Newsletter #48:Why Formula is not the Answer for Struggling Breastfeeding Mothers

By BMSG Editorial Team

If you have been on the BMSG’s private Facebook support group, you might have seen our advisory to members not to recommend formula feeding in their comments and replies to mothers who post on the group. Perhaps you’re wondering – what’s up with that stand, and why? 

Typically, recommendations to give formula are quite common in threads which talk about a drop in milk supply or when mums are unable to match the amounts that their babies drink in a bottle. 

The BMSG’s stand is that formula feeding should only be an option where medically indicated. This may mean that a mother has a medical condition that renders her too unwell to feed her baby, or that human milk donations are not readily available. There can also be situations where both the mother and baby are warded in the Intensive Care Unit (ICU) and are unable to establish a breastfeeding relationship.

Echoing the Stand of the WHO

The stand that we follow is in line with the World Health Organization’s hierarchy of infant feeding. A mother’s own milk is naturally the top priority, but it may surprise you that donor milk from another mother is the second best option, whether it has been expressed or if baby is nursed directly from another lactating woman. This may seem foreign to us urban dwellers in (almost) squeaky clean Singapore, but if we think about the lack of clean water and sanitation in some environments and situations, it is clear what is the obvious and, often, the life-saving choice.

(For those who seek donor milk or who wants to donate excess milk, you can do a shout-out at our Facebook private group, or at the Human Milk 4 Human Babies Singapore public Facebook page.)

The truth of the matter is that although we do have access to clean water, breastfeeding is something that we need to preserve especially when a breastfeeding mother seeks support. In our comfortable lives, it  can be convenient for us to reach out for infant formula when breastfeeding challenges arise. However, there are a few reasons why providing formula may not be the best way to get over a breastfeeding challenge.

Feeding a breastfed baby with formula milk in a bottle can make a baby too full to latch from mum. [Stock Photo]
  1. Giving formula can make baby too full to latch on mummy’s breasts

    When a new mother is just starting out with breastfeeding, the apparent low milk volume is often easily mistaken for milk insufficiency or “low milk supply”. Formula is often quickly given as a stop-gap measure, as parents are afraid of dehydration. 

    However, it is important for parents to be aware of how much (or how little!) milk is actually needed by babies at this stage. Newborn tummies are tiny and need very little milk – at best, the size of a newborn’s tummy at birth is about the size of a shooter marble (3-5ml). Furthermore, newborns drink colostrum, which appears in low volume but is incredibly rich in nutrients. We are so used to the media portrayal of a full bottle of formula that it makes us uneasy to think that an infant may only need a few millilitres of breast milk! It‘s time to recalibrate and understand that in nature, newborns drink less than what we might expect.

    As a result, when a baby receives formula, often more is given than what the baby actually needs. Baby’s tummy can become distended, leading to baby feeling too full to nurse. We also know that newborns are sleepy beings so an uncomfortably full tummy may mean longer sleep before the next feed as baby’s body works to assimilate the harder-to-digest formula. This contributes to the cycle of the formula top-up trap where the mother constantly feels resigned that she just does not have enough milk.

    This can also happen when water or even too much top-up of mother’s milk is bottle fed to baby. Excessive water can cause toxicity in baby.
The estimated sizes of a newborn's tummy during the first month. [Credits:]
  1. Mother’s Supply will be Affected

    Naturally, when a mother chooses to supplement with formula, she needs to ensure that she is also removing milk from her breasts. Just like in economics, the demand (or milk drank) by the baby is the amount that is signalled to the body to produce – thus, the more baby drinks, the more the body produces.

    However, when the breast is replaced by a bottle, mothers often miss out on pumping and may not remove the amount that baby would need. It becomes necessary for the mother to play catch up by taking more time to pump and remove the amount that has been drunk.

    In the event that the mother does not return to latching her baby or is not able to express the amount of milk equivalent to that which baby drinks in the bottle, the mother is at risk of facing a dip in her supply. This will then sabotage her efforts to continue latching at the breasts because a drop in supply will make it hard for her baby to be satisfied at the breast. Inevitably, this is highly likely to lead to a premature end to breastfeeding when the mother is unable to catch up with expressing the amount of breastmilk that is required.

  2. There are risk of allergies with formula

    It can be tempting to provide a baby with formula in times of desperation but it is a temporary solution to a problem that can be fixed. While it is natural, breastfeeding is a skill that takes time to learn. With the right support, most mothers should be able to breastfeed. In the event when a mother is unable to provide breastmilk for her baby for whatever reason, it has also become socially acceptable to provide an alternative in the form of human milk donations.

    We don’t talk enough about this but there are babies in the world who cannot take formula milk. For a mother of a newborn, introducing formula milk for the first time can be a make-or-break moment. If the child has an undiscovered allergy to dairy or cow’s milk, there is always a possibility of an allergic reaction to the said formula milk.

    A newborn baby has a stomach that is vulnerable to pathogens. It is a built-in mechanism that prevents a baby from having harmful germs enter its system. Breastmilk has the natural ability to protect the linings of baby’s intestines as it forms a layer that prevents the intestines from absorbing these harmful stuff. But when you introduce formula or other substitutes that are not appropriate for a baby, this protective layer is destroyed.

    Babies then are at risk of developing digestive issues as well such as lactose intolerance, reflux and constipation, which can lead to discomfort in the baby.
  3. Economic sustainability of formula milk

    It can be “helpful” for a stressed-out mother at first to use formula, but as the breastfeeding journey begins to end prematurely, the baby will then become dependent solely on formula milk.

    We don’t know what the situation of the mother’s family is like when we suggest formula. Formula milk can be economically unsustainable for a family in the long run, should the family income be decreased. With a dried-up milk supply and a limited amount of powder left in the can, a mother may be forced to stretch out her baby’s feeding, or dilute her baby’s milk. In fact, this has happened and is already happening in Singapore, and even in more dire situations where the baby is very, very young. The baby will not be receiving enough nutrients to grow and develop properly.
Breastfeeding has to contend with formula milk companies, who invest in heavy marketing to parents. [Stock Photo]

We hope the explanation above has provided a clearer picture on the reasons why formula feeding is not always the one-size-fits-all solution for mothers who are still trying to overcome breastfeeding challenges. We, all of us as women, help the mother to help the baby – it is a community effort.

Newsletter #43: Total Defence Day – Protecting Babies During Emergencies

By BMSG Editorial Committee

It is significant that we commemorated Total Defence last week on 15 Feb just as the nation is coming to terms with the recent outbreak of COVID-19 (previously also known as the coronavirus). While we grapple with the possible impact of the virus on our community, our resilience was tested as fearful members of the public took to stockpiling household supplies when Singapore raised its DORSCON level to Orange. Racks were swept clean, especially those that housed rice, instant noodles and toilet paper previously.

Sadly, formula milk also fell victim to the hoarding of the public. Some mothers on online forums were lamenting that they were worried about the shortage of formula milk stocks. While the government eventually swooped in to assure Singaporeans of our supplies, the incident is a strong reminder that young babies and infants remain vulnerable in the event of an emergency, whether real or perceived.

As a charity committed to upholding the rights and welfare of young children to be fed and taken care of in times of crises, we line out several measures in this article that parents can take to ensure sufficient feeding of their infants in the event of a national crisis.

Singaporeans took to panic buying when Singapore raised its precaution levels. [Credits: @ikansumbat / Twitter]

Emergency Preparedness
While a disaster or nation-wide crisis may appear unlikely to happen in Singapore, the tagline “Not if but when” on our national security campaigns clearly reminds us that threats such as terrorist attacks and other unexpected dangers are always lurking. The current COVID-19 situation here was something none of us would have expected just a few months ago. Its impact on our economy and safety is unprecedented.

In such situations, especially because threats are unpredictable, it is all the more important that we equip ourselves with knowledge on what infants and/0r young children would need in the event of an emergency.

Australian Bushfires: Lessons Learnt for Feeding Children in Emergencies
The recent Australian bush fires endangered many civilians and affected infrastructure across the country; an annual affair especially with scorching summer heat they were particularly bad this bushfire season. While cyclones, floods and bushfires are common occurrences for the continent, a recent research study by Australian academic Dr Karleen Gribble last year discovered that one-quarter of families who evacuated during the 2011 Queensland flooding and Cyclone Yasi were unable to pack adequate supplies for infant feeding despite the fact that such natural disasters have been happening in Australia almost every year for decades.

It was also found that guidelines for emergency packing were more detailed for adults and pets, as compared to very young children.

Families may not be sufficiently equipped to provide enough supplies for babies in an emergency, which was what academic Kate Gribbles discovered in her study. [Stock photo]

Current Situation in Singapore
While such emergency situations may sound extreme for a country such as Singapore not known for emergencies or natural disasters, BMSG (Singapore) recommends parents, caregivers and agencies remain up to date on the requirements for emergency kits for infant babies, whether breastfed or formula-fed. We also cannot afford to be complacent and expect that supplies will be readily available in the event of an emergency.

Currently, the Singapore Civil Defence Force (SCDF) recommends that citizens prepare a Ready Bag (P43) as written in its Emergency Handbook. The Ready Bag should be pre-packed with items that individuals require, preferably one bag per family member including infants and young children.

The SCDF also writes in its handbook (P44) that there should be food rations enough for two weeks of non-access to food and water for each individual in the household. For infants, it is recommended that one to two tins of formula milk be stocked up for emergencies depending on the age of the baby.

Screenshot of P44 of the SCDF Emergency Emergency Handbook. [Credits: SCDF]

Suggestions for Changes
Unfortunately, current recommendations do not fully detail what are the exact needs for young babies and children.

  • First and foremost the current guidelines assume that babies are formula fed, and the public is encouraged to keep tins of formula. There is a possibility that families who are not formula-feeding may mistakenly feel that formula milk is prefered to breastmilk in emergency situations for some reason. We would like to see guidelines updated to include breastfeeding, expressed breastmilk feeding and mixed feeding. It should be made clear that mothers who are breastfeeding should continue to do so, in fact they should consider taking steps to relactate if they have recently stopped breastfeeding as dried formula milk can only be fed with access to clean potable water which may be limited or even unavailable.

    In fact, it is precisely this that poses danger to vulnerable infants where the threat of contaminated water, unsanitized preparation areas and the lack of hot water make safe formula preparation problematic. In Gribble’s recommendation of guidelines for baby food and milk in times of disasters, she recommended that 15 L of water be set aside for washing of hands and milk preparation areas alone. She also mentions other specifics that would be mandatory for sanitised preparation of formula milk that is safe to drink.

  • Secondly, in the event that parents are not able to secure tins of formula milk to be stocked up, there seems to be no alternatives in place for infants that rely on formula milk. There would also be the likelihood of inflated costs of supplies, including formula milk, in the event that demand is excessive – families with a lower income would be particularly vulnerable. How then do we ensure that all children are able to receive adequate nutrition and hydration during times of crisis, regardless of how they are fed?

  • Thirdly, human milk sharing should be considered in the updated guidelines, i.e. cross-nursing and/or feeding donated expressed breast milk. This is arguably one of the best ways to sustain young infants in emergencies as breastmilk can be transferred without a receptacle in the case of direct latching, or hand expressed into a sterile container and fed to babies straight away.

    While storing expressed breast milk may be challenging when there is limited electricity, the supply of breast milk to vulnerable infants could be maximised by encouraging breastfeeding mothers in disaster areas to come together to help breastfeed or hand express breast milk for other babies. You can read more about similar efforts that have been practiced by the breastfeeding support groups in the Philippines in our interview with a veteran Filipina breastfeeding advocate, Ines Fernandez, last year. Such an example sets precedence for situations we can never imagine.

AP Gribble’s Guidelines for Baby’s Sustenance in Emergencies

Taking a closer look at AP Gribble’s recommendation, we can take stock of how specific these guidelines are. Note that these are supplies meant for three days without any access to clean food, potable water and electricity. It is assumed that after three days, the family would be evacuated or rescued.

Breastfed Babies

Expressed-Milk Fed Babies

Formula Fed Babies

• 10 L water for mother to drink

•36 nappies

•100 nappy wipes

** Gribble and Berry also recommended that mothers learn the national breastfeeding hotline.
** BMGS (Singapore)’s hotline is +65 6339 3558

• 10 L water for mother to drink

•10 – 20 L of water for hand washing

•30 cups/bottles for expressing and feeding

•Detergent to wash receptacles

•100 nappy wipes

** Keep in mind milk storage guidelines e.g. milk can be stored at room temperature for 3 hours in Singapore’s climate and to do a taste test before every feed.

** Feeding cups must only be used once.

• 1 unopened tin of baby formula

•27 feeding bottles and teats

•14 bottles of still water for reconstitution

•15 L of water for washing of hands and preparation areas

•Detergent for washing of hands and preparation areas

•100 sheets of paper towels for drying wet hands and preparation area

•Large storage container with sealing lids for storage; lid can be used as preparation area

•36 nappies and 100 wipes


[Image credits to: Dr Karleen Gribble & Dr Nina J Perry]

Extra Precautions for Formula-Fed Babies

Referring to the table above, you will find that for formula fed babies, preparations are a little more extensive. Additional guidelines include:

  • Each storage bottle must be sterilised and fully dried before being put in a ziplock bag and then stored
  • Washing hands and drying them are important when preparing infant formula
  • Use small bottles of water for reconstitution
  • Always use the correct amount of infant formula. It is not advised to dilute formula to extend its shelf life, especially for babies younger than 6 months old
  • Prepared formula should be fed to baby straight away
  • It is not recommended to keep unfinished formula for feeding later on as it can be a breeding ground for bacteria. In emergency situations, tummy issues would be something unwelcome and challenging to manage, not to mention dangerous, for young children.

Babies Over 6 Months

Babies over 6 months who have started on solids would need sufficient packaged baby food, disposable spoons (unless there is sufficient potable water) and drinking water prepared for emergencies. This is on top of the amount of milk the baby needs as per the guidelines above.

It is also worth noting that babies over 1 year old need not consume any form of formula milk. You can stick to clean plain water for baby’s hydration. 

In times of crises and natural disasters, children remain one of the most vulnerable groups of people who will need extra care. [Stock Photo]


As the number of breastfeeding mothers and babies is growing significantly and in view of the times that we are in, there is a need to unlearn and relearn new ways to support the breastfeeding mother and baby in emergency situations.

Just last year alone, BMSG (Singapore), the sole charity for breastfeeding support, provided counselling to nearly 7000 individuals, including mothers, spouses and family members. This shows that there is a significant number of families who comprise of a breastfeeding baby or child. Their needs remain paramount just like other babies and children.

The recent panic-buying episode also shows how especially vulnerable non-breastfed infants are in times of public anxiety, where there were anecdotes of parents unable to purchase their babies’ formula milk powder in supermarkets due to hoarding. 

We sincerely hope that our suggestions and recommendations will be useful for agencies and families alike who can help citizens and residents of Singapore be better prepared for any forms of emergencies, expected or otherwise.

If you need breastfeeding support, contact our breastfeeding counsellors at no charge on the following platforms: