Partial breastfeeding

Can I breastfeed for some feeds and use infant formula for others?

Partial breastfeeding means breastfeeding at some feeds and using infant formula at others. In partial breastfeeding, expressing is done only to remove a bit of milk if the breasts are too full or painful and not to support the milk supply. It has risks for both mother and baby. Mothers will have a reduced milk supply and may have breast problems caused by fullness, a higher risk of obesity, and an earlier return of their periods. Babies who are partially breastfed have a higher risk of illness, obesity, asthma, and higher cholesterol as older children. Partial breastfeeding can be ongoing or used when weaning a baby but may also cause unwanted weaning.

A) Partial breastfeeding

Partial or mixed breastfeeding is breastfeeding at some feeds and giving replacement feeds of infant formula at others.

In partial breastfeeding, mothers do not express for missed feeds. They do it only as needed to remove a bit of milk if the breasts are too full and painful.

Partial breastfeeding can be used when weaning a baby. 

It is different from supplementing. Supplementing means breastfeeding, and possibly expressing, at all feeds and giving the baby extra milk as needed after breastfeeding. Supplementing is medically required because a mother has a low milk supply or a baby has a another feeding problem

By contrast, the decision to partially breastfeed is highly individual and can be based on personal preferences, worry about the baby's milk intake, the mother's painor other circumstances of the mother and family (Monge-Montero 2021). 

Please seek help and information from your health-care providers or from breastfeeding specialists if you are unsure of how to proceed.

B) Risks of partial breastfeeding

Current national and international recommendations are that mothers exclusively breastfeed their babies for about six months and continue breastfeeding for two or more years. This is based on research that shows this approach is the best for the health of mothers and babies.

Partial breastfeeding has many significant benefits over full formula-feeding. However, compared to exclusive breastfeeding, partial breastfeeding has risks for both mother and baby.

Partial breastfeeding with infant formula both lowers the amount of breast milk a baby takes in and introduces non-human milk and other components. This appears to have a wide range of possible negative effects on both. It also increases the likelihood that the baby will be completely weaned. (Holmes 2011; Karall 2015; Kim 2013; Marandi 1993; Martines 1989).

1) Possible negative effects on the mother

When compared to mothers who exclusively breastfeed, mothers who partially breastfeed will have a reduced milk supply (Peaker 1996; Wilde 1995). They may have:

  • Breast problems caused by being overfull with milk.
  • Lower prolactin levels (Uvnäs-Moberg 1990).
  • Less weight loss after giving birth (Guzmán-Mercado 2020; Waits 2020).
  • More obesity (Neville 2014).
  • More insulin resistance if they are type 2 diabetic and obese (Yashui 2019).
  • An earlier return of their periods and lose the contraceptive benefits of breastfeeding.

2) Possible negative effects on the baby

Compared to exclusively breastfed babies, babies who are partially breastfed and given infant formula may have an increased risk of:

  • Illness (NEOVITA 2016; Huffman 1990).
  • Diarrhea (Diallo 2019).
  • Hospitalization (Christensen 2020; Quigley 2009).
  • Antibiotic use (Di Mario 2019).
  • Asthma if the mother is asthmatic (Azad 2017).
  • Allergy to cow’s milk protein (Liao 2014).
  • The bowel telescoping into itself (intussusception) (Fotso Kamdem 2019).
  • Higher bad cholesterol (total and LDL) levels at 17 years of age (Hui 2019).
  • Less health-promoting gut bacteria (microbiome) (Bullen 1977; Liu 2019; Mueller 2015; Fehr 2020).
  • Poorer motor development (Tinius 2020).

Partial breastfeeding appears to increase the risk of obesity (Azad 2018; Park 2018; Patro-Gołąb 2019). This may be directly caused by the baby taking in more milk or through genetic changes caused by partial breastfeeding (Cheshmeh 2020).

3) A weakened connection between mother and baby

Breastfeeding is more than just giving nutrition to the baby. Rather, when breastfeeding, the mother and baby are connected through hormonal and microbial signals that help to protect and program the baby.

The breast monitors the baby’s health. If the baby develops an infection, the milk is adjusted to increase the number of white blood cells and other components to minimize its severity. This response is weaker when mothers are partially breastfeeding (Hassiotou  2013). 

Mothers who partially breastfeed have been shown to have lower levels of infection-fighting antibodies (IgG) in their milk (Abuidhail 2018).

Babies who are partially breastfed have been shown to have poorer development of their internal clock (circadian rhythm) (Kikuchi 2020).

C) How to partially breastfeed

To partially breastfeed, mothers need to make sure they do not decrease the daily number of breastfeeds too quickly. They may need to express for comfort if their breasts are too full or tender between breastfeeding sessions. As when drying up, leaving too much milk in the breasts can cause breast pain and other problems.  

The breasts will eventually only make as much milk as the baby takes from them. This is called “supply and demand”.

References

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