What's in the Bottle - From Nancy Morbacher ICBLC

What's In the Bottle?

Nancy Mohrbacher Tuesday, May 17, 2011 at 8:54AM

Scientists have found that babies not breastfed have a 30% to 40% increased risk of childhood obesity.¹ Milk intake and weight gain vary greatly among formula-fed and breastfed babies.  (For more, see my earlier post.) Formula-fed babies consume 49% more milk at 1 month, 57% more at 3 months, and 71% more at 5 months.² This significant difference in milk intake is due in part to how milk flows from breast and bottle.  Recent studies have examined these feeding differences in more detail to help answer the question “How is obesity risk affected when the feeding bottle contains mother’s milk?”  

The study mentioned above provides a partial answer.  Caregivers’ behaviors during bottle-feeding—which are independent of the milk—influence babies’ intake.  For example, when bottles contain more than 6 oz. (177 mL), babies consume more milk.  Also, babies whose caregivers encourage them to finish the bottle are heavier than other babies.
An important part of obesity prevention is the ability to self-regulate what we eat to match our energy needs.  Breastfeeding naturally teaches babies this self-regulation by giving them more control over feedings.  While breastfeeding, baby must actively draw milk from the breast.  He learns to take milk when hungry and stop when full.  This helps baby become attuned to his body’s hunger and satisfaction cues.  During bottle-feeding, baby’s role is more passive.  Fast, consistent flow and regular coaxing to take more milk, even when full, can lead to a habit of overfeeding and poor self-regulation.
In one recent study of 1250 U.S. babies, researchers used bottle-emptying as a measure of poor infant self-regulation.³ (An earlier study verified this link.⁴) It didn’t matter whether expressed milk or formula was in the bottle.  The more often the babies were fed by bottle during their first 6 months, the more likely they were to empty the bottle during their second 6 months.  Only 27% of the babies who were exclusively breastfed during their first 6 months emptied the bottle during their second 6 months.  Of those fed at first by both breast and bottle, 54% later emptied the bottle.  Of those fed at first only by bottle, 68% later emptied it.
In a U.S. pilot study,⁵ weight gain was monitored for the first 4 months in 37 human-milk-fed babies.  Nineteen were bottle-fed no more than once per day and 18 were bottle-fed significant amounts of expressed milk because their mothers were employed full time.  Although the difference in weight gain between these groups was not statistically significant due to the small sample size, the differences were obvious.  From 4 to 6 months of age 10% of the babies in the breastfeeding group were at or above the 85^th percentile for weight, whereas 33% of those in the bottle-feeding group were at or above the 85^th percentile.
Mother’s milk plays a vital role in a healthy beginning.  But as these studies demonstrate, there is more to breastfeeding than the milk.  Even when mother’s milk is in the bottle, regular bottle-feeding can increase a baby’s risk of childhood obesity.
References
¹Dewey, K.G., Infant feeding and growth.  In G. Goldberg, A. Prentice, P.A. Filtreau, S., & Simondon, K. (Eds.)  Breastfeeding : Early influences on later health (pp. 57-66).  New York, NY: Springer.
²Kramer, M. S., Guo, T., Platt, R. W., Vanilovich, I., Sevkovskaya, Z., Dzikovich, I., et al. Feeding effects on growth during infancy. Journal of Pediatrics 2004; 145(5): 600-605.
³ Li, R., Fein, S.B., & Grummer-Strawn, L.  Do infant fed from bottles lack self-regulation of milk intake compared with directly breastfed infants?  Pediatrics 2010; 125(6): e1386-e1393.
⁴Li, R., Fein, S.B., & Grummer-Strawn, L.M.  Association of breastfeeding intensity and bottle-emptying behaviors at early infancy with infants’ risk for excess weight at late infancy.  Pediatrics 2008; 122 Suppl 2: S77-S84.

Should you buy a used breast pump?

Well, we have been asked this question many times, and there is a lot of information and mis-information out there. There are 2 types of breast pumps - single user and multiple user (hospital grade pumps or rental pumps).
Hospital grade pumps are sealed. It prevents any viruses from being transferred between users and should be wiped with a disinfectant cleaner after each patient. These are meant to be used over and over, sometimes many times in a day.  They have a much sturdier motor and will generally last much longer. As long as each user has their own collection kit, or a hospital sterilized one the risk of transfer of viruses and or bacteria is very small.
The bigger issue is all of the pumps you can find on used sites such as Craigslist and EBay. First of all, many of them are old, will be void of warranty and the collection kits might contain BPA which was banned in Canadian baby products in 2008.  Second of all, many people feel they are being thrifty or helpful by selling or lending their pumps to a friend. Health Canada designates (not the breast pump companies!) these items as single user. You can't return these to the stores if they are broken or if you don't like it. You must deal directly with the manufacturer or distributor for any warranty issues. I have always looked at it this way. Would you share your diabetes monitor? It is essentially the same thing, as breast milk is considered a body fluid on the same level as blood. Plus would you really want to put your newborn sweet baby at risk?
There are 2 types of electric breast pumps out there - closed systems and open systems. If you are for sure planning to buy a used pump, make sure you buy one that uses a closed system. A closed system means that the milk in the collection kits stays contained and there is no way to travel into the tubing to get into the pump motor. No matter which type you buy make sure you buy a completely new collection kit for the milk. This is the most at risk part of the pump. You can purchase them at any rental pump location or at most of the places that sell new breast pumps.
There is also the main question you need to ask yourself about why you are buying a pump. Are you planning to breast feed your baby or feed your baby breast milk? The answer to that will give you a good insight as to whether you will even need an electric pump. For most moms who are planning to breastfeed and give the occasional bottle, a hand pump will suffice.  You might find your baby won't take a bottle and prefers the breast or you might have the best intention of breast feeding and run into complications you didn't know you would face. Either way you don't need to invest in a pump until after the baby comes. Do all of your searches and have an idea of what kind of pump you think you will want; and when your beautiful sweet baby comes along you will have a good idea of your breastfeeding rhythm. Every breastfeeding "couple" has its own rhythm (Nancy Morbacher - The 7 Natural Laws of Breastfeeding) and you will find yours!