To many breastfeeding advocates, “formula” is a bad word.

Now, a new study from the University of California San Francisco has added fresh fuel to that fractious topic by suggesting small amounts of formula for certain newborns may help lay the foundation for long-term breastfeeding.

Use of formula is generally considered a “slippery slope” to stopping breastfeeding, says Dr. Valerie Flaherman, pediatrician and lead author of the study, released Monday in the journal Pediatrics.

“But our goal is to get babies to breastfeed for longer,” she said in an interview.

In the small randomized control study of 40 full-term infants, half received 10 millilitres of formula through a syringe after breastfeeding during the first few days after birth. This was done to relieve anxiety among their mothers, who feared they weren’t getting enough from the breast. The other 20 babies did not receive any formula. All the infants had lost at least five per cent of their birth weight.

Three months later, 79 per cent of the babies who had received formula for a few days were exclusively breastfeeding, versus 42 per cent of the control group.

While Flaherman stresses that most babies don’t need formula and breast milk is best, the study suggests in cases when moms are stressed about milk supply and want to keep nursing, limited doses of formula may help.

But critics say the message is dangerous at a time when hospitals are embracing the Baby Friendly Initiative to promote breastfeeding and have been actively discouraged from providing formula.

“This is a very problematic study,” said Edith Kernerman, director of the Newman Breastfeeding Clinic in Toronto. “I’m surprised Pediatrics even published this, they are going to get a lot of mail.”

She said while the approach is positioned as boosting mothers’ confidence, it actually undermines it by suggesting their nutrient-laden colostrum isn’t adequate and that babies may need supplements.

“They’re telling mothers ‘your early milk is a problem, and we’ll fix it.’”

Instead, physicians and nurses should be reassuring them that weight loss, fussiness and an infant’s demand for a cluster of feedings are all normal in the first few days. Rather than formula, moms need encouragement for skin-to-skin contact to soothe their newborns and breastfeeding support to ensure babies latch on to the nipple properly to get enough milk, she said.

Concern over milk supply is one of the most common reasons women stop nursing. Breast milk provides nutrients and antibodies that boost health, protect against allergies and infection and promote bonding between mother and baby. Health authorities around the world recommend women breastfeed exclusively for at least six months and continue nursing for two years.

While the researchers’ approach is counterintuitive and “very unusual” says Flaherman, the study suggests it may work for a small group of babies, especially when their mothers are committed to breastfeeding. It was funded by the U.S. government’s National Institute of Child Health and Human Development.

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The babies were fed formula by syringe to avoid nipple confusion and given the equivalent of one-third to half a typical feeding at the end of every breastfeeding session, which averaged 8 to 12 times over 24 hours. The formula stopped once the mothers’ milk came in, two to five days after birth.

But Kernerman warned there is no research to show any amount of formula is safe for a newborn’s sensitive digestive tract. Introducing anything other than breast milk is known to change a baby’s gut flora, which is critical to health, allergy resistance and digestion.