Currently there is no doubt that breast milk is the ideal food for the baby during the first six months of life; This is recommended by the WHO. From then on, and up to two years or more whenever the mother and baby wish, it continues to be essential, but it is necessary to take other foods as well.
As a nutrient, it has been seen that breast milk provides everything a baby needs in its first months of life. In addition, multiple benefits have been observed, both for the baby who receives breast milk and for the mother who gives it.
Despite this, there are situations in which, for medical reasons or by choice, you have to resort to formula milk. When is it necessary to turn to formula milk to feed the baby?
1. By maternal desire
The way to feed a baby should be a decision made as a family, once they have been informed of the different options, with their risks and benefits.
There are mothers who are clear from the beginning that they do not want to breastfeed; Others find themselves with so much difficulty, or so little support, that they decide to quit at some point. And this must be respected. In our environment we have different starting formulas and it is a safe option for the baby.
2. By hypogalactia
Fortunately, primary or true hypogalactia is very rare. We can see it in mammary hypoplasias, after some breast surgeries (for example in reductions) or in some endocrine disorders such as polycystic ovary syndrome.
Secondary hypogalactia (for example, due to rigid breastfeeding schedules, poor latch on or some anatomical condition of the baby that makes it difficult to express milk) is more common but, luckily, it has a solution. In any of these cases in which the mother is not able to produce enough milk for her baby (temporarily as in secondary hypogalactias or permanently, as in primary hypogalactias), we must resort to formula milk to complete the contributions that our baby needs.
3. Contraindication to breastfeeding due to the baby’s illness
Most mothers can breastfeed and the vast majority of babies can receive breast milk (otherwise, we would have become extinct). But there are some very, very specific situations in which breastfeeding is contraindicated. This can be due to either a mother’s illness (as we will see later) or a baby’s illness, as we will see below.
- Galactosemia . Galactose is a simple sugar that is converted into glucose in the liver. Lactose is made up of galactose and glucose. Converting galactose into glucose requires several enzymes. If they are absent, galactose or its derivatives accumulate in different parts of the body (liver, brain, eye) and can cause vomiting, lack of growth, cataracts, liver failure, brain symptoms … Therefore, treatment in these people is to eliminate lactose and galactose from the diet. Breast milk contains lactose, so breastfeeding is contraindicated in cases of classic galactosemia , in which there is a total deficiency of an enzyme involved in the passage of galactose to glucose. In other pathologies, such as the Duarte type variant, the enzyme has a reduced activity and could, according to some recent authors, maintain breastfeeding.
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Maple syrup urine disease . This rare disease is also due to the lack of an enzyme, in this case involved in the breakdown of three amino acids: leucine, isoleucine and valine. These substances accumulate in the body and babies present, in addition to a urine with a characteristic smell that gives its name to the disease, rejection of feeds, drowsiness and brain involvement. In this case, breastfeeding is also contraindicated and these babies should receive special formulas without leucine, isoleucine or valine.
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Phenylketonuria In this disease there is a deficiency of the enzyme involved in the metabolism of phenylalanine. Phenylalanine then builds up and can cause mental retardation. The treatment consists of restricting the foods that contain more phenylalanine (legumes, soy, fish, eggs, dairy …). Breast milk contains low amounts of phenylalanine, so breastfeeding is not completely contraindicated. Breastfeeding can be combined with phenylalanine-free formulas , with medical control and monitoring of phenylalanine levels in the baby.
4. Contraindication to breastfeeding due to maternal illness
– HIV. In developed countries , where formula is accessible and safe, it is recommended that mothers infected with the human immunodeficiency virus (HIV) do not breastfeed their babies, as it is known that they can be transmitted through breast milk. However, in developing countries, not giving these babies breast milk is associated with increased morbidity and mortality, and the benefits of receiving breast milk may outweigh the risk of contracting HIV through milk. In these cases, it is recommended to maintain exclusive breastfeeding for 6 months and continue it later along with other foods until one year of life. If they are receiving antiretroviral therapy, breastfeeding is recommended for up to 24 months. Mixed breastfeeding has been associated with an increased risk of contracting HIV.
– Herpes simplex type 1 on the nipple. If the herpes lesions are on the nipple, breastfeeding should be discontinued until they have healed. There would be no problem in maintaining lactation on the other breast if it is not affected.
If the herpes is in another location, we must take the usual care (hand washing, cover the lesions to avoid contact with the baby, avoid kisses if it is a cold sore …).
– Maternal medication. Some medications, such as chemotherapy or radioactive iodine, contraindicate breastfeeding. If the time that we must suspend breastfeeding is short, we can express the milk and discard it (in order to maintain production). If we know in advance that we are going to have to undergo this treatment, we can do a milk bank beforehand and do delayed breastfeeding.
Some drugs that are not compatible with breastfeeding can be substituted for similar ones from the same group that are compatible. To check the compatibility of drugs with breastfeeding, visit the website www-e-lactancia.org, a project of the Association for the Promotion and Scientific and Cultural Research of Breastfeeding (APILAM).
5. Other situations in which we must temporarily resort to formula milk
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Serious maternal illness that prevents the baby from breastfeeding, for example, admission to the ICU. In some cases it will be possible to express the milk and give it later to the baby (delayed breastfeeding).
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Newborns at risk of hypoglycemia may require mixed breastfeeding in the event that breast milk is not sufficient to meet their glucose needs. After the first hours or days of life, this is usually not necessary.
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