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Why do doctors say no to formula milk?
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Why do doctors say no to formula milk?

WHO raises concerns over the aggressive marketing of infant formula milk. Experts recommend formula feeding can never mimic or substitute breastmilk

Formula feeding: Understanding the disadvantages

Concerned about the unethical marketing of formula milk for babies, the World Health Organisation, along with United Nations Children’s Fund (UNICEF) hosted the global congress on June 20-22 in Geneva. Delegates from 130 countries discussed strategies to end the unethical marketing of breast milk substitutes. Tedros Adhanom Ghebreyesus, director general of WHO, expressed his concern regarding the drastic reduction of exclusive breastfeeding due to decades of aggressive marketing of breast milk substitutes.

Tedros mentioned that digital marketing strategies have largely replaced traditional marketing techniques like billboards or images of cute babies on formula labels. “These include targeted ads on pregnant mothers’ mobile phones, clandestine participation in online baby clubs or coaxing mothers to market formula to one another.”

What is formula milk?

Formula milk for babies is a breast milk substitute manufactured industrially. There are myriad formula feed substitutes manufactured by the commercial milk formula (CMF) industry globally. Though it claims to be a ‘substitute’ for breast milk, it does not contain the nutritional value of breast milk.

WHO lists out some of the false claims used by formula milk companies including:

  • Formula products with added ingredients improve brain development and immunity
  • Formula products are needed after 12 months of age
  • That breast milk is inadequate for the nutrition of older infants and children
  • That formula keeps babies fuller for longer and therefore helps them sleep
  • That the quality of breast milk declines with time.

Formula milk: A mimic of breastmilk?

Formula milk and breast milk are very different. “Formula milk for babies contains preservatives, additives, flavouring agents and highly unnatural elements which can eventually cause long-term diseases in infants, hence can never be recommended,” confirms Dr Asha Benakappa, a pediatrician at Dr Chandramma Dayananda Sagar Institute of Medical Education and Research, Bengaluru.

Studies suggest that formula feeding attempts to mimic mother’s milk in its nutritional composition, but not its functionality. In breast milk, the nutritional composition changes with the child’s needs.

“Many parents are made to believe that formula feed and breastmilk have equivalent nutrition,” says Prachi Omkar Shetye, lactation consultant, Somerset Clinic, Medeor Hospital, Dubai. “Breast milk contains antibodies that help babies fight infection. This is not true for formula milk.”

Damanjeet Kaur, a practising nutritionist from Brisbane and the founder of the online nutrition portal, Food and Mind Zone, says that colostrum, the first thick breastmilk given to the baby an hour after birth, is highly immunogenic. “This helps in lifetime immunity development in the child. Exclusive breastfeeding is the best option to meet the child’s nutritive requirements for the first six months. Formula feeding can never substitute breastfeeding.”

Kaur asserts that formula feeding should only be resorted to as a supplementary alternative in exceptional situations

Not enough breastmilk: So, formula milk?

“One of the prime reasons for mothers resorting to formula feeding is the notion of insufficient lactation or breast milk production. This lack is largely psychological,” says Dr Benakappa.

The other reasons for insufficient breast milk production include incorrect latching, inadequate emptying of breasts due to poor sucking of the baby and inadequate pumping, says Shetye. She adds that these situations can be resolved within four to six weeks of delivery. But when mothers resort to using formula milk rather than correcting these issues, breast milk production reduces further, say experts.

“Every pregnant woman produces lactation hormones (prolactin and oxytocin) within 48 hours after delivery. This is naturally produced when pregnancy hormones known as oestrogen and progesterone disappear from the body. The initial breast milk quantity will be 5 ml/ breast and gradually increases,” points out Dr Benakappa.

Apart from limited or no milk supply, breastfeeding pain due to incorrect position and latching technique, sore nipples due to engorgement (an increase in the amount of breast milk in the first week of birth), flat or inverted nipples or pain in the nipples are the common hindrances for exclusive breastfeeding in recent times, say experts. Dr Shetye says that teaching correct breastfeeding techniques can correct most of these issues.

Breastfeeding and its alternatives

Dr Benakappa says, “To prevent any adversities, lactating mothers must express milk every two to three hours, on the child’s demand. Not expressing can lead the brain to send inhibition signals that prevent further milk production.”

Also, the sucking-swallowing-rooting reflex of the mother’s breast by the infant stimulates more breast milk production in the breast gland, explains Dr Benakappa.

Kaur points out that when the mother is unable to breastfeed due to her physical unavailability, one can also opt for breast pumps for expressing breast milk. However, she underlines the importance of sterilising the feeding bottles and breast pumps to avoid bacterial growth.

“Breastmilk and formula milk for babies contain the proteins, casein and whey. Though formula milk mimics the nutritional composition of breast milk, whey protein is higher in mother’s milk and casein protein in formula milk. Whey promotes easy digestion. Formula milk, with high casein quantities, takes longer to digest,” explains Kaur.

Though formula milk attempts to mimic breast milk, it does not have anti-inflammatory properties which are provided by human milk oligosaccharides (HMOs), bioactive molecules found in breast milk.

Risks of formula feeding

A staunch advocate of exclusive breastfeeding, Dr Benakappa condemns formula feeding as it increases the risk of respiratory tract infections, asthma, high blood pressure and diabetes, digestive problems, sleep apnea and dental issues in infants. Studies suggest that formula feeding increases the risk of obesity in later life.

She adds, “For the mother, who has not been breastfeeding, the chances of gestational and type 2 diabetes, cardiovascular diseases, ovarian cancer, breast cancer, obesity and other weight-related issues are high.”

Milk banks can help

Milk banks are the next suitable option when exclusive breastfeeding is difficult, say experts. “Milk banks provide breastmilk donated by new moms. The milk is stored in sterilised feeding bottles at appropriate temperatures for a specified number of days,” explains Kaur.

When to choose formula milk

According to Kaur, formula milk can be suggested only if the mother is suffering from tuberculosis, hepatitis or is on chemotherapy. Besides, consumption limits vary among babies. So, it is important to consult a doctor before using formula. Its usage depends on the baby’s age, weight, growth rate and whether the baby is full-term or preterm.

Takeaways

Formula feeding is not a substitute for breastfeeding. No brand of formula milk can mimic the antibodies and immunogenic properties that breastmilk provides. Meeting a lactation expert can help a mother who has issues with breast milk production.

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