Infant Feeding Options

People’s Opinions…

Infant feeding options are highly personal decisions that can only be made by an individual family in respect to their circumstances at a given time. Families deserve the information they need to make their choices, and judgment free support when that choice is made.

Infant feeding choices can be considered on a continuum from the provision of the infant’s own mother’s milk, to milk from another human mother provided in a variety of ways, to commercial infant formula, to homemade infant formula. Let’s break these options down to understand the recommendations and cautions for each one.

Always remember that the reason for the unavailability of a particular option can be parental choice to not utilize that method of infant feeding. Parental autonomy when making infant feeding choices should always be respected.

Option 1: Mother’s Own Milk

The ideal infant food and feeding situation would always be the infant nursing at the mother’s breast. There are a few contraindications to the provision of mother’s own milk, including some medical conditions and medications. These are fairly uncommon, and in most cases nursing at the mother’s breast provides the highest health benefits to the mother and infant, and provides the optimal infant nutrition.

If a baby can not nurse at the breast for any reason (including parental choice) expressed milk from the mother is the most beneficial option. This option conveys the health benefits of lactation for the mother, and provides the infant with their own mother’s milk tailor made for them, from their mother who shares their environment.

Option 2: Milk from Another Mother

If an infant’s own mother’s milk is unavailable, milk from another human mother is the most preferred food for this infant. There are varied ways an infant can receive this milk from another mother including:

• Wet-nursing, cross-nursing, or co-nursing: In this scenario the infant receives the milk of the other mother directly at the breast of that mother. The benefit to this is that the infant is receiving human milk from a mother sharing their environment, which increases the specificity of the immunological benefits to that particular infants environment. This practice is not very common in the United States, at least on a publicly visible level. There are same sex couples who choose to have the non-gestational parent induce lactation, either handling some or all of the nursing needs of the infant. There are extended family situations in which another family member assumes breastfeeding responsibility for the infant when the infant’s own mother is unavailable. In countries with less resource availability wet-nursing can be a life saving measure as infant formula is hard to obtain or safely prepare.

• Informal milk sharing is an increasingly common practice in the United States, with parents who are unable to supply a baby with their own mother’s milk in sufficient quantity to meet the baby’s needs with milk donated by another breastfeeding parent. Typically the donors of this milk are mothers with an oversupply, or bereaved mothers who pump their milk after an infant loss. This form of milk sharing is done via sites like Eats on Feets or Human Milk 4 Human Babies.

• Formal Donor Milk, or donor milk obtained from a milk bank that screens the donors, tests the milk, and pasteurizes the milk for safety in another option. Typically this type of donor milk is very expensive, and is reserved for infants who can not medically handle formula safely.

Option 3: Commercial Infant Formula

Commercial infant formula is a safe, nutritionally complete, alternative to human milk, and will meet the needs of the infants nutritional needs in the absence of human milk. There are concerns related to infant formula pertaining to food security, contamination, and safe preparation and handling of infant formula.

Commercial infant formula comes in two forms, liquid and powder. Liquid formula is considered sterile, and is the more expensive formula option. Powdered formula is not-sterile, and proper preparation and handling is important for assuring infant safety. Regardless of the type of formula there is a risk of contamination due to improperly cleaned bottles and nipples.

Commercial infant formulas are available under brand name and generic names. All commercially available formulas in the United States are regulated by the FDA, and are considered safe for infant consumption.

A large concern, and one that was recently highlighted in the United States, is the impact of infant formula on food security for infants. There was a temporary shortage of commercial infant formula due to supply chain disruptions and hoarding of formula. Loss of income for many families put economic pressure on them making it harder to obtain sufficient quantities of formula to meet their baby’s needs. The WIC program, which provides infant formula to many families, struggled with office closures, and difficulties getting the families they serve the vouchers needed to purchase formula. This has sparked an interest in the idea of re-lactation to provide some of the infants nutrition by returning to nursing or exclusively pumping. It is important to understand however, some of that push towards re-lactation was made possible as mothers and infants were separated less frequently during social distancing.

Option 4: Homemade Infant Formula

Homemade infant formula used to be the primary alternative to breastmilk, and many of our grandparents and great grandparents fed their own children homemade infant formulas. There are a number of recipes floating around on the internet, with a wide variety of ingredients. The concern here is that while homemade infant formula might meet the immediate needs of the infant to be fed, there is a high risk of contamination and a lack of vitamins in these homemade formulas. Homemade infant formulas should be considered as a last resort, when the option is between the risks associated with these formulas and a child starving.