Most people do not think of the industrial revolution when they think of the breast feeding-formula feeding debates but it is arguably the reason the discussion exists today (National Academy of Sciences, foodtimeline.org, wikipedia.com). In the early 19th century breast feeding was the norm around the world. Women who had difficulties with breast feeding found wet nurses for their infants or created homemade formulas. The 1845 advent of the rubber nipple was the first step toward the formula feeding boon of the 20th century. Enterprising budding industrialists introduced the first manufactured formulas in 1867, advertising them as equal or superior to breast milk (though later generations would repudiate these claims). Yet formula and the bottle would have remained the recourse for women who could not nurse or find a wet nurse had not two other major changes taken place. Perhaps the most critical change was in the minds of newly industrialized countries—namely the discovery and acceptance of germ theory. The desire to avoid potentially tainted milk combined with medicine’s endorsement of formula to change the tide against breast feeding. Yet more than half of the infants in the United States were still breast fed until the late 1920s/early 1930s when refridgeration became more common. By the 1950s breast feeding was summarily dethroned as the preferred method of infant feeding with the rise of commercialized formulas.
Breast feeding provides infants with more than energy (Fomon, Anderson et al.). Proteins, vitamins and minerals are used by the infant to grow and mature. Antibodies, growth factors and enzymes provided by the mother aid immunity, growth and development until the infant’s own systems mature. Lipids and neurotransmitters aid in brain development while other components of breast milk sharpen vision. Formulas have developed remarkably in the last 150 years but they do not provide all the beneficial components of breast milk nor do they necessarily provide them in a form usable by the infant. As the infant’s systems are developing some components of breast milk rely on other components for activation or digestion. Furthermore, while some doctors may prescribe, or at least be aware of a potential need for, vitamin K and iron to breast-fed infants (likely dependent on the mother’s own levels) most components are in the ratio needed by the infant at that stage of development, measurements that are often difficult to apply to formula ingredients.
The superiority of breast milk to formula is advocated by doctors today. Debates exist, however, on the duration and exclusivity of breast feeding. The World Health Organization (WHO) and American Academy of Pediatrics (AAP) both recommend exclusive breast feeding for the first 6 months (except in rare circumstances, discussed below). Exclusive not only means without formula supplementation but also without supplementation of other milks, liquids or solid foods. At 6 months of age solid foods can be introduced and fed along with breast milk until at least age 12 months (AAP) or 24 months (WHO). Neither organization makes overt recommendations on when to stop breast feeding, ie when breast milk is no longer providing what solid foods and the toddler’s body cannot, but simply recommend continuing as long as both mother and child desire it. Mothers in developing countries may find extra benefit in prolonged breast feeding due to the high risk of contaminated water and food that would more harshly effect toddlers over older children and adults with more mature organs.
Certainly today some women may find, as they have throughout history, extreme difficulty in nursing. For these women, adoptive parents, and others the formula options are quite good compared to earlier forms (Owen, Fomon, Kramer et al., Anderson et al.). Nutrients are made more bioavailable and mineral contaminants such as lead have been removed. Developed countries see little difference in formula-fed infants compared with breast-fed infants in the long run. Certainly breast-fed infants are ill less frequently and less seriously when they are ill (mostly applicable to respiratory and gastrointestinal disease) while being breast fed. They may also have a slight advantage with mental acuity (one study suggests an average of 3 points on an IQ test) and visual acuity in the long term. Although formula-fed infants are by no means absolutely doomed to a life poor health and average achievement, it is simply not a complete replacement for breast milk. Advantages to formula feeding over breast feeding exist for particular situation as well. For women who are on drugs, chemotherapy, radiation, are infected with HIV or TB, or have infants with a rare genetic disorder that prevents the digestion of breast milk formula is recommended by the AAP over breast milk. The WHO has similar recommendations but does point out that while HIV can be transmitted by breast feeding (from 5-20% transmission rate for some breast feeding to 30-45% transmission rate for 18-24 months of breast feeding) other immunological (including HIV) and nutritional benefits from breast milk will be lost. In the United States and other developed countries, as stated above, choosing formula may not present a long-term observable effect but in developing countries it could mean gambling with the child’s life as much as the risk of HIV infection.
Breast feeding is best for the mother and child (Ruowei et al., Fomon, Anderson et al., Hediger et al). It is the natural process both bodies desire and should be promoted over formula feeding in almost all cases in the US. Multiple studies have shown, however, that only approximately 71% of infants in the US are ever breast fed and only approximately 14% of these infants are breast fed exclusively for 6 months. The percentage of mothers who nurse has been increasing since the late 1960s. Most women who breast feed exclusively are white, at least 25 years of age, well-educated and reside on the west side of the country. Mothers who are black, young and without a high school diploma are most likely not to breast feed. While infants in low socioeconomic groups could benefit greatly from breast feeding over formula feeding the education and resources to breast feed, especially in single-parent homes, are lacking.
The emotional, biosocial, nutritional and developmental benefits to breast feeding over formula feeding are proven (Ruowei et al., Fomon). What remains is to provide viable options for women and infants for whom breast feeding is not an option and resources for working mothers to breast feed their infants for at least the first 6 months to a year. Widespread education and cultural shifts may be required as they were to make the shift to formula in the 19th and 20th centuries (Montagu).
National Academy of Sciences. Evaluating the Safety of New Ingredients, 2004.
WHO: http://www.who.int/topics/breastfeeding/en/
http://www.who.int/nutrition/publications/HIV_IF_guide_for_healthcare.pdf
AAP: http://aappolicy.aappublications.org/cgi/content/full/pediatrics%3b100/6/1035
http://pediatrics.aappublications.org/cgi/content/abstract/112/5/1196
Foodtimeline.org
Wikipedia.com
Ruowei, L. et al. Changes in Public Attitudes toward Breastfeeding in the United States, 199-2003. Journal of the American Dietetic Association. Vol. 107. No. 1, 2007.
Montagu, M. Nature, Nurture and Nutrition. The American Journal for Clinical Nutrition. Vol. 5 No. 3, 1957.
Forman, M. et al. Exclusive breastfeeding of newborns among married women in the United States: the National Natality Surveys of 1969 and 1980. The American Journal for Clinical Nutrition. Vol. 42. 864-869, 1985.
Owen, G. Interaction of the infant formula industry with the academic community. The American Society for Clinical Nutrition. Vol. 46. 221-225, 1987.
Fomon, S. Reflections on infant feeding in the 1970s and 1980s. The American Journal for Clinical Nutrition. Vol. 46 171-182., 1987.
Anderson, J. et al. Breast-feeding and cognitive development: a meta-analysis. The American Journal for Clinical Nutrition. Vol. 70. 525-535, 1999.
Hediger, M. et al. Early infant feedign and growth status of US-born infants and children aged 4-71 mo: analyses from the third National Health and Nutrition Examination Survey, 1988-1994. The American Journal for Clinical Nutrition. Vol. 72. 159-167, 2000.
Kramer, M. et al. Infant growth and health outcomes associated with 3 compared with 6 mo of exclusive breastfeeding. The American Journal for Clinical Nutrition. Vol. 78. 291-295, 2003.
