@drizzt777 Thanks for sharing that study, good to see a literature review and understand the main findings in benefits from breast feeding.
And you have a great doctor!
And you have a great doctor!
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Is it better to give my baby as much breast milk as possible in 6 months or space it out in smaller amounts for a year?
- Thread starter terrywinkle
- Start date
thedancingbaptist
New member
@thedancingbaptist I read it and the focus is on the benefits of continuing exclusive breastfeeding in months 4,5 and 6. It seems there isn't a whole lot to gain for the baby, some benefits for the mother.
" Exclusive breastfeeding for six months (versus three to four months, with continued mixed breastfeeding thereafter) reduces gastrointestinal infection and helps the mother lose weight and prevent pregnancy but has no long‐term impact on allergic disease, growth, obesity, cognitive ability, or behaviour.
The results of two controlled trials and 21 other studies suggest that exclusive breastfeeding (no solids or liquids besides human milk, other than vitamins and medications) for six months has several advantages over exclusive breastfeeding for three to four months followed by mixed breastfeeding. These advantages include a lower risk of gastrointestinal infection, more rapid maternal weight loss after birth, and delayed return of menstrual periods. No reduced risks of other infections, allergic diseases, obesity, dental caries, or cognitive or behaviour problems have been demonstrated. A reduced level of iron has been observed in developing‐country settings"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154583/
" Exclusive breastfeeding for six months (versus three to four months, with continued mixed breastfeeding thereafter) reduces gastrointestinal infection and helps the mother lose weight and prevent pregnancy but has no long‐term impact on allergic disease, growth, obesity, cognitive ability, or behaviour.
The results of two controlled trials and 21 other studies suggest that exclusive breastfeeding (no solids or liquids besides human milk, other than vitamins and medications) for six months has several advantages over exclusive breastfeeding for three to four months followed by mixed breastfeeding. These advantages include a lower risk of gastrointestinal infection, more rapid maternal weight loss after birth, and delayed return of menstrual periods. No reduced risks of other infections, allergic diseases, obesity, dental caries, or cognitive or behaviour problems have been demonstrated. A reduced level of iron has been observed in developing‐country settings"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154583/
thedancingbaptist
New member
@drizzt777 I think you've fundamentally misunderstood the research you're citing. The meta analysis isn't about "breastfeeding," it's about exclusive breastfeeding vs. mixed feeding. All the participants were breastfed.
@thedancingbaptist That’s what OP is asking about though, isn’t it? Exclusive breast feeding vs combo feeding?
thedancingbaptist
New member
@drizzt777 I'm addressing your claims about the benefits of breastfeeding. You didn't make a distinction at all.
sarebear1992
New member
@terrywinkle So there’s really no good studies on this question (ie how much breast milk provides “benefits”). The general consensus is that breast milk provides the most benefits during the first 4-6 months of life.
Pumping is hard work! And for twins nonetheless. For me personally, based on the research and consultation with my doctor and husband (ER doc), I ended up exclusively pumping for 5 months and then we transitioned to formula and solids. Based on my review of the research it seemed baby “benefits” most from breast milk during the first 4-6 months of life.
Reposting more or less the same thing I post every time in response to a post like this.
There is really no science analyzing combo feeding or what amount of breast milk provides “benefits” as almost all studies compare exclusively breast fed babies to exclusively formula fed.
Longer discussion below:
So there’s no actual science supporting X amount of breastmilk delivers “benefits”. Largely because most studies compare exclusively formula fed babies to exclusively breast fed babies. It’s also hard to measure because it’s unclear which “benefit” we would be trying to measure and how to decide how much breast milk to test (25%, 50%, a set ounce amount). It’s a real gap in the research that I think we all wish we had a better answer for. People usually cite to a Kelly mom article for the 50ml stat but she doesn’t provide any sourcing to back it up.
The AAP has a study that shows some benefits (table 2) using an “ever” vs never breastfed comparison but it’s not adjusted for socioeconomic status and therefore it doesn’t really make a lot of sense (like it doesn’t make sense that one instance of breastfeeding (an “ever”) would result in a 40% decrease of some disease). https://publications.aap.org/pediat...ding-and-the-Use-of?autologincheck=redirected
What we do know from the sibling studies and PROBIT, is there is really no discernible or lasting difference in health or intelligence outcomes between formula fed and breastfed babies. So do whatever works best for you, your mental health and your family.
Here’s one sibling study.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4077166/
Breastfeeding rates in the U.S. are socially patterned. Previous research has documented startling racial and socioeconomic disparities in infant feeding practices. However, much of the empirical evidence regarding the effects of breastfeeding on long-term child health and wellbeing does not adequately address the high degree of selection into breastfeeding. To address this important shortcoming, we employ sibling comparisons in conjunction with 25 years of panel data from the National Longitudinal Survey of Youth (NLSY) to approximate a natural experiment and more accurately estimate what a particular child’s outcome would be if he/she had been differently fed during infancy.
Results from standard multiple regression models suggest that children aged 4 to 14 who were breast- as opposed to bottle-fed did significantly better on 10 of the 11 outcomes studied. Once we restrict analyses to siblings and incorporate within-family fixed effects, estimates of the association between breastfeeding and all but one indicator of child health and wellbeing dramatically decrease and fail to maintain statistical significance. Our results suggest that much of the beneficial long-term effects typically attributed to breastfeeding, per se, may primarily be due to selection pressures into infant feeding practices along key demographic characteristics such as race and socioeconomic status.
Additional easier to digest research here:
https://fivethirtyeight.com/features/everybody-calm-down-about-breastfeeding/amp/
https://freakonomics.com/podcast/how-important-is-breastfeeding-really/#:~:text=OSTER%3A%20One%20of%20the%20real,this%20if%20they%20want%20it.
For some more science: milk from 4 weeks through 18 months is extremely stable and suitable for babies in that age range. Very little nutrition changes during that age range for milk.
Milk matures by 4-6 weeks and is extremely consistent in nutritional composition from that point forward. Mature milk is incredibly stable during the first 12-18 months of life in terms of calorie, fats, protein, ect. What does change are antibodies and the like and that is usually in response to environmental factors, like if mom or LO has a cold or something.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/#:~:text=A%20dynamic%2C%20bioactive%20fluid%2C%20human,%2C%20diurnally%2C%20and%20between%20mothers.
By four to six weeks postpartum, human milk is considered fully mature. In contrast to the dramatic shift in composition observed in the first month of life, human milk remains relatively similar in composition, although subtle changes in milk composition do occur over the course of lactation.
See also: https://www.medela.com/breastfeeding/mums-journey/breast-milk-composition
By the time your baby is four weeks old, your breast milk will be fully mature. It’s rich in protein, sugar, vitamins and minerals, plus numerous bioactive components – such as hormones, growth factors, enzymes and live cells – to support your baby’s healthy growth and development.
From four weeks, the nutritional content and levels of ingredients in mature milk generally remain fairly consistent. But the composition of your breast milk can still change from day to day and feed to feed.
For an extended discussion of when statistically significant changes in breastmilk do take place (generally in prolonged feeding of 18 months plus) see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6316538/
Pumping is hard work! And for twins nonetheless. For me personally, based on the research and consultation with my doctor and husband (ER doc), I ended up exclusively pumping for 5 months and then we transitioned to formula and solids. Based on my review of the research it seemed baby “benefits” most from breast milk during the first 4-6 months of life.
Reposting more or less the same thing I post every time in response to a post like this.
There is really no science analyzing combo feeding or what amount of breast milk provides “benefits” as almost all studies compare exclusively breast fed babies to exclusively formula fed.
Longer discussion below:
So there’s no actual science supporting X amount of breastmilk delivers “benefits”. Largely because most studies compare exclusively formula fed babies to exclusively breast fed babies. It’s also hard to measure because it’s unclear which “benefit” we would be trying to measure and how to decide how much breast milk to test (25%, 50%, a set ounce amount). It’s a real gap in the research that I think we all wish we had a better answer for. People usually cite to a Kelly mom article for the 50ml stat but she doesn’t provide any sourcing to back it up.
The AAP has a study that shows some benefits (table 2) using an “ever” vs never breastfed comparison but it’s not adjusted for socioeconomic status and therefore it doesn’t really make a lot of sense (like it doesn’t make sense that one instance of breastfeeding (an “ever”) would result in a 40% decrease of some disease). https://publications.aap.org/pediat...ding-and-the-Use-of?autologincheck=redirected
What we do know from the sibling studies and PROBIT, is there is really no discernible or lasting difference in health or intelligence outcomes between formula fed and breastfed babies. So do whatever works best for you, your mental health and your family.
Here’s one sibling study.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4077166/
Breastfeeding rates in the U.S. are socially patterned. Previous research has documented startling racial and socioeconomic disparities in infant feeding practices. However, much of the empirical evidence regarding the effects of breastfeeding on long-term child health and wellbeing does not adequately address the high degree of selection into breastfeeding. To address this important shortcoming, we employ sibling comparisons in conjunction with 25 years of panel data from the National Longitudinal Survey of Youth (NLSY) to approximate a natural experiment and more accurately estimate what a particular child’s outcome would be if he/she had been differently fed during infancy.
Results from standard multiple regression models suggest that children aged 4 to 14 who were breast- as opposed to bottle-fed did significantly better on 10 of the 11 outcomes studied. Once we restrict analyses to siblings and incorporate within-family fixed effects, estimates of the association between breastfeeding and all but one indicator of child health and wellbeing dramatically decrease and fail to maintain statistical significance. Our results suggest that much of the beneficial long-term effects typically attributed to breastfeeding, per se, may primarily be due to selection pressures into infant feeding practices along key demographic characteristics such as race and socioeconomic status.
Additional easier to digest research here:
https://fivethirtyeight.com/features/everybody-calm-down-about-breastfeeding/amp/
https://freakonomics.com/podcast/how-important-is-breastfeeding-really/#:~:text=OSTER%3A%20One%20of%20the%20real,this%20if%20they%20want%20it.
For some more science: milk from 4 weeks through 18 months is extremely stable and suitable for babies in that age range. Very little nutrition changes during that age range for milk.
Milk matures by 4-6 weeks and is extremely consistent in nutritional composition from that point forward. Mature milk is incredibly stable during the first 12-18 months of life in terms of calorie, fats, protein, ect. What does change are antibodies and the like and that is usually in response to environmental factors, like if mom or LO has a cold or something.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/#:~:text=A%20dynamic%2C%20bioactive%20fluid%2C%20human,%2C%20diurnally%2C%20and%20between%20mothers.
By four to six weeks postpartum, human milk is considered fully mature. In contrast to the dramatic shift in composition observed in the first month of life, human milk remains relatively similar in composition, although subtle changes in milk composition do occur over the course of lactation.
See also: https://www.medela.com/breastfeeding/mums-journey/breast-milk-composition
By the time your baby is four weeks old, your breast milk will be fully mature. It’s rich in protein, sugar, vitamins and minerals, plus numerous bioactive components – such as hormones, growth factors, enzymes and live cells – to support your baby’s healthy growth and development.
From four weeks, the nutritional content and levels of ingredients in mature milk generally remain fairly consistent. But the composition of your breast milk can still change from day to day and feed to feed.
For an extended discussion of when statistically significant changes in breastmilk do take place (generally in prolonged feeding of 18 months plus) see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6316538/
@sarebear1992 I know people often say that it changes to become more calorie dense as they get bigger— do you know why they don’t take a lot more as they grow if it’s not changing in composition?
javier_is_life
New member
jointron33
New member
almostdawn
New member
@sarebear1992 Agree with everything here in terms of research. Adding my two cents as an exclusive pumper for twins - I would use the milk now just to make things easier. I exclusively pumped, then went through my frozen stash before switching exclusively to formula. It was so nice to just make a pitcher of formula and not have to worry about defrosting milk every night. Especially once you’re going solids multiple times a day and having to prepare and clean up from all of that x2.
@terrywinkle I did my PhD in infant gut microbiome development over the first year of life and wrote a couple of papers that tried to incorporate combo feeding into the analysis. It’s a tricky topic to study, and it’s even more difficult to define “better.”
From my research I can tell you that introducing any amount of formula has a large effect on the gut microbiome composition and function. But ceasing breastmilk all together has an even larger effect.
https://pubmed.ncbi.nlm.nih.gov/25974306/
Formula facilitates a diversification and therefore maturation of the gut microbiome so any microbiome or metabolomic metric will look heavily influenced by these factors. However, any amount of breastmilk promotes the growth of a few KEYSTONE species of bacteria that are very influential and can help slow down the maturation of the microbiome. Once breastmilk is removed, the composition changes very rapidly.
Somehow I doubt that’s what you mean when you ask which is better. Are thinking in terms of clinical outcomes like rates of infection, risk of atopic disease, propensity for obesity, cognitive scores at some random age, etc?? There really is no gold standard study looking at these things. There is the Dunedin study which retrospectively compared outcomes and found that breastfed babies (for at least 4 weeks only) have lower rates of infections, but higher rates of atopy as toddlers. Breastfed infants also had slightly higher cognitive scores (4 points) and lower rates of obesity. The weight trend starts in infancy, with formula fed babies generally putting on weight faster than breastfed, and showing reduced intake regulation around solid foods as well.
https://dunedinstudy.otago.ac.nz/files/1651633674775.pdf
From my research I can tell you that introducing any amount of formula has a large effect on the gut microbiome composition and function. But ceasing breastmilk all together has an even larger effect.
https://pubmed.ncbi.nlm.nih.gov/25974306/
Formula facilitates a diversification and therefore maturation of the gut microbiome so any microbiome or metabolomic metric will look heavily influenced by these factors. However, any amount of breastmilk promotes the growth of a few KEYSTONE species of bacteria that are very influential and can help slow down the maturation of the microbiome. Once breastmilk is removed, the composition changes very rapidly.
Somehow I doubt that’s what you mean when you ask which is better. Are thinking in terms of clinical outcomes like rates of infection, risk of atopic disease, propensity for obesity, cognitive scores at some random age, etc?? There really is no gold standard study looking at these things. There is the Dunedin study which retrospectively compared outcomes and found that breastfed babies (for at least 4 weeks only) have lower rates of infections, but higher rates of atopy as toddlers. Breastfed infants also had slightly higher cognitive scores (4 points) and lower rates of obesity. The weight trend starts in infancy, with formula fed babies generally putting on weight faster than breastfed, and showing reduced intake regulation around solid foods as well.
https://dunedinstudy.otago.ac.nz/files/1651633674775.pdf
nicholaste
New member
christina564
New member
@nicholaste When introducing formula and/or solid foods my understanding is that it’s not good vs. bad, it’s just different. The large effect is greater diversity in the child to adult microbiome and greater abundance of particular phyla (Clostridium and Bacteroides for example). Also, there aren’t many studies on the human microbiome during weaning, most of these studies are in mice.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10114993/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10114993/
javier_is_life
New member
terrywinkle
New member
@tag77 In my own experience, gut health has had a major impact on my life and when I had an imbalance it affected me in all aspects — so this is good information to have. I also had a c section which I did know has an effect on the microbiome — but from what I understand is that in general it’s just different types of bacteria, not necessarily better or worse? Forgive me if the study outlines that more clearly, I did my best to interpret.
And from the study, I understand that formula makes the microbiome more similar to an adult, but again is that worse or better?
And from the study, I understand that formula makes the microbiome more similar to an adult, but again is that worse or better?
carlamaejose
New member
@terrywinkle Breast milk changes as your baby grows to meet development needs. Breast milk is not the same in month 1 as it is in month 8 because the baby has different needs at different stages of development. Breast milk is so important for gut health(which plays a role in brain development), hormone development, immunity, etc etc.
if it were me, I’d exclusively breastfeed for 6 months and then decide how to proceed afterwards. At 6 months, babies begin their journey of solid foods and small amounts of water with food. So assuming they get proper and nutritious meals (ie real fruits and veggie purées rather than store bought processed pouches), then you can probably slowly transition from full time breastfeeding to a combo of breast milk and formula.
Best of luck!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/
if it were me, I’d exclusively breastfeed for 6 months and then decide how to proceed afterwards. At 6 months, babies begin their journey of solid foods and small amounts of water with food. So assuming they get proper and nutritious meals (ie real fruits and veggie purées rather than store bought processed pouches), then you can probably slowly transition from full time breastfeeding to a combo of breast milk and formula.
Best of luck!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/
sarebear1992
New member
@carlamaejose This actually isn’t true about milk adjusting for baby’s development. The composition of breast milk is VERY stable once mature milk comes in.
As the article cited makes clear: “By four to six weeks postpartum, human milk is considered fully mature. In contrast to the dramatic shift in composition observed in the first month of life, human milk remains relatively similar in composition, although subtle changes in milk composition do occur over the course of lactation.”
As the article cited makes clear: “By four to six weeks postpartum, human milk is considered fully mature. In contrast to the dramatic shift in composition observed in the first month of life, human milk remains relatively similar in composition, although subtle changes in milk composition do occur over the course of lactation.”
justintime25
New member
@carlamaejose In addition, I think some of the benefits of breastmilk start to dissipate after being frozen for too long
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