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June 09, 2020
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Newborns fed in-hospital formula are weaned from breast milk earlier

Source/Disclosures
Disclosures: The authors report no relevant financial disclosures.
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Breastfeeding infants who were fed formula during their post-partum hospital stay were 2 1/2 to six times more likely to be weaned off of breast milk in the first year of life compared with infants who were breastfed exclusively, a study published in Pediatrics found.

Marcia Burton McCoy, MPH, a research scientist for the Minnesota Department of Health, and colleagues followed 5,310 infants enrolled in the Minnesota Special Supplemental Nutrition Program for Woman, Infants, and Children.

Photo of mother breastfeeding her infant
Source: Adobe Stock

“Widespread in-hospital formula feeding of breastfeeding infants is a practice that is having a negative impact on mothers’ and children’s health across the lifespan,” McCoy told Healio. “Formula needs to be treated as a last — not first — resort when breastfeeding difficulties arise and needs to be regarded as an intervention that carries risks for the mother and baby dyad.”

Marcia Burton McCoy

For the study, McCoy and colleagues matched breastfed infants given formula in the hospital with infants who were exposed only to breast milk and found they were 6.1 times more likely to be weaned from breast milk (95% CI, 4.9-7.5) in the first year. A more conservative estimate showed that it increased the risk by 2.5 times (95% CI, 1.9-3.4).

McCoy and colleagues recommended several strategies to reduce in-hospital formula feeding, including “culturally appropriate prenatal education, peer counseling, and hospital implementation of [Baby Friendly Hospital Initiative] steps, such as staff and physician education, giving supplementation only when medically indicated, and early skin-to-skin contact.”

“Exclusive breastfeeding during the hospital stay is the best start in life for your infant and family,” McCoy said. “Don’t wait until the baby is born to think about breastfeeding. Seek out education and community resources during pregnancy. Learn about hand expression while pregnant. Communicate to those caring for your family, that you want to exclusively breastfeed, and ask for help in achieving your goals.”

McCoy also recommended that mothers “seek out a breastfeeding-friendly birthing facility and ask about the availability of lactation support and pasteurized donor human milk.”

“Seek out breastfeeding supporters among your family and friends, so they’ll be there in the early weeks of breastfeeding when you’re going to need help. Know where you can turn to postpartum for medical lactation care if you need it,” McCoy said.

In a related editorial, Lori Feldman-Winter, MD, MPH, professor of pediatrics at Cooper Medical School of Rowan University, said that exclusive breastfeeding is recommended for newborns for the first 6 months of life.

“This recommendation results in numerous beneficial health outcomes for the mother and infant, lasting well beyond the period of breastfeeding,” Feldman-Winter wrote. “Recent evidence provides the scientific basis to explain the importance of an exclusive breast milk diet and draws attention to the potential health risks of early infant formula supplementation.”

Both McCoy and Feldman-Winter said that societal, structural and procedural factors contributing to in-hospital formula feeding need to be addressed.

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