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Breast V/s Bottle- What wins in the long run?

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Health experts around the world are unanimous concerning infant nutrition in the first few months of life. Breast milk is a complete and wholesome food for infants. Exclusive breastfeeding for at least 6 months is advised to all expectant and new mothers. Exclusive breastfeeding implies no other nutrition (not even water or liquids like honey) to the newborn for the first 6 months of life. Post 6 months, gradual weaning is advised so that the baby can tolerate foods other than breast milk. (gradual weaning  means complementary foods and breastfeeding such as cow’s milk, porridge)

Parenthood and especially motherhood, can be challenging for first-time mothers. While the joy of delivering a new life is immense, the challenges of sustaining it and helping it grow also loom on the horizon. Newborn nutrition is one of the most widely debated topics in such households. Besides, it is among the biggest decisions that can impact the child in later life.

Breastfeeding Perspective

From the maternal perspective, breastfeeding (for at least one year) is protective against breast cancer development later in life. It also helps develop a bonding between the mother and the baby and is shown to relieve stress and the incidence of post-partum depression. Besides, it empties the breast, prevents lactational breast abscess due to pent-up secretions, and prevents breast engorgement and mastitis. 

For the infant, besides the nutritional advantages of breast milk, there are immune benefits as well. Breast milk for the initial few days is termed as colostrum. It contains preformed immunoglobulins (antibodies which protect against infections), which provide immunity to the infant against pathogens. It also decreases the incidence of diabetes and obesity in children in later life.

While it is clear from the above points that breast-feeding has undeniable benefits, it might not always be possible for all women. Depending upon mothers’ lifestyle, commitments, and priorities, they may take an independent decision to breastfeed or bottle-feed, as it suits them.

Bottle feed or formula feed provides the baby with the nutrients for normal growth and development. They contain a mix of micronutrients (Zinc, potassium) and macronutrients (proteins, fats, and carbohydrates) to replicate or imitate breast milk composition.

While it is a viable alternative to conventional breastfeeding for mothers who cannot breastfeed (e.g., post-chemotherapy or certain surgical procedures), feeding is ultimately the one taken by the mother. Comparing and contrasting the advantages and challenges of breastfeeding and bottle feeding may help mothers make an informed decision regarding the same,

 

Breastfeeding

As mentioned above, breastfeeding/nursing is the gift of life a mother can give to her baby. It is the ideal food for the infant and promotes bonding between the two.

According to the Indian Association of Pediatrics and the World Health Organization, breast milk has a 3 pronged advantage: Nutritional, Immunological (against allergies and infections), and Protection against chronic conditions (Obesity and others).

Breastfeeding involves several reflexes by the mother and by the baby. The mother’s side includes galactopoiesis (milk production stimulated by prolactin) and galactokinesis (milk ejection reflex stimulated by oxytocin). From the baby’s side, it involves the coordinated actions of rooting, sucking, and swallowing.

It is thus pertinent to elaborate on these proven benefits of breastfeeding:

Nutritional benefits: 

Breast milk is referred to as the perfect food for the newborn’s immature digestive system. It contains about 67 kcal/100 ml of breast milk.

The components include:

  • Carbohydrates: Breast milk is rich in carbohydrates. Lactose is the predominant carbohydrate. It is broken down to glucose and galactose and ( also contains lactoferrin and lactobacillus gut bacteria).
  • Proteins: They are relatively low in breast milk. The predominant protein is the whey group of protein, which includes lactalbumin and lactoglobulin. It is easier to digest (compared to formula feeds and animal milk) and is essential for brain growth. (Cow milk, on the other hand, has casein as the predominant protein and is difficult to digest and has increased chances of constipation and allergy.)
  • Fat: Breast milk is rich in polyunsaturated fatty acids (docosahexaenoic acid and arachidonic acid), which aid in brain growth.
  • Deficiencies: Breast milk is deficient in vitamin K and vitamin D. In strict vegetarian mothers, vitamin B12 is often absent. However, in term babies, sufficient stores are available as a reserve. However, in pre-term babies, supplementation is advised.

At birth, vitamin K injection is given to infants. Also, vitamin D supplementation is given during the first 2 months and continues until 1 year.

Thus, human milk is personalized nutrition for the baby and differs from one human to the other as opposed to formula feeds (one-size-fits-all composition) 

 

Immunological benefits

It has been shown that infants who have been breastfed had fewer infections and hospitalizations than infants who were not. The immunoglobulins and vitamins in the colostrum (in the initial 3 days) protect against many pathogens. Also, in preterm infants (who are at an increased risk of hypothermia and infections). The mother’s milk naturally has increased concentrations of calories, ions, and immunoglobulins. Thus the protection is provided against the following diseases:

  • 1. Ear infections (otitis media)
  • 2. Gastrointestinal infections (manifest as diarrhea)
  • 3. Respiratory infections (pneumonia)
  • 4. Nervous system infections (meningitis)

Protection against chronic diseases

They result due to an interaction between genetic factors and environmental triggers. They include:

  • 1. Hypersensitivity Reactions (Allergies and Asthma)
  • 2. Metabolic Abnormalities ( Obesity and Diabetes)
  • 3. Sudden Infant Death Syndrome (when no other cause is attributable)

 

Other Considerations

feeding

  • Cost: Breast milk is free, as the mother’s body ensures nutrition to the infant even at her own cost. Besides, supplies such as bottle pumps and the formula-feed mixture are costly and still not accessible to a wide range. As an extension, it also saves the medical (consultation and drugs) expenses since breastfed babies are less likely to fall ill and contract a disease.
  • Cultural Acclimatization: A breastfeeding mother requires additional calories to the tune of 500kcal per day. Invariably, the breast milk of each mother tastes different since it is derived from maternal food preferences. This exposes the baby to different foods, which help in weaning later and help them accept solid foods with relative ease.

  • Convenience and Availability: Paediatricians across the spectrum support ‘on-demand’ feeding to the infants, as and when the baby desires. Thus it is always fresh and readily available (as opposed to formula feeds, which need to be purchased, constituted, and then fed in bottles.

  • Intellectual Development: The proteins and fats mentioned above stimulate brain growth. Thus, breast-fed babies have been shown to have slightly higher Intelligence Quotient than those who were bottle-fed.

  • Kangaroo-Mother Care and Skin to Skin Contact: Especially in low birth weight babies, close skin to skin contact provides warmth to the babies and enhances bonding. This prevents hypothermia and other complications.

  • Maternal Benefits: Breastfeeding helps burn calories and helps accentuate the return of body physiology to pre-pregnancy states. It also reduces the risk of ovarian, breast, and uterine cancer and hypertension, and diabetes.

 

Challenges Associated with Breastfeeding

Breastfeeding must be a routine practice, and as with any other routine, it can be difficult for both the mother and the baby to get used to it.

Some of the common concerns during the first few weeks and months include:

  • Improper Technique: There are various positions advised by professional bodies for proper latching of the newborn, exposing the nipple and allowing the baby to crawl on to the breast. Latch-on pain in the first week or so generally subsides. However, nipple cracking and dryness may be experienced by some females, along with persistent pain. Thus, it is important to consult a pediatrician regarding the proper-technique and rule out other causes like an infection, an abscess, or an inefficient milk let-down.
  • Frequency of Feeds: Initially, the babies feed often, and there is no particular feeding time. Thus, it might become difficult for working moms or professionals to provide on-demand feeding. Besides, breast-feeding infants also have a higher frequency of feeding since breast milk is easy to digest, and it also promotes gastrocolic reflex (promotes peristalsis). Thus, such babies might even require feeding every 2-4 hours, which may not always be feasible.
  • Monitoring one’s diet: Inevitably, the mother’s nutrition affects the baby’s nutrition via breast milk. Thus, special care needs to be taken to consume seafood (risk of contamination with mercury- Minamata disease in Japan). Social stimulants like alcohol should also be avoided to prevent lethargy and dullness in children and an increased risk of developing liver diseases later in life. Conversely, excitants like caffeine and tea should be consumed in moderation to prevent restlessness and irritability.

 

Maternal medical conditions, medicines, and surgery

 

A mother on chemotherapy or radiotherapy and the baby diagnosed with lactose intolerance or galactosemia are absolute contraindications for breastfeeding. 

Medical conditions like HIV, TB, Herpes, or Varicella infection are relative contraindications. A decision must be taken after an appropriate cost-benefit ratio. 

In women with breast surgery such as reduction, it may not be easy to feed the baby. Breast-milk expression and feeding with Paladai can help. It is always advisable to consult one’s doctor regarding the medications one can or cannot take while breastfeeding and other specific concerns.

Bottle Feeds:

Bottle feeds, or formula feeds, have emerged as an alternative to breastfeeding and contain the supplements that are generally lacking in breast milk and need to be provided from outside.

The formulation is complex, managing the right mix of nutrients to match the nutritive content of mother’s milk. However, it is not custom made (like breast milk) but may help women who find breastfeeding stressful or too difficult. Other positives for formula feed include:

  • The convenience of Feeding: Once constituted, either the parent or the caregiver or the other partner can provide the bottle feed to the baby. If the milk is expressed in a bottle, the mother can also feel involved. It also helps to promote bonding between the feed giver and the baby.
  • Flexibility: The necessity for frequent feeding is reduced, as it may become uncomfortable for the mother to nurse in public spaces. Thus, there is no need to reschedule work or other obligations as the feeding is taken care of bottle feeding.
  • Frequency: As opposed to breastfeeding, formula feeds take more time to digest, and hence, they feed less frequently.
  • No-Diet Monitoring: The mother’s nutrition would not affect the composition of the breast milk provided to the baby.

Formula Feeding Challenges

The challenges associated with bottle feeds include:

  • No immunological function: The maternal pre-formed antibodies and bioactive substances (for the maturation of the gut) are absent in formula feeds, and thus, the infant is at a higher risk of infections (immediate and late complications)
  • Composition: Breast-milk is tailor-made by the mother to suit the baby’s demands. It evolves according to the baby’s feeding patterns, which cannot match in complexity.
  • Constitution and Feeding:  Unlike breast milk available in the right form at the right temperature, formula milk must be properly prepared, with planning and organization to ensure that it is always handy when the baby needs it. The accessories like bottles and nipples must also be clean and readily available. For babies who feed frequently, this routine can become overwhelming and time-consuming.
  • Cost: It comes as no surprise that ready-to-feed foods are expensive. (Powdered feeds are relatively less expensive). Thus, it may not be affordable to families who are the most in need of them. Special feeds (which don’t have soy or other processing substances) may even cost higher.
  • Diarrhea, Constipation, and Bloating: There is a slightly increased chance for diarrhea due to infections by water. Also, formula-fed babies have more bloating and constipation, as the feeds are relatively difficult to digest.

Making a Choice: Breast vs. bottle

Undoubtedly, breastfeeding must be encouraged with feeding in public spaces; it might not always be the answer to a mother’s work and lifestyle. It is natural for many women to switch choices after the baby is born, continuing breastfeeding and bottle feeding, considering their family and lifestyle.

Talking to the pediatrician or, better, a lactation consultant helps make the mother an informed choice regarding her options and the relative benefits-challenges of both.

 

References

 

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