Breastfeeding or Formula: Do You Have to Choose?

For many new parents, the choice about whether to breastfeed or give formula feels like a huge decision. It can be one of the first major choices you make as a parent. While there are plenty of health benefits to breastfeeding, every family is unique. And the decision will boil down to what is best for you and your baby. 

After all, breastfeeding is far from universal. In the U.S., over 8 in 10 babies get some breast milk at birth. By 6 months, just over half are still receiving some breast milk, but only 25% of babies are exclusively breastfed. Over 7 in 10 babies are getting formula at 6 months, whether it's in combination with breast milk or formula alone.

Is breastfeeding or formula feeding healthier for babies?

You can have a healthy, thriving baby whether you feed them breast milk or formula. The best option for you and your baby will depend on a number of factors. But experts generally consider breastfeeding to be a healthier option for babies.  

The following organizations recommend exclusive breastfeeding for at least the first 6 months of life:

• American College of Obstetrics and Gynecologist (ACOG)

• World Health Organization (WHO)

• U.S. Department of Health and Human Services

• American Academy of Pediatrics (AAP)

The AAP recommends introducing food at 6 months and breastfeeding as long as “mutually desired by mother and child until 2 years and beyond.” 

The scientific evidence on breastfeeding vs. formula

The studies that look at breastfeeding benefits aren’t as clear-cut as they may seem. Women who choose to breastfeed are more likely to be white and have a higher level of education and socioeconomic status. These factors are associated with better health outcomes. This means it can be hard to tease out how much of the benefits of breastfeeding are related to demographics versus the breast milk itself. 

Some researchers tried to understand this question by looking at health outcomes in children who were fed formula but had siblings who had been exclusively breastfed. When they compared formula-fed children to their breastfed siblings, there were fewer health benefits of breastfeeding. When they compared formula-fed children to breastfed children from other families, breastfeeding was linked to more health benefits.  

In other words, if a baby is born to a mother who has breastfed her other children, how she chooses to feed her infant might play less of a role in her child’s health. It’s possible that the demographics of the mother and family are more important than how the baby is fed. 

What are the pros and cons of breastfeeding?

The health benefits of breast milk have given momentum to the “breast is best” movement. But breastfeeding comes with certain risks or challenges. Here’s a side-by-side comparison of pros and cons of breastfeeding. 

Advantages of breastfeeding

People often talk about the benefits of breast milk for babies. Babies who are breastfed tend to have:

• Fewer infections (like ear infections, severe diarrhea, and upper respiratory infections)

• Less chance of sudden infant death syndrome (SIDS)

• Less childhood obesity

• Lower rates of chronic diseases like asthma, eczema, and diabetes

• Better brain development for premature babies 

But breastfeeding can also benefit the health of the nursing mom. Benefits of breastfeeding for moms include: 

• Lower rates of diabetes

• Better blood pressure

• Lower rates of breast cancer and ovarian cancer 

• Easier loss of pregnancy-related weight

• Lower chances of postpartum depression 

• Convenience and ease for some (no need to pack bottles for the road) 

• Bonding time with your baby 

Disadvantages of breastfeeding

Here are some drawbacks of breastfeeding:

• There’s a higher risk of jaundice in the first week.

• You need to supplement with vitamin D drops since this essential vitamin isn’t absorbed well from breast milk. 

• It’s a big time commitment, especially for working mothers with limited maternity leave. 

• Some medications can pass through breast milk, making the breast milk unsafe. A mom may have to avoid taking certain medications because of risk to the baby. 

• Breastfeeding can be difficult and painful, especially at first. Lactation support can help, but not all have access to lactation services. 

• Some may struggle with milk supply, even with lactation support. 

What are the pros and cons of formula?

Some families choose to feed with formula out of necessity, while others choose it for practical or psychological reasons. Whatever your reasons, it’s a valid choice. Let’s look at some specifics to help you make the best decision for you.

Advantages of formula

Here are some possible benefits of formula: 

• There’s more flexibility with feeding options. For example, different people can feed the baby.

• Mom’s intake (like medication or alcohol) doesn’t come into play.

• The wide accessibility of formula can make it a great option for a range of families, including adoptive families, those with two dads, or moms unable to breastfeed. 

• Work and home life can be easier to balance.

• Formula can be specialized to target the needs of babies who need special formulas for health reasons. 

• Formula is fortified with vitamin D, so you don't need to supplement as long as your baby is getting at least 32 oz per day of formula.

Disadvantages of formula

No matter what method you choose, feeding your child is a lot of work. Here are some disadvantages of formula:

• You need to have supplies on hand (formula, bottles, nipples). If you’re going out, this means you need to plan ahead.

• There’s more work before and after feeding. For example, you need to prepare bottles and then wash supplies.

• You need access to clean water.

• There’s a risk of formula shortages. 

• There’s a rare risk of formula contamination. 

• The baby misses out on the health benefits of breast milk.

Is formula more expensive than breast milk?

This is a tricky question to answer. The average cost for a year’s supply may range from $821 to $2,921. It can cost more if you use expensive brands or ready-to-feed formula instead of powdered formula. On top of the actual formula you’ll also need to buy supplies, like bottles and nipples. If you supplement with some breast milk or use generic brands, you’ll pay less.  

But it’s important to keep in mind the hidden costs of breastfeeding. When breastfeeding, you need to eat an extra 400 to 500 calories a day to keep up with your nutritional needs. That may not sound like much, but it can add up over a year. 

The time spent breastfeeding also adds up. Breastfeeding or pumping can take up 3 to 4 hours per day. Researchers from Yale estimated that the cost of breastfeeding could be as high as $10,500 in a year when these hidden costs were factored in. This might explain why moms with lower income are less likely to breastfeed. 

Can you mix breastfeeding and formula feeding?

While major organizations like AAP and WHO recommend exclusive breastfeeding, know that it’s not an all-or-nothing deal. Even a small amount of breast milk can offer health benefits and immune-boosting properties through antibodies. So if you make the choice to offer formula, it doesn’t mean that you need to stop breastfeeding. 

Many parents choose to supplement breastfeeding with formula at some point due to supply issues or lifestyle considerations. But keep in mind that sometimes adding in formula and dropping some nursing sessions can cause your milk supply to go down. So it’s helpful to talk with your pediatrician, primary care provider, or lactation specialist for advice about how best to add in formula. 

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Written by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician in a variety of clinical settings. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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