case, formula is a safe and healthy alternative.
 

My daughter is a little over 7 months old and she has 2 teeth already. I want to wean her, but she will not take formula. I have tried 3 different brands and she just refuses. What can I do to wean her since she won't take formula?

It's not unusual for an older baby who has been exclusively breast-fed to balk at the taste of formula. I would suggest you get her used to the formula by diluting it with expressed breast milk. You can gradually lower the ratio of breast milk to formula until she is getting only formula.
 

My one year old will not drink milk, however I am still nursing her. Will she get enough calcium from breast milk?

One ounce of human milk contains 10 mg of calcium. Depending on how much breast milk she is drinking, it is possible she isn't getting all the calcium she needs. From seven to twelve months, the adequate intake of calcium is determined to be 270 mg. If your 12 month old is getting 27 ounces of breast milk a day, she's getting enough calcium. However, the adequate intake of calcium jumps up to 500 mg per day for a one to three year old, so soon your daughter will need more and more calcium. Unless or until she begins to drink milk, you will need to begin to identify other good sources of calcium for her. Will she eat yogurt? How about some of the calcium fortified juices and toddler snacks? Try to include snacks such as Earth's Best calcium fortified teething biscuits or serve up some calcium fortified instant oatmeal which contains calcium.
 

I read that I shouldn't breastfeed my baby together with the meal in which I give a vitamin supplement with iron, because some studies show that calcium binds with iron, decreasing availability to the body. What is your opinion and if you agree, would it be ok to breastfeed her an hour before (or less) or after her vitamins?

It is true that calcium can decrease the absorption and or utilization of iron (the mechanism isn't entirely clear) so, if it's just as easy to give the iron containing vitamins at some other time then when you are nursing, then by all means, separate the two. However, keep in mind, in reality, these sorts of interactions go on all the time and generally balance each other out in the end. Did you know that the presence of vitamin C greatly enhances the absorption of iron, so if the vitamin and mineral supplement you are giving your baby contains vitamin C it will actually enhance the absorption of the iron in your breast milk? As you can see, these interactions are very hard to balance out. Perhaps the best way to maximize both calcium and iron absorption would be to give an iron supplement separate from the vitamin supplement. Give the vitamin supplement at nursing time. With nursing, the vitamin C in the supplement will counter-act the inhibition of the calcium and will enhance the absorption of the iron in your breast milk (which is very low in vitamin C). Give the iron supplement with the fruit/vegetable meal. Serving the iron supplement with your fruit and veggie meal rather than the cereal meal will ensure maximum iron absorption from the supplement because the vitamin C in the fruits and vegetables will enhance the iron absorption.
 

My son is eight months old and breastfed. He is a vegetarian and a healthy eater. Can I give him soymilk instead of cow's milk and when should I introduce it. He will not take a bottle.

Soymilk is a very appropriate alternative to cow's milk. In fact, there are some soymilks now available that are enhanced with vitamins, minerals, and healthy fats that would be a perfect weaning soymilk You can begin to introduce it any time in a sippy cup. West Soy offers a couple of child-appropriate soymilks such as WestSoy Plus or WestSoy Enriched.
 

My baby just turned 3 months old and has only been breast-fed. If I have to leave him occasionally with my mother (and her supply of my pumped breastmilk runs out) could we give him some baby apple juice at this age? Should we water it down?

Apple juice is a very poor substitute for breast milk. In fact all it will offer your baby is a few calories and fluid to tide him over until he is able to get some breastmilk again. A better solution would be to have some formula on hand to use in case of an emergency. The formula more closely matches your breast milk from a nutritional standpoint and it will satisfy his hunger better and longer than the apple juice. However, feeding him apple juice at this age on a very occasional basis certainly won’t hurt him. I would water it down at first, simply because the carbohydrate load may give him gas or diarrhea. However, watered down apple juice will be even less satisfying when he is hungry for a meal of breast milk. If your return is immanent and you only need to tide him over for a few minutes to an hour, and you don’t want to spoil his appetite for a nursing, then by all means, use the apple juice in a diluted form. If he needs to wait for longer than an hour, I suggest a small bottle of formula.
 

I have a 5-month-old daughter who is exclusively breastfed. If I give her iron supplements when is the absolute latest I can keep her on breast milk alone. I have heard that some infants stay on the breast exclusively for almost a year. Is that wise?

There is no black and white answer as to when the last possible age at which a baby may be exclusively breast fed. The American Academy of Pediatrics recommends mothers breast-feed exclusively for the first six months, and then gradually introduce iron-enriched solid foods during the second half of the first year to complement the breast-feeding. The World Health Organization and UNICEF's message is that breast milk alone is the best possible food and drink for infants during the first six months of life.

So, in keeping with these expert recommendations, it seems like it would be best to start to introduce supplementary foods at around 6 months. That's not to say it would not be fine to exclusively breast feed for a year, but if you do, you must be aware of some nutritional issues. One, as you have already indicated knowledge of, is the need for supplemental iron. Are you also aware that breast milk is rather low in some other important nutrients, including vitamin C and vitamin D? Also, at around 6 months of age, a baby's ability to chew and swallow matures to where they can eat more solid foods. To deprive them of the opportunity to practice this new ability will delay its progression, and may make acceptance of solid foods at a later age more difficult. Although not as extreme, I equate not allowing a baby to have solids when they are ready for them, similar to not allowing them to practice walking when they are ready for that. Breast milk can still be the main source of nutrition for well into the first year, but solid foods can positively add to that, both nutritionally and developmentally from about 6 months on.

As with most 'rules' there are exceptions. In this case, babies who have a family history of food allergies may benefit from exclusive breast-feeding for a year, to allow their immune systems further chance to mature. However, for a baby not predisposed to allergies, waiting will not accomplish anything. Other babies who may benefit from 12 months of exclusive breast-feeding are those in underdeveloped countries where the weaning diet is nutritionally very poor, or here in the U.S., where a baby born into poverty or ignorance may not have the best weaning diet offered to them.
 

Our baby boy is 15 days old. He weighs 9 1/2 pounds. He cries angrily for food, biting on his hands every 2 to 2 1/2 hours. He usually eats 3 ounces of formula each time. We worry about over feeding him, and would like to know how much is too much food for a baby his age?

Please, do not worry about over feeding a baby. Babies are wondrously equipped with an inborn ability to answer their body's hunger and satiety cues. When they are hungry, they need to eat, and they cry to let you now. If you don't feed them what they need when hungry they cannot develop the sense of trust that their needs will be taken care of. For now, let your baby decide how much and how often he needs to eat. As he gets older, you can begin to regulate the when, and you will try to always regulate the what, but seldom try to regulate the how much. Young babies need to eat often because their tummies are so tiny they cannot hold too much at once. Therefore, expect to have to feed him every couple of hours.
 

What do you recommend feeding for the first four months if I cannot breastfeed?

You will need to give your baby a commercially made formula. Based on the mandate of the Food and Drug Administration, all formulas on the market are similar in that they will supply the appropriate amount of vitamins and minerals, and the proper ratio of protein to fat to carbohydrates to meet your baby's needs. However, the source of fat, protein and carbohydrate can and will differ from one formula to another. What you really must do is find the formula that works best for your baby.

Most pediatricians and nutritionist agree that the place to start is with a milk based formula which has been iron fortified and that contains the essential fatty acids, DHA and AA. A milk-based formula is the best choice because the protein in diary more closely matches the proteins in human milk and the sugars in dairy more closely match the sugars in human milk (lactose). DHA and AA are essential fatty acids that are critical in brain and visual development and are present in breast milk. Until recently, these essential fatty acids were not permitted to be in formula, but now there is overriding evidence that they are critical and should be included in the diets of young babies, so the Food and Drug Administration has allowed them. Some formulas still do not include these fats, so be sure you read labels carefully to choose one that does. Iron is a critical mineral for brain development and to supply growing baby's expanding blood volume. Again, be a careful label reader and choose one that is iron fortified.

Should you find your baby does not do well on this type of formula, you must determine if it is due to a milk allergy or a lactose intolerance. Both lactose intolerance and allergy may have digestive upset symptoms, but only an allergic reaction will cause hives or respiratory type reactions. If your baby does have a reaction, and the symptoms seem to be confined to digestive problems, such as gassiness and diarrhea, first try a milk based lactose free formula. This will give you the benefits of a milk-based protein, without the lactose. If you determine that your baby is allergic to milk I then suggest looking to a hypoallergenic type of formula, where the milk protein has been predigested to eliminate its allergenicity. Finally, if your baby still is not thriving, try a soy formula.
 

My daughter is having a difficult time breastfeeding. My granddaughter had a difficult birth, aspirating meconium and spending two weeks in the NICU. She is refusing the breast and my daughter doesn't seem to have enough milk. What is the best natural formula if she needs to supplement?

It is natural for your granddaughter to refuse the breast at first, if she was bottle fed in the NICU. Bottle feeding requires a little less work on the baby's part, and so the effort she must put into nursing may be discouraging her. It may be helpful if your daughter takes the time to consult with a lacatation expert to get some advise on how to encourage nursing and your daughter's milk supply. It's worth the effort to do so, since breastmilk is, by far, the best food for your granddaughter.

When looking for a formula to supplement, there are a few things to keep in mind. First of all, the term 'natural' has no formal definition, so there is no way to objectively evaluate the different formulas available from that perspective. Secondly, formulas are all required by law to meet certain nutritional standards so that regardless of the formula you choose, your baby will get the optimum nutrition for growth and development. Once those nutritional standards have been met, then the formulas begin to differentiate themselves from each other. That differentiation comes in the form of the ingredients that they use and any additional supplementation they may do above the required nutrients. The main difference in ingredients comes is their source of protein. Cow's milk and soy are the two main sources. Some very specialized formulas use milk or soy protein hydrolysates and are intended for babies that are allergic to both cow's milk and soy. They are very chalky in taste and not well liked by babies. If your granddaughter is not allergic to milk, then a formula that is milk based is the preferable choice. If she can't tolerate milk, then try a soy-based formula.

Other less important distinctions in ingredients are in the sources of fat and carbohydrates. Usually they pose less of a problem than the protein source in terms of allergies or sensitivities. In some cases, if a baby is lactose intolerant they will have to find a formula without lactose.

Or, for very young babies, an iron fortified formula is not yet important, since birth stores of iron still take care of their iron needs. But, once they turn four months, if they have not started on an iron-fortified cereal, an iron-fortified formula is important. Birth stores will have been depleted by then, and an outside source is necessary. Iron deficiency, if persistent, may result in life-long learning problems, poor appetite, and impaired immunity. Breast milk does have some iron, but not enough to meet baby's needs. And, finally, the supplementation of formula with DHA and ARA, two important essential fatty acids, is not yet required in formula, but is allowed and I highly recommend that you look for a formula that supplies them. They are essential in optimum brain and vision development and are present in breast milk.

Begin your search for a formula that is milk based and contain ARA and DHA. If your granddaughter thrives on that, great. If it contains iron, great, if not, switch at four months to one that does. If she doesn't thrive on it, then begin to look at alternative formula, beginning with the soy based ones.

Good luck to your daughter, that she and her baby might develop and strong and successful nursing relationship, and an acceptable supplemental formula can be found.