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Formula Feeding

Please Don’t Feed Your Baby Homemade Formula!

By March 24, 2016 6 Comments
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Yesterday a friend shared a story about Kristin Cavallari’s recipe for homemade baby formula.  In case you’re wondering, yes, the very same Kristin Cavallari that rose to fame in reality shows Laguna Beach and The Hills (Google it kids, if you don’t remember them). I’m sure Kristin is a great mother and loves her kids dearly – but a nutritionist or International Board Certified Lactation Consultant (IBCLC) she is not.

In my practice as an IBCLC, there are few topics that I feel strongly enough about to tell parents that they absolutely should not do. Many of our choices as parents are more of a matter of opinion and preference than safety. What we do is largely based in love and a desire to do the best for our children. How we feed them and view feeding them is no different, so I’m not going to mince words here: Please don’t feed your baby homemade formula period.

Let me be clear, it’s not just Kristin Cavallari’s recipe for homemade formula. It is any recipe for homemade formula. Do not feed your baby homemade formula at all. Full stop.

Why is that? It’s important to know that it is very difficult to make it a safer option than human milk or safely prepared commercial formulas, and the people giving you recipes for homemade formula (including Ms. Cavallari) are not telling you this, likely because they don’t understand it themselves. I’m going to break down, issue by issue, why feeding your baby homemade formula is a very, very bad idea:

Issue #1: Feeding your baby raw milk carries major risks

Most recipes for homemade formula call for raw (sometimes referred to as unpasteurized) cow’s or goat’s milk, and this carries significant risk for infants. The CDC released a report in January 2015 detailing outbreaks of food-borne illnesses related to raw milk consumption, and the statistics show that children were at the highest risk for serious illness of those affected. According to the report, “from 2007-2012, 26 states reported 81 outbreaks caused by raw milk to [the] CDC. These outbreaks caused 979 illnesses and 73 hospitalizations.” 59% of those outbreaks involved at least one child younger than 5. Keep in mind that these are only reported outbreaks, meaning the actual numbers are likely higher. Raw milk may not be investigated as a culprit because in areas where raw milk may not be as accessible or acceptable people may avoid mentioning it to avoid potential repercussions, and not everyone goes to the doctor or hospital when they have an illness.

While the existence of regulations alone doesn’t prove that consumption is harmful, it is worth noting that most states restrict raw milk sales in some form. Adults should be able to make the decision to purchase raw milk and consume it after weighing the risks and benefits for themselves. Children aren’t able to do this risk-benefit analysis for themselves, and unfortunately, they stand to be at the greatest risk, which is why it is important for parents to understand the potential for harm.

Issue #2: The correct balance of nutrients is essential, and difficult to achieve.

What makes formula difficult to make at home is the issue of renal solute load. That term refers to the digestive and metabolic byproducts that the kidneys are responsible for clearing out of the body. The higher the renal solute load of a food, the more water is needed for the kidneys to properly excrete those byproducts. Protein, calcium, phosphorus, sodium, and potassium contribute to potential renal solute load, and when an infant’s immature kidneys are overtaxed, this can lead to dehydration  – and worse. Infants who are fed cow’s milk are also at risk for anemia due to the low iron content of cow’s milk, the intestinal blood loss that occurs in infants who consume cow’s milk, and the high levels of calcium and casein in cow’s milk (which impact iron absorption).

milk

Comparison of protein, calcium, phosphorus, sodium, and potassium of human, cow, and goat milk. Click to view data source here.

As you can see from the adjacent table, human milk has much less protein, calcium, phosphorus, sodium, and
potassium than cow’s milk and goat’s milk. Goat’s milk is at times called the closest animal-milk substitute for human milk but, as you can see, it has an even higher potential renal solute load than cow’s milk.

A number of homemade formula recipes call for a liver-based mixture, which can easily contain too much vitamin A. Three ounces of chicken liver contains 185% of the daily Recommended Dietary Allowance (RDA) for vitamin A for an adult woman; this Weston A. Price liver-based formula recipe contains two ounces of liver for an infant per day, which far exceeds the upper bound. Since vitamin A is fat soluble, it is stored in the body, and accumulates over time.

Even if we presume that the many recipes floating around for homemade infant formula are providing the correct balance of macro- and micronutrients (which they’re not), what about the other variables?

  • Not all raw milk is created equal. A cow’s milk can change during the course of lactation, just like human milk can.
  • Not all supplements are created equal. Are you using the exact brand of supplement suggested by the recipe? Different manufacturers will have different formulations.
  • Supplements often change. Has the manufacturer’s formulation of the supplements stayed the same since the recipe was created and published?
  • Is the recipe itself accurate?
  • Is the equipment you’re using to measure your ingredients accurate? Are you measuring them accurately? Here’s the story of a baby who was hospitalized for a vitamin D overdose because her mother added a dropperful of vitamin D rather than a drop to the homemade formula she was making.

Here’s additional reading about the complexities of matching the nutrition and performance of breast milk when creating substitutes.

10058357146_6697db3dbf_oIssue #3: Commercial formula manufacturers aren’t making poison – it is safe for an infant’s consumption when prepared correctly.

People who make their own formula at home usually claim they do so because they feel that commercial formula is “poison,” or the ingredient list is long and confusing. However, the people and commercial entities who put the most money and effort into researching  and replicating breast milk are those who are trying to best replicate it, because the better the formula, the easier it is to sell it at higher prices. This is not skepticism or conspiracy theory; it is basic economics.

Consider that commercial infant formula is regulated by the Food and Drug Administration (FDA), and manufacturers are required to demonstrate not only that their product meets certain nutritional standards, but also that their supply chain meets certain health and quality control standards, so that the formula is manufactured safely and consistently. So commercial formula manufacturers have an economic interest in ensuring their formula is safe and nutritious with as little risk as possible. Not only do they have a vested interest in creating a product as close to human milk as possible, they have a vested interest in avoiding contamination and product recalls.

While commercial infant formula keeps getting better and better, it won’t ever be the incredible, varied, ever-changing composition of a mother’s milk. Yes, a mother’s breast milk is the ideal food for her baby, but in the end, fed is best. If you feed your baby formula and prepare it correctly, they’ll be OK. My job is to support women while they breastfeed – and I also don’t think commercial formula is poison.

What I do know with certainty is that while both breastfeeding and using commercial formula carry their own unique risks (nothing in life is risk-free), that the risk of your child contracting a food-borne illness or suffering from a nutrient deficiency is much, much higher with homemade formula than with commercial formula.

Issue #4: Homemade formula is more expensive and takes more time than commercial formula.

If I haven’t convinced you by now that homemade formula is a bad idea based on the safety or nutrition factors, can we just talk for a minute about how expensive and inconvenient it is to make homemade formula?  There’s no question that companies make money off commercial formula and that the price of that formula is unnecessarily high (especially for those with lower incomes). But homemade formula is even worse!

Raw, organic cream prices in California, where you can legally buy raw milk in a store, circa 2013.

You can purchase a pre-assembled kit for all of the supplements and additives you need for homemade infant formula from Radiant Life. A 37-day supply will set you back $174 (they throw in free shipping, so it comes out to $4.70 per day just for the additives). A gallon of raw milk costs significantly more than pasteurized, homogenized (aka regular store-bought) milk. This website gives it a range of $6 to $8 per gallon. Then you need whey (homemade), which is the liquid left over from making cultured dairy products such as yogurt, cream cheese, or sour cream (made from raw milk, of course). And don’t forget the raw cream. The photo to the right was taken by a friend of mine in southern California (where retail raw milk sales are legal). There’s quite a price difference between raw and pasteurized cream, and you need two to four tablespoons of it per batch of homemade formula.

Then there’s the time involvement. You have to assemble the ingredients. If you’re not buying a pre-packed kit, you’ll be spending time sourcing individual supplements. You’ll have to find a source of raw milk, and likely drive to the farm to purchase it. You’ll have to make a batch of it each day, which is a process much more involved even than safely preparing commercial infant formula.

Maybe you’ll end up saving time only feeding your baby six times a day, though, as some of the recipes recommend 6- to 8-ounce servings. The reality is that this means a baby is getting too much to eat at meal times that are too infrequent. Infants should be eating 8 times per 24 hours (including nighttime feedings), at a minimum.

So here’s the bottom line.

If your baby is not getting your breast milk, properly prepared commercially manufactured formula or donor breastmilk received from a donation bank. We’ve come a long way from the time when a third of all infants who were bottle-fed died and unregulated formulas of the past. Nothing is 100% risk free, but it seems clear to me that homemade formula’s risks outweigh any perceived benefit, particularly for infants who have not yet started complementary/solid foods.

Every baby deserves to be fed safely. Sometimes parents and caregivers have no choice but to feed breastmilk substitutes, and sometimes caregivers may choose breastmilk substitutes. There are organizations around the world trying their best to improve those situations (here is just one of many, focusing on refugee children: Infant Feeding Support for Refugee Children), and my heart breaks for any family who does not have access to the safest ways of feeding their baby.

However, most of the people reading this will have more options. This post is written in the spirit of giving you all of the information you need to make an informed decision. I’ll leave you with one final thought. I’ve said previously, the time, effort, and money put toward sourcing the ingredients and making homemade baby formula could be spent on finding donor human milk instead.

Editor Update 3/25/16: A sentence in an earlier version of this post could have been interpreted to imply that parents should choose peer-to-peer breast milk donation before feeding commercial formula.  Feeding your child peer-to-peer donated breast milk is a practice which can carry great risk, specifically in how, unlike screened milk bank breast milk, peer-to-peer breast milk does not control for or involve clinical screening for contaminants or disease that can be transferred to an infant via the donor’s breast milk and/or the donor’s other bodily fluids (that pass to the infant during actual breastfeeding). Breast milk acquired from a breast milk donation bank may be appropriate, but not in all circumstances. As always, we urge you to consult with your child’s pediatrician and clinical team first. 

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Categories: Ages + Stages, Food, Nutrition, + Infant Feeding, Newborns + Infants, Science 101 + Mythbusting

What Are We Telling Mothers When We Say “Breast is Best”?

By June 3, 2015 20 Comments
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When my baby boy arrived, he weighed 4 pounds, 13 ounces. He entered the world 8 weeks early and spent 29 days in the Neonatal Intensive Care Unit (NICU).

When your baby is in the NICU, there is enormous pressure to breastfeed. The nurses rolled a hospital grade pump to my bed side just hours after delivery and minutes after my first visit to my baby’s incubator in the NICU. “Breast milk is like medicine for preemies,” I was told.

Every day I pumped around the clock and delivered milk to the NICU in the insulated bags they provided … like I was packing his lunch for school. Every milliliter was carefully inventoried and measured by the NICU nurses. I always knew from the looks on their faces if I had made enough to feed him for the day. Like I said- ENORMOUS pressure.

Things were going okay until about 10 days after delivery. I developed mastitis on the right breast. For those unfamiliar, mastitis is an infection of the breast tissue. I had pain, high fever, and chills. After two antibiotics it resolved. Then I developed a second mastitis infection on the other side. The pain was excruciating. The infections did a number on my body, my sleep, and my milk production (and yes we worked with lactation consultants and did all sorts of tricks to try and increase production).

I was exhausted, emotionally raw and in extreme pain.  My husband and I made the decision to switch my son to formula at 3 weeks old. We did it for his health, my health, and my ability to care for him when he was discharged. I can easily say it was the best decision we could have made. My sweet boy absolutely thrived on his special preemie formula. He tolerated it very well, grew, and got stronger. We are incredibly grateful for formula. We consider it an amazing public health innovation. Formula fed our baby when I could not.

I’m a public health practitioner, so I’ve known for years that “breast is best,” but I’m also now a proud formula-feeding mom so I think this gives me a unique view on how we, in public health, talk about breastfeeding.  A recurring theme for me is concern about the language being used in these campaigns. Somehow public health has not found an effective way to promote breastfeeding without stigmatizing formula feeding.

For example:

  • Memes like this can make women unable to breastfeed feel like failures, when, in fact, breastfeeding isn't possible for all women.

    Memes like this can make women unable to breastfeed feel like failures, when, in fact, breastfeeding isn’t possible for all women.

    All birthing hospitals in Philadelphia (where we live) have officially discontinued the practice of giving free formula to new mothers. While I understand that this strategy is supported by evidence, it is part of a larger international initiative to make hospitals “Baby Friendly”. So using that logic, providing formula is “unfriendly” to babies? This message was reinforced by Nurse McGinn who was interviewed for the philly.com story. She reports that she “was given free formula and threw it out”. Quotes like these reinforce the message that feeding with formula is equivalent to giving your kid something bad. Every mother wants to do what’s best for their child, no mother wants to harm their child.

  • A friend sent me a link to a wonderful story about supporting formula feeding moms during World Breastfeeding Week. This article does a great job of examining the language being used in their recent campaign. The terms connect breastfeeding with “winning” and achieving “goals.” So is the flip side “losing” and “falling short of your goals”? This can be a rough reminder for formula-feeding moms. For many women, the switch to formula was made after extreme pain, guilt, and feelings of failure. Around the same time a public health colleague tweeted that we should use the language “breastfeeding is normal” instead of “breast is best” Although it was not her intention, I read that as meaning that anything other than breastfeeding is abnormal. So formula feeding is abnormal?!
Model Nicole Trunfio graced the cover of Elle Magazine last month breastfeeding her son.

Model Nicole Trunfio graced the cover of Elle Magazine last month breastfeeding her son.

We also see many efforts promoting the message that “breastfeeding is natural”. In the Olivia Wilde photo spread for Glamour Magazine which includes a photo of her feeding her son, she says “Breastfeeding is the most natural thing…” In the June 2015 issue of Australian Elle, we see model Nicole Trunfio breastfeeding her son on the cover.  According to US Magazine, “the powerful cover shot by Georges Antoni captures the natural moment between mom and child.” And while of course breastfeeding is natural…we have to think about the flip side of this message- are we telling parents that formula feeding is an unnatural act?

When thinking about health communication, we need to not only test the key terms for our campaigns but we need to consider their antonyms. Normal-Abnormal. Natural-Unnatural. Public health practitioners are (or should be) familiar with the theory of unintended consequences, but it seems that when it comes to infant feeding we aren’t thinking about the unintended consequences of our messaging.
So I ask readers

(1) While these breastfeeding and baby-friendly campaigns have well-intentioned public health goals (which I support):

  • What are the unintended consequences of their language and communication choices?
  • Do they help reinforce the divide between formula feeding and breastfeeding mothers?
  • What about the women who both formula feed and breastfeed? Where do they fit in?

(2) What are your suggestions for more effective language? How can we simultaneously promote breastfeeding without stigmatizing formula feeding?

Readers can comment below! 

*An earlier version of this post was published on Pop Health on August 7, 2014.

 

 

 

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Categories: Food, Nutrition, + Infant Feeding, Mental, Emotional, + Behavioral Health