Alternatives to Breastfeeding

Medically Reviewed by Dan Brennan, MD on July 06, 2022
5 min read

All moms want the best for their babies, but the best choices aren’t always black and white. You’ve probably heard the saying “breast is best,” right? The truth is that breastfeeding can be difficult for some moms and babies.

That’s OK. There are a number of good, safe, and healthy alternatives to breastfeeding.

“Fed is best,” says Melissa Pichetto, a neonatal nurse practitioner in Atlanta. “Fed babies are less likely to see me in the hospital. Fed babies have less failure to thrive, less jaundice, less lethargy.”

For some moms, the tough decision may not be whether to bottle feed, but instead what to put in the baby bottle. Pumped breastmilk or commercial formula? Plant-based or milk-based? American brands or European?

Ideally, breastfeeding is the healthiest way to feed your infant. It gives them nutrition along with important antibodies (proteins that support your immune system). Research suggests breastfed infants are less likely to get certain illnesses, from ear infections to allergies to tummy problems.

The American Academy of Pediatrics (AAP) recommends breast milk as the best nutrition for infants. Babies should be breastfed exclusively for the first 6 months, according to the AAP. After other foods have been introduced, the AAP encourages mothers to continue to breastfeed until baby is at least a year old, and as long after that as both mother and child are willing. There are continued benefits from breastfeeding beyond 1 year, and up to 2 years especially in the mother."

Now for a reality check: Most moms don’t follow those guidelines to the letter. In 2015, four out of five infants started out breastfeeding. By 3 months, just under half were breastfed only. By their first birthday, only a third were still breastfed.

You might choose not to breastfeed because you:

  • Don’t know about breastfeeding benefits
  • Think bottle-feeding is more socially accepted
  • Don’t have good family support, social support, and/or employer support
  • Have problems with latching, sore nipples, or inflammation

If breastfeeding doesn’t work for you, know your choices to keep your baby fed and healthy.

You can choose from:

Breastmilk (from a bottle)

Just because you’re not breastfeeding doesn’t mean you can’t give your baby breastmilk -- ideally, your own, expressed with an electric or manual pump, then stored for future use. But that’s not the only way people are getting it these days.

Pumping your own milk. Joan Y. Meek, MD a pediatrician and lactation consultant in Orlando, FL, believes that if you can’t or don’t want to breastfeed directly, pumping your breastmilk and then bottle-feeding it to your baby is the next best choice.

There’s a learning curve to it, though moms who have experience breastfeeding usually have experience pumping, too. Research suggests more than 85% of breastfeeding women pump milk at some point. If you’re new to pumping, Meek says the Office on Women’s Health website is a good source of information about pumping and storing breastmilk.

Breastmilk sharing. Some lactating women donate breastmilk to a milk bank. Most have strict safety and processing protocols, including pasteurization. This milk is usually sent to hospitals for babies there, but you can get it with a doctor’s prescription. Some people share milk casually: When friends or family members nurse your infant (and vice versa).

But be careful. This can be risky. If the mom providing the milk has an infection, she can pass it to your baby. Or the milk could get contaminated somewhere in the process, whether it’s expressing, storage, or handling. Someone might even mess with it on purpose, Meek says.

Online buying. It seems there’s nothing you can’t buy or sell on the internet, including breastmilk. The problem is you won’t really know if your purchase is 100% breastmilk, or if it’s free of things that could harm your baby, like prescription or illegal drugs. “Purchasing human milk over the internet from total strangers is very risky and should be discouraged,” Meek says.

Commercially available baby formulas usually list some special addition or benefit on their labels, like probiotics, omega-3s, eye health, and more. Meek says the differences in these formulas are tiny and have little impact on your baby’s health.

“Many of the claims made about particular formulas are based more on marketing to the consumer than they are on significant differences in the product,” she says. Head-to-head studies of infants who got the products showed little difference.

In other words, you won’t be shortchanging your baby if you pass on the vitamin-enhanced, small-batch, craft baby formula. You can skip name-brand formula, too, if you want. “Store-brand baby formula is often a repackaged version of a name-brand formula,” Pichetto says.

The main differences in formulas have to do with the type of protein and whether it upsets your baby’s tummy.

Cow-milk protein: Most formula is based on cow milk, which has been changed to closely resemble human breastmilk.

Soy-based formula: If your baby can’t handle dairy-based formula, soy-based formula is a safe and nutritious option.

Hydrolyzed formulas: With these, the protein has been broken down into smaller pieces (hydrolyzed), to make it easier to digest. Partially hydrolyzed formulas may ease symptoms of gut discomfort. Extensively hydrolyzed formulas are a good choice if you think your little one has food allergies.

To the untrained eye, some ingredients in commercial formula don’t seem very healthy for an infant. Parents who want to use a more natural or wholesome formula (based on their own views of natural and wholesome) may turn to European brands, purchased over the internet. Or they may make their own formula at home.

Medical experts warn against both choices. Here are some reasons why.

Imported formula. Hipp and Holle are two European brands that have become popular with some U.S. parents. They also aren’t registered with the U.S. Food and Drug Administration (FDA), which makes them illegal here. As such, they don’t undergo FDA review, and they’re sold to U.S. consumers online via third-party distributors.

The makers don’t have to follow FDA safety guidelines, which are designed to protect the formula from tampering, contamination, improper shipping, or improper storage.

Homemade formula. Making baby formula with “all-natural ingredients” is surely an act of love, but the result could harm your child. Why?

  • Commercial formula has been extensively studied. The ingredients provide a specific balance of nutrients to meet your baby’s needs. You might not be able to recreate this in your kitchen. “Homemade formulas may not provide the appropriate balance between water, protein, carbohydrates, fats, and vitamins and minerals that are standard in infant formula,” Meek says.
  • Commercial formula is regulated. That’s not the case with homemade formula where the first ingredient is raw cow's milk. There are also significant risks to feeding raw, unpasteurized milk to babies, Meek says. This was a common cause of newborn or infant death before formula became available.