Navigating the Formula Crisis

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Melissa Portunato MPH, IBCLC

Though most women have the initial desire to breastfeed, the CDC reports only 25% of babies meet the recommendation of exclusive breastfeeding for the first six months. As the baby formula shortages continue in the US, many parents are now faced with the unprecedented stress of keeping their babies fed. If you are concerned about your baby’s well-being, contact your pediatrician immediately for supplementation guidance and continued support. 

Read on for important information and resources every family needs to know about the current formula crisis. 

Brand Alternatives
Many families rely on specialty formulas to feed their babies and have been feeling the effects of the shortages even more. However, if you can not find the brand or specialty formula for your baby, often brand alternatives are available. For a formula compatibility chart, click here. 

DON’T
Experts warn against making formula at home or diluting formula. This can be dangerous and harmful to your baby. To find or exchange formula in your community, visit this free online tool – https://freeformula.exchange. 

Relactation 
Relactation is reestablishing your milk supply after your body has stopped lactating after several weeks or months. To start relactating, if you have a baby that will latch to the breast, take it back to the basics. Practice lots of time skin to skin and bring baby to the breast often. If your goal is to pump exclusively, start pumping every 2-3 hours for 20-30 min each pumping session. In order for relactation to be successful, experts recommend using a hospital strength pump like those available at Spectra baby USA. At first, you may only see drops of milk, but with commitment and support, milk supply will start to increase over time. Work with a skilled International Board Certified Lactation Consultant that can help you meet your breastfeeding goals. Find a local IBCLC here. 

Practice Safe Breastmilk Sharing 
For safe breastmilk sharing, ask your donor about their lifestyle, medical history, and medications. Ensure they are safely handling breastmilk and consider home pasteurization. To learn more about milk sharing, visit https://www.eatsonfeet.org/safeMilkSharing.

Become a Breastmilk Donor 
Breastmilk donors are in high demand. Consider becoming a donor if you are currently breastfeeding. For more information on how to become a breastmilk donor, visit these resources:

https://www.hmbana.org

https://www.eatsonfeets.org/DonatingAndRequesting

At Spectra baby USA, we believe breastmilk is the perfect composition for your baby and every mother should have access to support. If you are expecting a new arrival and would like more information on getting off to the best start with breastfeeding, schedule a complimentary consultation with a Spectra IBCLC today! 

Paced Bottle Feeding

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Jacque Ordner BSN, RN, IBCLC, RLC 

Are you worried your precious little one will grow to prefer the bottle over your breasts?  Are you concerned you might not be able to keep up once baby begins taking bottles regularly while you’re away? Are you exclusively pumping and looking for tips on bottle feeding?  We’ve got you covered with our full guide on Paced Bottle Feeding.  

Research indicates that infants will take more from a bottle than they would when nursing.  This can result in overfeeding, mom losing confidence in her milk supply, and can even contribute to later obesity.  One large study compared formula fed infants (via bottle) and breastfed infants (via direct nursing) and found that the bottle-fed infants consumed 49% more milk at 1 month, 57% more at 3 months, and 71% more at 5 months. In comparison, we know that directly breastfed infants do not increase the volume of breastmilk intake from one to six months of age.  The average daily intake for a breastfed infant from one to six months remains about 25 ounces per day.  

 Why do bottle-fed infants tend to consume more?  

  • The flow from a bottle can often be initiated by gravity alone, triggering innate sucking reflexes present in babies under 4 months old.  In other words, baby will often continue to suck and swallow milk from a bottle long after they’ve reached “fullness”.  In contrast, the flow of milk from the breast requires a coordinated suckle and does not flow consistently.  An infant can pause, breathe, relax, and reassess before initiating additional flow from the breast.  This puts the baby in greater control of the feeding.  
  • Formula fed infants regularly consume more than their breastfed counterparts because more formula is required to meet their nutritional needs.  Formula also does not contain hormones such as leptin and adiponectin which regulate hunger and metabolism.  It’s especially important to keep this in mind if your baby receives breastmilk and formula or if you are tempted to compare your breastmilk fed baby’s intake with that of a formula fed infant.  

 What are the benefits of Paced Bottle Feeding? 

  • Paced Bottle Feeding allows infants to develop and practice their innate feeding cues and skills rather than only responding to the consistent flow of the bottle over which they have no control.  This is especially important for newborns (particularly pre-term newborns) who require supplementation early.  Allowing newborns to develop natural feeding cues and skills can be instrumental in helping them return to the breast or to transition from breast to bottle and back.   
  • Babies often develop a preference for the fast and continuous flow from the bottle. In the past, this might have been labeled as “nipple confusion”, but we now call it flow preference.  We now know that when baby prefers the bottle over the breast, it’s almost always due to the preference and ease associated with the faster flow of the bottle.  Babies are smart, and once they learn that they don’t have to wait for milk from the bottle they may start to refuse or become frustrated at the breast. Paced Bottle Feeding helps to mimic the slower and non-continuous flow of milk that occurs during nursing.  
  • Paced bottle feeding allows time for baby’s satiation signals to be recognized.  Most of us know the experience of scarfing down a big holiday meal in 10 minutes or less only to realize we’re painfully full.  Similarly, a baby can often take copious amounts from the bottle, due to its rapid and persistent flow, before the brain has had a chance to realize the belly is full.  This can lead to a gassy, fussy, spitty baby. Over time, baby’s tummy can come to expect those large feeds even if the volume isn’t necessary for baby’s complete nutrition.  Additionally, the same large study mentioned above found that caregivers often encourage baby to finish a bottle even when they’re displaying signs of satiety. Caregiver pressure to empty the bottle is another contributing factor to overfeeding. This can also lead mom to believe her supply is inadequate when baby is actually being overfed. 

 What are the principles of Paced Bottle Feeding? 

  • Feed on demand following baby’s hunger cues (rooting, sucking on fists, smacking lips, restlessness, etc.) Remember crying is a LATE sign of hunger.  
  • Choose a slow flow nipple.  Not all slow flow nipples are as slow as they claim.  Click HERE for to check the flow rate of many popular brands.  
  • Feed baby in a nearly upright position. 
  • Allow baby to “latch” onto the nipple rather than inserting it into his or her mouth. 
  • Hold the bottle parallel to the ground so that milk just enters the nipple. 
  • Provide frequent breaks by tipping the bottom of bottle down or completely removing the nipple from baby’s mouth. This is especially important if baby begins to gulp. Watch baby’s cues! 
  • Switch sides halfway through the feeding to mimic a nursing session. This also provides cross-connectivity in the brain. 
  •  Feedings should take 15-30 minutes.  
  • Don’t force baby to finish the bottle.  Allow baby to determine when he or she is full rather than encouraging them to finish a specific amount.  

*These techniques are appropriate for babies under 6 months of age.  

Click HERE for a video demonstration of Paced Bottle Feeding. 

Paced Bottle Feeding helps protect the nursing relationship, reduces the risk of overfeeding, and gives baby control of their feedings.  Have concerns about bottle feeding?  We can help!  Our Board Certified Lactation Consultants can develop a plan to help you introduce or manage bottle feeding.  Click HERE to schedule your free virtual consultation or email us at ibclc@spectrababyusa.com.  We’re here to support you! 

References 

 Arenz, S., Ruckerl, R., Koletzko, B., & von Kries, R. (2004). Breast-feeding and childhood obesity–a systematic review. International Journal of Obesity and Related Metabolic Disorders, 28(10), 1247-1256. 

 Dewey, K. G. (2009). Infant feeding and growth. In G. Goldberg, A. Prentice, P. A., S. Filteau & K. Simondon (Eds.), Breast-Feeding: Early influences on later health (pp. 57-66). New York, NY: Springer. 

Kramer, M. S., Guo, T., Platt, R. W., Vanilovich, I., Sevkovskaya, Z., Dzikovich, I., et al. (2004). Feeding effects on growth during infancy. Journal of Pediatrics, 145(5), 600-605. 

Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395. 

Li, R., Fein, S. B., & Grummer-Strawn, L. M. (2008). Association of breastfeeding intensity and bottle-emptying behaviors at early infancy with infants’ risk for excess weight at late infancy. Pediatrics, 122 Suppl 2, S77-84. 

Doneray, H., Orbak, Z., & Yildiz, L. (2009). The relationship between breast milk leptin and neonatal weight gain. Acta Paediatrica, 98(4), 643-647.

Talking “Self Care” With Dr. Rachel

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By Dr. Rachel Goldman Ph.D., FTOS, Licensed Psychologist

Self-care. We have all heard about it and we know we “should” do it, but do we? Self-care is a broad term that encompasses just about anything that we do to be good to ourselves; it’s about being kind to ourselves. It doesn’t need to be going to a 5-star resort or having a spa day, although wouldn’t that be nice? I am talking about something we do more regularly, something you can do on a daily basis that is for YOU. You are probably thinking, how is that possible when I am a mom, have a baby to take care of, need to pump/breastfeed, change diapers, and keep this little human alive, but it’s not only possible, but it is actually necessary. Think about the instructions flight attendants give on an airplane- we need to put our oxygen mask on before we put anyone else’s on. Think about your cell phone- we don’t let our cell phone batteries run low, but we instead keep an eye on it and charge it when needed. Self-care is about knowing when your resources are running low and taking a step back to replenish and recharge.

You may be thinking this is a bit selfish to put yourself first, and especially with a baby at home, but I call it a “healthy selfishness”. When it comes to our health and wellbeing we have to be a little selfish. A “healthy selfishness” is knowing what you need to do (within reason) and allowing yourself to do it. If you think about everything we do for survival, such as sleeping and eating, those are examples of behaviors associated with a “healthy selfishness”. We need to participate in these behaviors in order to survive. We also need to participate in other behaviors to be healthy, both physically and emotionally, such as taking time out of our day for us, for “me time,” and to relax or de-stress. For some that may be going on a run or going to the gym, for others that may mean a quiet and relaxing bath. Whatever it is, it is needed to allow you to de-stress, refocus and be able to be productive and accomplish what you need to accomplish, which includes being a mom and being emotionally and physically available to take care of your little one. Without some of these behaviors and acts of “healthy selfishness” we will eventually burn out and not be productive in any aspect of our life. We may even start to feel regret, sadness, and anger, which is not uncommon feelings during the postpartum time, especially since your life has just drastically changed by having a new baby. These feelings are also signs that it is time to take a step back and to do something about it. We need to monitor and check-in with ourselves in order to see what we need in order to function to the best that we can at that given time. Keep in mind, what we need today may be different than what we need tomorrow. This may also look very different for different people and can change with different life circumstances.

So now what? Here are some things to think about to help YOU find the time YOU need to be the best YOU.

  • Make Yourself a Priority- think of the instructions regarding putting on an oxygen mask on an airplane. Decide that you deserve self-care.
  • What does ‘Me Time’ mean to YOU? This could be just a few minutes to yourself or can be an activity that you enjoy, so you will actually do it. We tend to make excuses for things we don’t enjoy doing, so think about activities that do not cause stress, but rather relaxes and recharges you. Besides the gym and running, I have made pumping be part of my self-care routine. I have my husband give our baby a pumped bottle while I pump, so I have some quiet time to relax and destress. This is also helpful as stress can affect our milk supply, so having this quiet time has been useful and works for me.
  • Use Relaxation Techniques – relaxation techniques, including meditation, massage, yoga, imagery, and breathing are very effective at decreasing stress levels and helping you relax. It can be useful to practice these techniques while you are pumping as well to ensure you are calm and not stressed.
  • Schedule – make sure you set aside time each day just for you (‘Me Time’). Consider this time like an appointment that you wouldn’t miss. Since I pump a minimum of 2 times per day (first thing in the morning and before I go to bed), this is already scheduled for me. I do schedule additional ‘Me Time’ though, including exercise and physical activity.
  • Create a Daily Routine – make it something you look forward to and will become part of your lifestyle. Your daily routine should also include what I call the key health behaviors (water intake, nutrition, physical activity, and sleep). AND these are also all key behaviors to helping your milk supply!
  • Be Assertive and Ask for Help – don’t say yes to everything. Learn to say no or to delegate responsibilities. For instance, my husband gives the morning bottle while I pump. I had to ask him to do this, but when I asked him and explained to him how it would help me (which would also help our baby), he was willing to do it. You don’t know until you ask ☺
  • Find Support – get support from your family, friends, and colleagues. Talk to them about your stress, your ‘Me Time,’ and your plan. Also, find people going through similar things and support each other.
  • Seek Professional Help – if stress and anxiety is impacting your daily functioning and is getting in the way of you fulfilling your responsibilities, there is help. Increased stress for prolonged periods of time can be bad for your physical and mental health, but can also impact your milk supply, and those around you, including your little one.

To YOU, taking care of YOU, YOUR health, and YOUR pumping and breastfeeding journey!

Connect with Dr. Rachel at www.DrRachelNYC.com