Feeding options for adopted young children

This is the first in a series of posts originally written as a teaching handout for clients.
Feeding options for adopted young children
by: Laura Dunn, LPN, IBCLC, RLC
There is a whole spectrum of options and factors to consider when deciding how you will feed your adopted child. Options are listed here with further resources for more information.

It is recommended that babies receive only breastmilk without any complementary foods for at least six months. After that it is recommended that babies are breastfed alongside other foods for up to two years of age and beyond.

1. Relactation
When a mother has nursed a biological child she can relactate to provide milk for her adopted child. The more recently she has nursed, the easier and more abundantly her milk will flow. When a supplement is needed she can provide it using one of the methods below.
 Here's a link with further resources.

2. Induced lactation
When a mother has never nursed before she can induce lactation to feed her adopted child. She will likely be supplementing her milk via one of the methods described below. Induced lactation involves pumping and may or may not include herbs or medications prescribed by her healthcare provider based on her choice. I recommend seeking advice from a registered lactation consultant, also known as an IBCLC for help with this. One IBCLC has written an article covering this topic.

3. Supplementing
Donor milk can be obtained through informed milk-sharing or from a human-milk bank. Informed milk-sharing is possible within your community through friends and family or via networks that facilitate contact between donors and recipients. Many mothers find themselves with extra pumped milk for one reason or another and are willing to share with a family who needs it. Ideally the donated milk was pumped for a child that is the same age as the recipient and is available within the same geographic region. It is my view that safe informed milk-sharing is entirely possible despite FDA's warning against it. Ways to minimize the risks include requesting evidence of health such as lab test results; you can request that a donor have further specific lab tests performed and interview them about their lifestyle choices per your standards. Home pasteurization can be done as an extra measure against certain diseases. Alternatively, at milk banks, the donors go through screening lab tests, and the milk through processing treatment and tests, these procedures make the milk costly; about $4 per ounce. Unfortunately banked milk is reserved for preterm and sick babies and requires a doctor’s prescription.

Click here for information on suggested blood tests for donors.
Click here for ideas about what questions to consider asking your donor.

Infant formula, though expensive, is readily available in the U.S. in powdered, liquid and concentrated liquid form. There are risks to feeding infant formula, since no formula comes nutritionally close to breastmilk. Provided formula is appropriately prepared and fed, some of the risks include allergies, infections, especially ear and respiratory, impaired cognitive development and visual acuity and obesity and its complications.

For information on the risks of early complementary feeding (infant formula or food) see Infant feeding the physiological basis Bulletin of the World Health Organization, Supplement to volume 67, 1989 (Chapter 4, pages 62-65) at this link.

Choosing a formula
Unless a family is vegan, in the case of a baby not tolerating cow’s milk or for a rare condition known as galactosemia, I recommend against the use of soy formulas. In some cases, parents of babies who have a family history of milk allergy choose to use soy infant formula. But there are studies showing that soy formula interferes with proper hormone function. Read the American Academy of Pediatrics recommendations in this regard here.

When companies that manufacture breastmilk substitutes use marketing techniques that undermine breastfeeding, they are in violation of the World Health Organization’s International Code of Marketing for Breast-milk Substitutes. Besides price, this is another reason why families who use breastmilk substitutes (infant formula) choose to support companies that are generic and less powerful.

In future posts in this series I will cover modes of feeding your adopted child and further global and  local resources.