Breast-feeding: contraindications and formula feeding

Breast-feeding: contraindications and formula feeding

Breast-feeding: contraindications and formula feeding

Breast-feeding is the optimal way to provide food for the health, growth, and development of the infant. In addition to its unique nutrient composition, it offers immunologic and psychosocial benefits that are not provided by any other feeding substance. 

Human milk is unique in that it provides docosahexaenoic acid (DHA), a long-chain fatty acid that is essential for infant brain and eye development. Lactoferrin, an iron-binding protein found in whey of human milk, has been observed to inhibit the growth of certain iron-dependent bacteria in the gastrointestinal tract.

Infants who are breast-fed usually have fewer gastrointestinal and nongastrointestinal infections, including otitis media, pneumonia, bacteremia, diarrhea, and meningitis. They have fewer food allergies and a reduced risk of certain chronic diseases throughout life (eg, type 1 diabetes

, lymphoma, and Crohn’s disease).

Contraindications for Breast-Feeding

Infants with certain inborn metabolism errors, such as phenyalamine, maple syrup urine disease, or galactosemia should not be breastfed

Breast-feeding is contraindicated for women who:

Use addictive drugs, such as cocaine, marijuana, and phencyclidine (PCP)

Drink more than a minimal amount of alcohol ·       

Receive certain therapeutic or diagnostic agents, such as radiation or chemotherapy

Are infected with the human immunodeficiency virus (HIV) Women should not breast-feed when they are receiving certain therapeutic medications. Not only is toxicity to the infant a concern, but research has indicated that some medications affect the infant’s metabolism.

In addition, some agents (eg, bromocriptine) decrease milk production. Whereas most medications are considered compatible with breast-feeding, there are substances for which the risk of toxicity to the infant is considered to be greater than the benefit to the mother.

Formula Feeding

The use of commercially prepared infant formula is an acceptable alternative to breast-feeding. These formulas are designed to approximate the composition of human milk as closely as possible. Most commercial infant formulas are composed of milk proteins or soy protein isolate. Milk-based formulas are generally appropriate for use with the healthy full-term infant. Standard formulas have a 60:40 whey-to-casein ratio, which is desirable in a formula; they provide 20 kcal/oz. Breast milk yields an 80:20 whey: casein ratio with about the same number of calories. Soy-based formulas are often used from birth to prevent allergic disease in infants with a strong family history of allergies.


If the infant consumes an adequate amount of breast milk, formula, or both, the infant will have an adequate intake of water.

Cow’s Milk

Cow’s milk should not be introduced until a child is 1 year of age. The nutrient composition of cow’s milk varies substantially from that of human milk. Feedings with cow’s milk causes a markedly high renal solute load due to its protein and sodium content, and infants are not generally able to concentrate urine well. The ingestion of cow’s milk increases the risk for gastrointestinal blood loss and allergic reactions. Whole milk can be introduced after the first year and continued through the second year. After the second year, reduced-fat milk can be served.

Introduction of Solid Food


There is no nutritional need to introduce solid food to infants during the first 6 months of age. The infant’s individual growth and development pattern is the best indicator of when to introduce semisolid and solid foods. 

Generally, an infant will double his birth weight and be able to sit upright without support by the time semisolid foods are introduced. By 4 to 5 months, the infant has the ability to swallow nonliquid foods. If solids are introduced before this time, these foods may displace breast milk or formula and the infant may receive inadequate energy and nutrient needs.


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