Dear Pediatrician: Is It Okay If I Don’t Breastfeed?

If you’re unable or choose not to breastfeed, it’s definitely okay—and you’re not alone. Canadian and U.S. surveys have shown 10% to 32% of mothers never begin breastfeeding and 4% stop within the first week of life. An additional 14% of mothers stop nursing before their baby is 2 months old. Fortunately, there are safe and nutritious alternatives to human milk.

Why Breastfeeding Doesn’t Always Work

Let’s face it—breastfeeding is hard. The breast is a complicated organ that doesn’t always work as expected, even with the best of intent. In addition, successful lactation requires balancing a complex combination of physical, emotional and personal factors. Some women can manage breastfeeding beautifully, while others run into challenges that make breastfeeding impossible.

The most common reasons breastfeeding doesn’t work include:

• Lactational complications
  • Physical discomfort while nursing or pumping
  • Perception of inadequate milk supply
  • Baby not satisfied by nursing
  • Infant weaned on their own
  • Pumping is too difficult

• Medical issues
  • Concern about baby’s lack of weight gain
  • Extensive neonatal intensive care unit (NICU) stay
  • Starting birth control or other prescription medications
  • Breast hypoplasia or glandular dysfunction
  • History of breast augmentation

• Personal conflicts
  • Returning to work or school
  • Needed help with infant care
  • Current or past sexual abuse
  • Didn’t like breastfeeding
  • Negative experience with breastfeeding in the past

With all of these unexpected or unavoidable nursing challenges, breastfeeding can’t be the only way to provide our babies with food.

Successful Infant Feeding Doesn’t All Look the Same

There are many ways to successfully feed an infant. Other than breastfeeding, the most common types of feeding plans include:

• Combination feed. When exclusive breastfeeding isn’t possible, parents may choose to feed any available breastmilk (by nursing or pumping) in addition to infant formula. Combination feeding is one way to maintain a baby’s growth if maternal milk supply doesn’t seem sufficient or if a baby’s physician is concerned about infant growth.

• Pump and feed. When surveyed, up to 6% of American women report pumping and feeding human milk without any direct feeding from the breast. For parents who choose this method of feeding, a baby can receive the benefits of human milk with more caregiver flexibility. Plus, milk volumes can be monitored if infant growth is a worry.

• Exclusively formula feed. For parents not offering human milk, infant formula is a safe and nutritious solution. Commercially available infant formulas are strictly regulated by the Food and Drug Administration. They mimic the nutritional components of human milk and come in a variety of baby-friendly options.

Regardless of which type of feeding plan works best, every parent’s decision represents careful thought that deserves unquestionable support.

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There’s a lot of stress on parents to exclusively feed human milk. In addition, mothers are often subject to moral-based language surrounding infant feeding practices which can increase the feeling of judgment. Comments like, “Breast is best,” or, “You must not have tried hard enough,” painfully imply second-rate parenting. As a result, it’s not uncommon for parents to experience guilt or shame if breastfeeding doesn’t occur.

Framing this feeling as grief, not guilt, is more accurate, says Summer Friedmann, a lactation consultant in Kansas City, Missouri. “Guilt is what we feel when we have done something wrong—almost sabotaging ourselves,” Friedmann says. “Grief is what we feel when something is important to us and it doesn’t go the way we desired. I stress how [stopping breastfeeding] was out of their control. There was nothing they did to feel guilty about.”

Parents should be aware that negative feelings about feeding choices can increase the risk of postpartum depression. Postpartum depression is a medical problem that can be treated. If you begin to feel unhealthy emotions getting in the way of caring for yourself or your infant, talk to a trusted friend, family member or health care professional.

Absolutely. Attachment is an emotional connection between parent and child which happens over time. Breastfeeding isn’t required for parent-infant bonding nor secure infant attachment.

5 Ways to Connect With Your Baby

1. Spend time skin-to-skin. The benefits of skin-to-skin contact with a parent are well documented. Physical touch stimulates oxytocin, also known as the “love hormone,” in both parent and infant. Oxytocin is used by the body to decrease the stress response and promote social interaction. Research has also shown repeated sessions of skin-to-skin in full-term babies have a positive long-term effect on social skills.

2. Wear your baby. Babywearing, or carrying a baby face-to-face using a wrap or sling, promotes attachment in various ways. The constant physical contact during babywearing increases the amount of talking and eye contact between baby and parent. In addition, studies have shown that babies near their mothers have needs met more quickly, increasing security and trust.

3. Talk and sing to your baby. Talking and singing to your baby continues to add to the physical and emotional benefits of parent-child connection.

4. Limit screen time while with your baby. Eye contact with others is bonding behavior. This type of attachment can’t occur when a parent’s eyes are scrolling social media during feeds or diaper changes.

5. Enjoy feeding time. Every feeding experience provides your baby warmth, security and satisfaction. Those feelings are foundational for attachment, no matter the type of milk served.

Commercial formula companies have years of experience in helping babies safely grow. Although many of the ingredients may sound foreign or complicated, most of the words are simply chemical names for food-grade carbohydrates, fats, proteins and micronutrients.

Be assured that all commercial infant formula sold in the U.S. is strictly monitored by the FDA. To be safe for infant feeding, formulas must have a minimum amount of 29 key nutrients and a maximum amount for nine of those nutrients. Both name-brand and store-brand formulas are monitored for these important qualities.

No. Babies require intricately balanced food components for optimal growth. During infancy, a baby is building a foundation for long-term development. A lack of certain nutrients during this critical time may result in babies falling short of their potential. In addition, many recipes for homemade formula include unpasteurized ingredients known to cause illness.

Due to the risk of foodborne illness from homemade formula, as well as the risk of inadequate infant nutrition, the FDA warns that parents should not make or feed homemade infant formula.

“Dear Pediatrician” is for informational purposes only and should not substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your child’s pediatrician or other qualified health provider with any questions about a medical condition.

By submitting your letter, you’re agreeing to let Forbes Health use it in part or in whole, and we may edit the letter for length and clarity.

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