I wonder if we don't inadvertantly contribute to the idea that breast milk
and formula should not be mixed together when we advocate for exclusive BF.

 In the early days, we tell moms not to combine BF and bottles, to get avoid
nipple confusion, get BF off to a good start, and establish a good milk
supply.  When they are having problems with supply or weght gain, we tell
them to exclusively BF and increase the number of feedings, but don't add
formula.  We talk about the health benefits of exclusive BF and that these
benefits are dose-dependant. We tell them even one bottle of formula changes
the baby's gut forever.

That is what we "say".  I wonder how they interpret what they "hear"?

"Mixing formula and breast milk is not good for the baby."  "Adding formula
will compound the problems by decreasing production even more; but
correcting supply issues takes a time, and if I give a bottle it is
instantly fixed.  Since she said don't add bottles and I've decided to give
some bottles, I guess I should just stop BF."  "I'm already giving formula,
so the damage is done, and breast milk doesn't matter anymore."

I think it is important to keep "saying" what we say, but I think we have to
be careful how we "say" it.  Some moms will choose to combine breast milk
and formula feeding.  The challenge is to advocate for exclusive BF, while
extolling the benefits of any BF.  Even one BF is beneficial for a baby.

Barb Berges BS, RN, IBCLC
Rochester, New York

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