Looking a while back at History.
If you've had a baby in the last couple of decades or so, you have heard that breastfeeding is the best. That you should make sure your baby gets only breast milk for the first six months of its life. It's a saying that has the ring of science to it.
Breast milk has so many amazing properties and it must be far superior to anything else we can give to our infants. That includes commercial infant formula, but a three-word phrase does not ever paint the whole picture.
So what is the truth about breast milk and infant formula? As mammals, we adapt to produce a fluid that meets our offspring's nutritional needs. Remember our newborns can't process solid food, so they need to eat something liquid.
But what about when a newborn doesn't have access to breast milk? The use of wet nurses or people who breastfed other people's babies was common before bottle-feeding became a thing. This was an option when there wasn't another lactating person available.
Throughout recorded history, infants have been given all kinds of breast milk alternatives. These included animal milk, softened bread, soups, honey, and even wine. These alternatives had the potential to make babies sick and also it was hard to keep feeding vessels clean enough to stave off infection.
Not that commercial formulas were much better. When they first started hitting the market in the early 19th century, they didn't contain enough protein, vitamins, and minerals. The improper storage often caused them to spoil.
So most infants were still breastfed prior to the 1930s. But that began to change thanks to several factors, including more aggressive marketing from manufacturers of infant formula.
By 1929 the American Medical Association formed a committee to oversee baby formula. The government created regulations to prevent formula companies from hocking their products to consumers.
These companies were allowed to solicit physicians who would turn around and share glowing reviews about formula with their patients. Breastfeeding rates dropped steadily through the 1970s breastfeeding also declined in economically disadvantaged regions of the world.
Many people couldn't afford enough formula to feed their infants so they diluted it. Still, on the case, some did not at all have access to clean water. To make matters worse, some were illiterate and couldn't read instructions to prepare formula safely.
It is hard to separate from other factors that could have contributed to the decline. Many doctors and researchers blamed aggressive advertising tactics as early as the 1960s people around the world were starting to fall out of love with formula feeding.
By 1991 the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) launched the baby-friendly hospital initiative known as the BFHI. Their goal was to help maternity wards support breastfeeding and thereby drive rates of breastfeeding up.
There are 10 guidelines that they call the 10 steps to successful breastfeeding. Birthing facilities needed to follow these guidelines to earn Baby-Friendly- Hospital-Initiative(BFHI) accreditation. They include teaching parents how to breastfeed and making sure parents and infants have access to breastfeeding support even after they leave the hospital.
Breastfeeding better outcomes. Breastfed babies have lower incidents of childhood obesity and the longer they are breastfed. They are less likely to become obese or get diabetes. Breastfeeding seems to protect against later development of type one or type two diabetes in babies. It also helps against the development of type two diabetes on parents who breastfeed.
Necrotizing Enterocolitis is another big one. It's a devastating disorder that leads to tissue death in the bowels of premature infants and breast milk has been shown to protect against it. It doesn't stop there. Breastfeeding is also associated with a whole raft of other desirable outcomes. These includes:
- lower incidents of asthma,
- childhood leukemia,
- ear infections,
- respiratory infections, and
- sudden infant death syndrome.
Breastfeeding rates have improved globally ever since. Breastfeeding rates went up and kids are doing better because of it. Breast milk is best, the end roll the credits except, as usual, the truth doesn't boil down to a simple slogan. Breastfeeding is linked to better health outcomes.
The data pretty clearly shows that on the whole breastfed babies tend to fare better than those who get formula feeding. Breastfed babies also seem to do better later in childhood and even adulthood. On the whole, they have better school performance and possibly even higher salaries than those who weren't breastfed.
All the research from government agencies and medical journals over the past few decades it is pretty compelling. But is it the actual material properties of breast milk at work or something else? See, there's a complicating factor that goes with all that science on the benefits of breast milk.
The vast majority of data on longterm infant feeding outcomes are observational. That means they're from studies where researchers watch what people do and take notes on what happens next rather than designing a controlled experiment for them to participate in.
Unlike the formula companies of yesteryear, researchers are sticklers for ethics. There are ethical barriers to randomly assigning one group of infants to receive breast milk and the other to receive formula. Instead of randomized controlled studies, researchers who study the effects of breastfeeding and formula feeding are comparing the babies who happen to breastfeed with the babies who happen to get the formula feeding. And families that breastfeed tend to differ in several important ways from families that don't.
For example, at a sample of Florida mothers from 2013 those who breastfeed were more likely:
- to be married than single
- to have achieved higher levels of education,
- to not smoke and
- to have better access to health care than their formula-feeding counterparts and in lower-middle-income countries.
U S data from 2013 showed that 70% of college graduates breastfed infants for at least six months compared to 38% of those who hadn't graduated from high school. Those living at six times the poverty line, 70% were still breastfeeding at six months compared to 38% of those living below the poverty line.
In high-income areas, breastfeeding moms are more likely to be health-conscious. They have the time and resources to promote healthy behaviors. So it's very tricky to control for other factors when looking at the potential benefits of breast milk. One way that researchers have tried to wrangle these variables is to look at siblings.
Siblings are exposed to a lot of the same socioeconomic factors and often have the same parents. So if one was breastfed and the other wasn't, they can be compared to one another and some of those variables are controlled for. In 2014 US researchers carried out a major sibling study that compared feeding methods for thousands of siblings born since the 1980s.
When comparing kids from between the ages of four and 14 from different families, those who were breastfed had lower incidents of:
- obesity,
- asthma,
- hyperactivity, and
- higher math and reading proficiency.
Researchers didn't assign some babies to receive breast milk and others to receive formula but instead, they randomized over 17,000 mother-infant pairs into two groups and one group. The BFHI chain model was used to encourage breastfeeding. The other group wasn't given those guidelines as expected.
The group that received the encouragement ended up with higher breastfeeding rates. The researchers followed these kids into childhood and adolescence. They found that both groups ended up with similar incidents of asthma and allergies, no difference in behavioral issues, similar weight and blood pressure and more.
So yeah, breastmilk is pretty awesome, but once you start to account for all of the other variables that can affect an infant's life, it becomes really clear that feeding is not the only thing that affects an infant's future. There is one notable exception to all of this.
There is strong evidence that breast milk has a significant protective effect on the incidence of necrotizing enterocolitis and premature and low birth weight newborns. But outside of that, there's not actually enough evidence to tell parents that they have to breastfeed to ensure their kids will be healthy despite how messy all of this is.
The breast is the best adage still prevails in many circles, but some researchers are starting to suggest that certain BFHI guidelines like a ban on pacifiers could be doing more harm than good. Some of the guidelines provide great support for new parents just to learning how to care for their baby, but others might be less great. One of the most widespread breastfeeding recommendations related to BFHI.
Step six is to breastfeed exclusively for the first six months of life. No other food or drink at all, but that idea isn't backed by science or by history. Newborns have been fed milk alternatives throughout time for lots of reasons. Reasons included their parents not being able to produce enough milk in the first few days after birth.
New parents may be told that newborns who nurse frequently will get enough milk that their bodies will produce as much as the infant needs, except that that's not true up to an estimated 15% of people breastfeeding. Don't make enough milk.
In fact, in limited cases, dehydration can actually arise as a complication of exclusive breastfeeding when parents aren't making enough milk.
Nutritional deficiencies and failure to thrive have been seen as well. Supplementing frequent breastfeeding with formula or pumped or pasteurized donor breast milk can prevent excess weight loss in infants and other words.
A bit of formula can sometimes be a big help. In fact, there's some evidence to show that a little extra formula early on may help establish breastfeeding longterm with all of the baggage that comes with a conversation on how to feed our babies.
One thing is clear, breast milk is great, but that doesn't mean a formula should be framed as harmful because the evidence is not there. Formula companies have definitely acted on ethically at certain points in the past, and the formula feeding is not identical to breast milk, but formulas these days are legs above those of yesteryear.
They're highly regulated to contain as much good healthy nutrition as we can. Formula milk still doesn't mimic everything about breast milk including those good bacteria and immune proteins. These do confer certain benefits like especially helping protect against necrotizing enterocolitis.
It's just that the lack of these things doesn't have to be a deal-breaker. Breastfeeding and formula feeding come with pros and cons. These often vary from family to family depending on resources, employment status, and geographic location and lifestyle.
One important factor to consider is cost. Yes, you don't want to have to fork over cash money for breast milk like you do with the formula feeding, but breastfeeding is only free if a parent's time is worth nothing. Bottom line, if you have the means to prepare formula, right, there's no reason to fear it.
This is ultimate, of course, the decision for parents to make for themselves, but we can tell you that the evidence says the formula feeding is fine. Just remember to ask your doctor if you have any concerns.
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