Is breast-feeding really better for babies than formula?

April 13, 2007

Dear Cecil:

Is there any proof that breast-feeding is better for a baby than formula or vice-versa? Benefits of breast-feeding are said to include bonding between mother and child, and the fact that the mother is passing immunities to her child through her milk. The main arguments I have heard for formula are that the vitamin content is just right for the baby, whereas breast milk lacks nutrients a baby needs such as vitamin D, and that formula digests more slowly than breast milk so the baby sleeps longer.

Interesting subject, Collin. Most arguments against breast-feeding, including the ones you mention, are so feeble they barely need refuting. What numbskull could believe a process that sustained our mammalian ancestors for 200 million years is missing vital nutrients? Or that breast-fed babies don't sleep enough? But the lameness of these objections obscures an important truth. While medical experts are virtually unanimous in agreeing breast-feeding is best for most babies, it's not best for all.

For centuries mothers unable to breast-feed have used animals' milk instead, cow being the most common due to its availability. Unsurprisingly, none is as good for a human baby as its mom's. Research has shown breast milk contains levels of protein and lactose better suited to infants, promotes the growth of helpful bacteria in the digestive tract, and passes along protective antibodies.

True, breast milk is low in vitamin D, but in normal circumstances infants synthesize their own with the help of sunlight. Granted, circumstances aren't always normal. Doctors began recommending vitamin D supplements in the 1990s after medical journals reported increasing numbers of U.S. and Canadian babies with rickets, a bone disease caused by vitamin D deficiency. On closer investigation, virtually all the afflicted kids (a) were of African or Asian ancestry with dark skin, (b) had minimal sun exposure, and (c) were breast-fed. But let's use a little common sense: while breast-feeding rates were rising at the time, this isn't so much a milk problem as a sun problem. Skin pigmentation blocks sunlight, meaning infants with more of it need to spend more time outdoors to make enough vitamin D, which in the North American winter can be hard to arrange. Alarmism over skin cancer confuses matters further. Yes, babies have sensitive skin, and no, you shouldn't let them fry, but they do need some sun. A readily identified subset of breast-fed babies arguably needs vitamin D supplements too, but it's absurd to suggest they all do. None of this, in any case, is an argument for replacing breast milk with formula.

Attitudes about formula, which first became available in the 1860s, have changed dramatically over the years. Before 1920 about 80 percent of mothers breast-fed; by the late 1950s the rate had dropped to around 20 percent. Formula feeding was treated as a scientific process, with detailed schedules, weighing the infant before and after feeding, and heavy doctor involvement.

But advocacy groups such as La Leche League, founded in 1958, resisted the trend, and research showed they were right. Breast-fed babies have a lower risk of postneonatal death, higher resistance to infectious diseases, less chance of developing Type 1 or 2 diabetes, lower incidence of obesity, and possibly higher intelligence. Mothers benefit from breast-feeding as well, with studies showing reduced postpartum obesity, reduced risk of breast cancer and type 2 diabetes, and of course emotional bonding. Breast-feeding enjoyed a resurgence starting in the 1970s, and eventually the World Health Organization, the American Academy of Pediatrics, the British National Health Service, and most major child welfare and development organizations acknowledged it was the best way to nourish an infant. Nowadays about 70 percent of U.S. children are breast-fed at birth, close to the worldwide average, and about 33 percent still are at six months.

Still, there's such a thing as taking enthusiasm for breast-feeding over a cliff. Standard medical advice nowadays is that babies should be exclusively breast-fed for the first six months of life, with no formula supplement. Good luck trying to do that and simultaneously hold down a job. (Sure, expressed milk means others can help with meals, but I have personal knowledge that newborns occasionally fed formula will survive.) More to the point, some women can't breast-feed--maybe 5 percent suffer from insufficient milk syndrome. A woman who can't produce enough milk but tries to breast-feed exclusively anyway can starve her child; some deaths have been reported. That's not to say you should give up on breast-feeding if the first couple attempts don't go well, but you do need to monitor weight, diaper filling, and overall health, and ignore dimwitted advice if the baby fails to thrive. Admittedly, sensible breast-feeding isn't made easier by bizarro attitudes in the U.S., where the female breast is routinely displayed for commercial purposes but you risk society's wrath if you publicly suckle your kid.

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