In recognition of National Breastfeeding Month this August, Dr. Alicia Dermer, a dedicated family medicine physician, takes a closer look at the vital role breastfeeding plays in the health and well-being of both infants and mothers.
With years of experience caring for families at every stage of life, Dr. Dermer emphasizes that breastfeeding is more than just nourishment—it’s a powerful foundation for lifelong health, bonding, and development. She highlights the need for greater awareness, education, and support to ensure that all families have the resources they need to make informed and empowered choices about infant feeding.
Why is breastfeeding important?
Breastfeeding is the natural way to feed babies and young children. Mother’s milk is a “superfood.” It contains all the nutrition nature designed for growing babies and young children, ensuring normal growth and development. It also protects them against many infections, some of which can be serious. Breastfeeding helps build a healthy immune system, so children who are breastfed are more likely to avoid some chronic illnesses like diabetes, certain childhood cancers and immune diseases. A breastfeeding baby controls the amount of milk it takes, avoiding overfeeding and being less likely to become overweight or obese. The closeness and warmth while nursing at the breast is a unique source of comfort as well.
This is why the American Academy of Pediatrics recommends that most babies (with rare exceptions) be breastfed and/or get their mothers’ milk without any other foods until about 6 months of age, then continue breastfeeding/mother’s milk feeds along with solid foods added gradually after 6 months, until at least 2 years and beyond for as long as the child and mother wish to continue.
Not only is breastfeeding important for babies and young children, but mothers’ health is protected as well. Right after birth, every time the newborn baby feeds at the breast, the mother’s womb contracts, preventing too much blood loss. Breastfeeding mothers tend not to get their periods back for months, so they have less risk of anemia. If their period has not returned, they are not delaying breastfeeds with pacifiers or formula, and the baby is less than 6 months old, breastfeeding is a natural way of spacing pregnancies. But anytime that feedings are delayed, formula is used, or the period comes back before 6 months, it’s important to see a provider to discuss a birth control method they can use while continuing to breastfeed.
Later in life, women who breastfed, especially if it was for several months to years, are less likely to have breast cancer, ovarian cancer, diabetes or heart disease. Breastfeeding can also lessen the severity of postpartum depression.
Breastfeeding is also more affordable. Even though formula is a substitute milk with much fewer health benefits, it is expensive to buy, while more medical expenses could be due to baby getting some of the diseases that breastfeeding protects against. The production, packaging and transportation of formula produces methane and carbon dioxide, adding to climate change. It also increases water waste and pollutes the air and water. All the packaging, bottles, and teats that families use when they feed formula also increase waste added to our landfills. By comparison, breastfeeding is a sustainable feeding method that is much better for the environment.
Top five questions my patients ask about breastfeeding
1) I didn’t make enough milk when I was breastfeeding my older baby/babies. I don’t think I will make milk, so I’m planning to give formula after every breastfeed.
a. Every pregnancy and every baby are different. If your breasts got a little sore and grew a bit during the early part of your pregnancies and if they got larger, harder and maybe even a bit sore a few days after giving birth, then you should be able to make all the milk the baby needs. If you never had any of these things happen with any of your pregnancies, it would help you to work with a lactation specialist. Even if you can’t make all the milk the baby needs, any amount of breastfeeding or feeding of your milk still has value.
b. There may be many reasons you believed you couldn’t make enough milk, but most women can produce enough milk. It’s natural to worry that the baby won’t get enough, more so in the first 2-3 days when the special early milk known as colostrum is concentrated and thick. Many parents think this is not enough for the baby, so it’s tempting to give formula just to be sure the baby gets milk. But this is not necessary. In fact, giving formula “just in case” can make it harder for your baby to learn to breastfeed, because sucking on a bottle teat feels different than feeding at the breast. Also, if you do it often, your breasts won’t know how much milk to make (they will sense that the baby needs less milk as the baby who is full with formula doesn’t feed as often). Breasts produce milk based on the amount that gets removed. That’s why it’s important to breastfeed every time the baby shows signs of hunger and avoid giving formula without getting expert help with breastfeeding first.
c. The main reason newborn babies have trouble getting enough milk, even from mothers who can make lots of milk, is that they are not getting the help they need. Babies need to be with their mothers 24/7 after birth, spending a lot of time skin-to-skin with their mothers and breastfeeding very often. They also need to take the breast properly, which is hard for them if they are held in an awkward position.
d. When a baby attaches properly to the breast, mom should not feel pain throughout the feeding and should not get cracks or sores on their nipples. If the baby’s latch is causing pain throughout a feed, it usually means they are only taking the nipple, so they won’t be able to get the milk they need. It’s important to get help right away from someone trained in breastfeeding (a nurse on mother/baby unit, a lactation consultant, or a WIC lactation counselor once out of the hospital.)
e. Babies who are attaching well to the breast, allowed to feed every time they show early hunger signs (smacking lips, bringing hands to their mouths; crying), breastfeeding at least 8-12 times in 24 hours, having poop and wet diapers which increase especially after mom’s milk has changed from colostrum to whole milk around the 2nd to 4th day after birth, are doing well. Watch the baby, not the clock!
f. All babies lose some weight after being born, and they start regaining weight once their mother’s milk changes from colostrum to whole milk.
g. Most mothers these days are discharged 24 hours after a vaginal birth and 48 hours after a Caesarean birth. This is usually before the colostrum has changed to whole milk. It’s important to bring the newborn baby to the pediatric provider within 2-3 days after leaving the hospital, even within a day if the baby is not feeding well, not pooping or peeing, or the skin is very yellow.
2) I’ve been trying to wean my baby from the breast and give them cow’s milk now that they’re a year old, but they don’t want to stop breastfeeding. What can I do?
a. I would ask why you are trying to wean your little one from the breast. There is no need to do so. In fact, the American Academy of Pediatrics recommends breastfeeding for at least 2 years and beyond for as long as you and your child want to continue. Cow’s milk has no advantage over your milk. In fact, it doesn’t provide the ideal nutrition your milk provides. Your milk also protects them against infections and keeps them healthy. Breastfeeding a toddler is nothing like breastfeeding a newborn. They are running around, eating lots of different foods, maybe drinking some water, and they may not nurse much during the day, a little more before naps or nighttime.
b. If you do need to wean your toddler, try to stop breastfeeds gradually, distracting the child from the feeding they are least attached to. If they don’t like the taste of cow milk, they can get the proteins and calcium they need from yogurt, cheese and other dairy products.
3) What about drinking alcohol? Do I need to pump and dump my milk?
a. Although women are advised not to drink any alcohol while pregnant to avoid fetal alcohol syndrome, there is no evidence of any harm to a breastfeeding child from mother having an occasional drink, such as a glass of wine or bottle of beer with a meal. As for pumping and dumping, there is no need because only a very tiny amount of the alcohol you drink gets into the milk, and if you wait about 2 hours, the alcohol that was in your milk has gone back into your bloodstream and there’s none left in your milk if your child nurses again. Some mothers like to pump some milk and keep it in the fridge so they can give that milk if the baby needs to nurse soon after mom has the drink. Other mothers choose to use formula on such occasions, but even if the child breastfeeds soon after mom has a drink, the amount of alcohol in the milk is very low, only a small fraction of the amount that’s in the mother’s glass of wine or bottle of beer.
4) Can I breastfeed if I need to take medication?
a. Most medications can get into the milk, but in very small amounts that usually don’t harm the nursing child. If you need to take medication, you can learn more about it from an app known as LactRx, or the website for the Infant Risk Center, at infantrisk.com. It is important to discuss any medication you need to take with your physician/medical provider who knows you and your child’s medical conditions and may be able to find an alternative medication for you that is known to be safe.
5) I am thinking of starting my baby on formula because I must go back to work.
a. If possible, speak with your employer before the baby is born. It helps if your employer understands that supporting you to keep breastfeeding and providing your milk for the baby while away from them will help you do your job better and miss less work for a sick baby. Many employers can help by allowing breaks and a sanitary space for pumping milk during work hours.
b. When and whether you need to start formula depends on how soon after giving birth you must return to work, how many days a week and how many hours per day you will be away from the little one. If your employer is supportive of your pumping at work, you may not need to use formula or at least not very much.
c. It helps to stay home for at least the first 4 to 6 weeks to be sure that you are producing enough milk. Those first few weeks are also the riskiest for your baby, and getting only your milk is the best protection. The longer you can stay home and just breastfeed, the better for both of you. When you do need to go back to work, you will have some peace of mind because your baby will be as healthy as possible.
d. Starting bottles before you return to work is no guarantee that the baby will accept bottles when you’re away, but it may make it more difficult for you to produce all the milk needed. It’s best for the caregiver who will be watching the baby to introduce the bottles while you only breastfeed when you are together with your little one.
e. If you plan to provide your milk up to 6 months, you can start pumping 1-2 weeks before your return to work. The best time would be after your morning breastfeeds, when you are likely to have more milk. You can keep what you pump in the fridge and add more milk to the container, but you should label the container with the date of the first milk. Once you have about 2-3oz, you can start the next container. If it’s been more than 5 days, store the 2-3 oz containers in the freezer. On your return to work, the baby can get the milk that’s still in the fridge, and the next day can have the milk you pumped at work (you will pump larger amounts when you’re away from the baby). If the milk you brought back in a cooler runs out as well as what’s left in the fridge, the frozen milk can be put in the fridge overnight to be fed to the baby. If there isn’t enough frozen milk, then the baby can have formula.
f. It helps for the caregiver to feed the bottles by the paced bottle feeding method. See the YouTube video “Paced Bottle Feeding for the Breastfed Baby,” by Jessica Barton.
g. When you’re home from work, breastfeed and don’t give any bottles. That will make sure you keep up your milk production.
Alicia Dermer, MD, FABM, NABBLM-C
Dr. Dermer is passionate about health promotion, with particular expertise in breastfeeding. She was certified by the International Board of Lactation Consultant Examiners in 1995 and recertified in 2005 and 2015. As a member of the Academy of Breastfeeding Medicine since its inception, she served on their Board of Directors and was awarded the Fellowship of the Academy of Breastfeeding Medicine in 2003. She is a Medical Associate of La Leche League International, and was certified by the North American Board of Breastfeeding and Lactation Medicine in October, 2024.
Dr. Dermer provides breastfeeding consultations throughout the state of New Jersey and is dedicated to improving breastfeeding outcomes by educating healthcare professionals on the subject, having developed a breastfeeding curriculum for Family Medicine residents, teaching basic breastfeeding to all medical students during their Family Medicine rotations, and providing more intensive education on the subject as medical director of the Breastfeeding Medicine Elective offered to 3rd and 4th year medical students through the Rutgers RWJMS Department of Family Medicine and Community Health for the past 10 years. She has published on the topic of breastfeeding and human lactation in peer-reviewed medical journals and presented on the topic at national and international conferences, including the Academy of Breastfeeding Medicine and the Society of Teachers of Family Medicine.
