Breast-feeding offers complete nutrition to newborns and infants. As the biologically normal source of nutrition, it can meet nutritional needs better than formula or prematurely introduced solids.
However, barriers to breast-feeding mean that just a third of mothers meet their breast-feeding goals.
Understanding the benefits and challenges of breast-feeding may help families to reach their breast-feeding goals.
Breast milk is the biologically normal choice for babies, so it is the safer and healthier choice.
Formula milk is a substitute for breast milk, so a mother should only use this if she cannot breast-feed, or when she chooses not to.
When a mother is able and willing to breast-feed, there are no health benefits to choosing formula over breast milk.
Breast milk is a dynamic substance that changes in response to the infant’s needs.
During pregnancy and in the days following birth, the breasts produce colostrum instead of milk. This sticky, high-protein substance is rich in antibodies that can support the newborn’s immune system and provide nourishment until the breasts begin producing milk.
When milk production begins, usually within a few days of birth, the milk changes over time based on the infant’s needs.
If an infant is born preterm, breast milk has more protein, calories, and other elements specific for a tiny baby. Breast milk changes during a feed with the sweeter watery milk at the beginning to get the baby interested and ends with milk higher in fat and protein to keep the baby feeling full.
Breast milk changes over a 24-hour feeding cycle. The milk is more watery, of a higher volume, and lower in fat in the morning, and richer in the evening.
Research suggests that white blood cells in breast milk increase when the infant is sick. Milk composition, including lipid levels, also change in response to a baby’s needs.
Formula is an appropriate substitute for breast milk, but it is not equivalent, and it cannot change in response to an individual infant’s needs.
Breast feeding has advantages for both mother and infant.
Benefits for infants
The benefits of breast-feeding for infants include:
- a reduced risk of ear infections, allergies, and colds
- a reduced risk of a potentially fatal disease called necrotizing enterocolitis
- higher intelligence quotient (IQ) scores in childhood
- a reduced risk of type 2 diabetes and obesity later in life
- lower risk of sudden infant death syndrome (SIDS)
- increased effectiveness of childhood vaccines
- reduced risk of diarrhea
- improved ability to fight infections
- fewer dental problems including less need for braces later in life
- fewer trips to doctors and dentists
Breast milk is also safer.
With formula milk, there are sometimes concerns about tainted produce. Any product can be recalled or tainted. Breast milk reduces the risk of exposure to potentially dangerous or recalled products.
In some places, there may be concerns about clean water. Exposure to contaminated water while traveling or camping can endanger an infant. Breast milk lowers or eliminates this risk.
During the first 6 months of life, an infant who is breast-feeding has no need to drink water, so parents do not have to worry about drinking water quality.
Benefits for mothers
Mothers also benefit from breast-feeding.
- Helping the uterus to contract after delivery, which reduces the risk of excessive blood loss after giving birth
- A lower chance of postpartum depression
- Burning more calories can make it easier to lose weight after giving birth
- A reduced risk of breast, cervical, and ovarian cancer
- Lower risk of osteoporosis
Breast-feeding for at least 6 months can bring lifelong benefits.
It can also be convenient, since it does not require any special supplies, sterilizing of equipment, or planning ahead.
It can help promote bonding between mother and infant, potentially offering short and long-term emotional benefits to each.
Breast-feeding is comforting to infants, who have a natural suckling reflex. Nursing offers a quick and safe way to soothe a crying, sick, or sleepy baby. Many women nurse their babies to sleep.
Breast-feeding is completely safe for most women, but the Centers for Disease Control and Prevention (CDC) recommend that some women avoid breast-feeding.
This includes women in the United States and Canada who:
- Have human immunodeficiency virus (HIV), or who are taking antiretroviral medications
- Have untreated, active tuberculosis. However, once treatment for TB is started a mother can pump and give that breast milk to the baby
- Have human T-cell lymphotropic virus type I or II
- Are undergoing radiation treatment, although radiation does not necessarily require a permanent stoppage of breast-feeding
- Take some cancer medications, including chemotherapy, which interferes with cell division or DNA replication
Outside of these groups, there are no specific risks associated with breast-feeding.
Challenges of breast-feeding
Breast-feeding is not always easy, particularly in the early weeks.
- finding a comfortable position
- knowing how frequently to feed
- getting a comfortable deep latch
- managing nipple tenderness
- infections such as mastitis and thrush
Education and support from a breast-feeding expert can help to avoid many of the problems.
State-based and national helplines offer phone advice from specialists, and support groups provide professional help in offices and homes in each state.
Breast-feeding can also be inconvenient, especially for women who work away from home.
Other issues include:
- Frequency: Breast milk is easier to digest, so breast-fed babies tend to feed more often. Newborns may “cluster feed” several times within a short period.
- Expressing milk: Women who need to spend time away from their infant for work or other reasons will need another way to feed their infant. Expressing breast milk manually or with a pump can take time, and it can be uncomfortable.
- Nipple issues: Sometimes problems such as poor latch can leave the nipples too sore for breast-feeding for a while. A baby may refuse the breast if they use a pacifier or bottle too soon, and they need to be encouraged to go back to the breast.
- Balance of responsibility: Breast-feeding demands significantly more work from the mother than her partner. This can be overwhelming for some mothers. It is helpful if the partner takes responsibility for baths, diaper changes, laundry, and rocking.
- Fatigue: Newborns, and older infants too, wake repeatedly at night and need frequent nighttime feedings. As breast milk is easy to digest, a breast-fed baby wakes more frequently.
- Cultural stigma: Strangers or family members may urge women not to breast-feed publicly. Most states have laws to protect mothers from being shamed in public for feeding their baby. Some women face pressure to wean their infant too soon.
Breast milk is best for babies, but it is not the only factor in infant well-being. A mother’s mental health can affect her child’s well-being. If a woman feels overwhelmed by breast-feeding, she may be advised to formula-feed instead.
How much is enough?
Formula-feeding is exact and easy to measure.
Breast-feeding is less precise, so it can be hard to know whether an infant is consuming enough.
However, formula-fed babies may be overfed because of a tendency to “finish the bottle.” Breast-fed infants learn to obey the signals that show they are full and to stop consuming when they have had enough.
Breast-feeding operates according to supply and demand. The more a mother nurses or expresses her milk, the more she will produce, so it is wise to nurse a baby every time he or she shows signs of hunger, or the supply might go down.
Women who are concerned about supply can pump breast milk after each feeding.
If a mother feels she does not have enough breast milk, she should feed more frequently. Within 48 hours, the supply will have increased.
Signs that an infant is not getting enough breast milk include:
- Persistent weight loss in the weeks following birth. Some weight loss in the days following birth is normal, but weight should increase after this.
- Few sounds of swallowing during feeding.
- Lethargy or signs of dehydration in the infant, such as dry lips or infrequent wet diapers.
If an infant over 1 week old has 6 to 8 wet diapers a day, this suggests they are not dehydrated and they are getting enough breast milk. Babies under 1 week old may have fewer wet diapers.
Good nutrition is vital to a newborn’s early development. If a mother has issues with breast milk supply, this calls for immediate intervention. Many issues can be fixed with the help of a trained lactation consultant. A doctor can arrange this.
Some companies offer herbal remedies to increase breast milk supply, but research on their efficacy is mixed. Herbal remedies should not be used without first speaking to a doctor.
Can I breast-feed after breast surgery?
A small number of women who have breast surgery, either augmentation or reduction, may not be able to produce enough breast milk. They should seek advice from a lactation consultant.
They can still breast-feed, but they may need to supplement with either donor milk or formula. Breast milk can be offered in addition to these supplements, or as a form of comfort. Even small amounts of breast milk will help the infant’s immune function.
Breast-feeding recommendations vary, and there is no specific time limit.
The American Academy of Pediatrics (AAP) recommend giving only breast milk to breast-fed infants for the first 6 months. After this, solids can be introduced, but breast-feeding should continue until the infant is at least 12 months old, or longer if the mother and infant so desire.
The World Health Organization (WHO) recommend breast-feeding for at least 2 years, and longer if mutually desirable. The antibodies in breast milk continue to benefit the infant even after adding solids.
As breast milk contributes to bonding, some mothers opt to breast-feed as a supplement until the infant is a toddler or preschooler.
Inspired by the health benefits of breast milk for babies, some adults advocate drinking breast milk. No evidence supports any benefit to adults of consuming breast milk.
Black-market breast milk may be tainted, and breast milk contains less protein than most other forms of milk.
An adult may consume breast milk incidentally, when test the temperature of breast milk, or for other reasons. As long as it is safe for the woman to breast-feed, there is no evidence that this incidental consumption is harmful.
Breast milk from a safe source has been known to help wounds and burns heal, and to help clear up eye and skin infections.
Social support can encourage women to breast-feed, so many organizations sponsor nurse-ins and other public breast-feeding events.
The Global Big Latch-On is one of the largest events of its kind. Latch-On events occur each year. They encourage women to gather together to breast-feed, aiming to normalize breast-feeding and support nursing mothers.