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Formula and Breast Milk Combo May Be Best for Some Babies, Study

Update Date: May 13, 2013 11:42 AM EDT

Just breast may not always be best, according to new research that revealed that feeding underweight babies formula milk along with breast milk immediately after birth can actually significantly increase the length of time their mothers end up breastfeeding.

While efforts to increase breastfeeding in the U.S. have focused mainly on reducing babies' exposure to infant formula, a new study has found that a combination of infant formula and breast milk can actually help long-term breastfeeding rates.

The latest study published online in the journal Pediatrics found that 79 percent of babies who were given a combination of formula and breast milk in the first few days after their born were still breastfeeding three months later.  On the other hand, only 42 percent of babies who were only given breast milk were still being breastfed three months later.

Researchers said that latest findings suggest that if mothers feel able to give their babies some formula milk alongside breast milk, they are more likely to breastfeed for longer.

"Formula use has the potential to be a slippery slope to breastfeeding discontinuation, but ELF is a different way to envision using it," lead author Dr. Valerie Flaherman, an assistant professor of pediatrics and epidemiology and biostatistics at UCSF and a pediatrician at University of California San Francisco Benioff Children's Hospital, said in a news release. "Rather than giving full bottles of formula that make it hard for the baby to return to the breast, early limited formula is a small amount of supplementation with a clear end point that alleviates some of the stress new mothers feel about producing enough milk."

Flaherman explains that women do not immediately produce high volumes of milk after childbirth.  Instead, they secrete small amounts of colostrum, which contains high concentrations of nutrients and antibodies for the baby.  

Researchers say that during this time, babies often lose weight and new mothers may be concerned that their babies are not getting enough nutrients.

"Many mothers develop concerns about their milk supply, which is the most common reason they stop breastfeeding in the first three months," Flaherman explained. "But this study suggests that giving those babies a little early formula may ease those concerns and enable them to feel confident continuing to breastfeed."

The study included 40 underweight newborns between 24 and 48 hours who had lost more than 5 percent of their birth weight. The newborns were randomly assigned to either early limited formula (ELF), which consisted of one third of an ounce of infant formula by syringe followed by breastfeeding or breast milk alone. Researchers explained that the syringe was used to prevent the babies from developing nipple confusion.

Study authors said that the babies in the ELF group stopped the formula when their mother began producing mature milk, approximately two to five days after birth.

One week later, researchers found that all the babies in both groups were still breastfeeding, but only 10 percent of the ELF babies had been given formula in the last 24 hours compared with half the control group.

Furthermore, researchers found that three months later, EFL babies were almost twice as likely to still receive breast milk compared to the control group.

Researchers stress that the study was conducted to help babies breastfeed for a longer duration because breastfeeding is the best method for feeding infants. Breastfeeding offers wide-ranging preventative health benefits for babies like reducing their risk for infections and allergies and providing the perfect balance of nutrients to help infants grow and develop strong and healthy bodies.

While the American Academy of Pediatrics currently recommends that women should exclusively breastfeed for the first six months of a child's life, researchers say that the new study shows that for some newborns with high, early weight loss, a small amount of infant formula may help achieve the goal of long-term breastfeeding.

"The results of this study are provocative and challenge conventional wisdom," Dr. James Taylor, medical director for the University of Washington Medical Center's Newborn Nursery, who was involved in the study, said in a statement. "It is crucial that we have more randomized controlled trials on interventions to increase breastfeeding rather than relying on heavily confounded observational studies or biased expert opinion."

Researchers say the findings need to be confirmed in larger, more randomized studies.

"It will be important to see whether these results can be confirmed in future, larger studies and in other populations," said senior author Dr. Thomas Newman, a professor of pediatrics and epidemiology and biostatistics at UCSF and a pediatrician at UCSF Benioff Children's Hospital.

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