Breast feeding vs formula feeding

[oimissus]

how is 'formula feeding' euphemistic? Sounds pretty straightforward to me - feeding your baby with formula.

For the record, I'm not offended, or distressed - I just think it's a horrible, unempathetic and totally unnecessary term to use when 'formula feeding' is out there and perfectly understandable. Can you really not see why? Have you not read stories (on this very thread) of women who have not been able to breastfeed, or breastfeed as long as they would like, and feel guilty (or, worse, are made to feel guilty) for feeding their babies formula - can you not see how refer to their babies' food as 'artificial' is just . . . wrong?

[susyp]

I've only just caught up with this (trying not to get too involved or I'll lose the plot...) but I've never heard the term "artificial feeding" Now my daughter is on artificial milk (neocate) because she can't tolerate cows milk. But cow's milk = artificial? Really.?!!

Unbelievable.

It's nice to know that we seem to be turning the debate on this away from the breastapo, at least on this forum.

Hope it gives any new mums reading this the support that I so badly needed early on.

Susypx

[Monkey]

Cyberia Wrote:

-------------------------------------------------------

> Well, if a majority of people really think it

> makes no difference (or very little) then no

> wonder:

>

> - that there is exactly one baby-friendly hospital

> in all of London (accounting for just 3.54% of

> births) - as of about a year ago!

>

> - health professionals in the NHS simply couldn't

> care less and rather than provide bf support they

> simply give or recommend formula (sorry, can't

> rely on Unicef for this one, but it happened to me

> - and when I finally found help outside the NHS,

> no one seemed surprised to hear it... 'happens all

> the time'... apparently)

>

> Seriously, is there a single OB or paediatrician

> in all of South London who is also an IBCLC? It

> would be delightful to hear that such a person

> exists.

>

> What me, bitter? ;-/

A lovely paediatrician from the neonat unit at King's told me that if the biggest problem at King's was a baby refusing the boob, life would be fantastic. I have no idea what's on offer privately but at King's at least the ob and paediatrician have sadly much more serious problems to deal with.

[gillandjoe]

I take offense at the term 'breastapo'! How dare you?!

only kidding ;)

[Saffron]

Why is "artificial" milk a "bad" thing, but an artificial heart or artificial blood or an artificial arm is a good thing?

And, yes, formulated cow's milk is artificial in the sense that the original solution is manipulated by chemistry to produce the final formulation. The word artificial carries no emotive context in this sense. It simply means made or produced by human beings rather than occurring naturally. You won't find Aptamil growing on trees. Humans make artificially formulated milk by modifying the milk of other mammals, or other foodstuffs.

However, colloquially, I wouldn't personally use the term "artificial feeding", because it could be confused with feeding expressed breast milk in a bottle. In which case, "artificial" would refer to the use of a bottle as a prop for feeding.

Non of these are bad things in the right context.

Nevertheless the benefits of breast milk should not be understated, because actually there is lot we're still learning about breast milk. For example, it's only recently been shown that human breast milk contains exosomes with RNA, ie small lipid-bound capsules carrying genetic messenger molecules. Here's one example: http://www.biolsci.org/v08p0118.htm .

That being said, if parents need to give their baby formula, then thank goodness modern formulated baby milks are safe and generally well-tolerated. I'm only sad that the rise of the formula industry combined with the HIV/Aids epidemic has killed off the wet nursing profession. I would have loved to have had a wet nurse when my daughter was an infant. And I get really p1ssed off that so many HVs/GPs are still comparing breastfed babies to formula fed babies. The standard that nature designed through evolution is breast feeding, and we actually do a disservice to formula fed babies as well to make the comparison incorrectly. It's both misleading and unscientific, and does not promote either good breastfeeding or good research into better formulated milks.

[sillywoman]

susyp Wrote:

-------------------------------------------------------

> I've only just caught up with this (trying not to

> get too involved or I'll lose the plot...) but

> I've never heard the term "artificial feeding"

> Now my daughter is on artificial milk (neocate)

> because she can't tolerate cows milk. But cow's

> milk = artificial? Really.?!!

>

> Unbelievable.

>

> It's nice to know that we seem to be turning the

> debate on this away from the breastapo, at least

> on this forum.

>

> Susypx

Susyp - are you calling me out as 'breastapo'? If not then could you please be clear about which posters you mean on here? I thought I'd made my position plain both here and on the other thread, but it would seem I haven't been as clear as I thought.

Personally I have both formula fed and breast fed with equal success and have no gripe with whoever choses to feed their baby by whatever method. Professionally I think that every women finds herself and her baby in her own particular set of circumstances and has to make the decisions that are best for her & her baby at the time. I make no apology at all for holding that belief.

But - I do have a gripe with being called nasty, mean-minded names on public forums and I won't be cyber bullied susyp. I understand of course that this is an emotive subject, but some of you are a bit too keen to assume everyone is against formula feeding. So keen in fact that you are jumping to all sorts of incorrect conclusions and becoming quite nasty.

There are a lot of women out there who do want to breastfeed. Some can't, some can with a lot of help and encouragement. Just because Midwives, Midwifery Support Workers, Breastfeeding counsellors, & Health Visitors might be positive about breastfeeding, so as to be helpful to those women who need that encouragement, that doesn't mean they should be labelled 'breastapo', they're usually as keen to support choice as you - keener in fact as you seem to be wanting to devalue the posts and opinions of anyone seeming to be slightly pro-breastfeeding. How nasty and derogative to the very valuable support work they do - shame on you.

Thanks to Saffron for clarifying what artificial milk' means. As ever the voice of sanity.

[shaunag]

ehh, don't mean to be a smart arse, but breast milk is "made or produced by human beings" too!

I think the upset is caused because we are all organic mad, wanting the absolute best for our little ones, and the idea that someone would choose to intentionally use an "artificial" means of feeding to their precious baby frankly just does not go down well. Scientific terms are fine, but in context, and to other scientists or health professionals; we don't call them "mammary glands", we call them breasts (who wants to feel like daisy the cow). To a hormonal new mum that can't breastfeed, telling her bottle feeding is artificial, whether or not it actually is, just isn't the nicest/most sensitive of things to do. Ladies (and gents), I fear we could debate all this till the cows come home! Im just glad we are fortunate enough to be able to feed our little people, by whatever means.

[sillywoman]

I've already apologised for terming it in a way some people don't like shaunag. It's not a scientific term, just another term to describe a method of babyfeeding. I wouldn't use it to a new Mum of course (I'm not daft), but it seemed appropriate in the impersonal public space of a forum. I've been made aware that I was wrong though.

I'd like susyp to clarify exactly who she was name calling.

[The Nappy Lady]

OK, deep breath....

'Artificial milk' = Artificial human breast milk - which is, at the core, what it is. In all honesty, does it really matter what you call it?

I know when I was a breast milk donor for the SCBU at Kings they told me that they purposely choose to call it artifical milk vs 'human donor milk' when discussing with parents to help them to think realistically about what the 2 options are (specifically in terms of choosing which should be fed to the premature babies).

The manufacturers of Formula Milk work hard to ensure that their product will appeal to parents - as do the manufacturers of all the other baby products that are out there on the market. Of course they all do - there is lots of money to be made out of us!! Right now, in this thread, several of you have made it clear that the term 'Artificial milk' does not appeal to you as much as the term 'Formula Milk'. But whatever you call it, it does the same thing. I'm willing to bet the term 'Formula' was dreamed up by one of those same manufacturers for this very reason.

Sillywoman spends her time with medical and other health professionals, so to her it would be natural to refer to it as Artificial (human breast) Milk.

No one should judge anyone until they have walked a day in their shoes. I breast fed, but don't make assumptions about those who formula feed. Equally I'd hate to think that anyone would make assumptions about me (being breastapo or anything else). I trained as a breast feeding counsellor, not to try to force any woman to do anything, nor to judge, but simply to try to share my knowledge with other women should they require help. Isn't that what all of us, as women have a duty of care to do for each other?

Please guys, let's not fall out about this subject. I always get a terrible sinking feeling when it comes up on here, because I KNOW it is a sensitive subject, but I think often it is those who have bottle fed who are quickest to judge themselves, or feel they need to defend themselves, when in all honesty they are not being judged in any case. I can understand why, especially if you are someone who tried hard, or really wanted to breastfeed and couldn't this might be the case but I will say again what I have said before.....

Thank goodness we live in a country where we can feed our babies, one way or the other, so that they thrive, and we can still raise them to be happy, healthy children.

Surely that is all that matters?

Peace and love people.

[Saffron]

shaunag Wrote:

-------------------------------------------------------

> ehh, don't mean to be a smart arse, but breast

> milk is "made or produced by human beings" too!

Technically, no. It's synthesized in the human mammary gland.

[Saffron]

Well said, Molly. It's not only a sensitive issue, but a devisive one as well.

At the level of Public Health, more should undoubtedly be done to promote and support breastfeeding. While at a Personal Level, more could be done not to render judgement on individuals. These two goals unfortunately sometimes seem at odds.

What I think most people would agree with is that we don't want to end up with a culture like in many places in the States (have lived there, so feel qualified to say this... deep breath), where bottle-feeding is frequently seen as the norm and breastfeeding is seen as redundant or weird, part of what has prompted such huge recent backlash by some breastfeeding mothers there.

[LondonMix]

Breast milk has distinct properties that confers certain benefits but I think we need to be careful about what we know scientifically and what some of us may believe about it intuitively. I don't want to turn this thread into a bunch of parents waving studies at each other and I think the tone so far has been great (save a few hurt feelings). I do think for those who may not be aware though its worth noting the gap in the scientific literature and the popular press / literature. Breast milk has only been consistently (from a scientific perspective) correlated with reduction in various infections during the period of breast feeding, reduction in SIDs and a few points increase in IQ.

http://www.motherhood-cafe.com/advantages-of-breastfeeding/

http://www.motherhood-cafe.com/breastfeeding-and-bottle-feeding/

The correlation with SIDs cannot be adjusted for all confounding variables (such as stronger risk aversion parenting). Breastfeeding is actually associated with lower death from physical injury (accidents) in general. It would be difficult to make the leap of logic that breast milk was actually conferring any actual protection against injury and so it could be that parents who breastfeed adopt other parenting behaviours that reduce various risks. The reduction in SIDs may also be the result of reduced rates of infection associated with breastfeeding. The correlation may be a combination of the two factors- we don't know. However, the real point is that the risk of SIDs remains incredibly low for both breastfed and formula fed babies (less than 1 per 1,000 live births). The marginal improvement is somewhere in the region of .2 per 1,000 live births and that is what I mean when I say the benefits are marginal despite being statistically significant.

Similarly, the correlation with IQ may be something in breast milk itself or it may be the additional interaction associated with breast feeding aiding cognitive development. The research is still unclear and contradictory evidence abounds. A similar increase in IQ is associated with taking music lessons before the age of 10 years old.

Fighting infection is without a doubt the strongest evidence that exists for breastfeeding's benefits despite certain methodological issues. http://www.nhs.uk/news/2010/09September/Pages/breastfeeding-helps-babies-fight-infection.aspx. However, in reality what does this reduction mean? It depends on the study but approximately moving from a 25% chance of infection over the course of a year to a 17% chance of infection is typical. In the case of diarrhoea it is the statistical likelihood of 1 bout per child over the course of a year vs. half a theoretical bout of diarrhoea.

I think it would be difficult to argue that breast feeding does not have real benefits but I also think in an attempt to increase rates of breast feeding we should not distort the proven impact. Mothers need to honestly weigh up the benefits and the costs (emotional / psychological etc) they feel breast feeding will involve for them and their families and make a decision accordingly.

[oimissus]

well, as the person who initially raised concern with the word 'artificial' (which I maintain in this context, we're not a bunch of medical or scientific experts; we're parents, in some cases expectant or new parents, and it's not a helpful phrase - glad to hear it's not used in front of new mums), I would also like to add that I think 'breastapo' is a pretty grim term too (also one that I've never heard before these threads) so can we not use that either?

[LondonMix]

This debate about artificial milk shows how full circle we've come. I'm guessing the term formula was coined to foster an association with science and medicine as well as the idea of mathematical precision. This would have been so appealing to a previous generation who had witnessed modern science's dramatic positive impact on human health and quality of life. I am sure if they'd written 'made in a lab' it would only have increased appeal back then!

[susyp]

Hi Sillywoman I'm not name calling you, although I don't agree that it was in any way helpful to use the term "artificial". Breastapo are those people who look at you as if you are a bad mum when you get a bottle out in public. I am quite sure you don't do that as you enter the debate in a meaningful way, even if I don't agree with you I do appreciate that (sadly! - joke!) not everyone can see things my way! Breastapo are also those cowards who message those of us who come out and question that breast is always best rather than post openly on here like you do. So not - no name calling you. You have given much sensible advice on this forum.

susypx

[Ellie78]

One of the things that's always confused me - the correlation between breast feeding and IQ...

Really? Aren't we just talking social factors here? I mean, aren't the 3%, or whatever it is breast fed babies are, pretty much from the more privileged backgrounds? In which case it doesn't surprise me that IQ SCORE is higher with these children (not that I think they are or aren't more intelligent, just more likely to score higher on IQ tests)...similarly, those who are having music lessons aged 10 etc

Someone point me to a study here...Saffron? Is there convincing research re breast feeding and IQ or is it all bunkum?

[R&A]

.

[Saffron]

Interesting question, Ellie78...

Here's a recently published article by Caspi et al (2007, from the journal PNAS):

http://www.pnas.org/content/104/47/18860.short

Children's intellectual development is influenced by both genetic inheritance and environmental experiences. Breastfeeding is one of the earliest such postnatal experiences. Breastfed children attain higher IQ scores than children not fed breast milk, presumably because of the fatty acids uniquely available in breast milk. Here we show that the association between breastfeeding and IQ is moderated by a genetic variant in FADS2, a gene involved in the genetic control of fatty acid pathways. We confirmed this gene?environment interaction in two birth cohorts, and we ruled out alternative explanations of the finding involving gene?exposure correlation, intrauterine growth, social class, and maternal cognitive ability, as well as maternal genotype effects on breastfeeding and breast milk. The finding shows that environmental exposures can be used to uncover novel candidate genes in complex phenotypes. It also shows that genes may work via the environment to shape the IQ, helping to close the nature versus nurture debate.

[Saffron]

LondonMix Wrote:

-------------------------------------------------------

> This debate about artificial milk shows how full

> circle we've come. I'm guessing the term formula

> was coined to foster an association with science

> and medicine as well as the idea of mathematical

> precision.

Spot on LondonMix...from wiki's history section on formula:

"As physicians became increasingly concerned about the quality of such [infant] foods, medical recommendations such as Thomas Morgan Rotch's "percentage method" (published in 1890) began to be distributed, and gained widespread popularity by 1907.[9] These complex formulas recommended that parents mix cow's milk, water, cream, and sugar or honey in specific ratios to achieve the nutritional balance believed to approximate human milk reformulated in such a way as to accommodate the believed digestive capability of the infant."

The wiki page on formula milk is actually quite interesting: http://en.wikipedia.org/wiki/Infant_formula .

[DaveR]

I guess it's easy for me to say, not being directly involved, but why should it be difficult for anyone to accept the following propositions:

there is evidence that breastfeeding provides advantages to baby and mother

consequently breastfeeding should be supported and encouraged

there are, however, many factors that impact on the wellbeing of babies and mothers, including many that are much more direct and signficant than breast or bottle

not breastfeeding, for whatever reason, should never be characterised as 'failing' or 'inadequate' or anything else pejorative.

To be honest, this seems to me to be more about manners than anything else, and consequently the term 'breastapo' is probably unhelpful, suggesting that the behaviour (essentially just rudeness) is inextricably linked to the issues.

(For those of you who have long memories, you will recall that this latter point was resolved once and for all on this forum by *Bob* and his Law of Cocks i.e. cockish behaviour derives from the condition of being a cock, rather than any other quality possessed by the relevant individual, or the situation within which the behaviour arises)

[LondonMix]

The strongest evidence regarding the increase in IQ came from a study in Belarus (PROBIT by Kramer) that is one of the only somewhat randomized studies ever conducted on breast feeding. The study controls for many confounding variables including maternal age and socioeconomic background though not maternal IQ (which the study admits might still be a uncontrolled confounding factor).

In a large meta-study of mothers and babies in highly developed countries, there is no IQ advantage once adjusting for maternal IQ. Der G, Batty GD, Deary IJ. Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis. BMJ

2006;333:945.

In response to the Balarus study done by Kramer, Unicef themselves discuss that broad based iron deficiency affecting school age children at that time in that part of the world and suggest that the iron in breast milk might be responsible for the intellectual advantage given poor later life nutrition. Analysis in countries not suffering from broad based nutritional deficiencies may produce different results (as in the meta-analysis). The advantages of breast milk must be analysed against broad based nutritional quality where you live, access to clean water, and the current quality of formula. Current formulas have less sodium than in the 80s and some are now fortified with fatty acids due to omega?s potential role in brain development meaning that the results of older studies are not always relevant.

Short answer, intelligence is partly genetic and partly socio-economic including the adequacy of basic nutrition. If over your child?s life they won?t be deficient in any key vitamins and minerals it really isn't something I?d be preoccupied about.

Many studies in breast feeding suffer from a self-selection bias (not sufficiently randomized) and small sample sizes. There are ethical issues that make this hard to overcome when designing studies. Many don?t properly adjust for maternal IQ and socio-economic background and there is a huge publication bias towards positive correlations. Even well designed studies cannot control for all confounding variables that might better explain observed correlations (see my SIDs example). Even then, while certain correlations are statistically significant they are not ?clinically? significant- i.e. they make no real difference in absolute terms.

None of this is to say that breast feeding isn't wonderful and beneficial but the state of the science is not always clear cut and even when the results seem robust, the clinical impact is usually marginal.

[LondonMix]

This is a very interesting study. It has come under some criticism for not having sufficient regression analysis but I haven't actually read it myself.

DaveR- most people fully agree with you (often based on person anecdotal experience). The difficulty is that popular literature often overstates the case to such an extent that people are not making informed decisions. There was a woman who actually delayed treatment for CANCER because it would have prevented her from breast feeding. Part of this is clearly misunderstanding the proven benefits and relative vs absolute outcomes (which I believe is widespread), part of it is wrapped up in our natural / organic zeitgeist which makes parents intuitively believe that breast milk is even better than practitioners say it is and part of it is wrapped up in this idea of mothering as a kind of annihilation of the self (no risk, no matter how remote can be accepted regardless of the personal cost to the mother).

Saffron Wrote:

-------------------------------------------------------

> Interesting question, Ellie78...

>

> Here's a recently published article by Caspi et al

> (2007, from the journal PNAS):

> http://www.pnas.org/content/104/47/18860.short

> Children's intellectual development is influenced

> by both genetic inheritance and environmental

> experiences. Breastfeeding is one of the earliest

> such postnatal experiences. Breastfed children

> attain higher IQ scores than children not fed

> breast milk, presumably because of the fatty acids

> uniquely available in breast milk. Here we show

> that the association between breastfeeding and IQ

> is moderated by a genetic variant in FADS2, a gene

> involved in the genetic control of fatty acid

> pathways. We confirmed this gene?environment

> interaction in two birth cohorts, and we ruled out

> alternative explanations of the finding involving

> gene?exposure correlation, intrauterine growth,

> social class, and maternal cognitive ability, as

> well as maternal genotype effects on breastfeeding

> and breast milk. The finding shows that

> environmental exposures can be used to uncover

> novel candidate genes in complex phenotypes. It

> also shows that genes may work via the environment

> to shape the IQ, helping to close the nature

> versus nurture debate.

[Ellie78]

Thanks Saffron - interestingly, it looks from this that genetics determine whether breast feeding has an impact on IQ or not, not that there's a uniform benefit...the study also referred to bfing's advantage only over cows milk and 'non supplemented' formulas - so do some formulas contain DHA/AA or whatever those fatty acids were?

(incidentally, read it yourself - don't take my word - no bloody study has highlighted the negative impact of having a baby and sleep deprivation on the MOTHER'S IQ or their command of grammar - typical...)

ANYWAY - I agree 100% with pretty much everyone else. Some mothers and babies will benefit from bfing, but some won't, in which case, hurray that we have such brilliant formulas around these days. I don't think 'breast is best' adequately describes this reality. And 'breastapo' did make me laugh - it can feel like that. A friend of mine was berated by a health visitor in a bfing cafe for topping up her twins with formula. THAT'S breastapo.

The whole 'natural' argument annoys me too - when has bfing ever truly been 'natural', un-civilised, un-socialised?

[susyp]

I ve had breast cancer and my oncologist told me you would have to bf for at least two years to see the cancer protection. Also having a baby gives you a short term increased risk of breast cancer so its v important to check yourself over the first 3 years post baby - difficult to do if you are bf ? Long term you gain protection after having a child though. It's all swings and roundabouts. So we come back to - just do what feels best for you in your own particular situation .

Susypx

[DaveR]

"DaveR- most people fully agree with you (often based on person anecdotal experience). The difficulty is that popular literature often overstates the case to such an extent that people are not making informed decisions. There was a woman who actually delayed treatment for CANCER because it would have prevented her from breast feeding. Part of this is clearly misunderstanding the proven benefits and relative vs absolute outcomes (which I believe is widespread), part of it is wrapped up in our natural / organic zeitgeist which makes parents intuitively believe that breast milk is even better than practitioners say it is and part of it is wrapped up in this idea a mothering as a kind of annihilation of the self (no risk, no matter how remote can be accepted regardless of the personal cost to the mother)."

I get all of this. But it's still essentially unobjectionable to say that there is evidence that breastfeeding has advantages, whereas it's completely objectionable to directly criticise or interfere in someone else's life and choices. And people who engage in the latter should not be associated with the former, because in truth, they are probably the kind of people who would find something to be objectionable about in any situation.