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Infant Formula – What IS The Magic More?

My baby needed more than just breastmilk..
Breastmilk wasn’t filling him so we had to give formula.
Baby was big/hungry and not satisfied on breastmilk alone, big babies sometimes need more than exclusive breastfeeding.
My baby isn’t getting what she needs as she wants to feed frequently every evening.
Baby wasn’t gaining enough weight and needed something more.
These are phrases many of us are used to reading online, and I have long pondered – what is the magic “more”?

Firstly let’s think about it logically – human infants are born perfectly designed to consume human milk; just like calves are to drink cow’s milk and piglets are to drink sow’s milk.  For this to be “inadequate” for some infants would make no sense, because before the days you could buy a tin it was the only option.  Secondly the volume of breastmilk isn’t limited to x oz per feed, if baby is hungrier they can drink more and mum makes more!  As the vast majority can (with the right support)  make enough milk for twins, even the hungriest baby can have their fill.

Standard breastmilk substitutes contain around 20 cals per oz, breastmilk contains on average 22.  Fat levels in substitutes are at around 3.5 g per 100ml, compared to an average of 4.2 in breastmilk.  Protein levels in a standard formula are approximately the same as breastmilk, around 1.3g per 100ml.

Breastmilk is often compared to a “healthy salad”, because of how easily it is digested and how the baby feels after feeding; in contrast substitutes are often compared to a “roast dinner”, because baby may zonk out for a long period.  This is partly because it’s easy to inadvertently overfeed with a bottle, but also because milk of another species is much harder to digest – whilst both contain protein, one is human and one is bovine.   In terms of nutrients to grow, breastmilk is no “lighter lunch” than the typical alternative.

So if substitutes offer nothing “more” than breastmilk (and lack all the immunological propertes of breastmilk), why do some parents feel their baby needs them?

I suspect there are several or more answers to this question.  Firstly, formula frequently matches what many mums perceive as a more sated infant, based on cultural expectations.  Many mothers only know infants who are fed substitutes and so their behaviour is held as the norm.   Breastmilk is digested in 1 1/2 - 2 hours, whereas formula can take 3-4 hours; if baby wants feeding every couple of hours or more, mums are often concerned her baby is hungry or “not as settled as they should be”.  The truth is breastmilk is digested at a normal rate - it’s non breastfed infants who often take a longer than normal time to digest, resulting in longer than normal feed spacings.  Nothing to do with “being more content” and all to do with working hard to digest foreign milk!

Some infants struggle so much to digest it results in cconstipation or colic – resulting in less sleep all round – the opposite of the desired result; and for a small proportion of infants the supplement makes absolutely no difference at all to sleep, settling, or frequency of feeding - but a big difference to their gut.
If the sitution in society were reversed and the majority of mums were breastfeeding every couple of hours – a baby suddenly going a long time between feeds would be the cause for concern, not the reverse.  I wonder if the advice then would be to supplement with breastmilk? ;)

It also comes down to ineffective breastfeeding support and education – most babies have fussy periods (previously called growth spurts) where they want to feed much more frequently for a few days, and many in the early weeks cluster feed (lots of feeds back to back early evening) but as a lot of mums are never even told about this, they understandably believe they aren’t making enough milk to satisfy baby, or that for some reason it wasn’t filling enough.  I for one fell into this group with my first and was quite gobsmacked when I read about it online that despite spending 9 months convincing me “breast was best”, nobody had bothered to let me know about that part!

It could also be down to less than great positioning and attachment - baby may not be actually drinking well and so in that case genuinely may need more milk; but that’s because the amount of milk being consumed is too small – not a quality issue.   With good support this can be quickly and easily overcome in the vast majority of cases.

Perhaps the visual aspect also plays a part? we are most used to bovine milk- skimmed is thin and watery, down to full fat which is rich and creamy.  Expressed breastmilk because of the type of protein and fats appears an almost blue colour, and is thinner in consistency than full fat milk; in contrast a bottle of formula appears much more as we expect a richy creamy milk to look.  A good (formula feeding) friend of mine once commented when my first was tiny, that my expressed milk “didn’t look very creamy or rich, was it filling enough?” (First baby didn’t sleep long periods and so the implication was obviously my uncreamy milk!)

Because non breastfed infants often gain more weight than breastfed after the early months, due to either wrong re-constitiuting of powder or overfeeding - perhaps this adds to the feeling formula offers something “more”?

As long as mum is consuming somewhere around the recommended calories per day (1500-1800) and not drastically below, diet has little impact on fat and calorie content of breastmilk.   It can vary mum to mum, feed to feed – but only volume of milk consumed has been correlated with growth.

Lastly the whole “big baby” statement makes so little sense if you think about it.  Those mums who do exclusively breastfeed for 6 months, do so not only when their baby is tiny, but when it is four or five months old too!  Even the chunkiest of newborns or young babies are smaller than this – so why would breastmilk be unable to sustain them when it  can do so fine with older bigger babies?  for those who become chunky – breastmilk made them so, how would it do that if so lacking?

So if anyone does work out what the magic more is, do let me know.

© 2010 milk matters


  1. This is very good info, I wish I had this info with my 1st as my HV suggested i introduced her to formula at 4 weeks and at 6 weeks i gave up BF completely :o( I have felt guilty about this every day since and put it down to lack of info/unsupportive/uneducated family and health care professionals. I have since done a lot of research on BF and breast milk and my second daughter is 3 months today and exclusively BF and going strong :o)

  2. There is one inaccuracy though...before formula feed there WERE alternatives to the mother's breast milk.
    a) a nursemaid's milk
    b) the use of diluted condensed/evaporated milk orsimilar.

    Adopted babies during the 60s and 70s were often brought up on the latter. We seem to forget that not all mothers are lactating ones.

    While I think breastmilk is a wondrous thing and has much to be promoted, I also think we shouldn't demonize women who choose alternatives. Often they have their (very good) reasons; they don't make this choice lightly and should be supported, whatever their decision.

  3. Well, there's also the experience that if a baby is very fussy in the evenings, and a bottle is offered (expressed milk or formula), baby may drink a lot on top of the breast feed, making mum wonder if she may not be making enough milk.

    With my first I had a few nights where I was sure she was hungry, and I fed non stop for hours. I don't have this with no. 2 at all. Yes, positioning may have been the issue, and the days when this happened were usually hot or busy, so it may have had something to do with a baby unusually hungry, but it was real.

    On the other hand, with all the support received, there was still an expectation by health professionals that at some point feeds should be 3-4 hourly, not 2 hourly, which doesn't do much for confidence if the best you get is 2 1/2 hourly feeds that take 45-60 minutes.

    Another piece of misinformation in my view is the one side per feed myth. Maybe it works for some, but it never worked for me. It made me feel like I wasn't producing enough milk. Now I'm confident that my babies just need both sides at each feed and that's how things work for us.

    I also have to say that with first baby I really didn't think she was always getting enough, whereas with second I'm sure she's getting enough -so there may well be real differences? I agree that the need for more is overrated, but on occasions it may in fact be the case.

  4. Hiya
    I forgot to italicise the "more" when I copied it over. The suggestion is that infants need something "more" than breastmilk - implying breastmilk as a milk is just not enough for some types of infants. Yep absolutely some babies will need more breastmilk - I've blogged about this here which might be of interest:

    Single side feeding is an interesting one as recently there seems to be a big move telling mums only to use one breast to ensure baby gets hindmilk. Some infants will take one and be happy for a couple of hours, others who only have one side will need feeding as frequently as every 45 mins:

    The cluster feeding in the evening can be common even in mums with great supply, but not all infants seem to do it. I had lots of milk with my first but she was a very frequent evening feeder (read as glued from 7-11!)and she gained large amounts of weight.

    With my second I had to work to build supply as he was prem, and never felt to have the abundance I had the first time - yet he didn't cluster feed beyond every couple of hours. Weight gain was also slower.

    Some mums who mention cluster feeding, then get a longer stretch of say 5/6 hours as "payoff" - whilst those who don't cluster feed may instead continue the every couple of hours pattern. This post looks at why that may be:

  5. Great post. I've never understood this either. My son gained 1lb a week for his first 10 weeks and is above the 91st percentile. He was EBF until 6 months and didn't need 'more' - and I'm only 105lbs myself! He did feed every 2.5 hours in the daytime though, and 3 times at night, so I do wonder if others would have thought he needed 'more' because he ate so often. But I believed that was normal for a big, EBF baby, and he was always very happy.

  6. I am sure this was left out because it wasn't relevant to the point of the article, but I would like to make the point that there are occasions when breastfeeding is so problematic and/or painful that some formula feeding is pretty much essential. In these cases I believe that mix feeding need not necessarily be permanent. I for one mix fed while having serious problems and later returned to exclusive breastfeeding. If I had tried to struggle on at the time I would undoubtedly have given up altogether before too long. Formula, while far from ideal, CAN be a short term tool that paves the way for long term breastfeeding when support on its own does not help.

  7. I mixed fed a little in the early days. My partner gave our baby a bottle when he was 4 weeks old, purely so I could have one feed off and have 3 hours straight sleep, but I'm so glad I did it. I was on the verge of giving up as I was beyoned exhausted and it was a short term solution to what led on to a happy 19month nursing period. I was extremely lucky to get 2 hours from one feed to the next and my son was a very slow feeder. In the words of a breast feeding counsellor ''well hes not the slowest feeder I've ever seen but he is slow!'' What was interesting was that my son never slept any longer after a bottle of formula, he still woke two hours later. If I did get the opportunity to express during the day for his 1 bottle then I would but to begin with that was hard to do so as the above anonymus said ''Formula, while far from ideal, CAN be a short term tool that paves the way for long term breastfeeding when support on its own does not help''.

  8. Hi Anon
    Did the bfc explore WHY he was such a slow feeder?

  9. The mum who compared expressed breast milk (unfavorably) with formula is ridiculous. Does she not realize, that formula makers try to imitate human milk?
    I'm surprised that she did not advise her friend to eat grass, to make "nice thick creamy milk!!"