Episode 3: When Breastfeeding Doesn’t Work: Reframing Infant Nutrition Without Shame

Breastfeeding doesn’t always go as planned—and when it doesn’t, many parents are left carrying unnecessary guilt, shame, and confusion about formula feeding. In this episode of The Lunchbox Reformation, I explore the emotional and clinical realities of breastfeeding struggles, supplementation, and transitioning to formula.

Drawing from my own experience as a new mom in medical training and over a decade of pediatric practice, I walk through common early breastfeeding challenges, including latch issues, tongue and oral movement concerns, head and neck restriction, breech positioning, and milk supply anxiety.

Most importantly, this episode reframes infant feeding away from performance and perfection. I offer compassionate guidance for parents who are supplementing or choosing formula, emphasizing that the “best” formula is often the one your baby tolerates well—and that a regulated, supported parent–infant dyad matters far more than meeting an idealized feeding goal.

This conversation is for anyone who is pregnant, breastfeeding, adopting, supplementing, or grieving a feeding journey that didn’t look the way they expected. The takeaway is clear and grounding: how you feed your baby does not define your worth as a parent—attunement, observation, and care do.

Register here for the science of breastmilk and formula masterclass!

NEW COURSE! "Read the Pattern: Feeding Your Baby 0–4 Months" — because a healthy relationship with food starts earlier than most people think. Course Link!

Transcript

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Feeding is so much more than just what's in the bottle. It's the eye contact. It's the predictability that when that baby cries and needs more food, you're there for him. Welcome to the Lunchbox Reformation with Dr. Liz. This podcast is for folks who are craving better nutrition for their kids, but are tired of the whiplash of nutrition claims and diet culture influence. You're reading labels, paying attention to ingredients, but you still doubt yourself. And for good reason, food goes deep, and often we fear making costly mistakes that as parents we hope to prevent. If you're ready to explore the ins and outs of your child's actual nutrition needs and nourish the whole child from the inside out, hang with me, Dr. Liz Daniels. I'm a board-certified pediatrician plus registered dietitian, and we're going to dig deep into real deal nutrition science, honest talk about barriers to health, and real stories that I help address. So let's dig in. Hey everybody, thanks so much for joining me today. Welcome back to the Lunchbox Reformation with Dr. Liz. Today, we're going to talk about the other side of the conversation when it comes to breastfeeding. Like, what do you do if you desire to breastfeed, but it's not working out? There's a lot of pressure to breastfeed around you, but you just kind of secretly don't want to. Or maybe you have a lot of other constraints on your time, your energy, your resources. And so it's just not the most, you know, realistic option for you. Maybe you can breastfeed in the beginning, but you're going to have to transition to formula at some point because of what you do. And I think that it's important to know how to walk through that process and feed your baby with confidence, whether it's working through choosing out the right formula or working through the emotional baggage that can come with this. I want to open that conversation up and dive a little deeper into it because as a pediatricianist and a mom, I see moms go through this all the time. And there's so much that I want to do to support them. And we just don't always have enough time in the exam room. So, you know, if you are about to breastfeed your baby, you're currently in the thick of it and it is stressing you out, or you are looking to support another mom who's going to be going through breastfeeding journey, then this episode is for you. And I'm just, you know, I'm excited about this because it's a topic that I really didn't get myself. You know, nobody helped me through this. And so this comes straight to you from my own wounds, my own experience. And I alluded to this a little earlier, but like, you know, I um had my first kid in the very beginning of medical school. And while my husband was really supportive of me, I knew that my schedule was going to be very demanding and I wasn't going to be able to be home for a maternity leave. I mean, I had six days for him. It was abysmal. But I still wanted to breastfeed. And part of it was because deep down, I felt like, you know, I knew my schedule was going to be hell and I wasn't going to be with him every minute of the day. And I walked into motherhood with guilt. You know, I walked in with this feeling of like, if I breastfeed him, then that's going to help us bond. It's going to mean that he's going to get, you know, the best nutrition and I'm going to be able to set him up for success, even though I'm not going to physically be there for all of those things in the first month. And I just, you know, people would tell me things like, oh gosh, that must be so hard. Or, you know, how are you going to be able to spend time with him? And just things that would make me feel like I was already failing him before I even started. And then frankly, I had a really rough delivery. It's not the worst in the world, but you know, I had preclancia. I had a fourth degree tear afterward. And so there was just a lot of tending to me that needed to happen and tending to him. So we didn't get to have the dreamy little like latch right away kind of experience. And it was challenging. I got him to the breast, but he also then experienced jaundice. And so it was super sleepy. And it took my body a little while for the milk to come in, given the stress that my body had been through during the last little bit of my delivery and pregnancy. And so I struggled. You know, he seemed to latch okay in the hospital. And then I remember, I mean, the hospital has gotten much better. But 15 years ago, when I had my son, we had to like wait for a PCA to take us down to the car. And there was all this frustration and making us wait. And we had to be strapped in at the time. And the baby was hungry and I didn't get to feed him. And it was like a whole thing. And so he ended up going six hours between feeding sessions, which is kind of a lot in the very beginning. And we got home and he just wouldn't latch. And I couldn't wake him up. And he just was so sleepy. And then it's just, I just remember sobbing in my rocking chair, feeling like, here it is. I failed him. You know, we're two days in and I have failed this baby. I remember, you know, like people were like, well, you can always supplement. It's okay. And I just was like, oh yeah, okay. That's even more of a failure. Please don't tell me that. What I didn't realize at the time is that I was like making myself pay penance for having a tough delivery and for knowing that I was going to have a challenging first few months with him. And I just wish that I had been able to name that, to recognize it for what it was at the time. And so, you know, this is my invitation to you that if you're in this place, you know, you're not alone. Like so many women want to be able to breastfeed. You're told it's natural. And yet you have barriers that either you didn't anticipate or you anticipated, but you didn't know that you were going to feel that way. And when it doesn't work, those feelings can feel so disproportionate to what others are expecting for you to feel. Like it's hard for sometimes for mother-in-laws or for people around you or your husband to get it, to like get the kind of deep grief that you feel when you can't breastfeed well. And there's anger and there's part of your like identity as a mother that suddenly is taken away from you. And you haven't even really set foot into motherhood yet. And here you are already feeling like that part of your identity gone. And, you know, what I want to say to that is that my goal today is not to convince you that you need to pick this one particular product and you're going to use this formula and it's going to be great, or you're going to use this breastfeeding supplement and it's going to be great. It's about processing what you're feeling and being able to regulate yourself so that you can be in the moment with your baby and support the baby who's there with you. For example, in my particular situation, I wish that I had been able to identify that feeding him in a different way was not my failure. It was just a moment in time. It was just a feeding. But I felt like, no, no, no, that's going to cause nipple confusion and that's going to cause this. And I had so much wrapped in my identity of controlling the scenario, controlling what it was going to look like. Yet, mind you, I had already pretended that that was like I was going to be okay with whatever happened. But in the moment, I really wasn't. And the reason I think this is so hard to anticipate how you're going to feel and anticipate that, you know, depth is that the emotions are so different. Like I love the movie turning red because it like visually represents this hormonal shift that girls go through during puberty. And it's so similar in that postpartum phase, you know, all these changes in hormones and all the like oxytocin and prolactin and all of, you know, the different emotions and hormones that you're going through and estrogen withdrawal, like all this stuff really affects your perception of what's going on. And so you truly can't see it with just a lens that somebody else on the outside of your own body is going to be able to feel. And when those tears come, just welcome them and thank them for coming. Oh my gosh, thank you for feeling. Thank you for experiencing this. Because that part of the story is what gets you through to the next thing. That identity and awareness and realization is so important. So, you know, part of the reason that this like hurts so much is that we have these cultural narratives of what good motherhood means. And we spend all this time during the pregnancy cultivating this identity of what we want that motherhood to look like. And it's formed as the baby is growing. And every day that you go through that process, you're you're wiring that in your head. And then when it doesn't happen, you don't have the framework for what it will look like. And it just feels like a complete loss. One of the things that I often tell my kids is whatever you believe, it's true. And in the same way, like if you believe that this is what good motherhood means, then you're gonna feel that way. So I would invite you to reframe that in general, that this like loss of breastfeeding is not failure. I hear that word a lot from moms, but failure. And really, it's actually a mismatch between your expectation of what was gonna happen and the reality. And that's influenced by a lot of things. If you experienced a lot of medical complications during the last part of your pregnancy or your delivery, if there's um latching difficulty, that's really common. But some babies are just have their palates are just shaped in such a way that it's really difficult, or they have a recessed jaw, or they have something else going on that impacts that. Just know that that is a challenge that you can't always anticipate. You can know that it's gonna happen, but the reality is going to be different because your expectations can't really be matched for that yet. And then there's also a huge role that our mental health plays into this postpartum depression is really important to recognize and be aware of. And so knowing that that plays into your decision making is really helpful, but that's often really hard for you to feel and identify. Again, it's not until you're in the moment where you're recognizing, okay, it's really impacting me. The other realization is that the structural barriers between, you know, being able to be successful with breastfeeding for some women is just more than what they actually can realize. Like that was my experience. I went back to med school and I was breastfeeding. My husband would sometimes bring him to my class because I was really hellbent on direct breastfeeding as opposed to pumping for what it was worth. There was no place to pump. I literally, I had nowhere to go. Like our bathrooms didn't even have outlets. And I spent many a bathroom with my pump going on and dealing with other women's comments about hearing the machine or being, you know, shocked that I was doing that. And it was like honestly, absolutely terrible. Pumped in my car a bunch. I pumped everywhere I could. I pumped while I was driving, don't recommend. I did it during surgeries. I did it, I mean, I did it all kinds of places. And I wasn't prepared for the kind of time constraints that it was going to cause for me. And so when it happened, you know, I think a lot of women go into lockdown mode and they go into this place of like really wanting to control even more instead of recognizing that they need to be open to that and how to walk through that. A lot of times they'll say things like, gosh, if I just tried harder, it would have worked, or my body failed me, or I'm choosing convenience over my baby, or this one decision will affect my child for a long time. I know, you know, the benefits of breastfeeding and they're, you know, it's going to impact their IQ, or it's going to impact their gut health or their immunity, and they're going to get sick all the time because I'm not breastfeeding them. And I would love to reframe that for you. The bottom line is that I cannot tell the difference as a pediatrician developmentally, I cannot tell the difference between a breastfed baby and a baby on formula. Like I can't, not at 12 months, not at 24 months, not at 12 years old. Like I can't see the difference. There are some studies that look at the comparative of formula to like IQ points for babies who are breastfed versus formula fed. And when you look at those, you're looking at a few point differences. This is not a tremendous IQ difference. Okay. And then when you look at that as they age, that tends to wash out and the confidence intervals overlap. And that's Nancy statistics speak for saying it probably isn't that different. So that's your mental lie that you're telling yourself or that you're choosing to believe. And I want to liberate you from that and say, it's okay. You don't have to believe that. The truth is it doesn't make that much of a difference. And will it help their immune system to have breast milk? Yeah, but really it's teaching their immune system how to function. It's not so much that it's providing them all the antibodies. That's another conversation for another day. But it is much more nuanced than I think a lot of people understand it to be just at surface value. And a baby who's growing well and a baby who has enough calories on board to grow and mature is actually at much better health outcomes long term. And frankly, if our babies are underfed or mom has inadequate nutrition and the and the baby's not getting enough nutrition, then that baby is going to have cognitive delay. That's the one that's going to have struggle. It's not a baby who's well fed and supportive, even if they're using formula. So, anyhow, we can talk more about the specifics of the formula here in a minute, but I just want to spend a little bit more time kind of helping you think through that thought process. So, number one, name this grief without getting stuck. So offer yourself permission to identify what it is that you're feeling. For example, you name the grief, like this mattered to me. I wanted to do this and recognize that you feel guilt. You feel sadness. And something that can help a lot of people is journaling, you know, talking to people around them who can will listen to them and just be an ear. But actually rewriting the birth story, journaling, can be really powerful and transformative. And letting somebody kind of talk with you who isn't just going to give you toxic posity or silver lining to everything and let you cry, let you feel. And you don't have to feel grateful for every moment postpartum in order to justify moving forward. You really can recognize what it is and then take the next step. And sometimes that next step is as simple as noticing that the baby feels really full because they had a full bottle, or noticing that your breasts are healing and they're no longer bleeding from having an improper latch. It's just awareness. And one of the things that I find really can be so simple and so helpful is sleep. So if you're in this place and you're feeling like you're starting to spiral, recognize that sleep will be really therapeutic for you. And maybe that means letting somebody else feed the baby so that you can get some good uninterrupted sleep, even just like three to four hours can be really helpful in the very beginning. Longer can be even better. But you, as a mom, will serve your baby better. You will love your baby better and more deeply and be more connected when you are a little bit more grounded. So I would invite you to welcome this process and notice that it's okay. It's okay. And in fact, for some women, I think they recognize that formula is incredibly therapeutic, not just a last resort. Meaning, when you see your baby well fed and you're like, oh my gosh, you see the satisfaction in their face. They just sort of relax their whole, their fists just loosen, their body sort of melts. And you get to snuggle and you know that you have taken care of that baby. That feels really good. So recognize that and notice how much of a benefit it can have just to be in that moment. So, what do you do when this baby is in front of you and you're shifting gears? Well, you pick a formula, you make the formula, you feed the baby, and notice. I would invite you to notice, have eye contact with your baby if they're awake enough to do so. And this is where we get to reclaim what that feeding relationship looks like. So think about what does matter for this baby. Feeding is so much more than just what's in the bottle. It's the eye contact, it's the predictability that when that baby cries and needs more food, you're there for him. That you're responsive to when the baby needs a diaper change or needs to be held or needs to be offered a pacifier. And that you're going to be able to be there for the emotional regulation that this baby needs. And that you're able to notice and pay attention to your baby's latch, how slow they're feeding, if they're feeding too long, if they're needing help with burping. All of that part of the feeding process is so key. And that responsive mana is the mana that you wanted to be in the beginning. The one who knows your baby, the one who's in tune with what your baby needs, and is able to be there and shift. Because the reality is parenting is a whole lot of this where you identify what the baby needs, you respond to the baby and you reiterate that because uh we don't know all of the answers. And this is just the beginning. So this process may not be what you invited, it may not be what you wanted, but it's where you're at. And so it's okay to reclaim this feeding relationship. It's okay to still be grieving while you're in this process. In fact, know that grief can coexist with confidence, you know? You go from one minute feeling like, okay, I've got this, everything's fine, till then like pulling up to the target parking lot and just sobbing for no reason. And that's okay. It's part of that process. So if you're there and you're in the thick of it, welcome it. But know that that is where you are. And your baby still needs you. Your baby still needs you to hold them, to feed them, to love them, to take care of them, to listen to all of the different types of cries that they have, to watch them sleep, to change their clothes, to do all those things. And that is motherhood too. So overall, like just remember that breastfeeding challenges are not a character flaw for you. Formula is not a moral compromise. And feeding your baby with formula is not a failure on a test. You didn't fail motherhood if you're feeding your baby with formula. You're choosing to respond to your baby's needs and meet them in the way that fits you best. Now, the other thing I like to help women think through is trying to pick the right formula. This is not a sponsored podcast. I have no one telling me what formula to tell you to like. Um, so I'll tell you my honest opinion. And I think that the reality here is that what's cool about breast milk is that it changes with the baby throughout the feeding, day by day, month by month. And that's really cool. That said, though, it's actually not perfect. And there are things that are missing in breast milk that are lacking, and the formulas actually are going to offer really amazing nutrition too. So the formulas that are out there, if it's on the market, it is safe. Now, I understand there's been recalls, I understand there's safety issues from time to time, and that's really, really rare. But the reality is that they have really high standards for what is considered safe and what can be sold. Um, they have a lot of regulation. And so um, for the most part, like truly, they're all great. And if I was to pick a formula for my own baby right now, I wouldn't really care. I would, I would pick the one that I can afford. I would pick the one that my baby would tolerate. And there are some other differences between them, but in general, like there's not one product that's like the best thing on the market, nor will there ever be. If you hear that, then know that there's something else underlying that statement. So the phrase like something that's closest to breast milk is really more of like a marketing phrase, not a clinical outcome. There's no formula out there that is exactly like breast milk. And it doesn't even really need to be. The purpose here is that formula needs to be able to provide the energy for growth and for development. It needs to have stable, safe ingredients that can be reconstituted easily with water. It needs to be safe and have out all of the essential amino acids, all of the essential vitamins and minerals to support growth, adequate energy, and in the right proportions that's designed specifically for what an infant's metabolism and an infant digestion can tolerate. And so, guess what? They all do. And, you know, the nitty-gritty, I love the conversations about the nuance between one formula versus another. And that is a really fascinating conversation, but it's for another day. The purpose here is to say that if it's on the shelf, it really is safe. By and large, I'm gonna recommend a standard cow product. So, like something that's gonna have lactose in it as a carbohydrate source, something that's gonna have whole intact protein, cow milk protein as a protein source, something that's gonna have stable vegetable oils or whole milk as a fat source, and then have all of the vitamins and minerals. And guess what? They really do. The standard products that are out there all meet those criteria. The differences are really how much they cost, who's making it, and what they claim on the label. And there's pros and cons to all of them. So it's really okay to just pick one. Now, that said, if you have questions, I'd love to support that. Reach out to me if you do. Happy to walk you through that in a little more detail. Or if you are interested, um, I'm going to be doing a masterclass on the science of breast milk and the differences between the formula on like the more nitty gritty nutrition side of things at the end of January. And you are welcome to join me. I would love to have you there. I would love to be able to support you in that decision. The idea here is that I like these conversations so much when I'm in my office, but we often are Having these conversations way late. And I love to have them before the baby's born. I think it's super cool to be able to be a part of that conversation prior to you going through this so that when you're in this situation, it's not a stressful moment and it doesn't feel like defeat. And it can feel like this is okay. This is where we go, and this is what we need. I hope this episode of the Lunchbox Reformation resonated with you. If it did, please hit subscribe or follow and share five star review. It would really mean a lot to me. Join me next week as we tackle another topic to help you feel more confident feeding your kids.