Feeding your baby

Mothers-to-be give serious consideration to how they should feed their newborn babies – either with formula or by breastfeeding. And to be honest, it can be difficult to make a decision, especially if you work outside the home. However, I feel that every mother should want to do what’s best for her child, and the fact is that, hands down, mother’s milk is far superior to any formula. So since this is the case, then why do nearly half of Irish mothers choose to formula-feed their children instead of breastfeeding them?

I feel it is primarily due to the myth that formulas are just as good as the milk a mother’s body has produced for her infant. To tackle this fallacy that formula milk is as good as breast milk, here are six reasons why breast milk is best:

Breast milk provides perfect infant nutrition because “Human milk is uniquely superior for infant feeding and is species-specific; all substitute feeding options differ markedly from it. The breastfed infant is the reference or normative model against which all alternative feeding methods must be measured with regard to growth, health, development, and all other short and long-term benefits” (American Academy of Pediatrics. Breastfeeding Policy Statement: Breastfeeding and the Use of Human Milk (RE2729)

According to paediatricians “human milk is uniquely superior for infant feeding. Human milk-fed premature infants receive significant benefits with respect to host protection and improved developmental outcomes compared with formula-fed premature infants… Paediatricians and parents should be aware that exclusive breastfeeding is sufficient to support optimal growth and development for approximately the first 6 months of life and provides continuing protection against diarrhoea and respiratory tract infection. Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child” (A.A.P. Breast-feeding Policy Statement: Breastfeeding and the Use of Human Milk Pediatrics Vol. 115 No. 2 February 2005).

Breast milk is more digestible than formula for “Since cow’s milk contains about twice as much protein as human milk, formula-fed babies usually receive more protein than they need (much of it in the form of the less digestible casein). The stools of formula-fed babies are so bulky because the babies cannot absorb so much protein, and excrete the excess in their stool, whereas breast-fed babies absorb virtually 100% of the protein in human milk” (The Complete Book Of Breastfeeding M.S. Eiger. MD, S. Wendkos Olds, Copyright 1999, Workman Publishing Co., Inc., 708 Broadway, New York, NY 10003).

Breastfeeding lowers a mother’s risk of breast cancer. Recent studies have revealed that women who breastfeed have lower risks of developing breast cancer. Most of us have heard this before but the newly conducted studies really do have eye-opening statistics! Data retrieved from 47 studies in 30 countries was re-examined (Collaborative Group on Hormonal Factors in Breast Cancer (2002) including 50,302 women with breast cancer and 96,973 women without the disease. The study group collaborated the results and came up with the follow conclusion: that the rate of breast cancer in developed countries could be reduced by more than half if women had ‘the number of births and lifetime duration of breastfeeding that have been common in developing countries until recently’ (Lee, SY et al “Effect of lifetime lactation on breast cancer risk: a Korean women’s cohort study.” Int J Cancer. 2003;105:390-393).

Basically, breastfeeding has the potential to account for almost two-thirds of this estimated reduction in breast cancer incidence…and that’s massive! (Jernstorm, H et al “Breast-feeding and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers.” J Natl Cancer Inst. 2004;96:1094-1098)

Formula feeding increases baby girls’ risk of developing breast cancer in later life. Women who were formula-fed as infants have higher rates of breast cancer as adults. For both premenopausal and postmenopausal breast cancer, women who were breastfed as children, even if only for a short time, had a 25% lower risk of developing breast cancer than women who were bottle-fed as infants (Freudenheim, J. et al. 1994 “Exposure to breast milk in infancy and the risk of breast cancer”. Epidemiology 5:324-331).

Not breastfeeding increases mother’s risk of developing ovarian cancer. Based on the research, breastfeeding for a total of 12 to 24 months can reduce your risk of ovarian cancer by about one-third (Hartage et al, “Rates and risks of ovarian cancer in subgroups of white women in the United States.” Obstet Gynecol 1994 Nov; 84(5): 760-764 & Rosenblatt KA, Thomas DB, “Lactation and the risk of Epithelial ovarian cancer”. Int J Epidemiol. 1993;22:192-197).

And here’s four more:

Breast milk contains immunities to diseases and aids in the development of baby’s immune system. Imagine with all the labels on the packages of baby formulas, not one of them can provide either of these benefits. “Breastfed babies have fewer illnesses because human milk transfers to the infant a mother’s antibodies to disease. About 80% of the cells in breast milk are macrophages, cells that kill bacteria, fungi, and viruses. Breastfed babies are protected in varying degrees from a number of illnesses including, pneumonia, botulism, bronchitis, staphylococcal infections, influenza, ear infections, and German measles. Furthermore, mothers produce antibodies to what ever disease is present in their environment, making their milk custom-designed to fight diseases their babies are exposed to as well”. (Williams RD,”Breast-Feeding Best Bet for Babies” & Koutras, A.K., “Fecal Secretory Immunoglobulin A in BreastMilk vs. Formula Feeding in Early Infancy”. J. Ped Gastro Nutr 1989).

Baby’s suckling helps shrink mother’s uterus after childbirth. I must confess that I have stored a box of my favourite clothes that I possessed before I ever had a baby. Because I have nursed our children, I have a ‘slim’ chance of getting back into them because breastfeeding uniquely helps to shrink the uterus back to its pre-pregnancy size. It will always remain slightly enlarged but “Nursing will help you to regain your figure more quickly, since the process of lactation causes the uterus (which has increased during pregnancy to about 20 times its normal size) to shrink more quickly to its pre-pregnancy size” (The Complete Book Of Breastfeeding M.S. Eiger. MD, S. Wendkos Olds, Copyright 1999, Workman Publishing Co., Inc., 708 Broadway, New York, NY 10003).

Formula Feeding has been linked to lower I.Q. It has been found in studies that human breast milk enhances brain development and improves cognitive development in ways that formula simply cannot provide. One study has found breastfed babies of 7 & 8 year olds was 10 points higher than their bottle fed babies of the same age. It’s important to note that all of the children in this study had been born prematurely and were tube fed the human milk, proving that the milk itself, not the nurturing of breastfeeding, demonstrated this difference in I.Q. level (Lucas A., “Breast Milk and Subsequent Intelligence Quotient in Children Born Preterm”. Lancet 1992;339:261-62). “The association between duration of breastfeeding and adult intelligence” JAMA 287: 2365-71) & (Horwood and Fergusson, “Breastfeeding and Later Cognitive and Academic Outcomes” Jan 1998 Pediatrics Vol. 101, No. 1).

Breastfeeding is essential for aiding in fulfilling a baby’s emotional needs and obviously increases the necessary bonding between mother and child. All babies need to be nurtured and loved. Nothing can match the comforting feeling for an infant than being held close and cuddled while breastfeeding. In fact, studies have proven that premature babies are more likely to die if they are not held or stroked. So it is in the breastfeeding that nurturing also plays a significant role to the nutrition of the breastfed milk. In addition, it seems that breastfeeding stimulates the release of the hormone called oxytocin in the mother’s body. “It is now well established that oxytocin, as well as stimulating uterine contractions and milk ejection, promotes the development of maternal behavior and also bonding between mother and offspring” (Uvnas-Moberg, Eriksson: “Breastfeeding: physiological, endocrine and behavioral adaptations caused by oxytocin and local neurogenic activity in the nipple and mammary gland.” Acta Paediatrica, 1996 May, 85(5):525-30).

The list goes on and on. The evidence that breast feeding is better than formula feeding is staggering.

Dr. Alan Greene MD FAAP (June 21st, 1996) was asked the following question by Robert Cohen Oradell, New Jersey: ‘Recently, I met with top scientists at the FDA in Rockville, Maryland, discussing among other things, breastfeeding. It was their collective opinion that breastfeeding offered psychological nurturing benefits, but nothing more. No immunological factors, etc. Their logic was that all proteins are broken down by strong digestive enzymes. What do you think?’

Dr. Greene replied, “I applaud the critical thinking and intellectual curiosity of these scientists. When immunoglobulins were first discovered in breast milk, the appealing and simple conclusion was drawn that these immunoglobulins would directly improve the immune status of the baby. Indeed, specific antibodies against respiratory and intestinal bacteria and viruses are found in human breast milk. These have been thought to increase a child’s resistance to infection. Apparently the aforementioned scientists have pointed out that this reasoning is overly simplistic. In fact, the strong digestive enzymes in the infant and the acid bath awaiting the antibodies in the stomach would tend to denature and digest these antibodies, rendering them useless.

While I admire their reasoning and believe that this line of thinking deserves further exploration, not all proteins are digested before they affect a baby’s health. Some proteins even make it through the stomach intact. Based on the available evidence, I vehemently disagree with the conclusion that breast milk is essentially no different from formula.”

The following are reasons he gave for his conclusion:

Immunoglobulins: All types of immunoglobulins are found in human milk. The highest concentration is found in colostrum, the pre-milk that is only available from the breast the first three to five days of the baby’s life. Secretory IGA, a type of immunoglobulin that protects the ears, nose, throat, and the GI tract, is found in high amounts in breast milk throughout the first year. Secretory IGA does its work before it is digested in the stomach. Secretory IGA attaches to the lining of the nose, mouth, and throat and fights the attachment of specific infecting agents. Breast milk levels of IGA against specific viruses and bacteria increase in response to a maternal exposure to these organisms. Human milk has been called environmentally specific milk - the mother provides it for her infant to protect specifically against the organisms that her infant is most likely to be exposed to.

Lactoferrin: Lactoferrin is an iron-binding protein that is found in human milk, but is not available in formulas. It limits the availability of iron to bacteria in the intestines, and alters which healthy bacteria will thrive in the gut. Again, it is found in the highest concentrations in colostrum, but persists throughout the entire first year. It has a direct antibiotic effect on bacteria such asstaphylococci and E. coli.

Lysozyme: Human breast milk contains lysozyme (a potent digestive ingredient) at a level thirty times higher than in any formula. Interestingly, while other contents of breast milk vary widely between well nourished and poorly nourished mothers,the amount of lysozyme is conserved, suggesting that it is very important. It has a strong influence on the type of bacteria that inhabit the intestinal tract.

Growth Factors: Human breast milk specifically encourages the growth of Lactobacillaceae, which are helpful bacteria that can inhibit many of the disease-causing gram-negative bacteria and parasites. In fact, there is a striking difference between the bacteria found in the guts of breast- and formula-fed infants. Breast-fed infants have a level of lactobacillus that is typically 10 times greater than that of formula-fed infants. Both the presence of the lactobacilli and the action of the lactoferrins and lysosomes help protect the infant.

Allergic factors: The cows’ milk protein used in most formulas is a foreign protein.When babies are exposed to non-human milk, they actually develop antibodies to the foreign protein. Research has shown that without exception the important food allergens found in milk and soybean formulas are stable to digestion in the stomach for as long as 60 minutes (as compared to human milk protein which is digested in the stomach within 15 minutes). The foreign proteins pass through the stomach and reach the intestines intact, where they gain access and can produce sensitisation. While research in this area is still relatively new,this early exposure to foreign proteins may be the predisposing factor in such illnesses as eczema and asthma. The effects of early exposure to foreign protein are explored in three abstracts in the Journal of Allergy and Clinical Immunology, from January of 1996.

Carnitine: While carnitine is present in both breast milk and formula, the carnitine in breast milk has higher bioavailability. Breast-fed babies have significantly higher carnitine levels than their counterparts. Carnitine is necessary to make use of fatty acids as an energy source. Other functions of carnitine have been hypothesised, but have not yet been proven.

DHA &ARA: The main long-chain fatty acids found in human milk are still not present in many formulas in the United States. These lipids are important structural components, particularly in the substance of the brain and the retina. Significantly different amounts of these ingredients have been found in the brains and retinas of breast-fed versus formula-fed infants. This difference may have other subtle effects on the cell membrane integrity in other parts of the body as well.

Psychological factors: You mentioned that these scientists suggest that the only difference between formula and breast milk is psychological. I strongly disagree that this is the only difference, but I agree that the psychological difference can have profound implications. Over the last decade-and-a-half, the developing field of psychoneuroimmunology has demonstrated repeatedly that an individual’s psychological state has a direct effect on his or her immune function. Perhaps the nursing experience by itself does directly improve the immune status of infants.

Apart from the specific properties that I have mentioned above it is important to emphasise that breast milk is a dynamic fluid that changes in composition throughout the day and throughout the course of lactation. It provides the specific nutrients for the baby that are needed at each age and in each situation. The early data about breast milk was obtained from the pooled breast milk of many mothers. At that time it was not understood how unique human breast milk is for each individual infant (Lawrence, P.B. Breast Milk, Pediatric Clinics of North America, Oct. 1994).

Breast milk tastes different from feeding to feeding, which is another advantage over formula, as it prepares babies for the wide variety of foods to which they will be exposed in the future (Reviewed by Khanh-Van Le-Bucklin MD April 2001).

I must say that I find it ridiculous that the Federal Drug Administration of the United States would make a comment which elevates formula to the status of breast milk. The Department of Health and Children in Ireland, in contrast, highlights the benefits of breastfeeding for both mother and baby. “Breast milk provides all the nutrients your baby needs for growth and development, it contains anti-bodies which can help your baby’s immune system and it assists the emotional well-being of both mother and baby” they say. In fact, to encourage breastfeeding in 2002 a National Committee on Breastfeeding was established. Among the initiatives contained in the Action Plan include:

• education on breastfeeding;
• regulating the marketing of breast milk substitutes;
• the introduction of at least ten regional breastfeeding coordinators;
• supports for mothers to breastfeed for longer;
• improved, flexible working conditions for breastfeeding

The website for the Department of Health and Children in Ireland states that “practically all mothers can breastfeed but it does take dedication and commitment. You will need to balance the baby’s demands for milk with your supply. This can take time, as does getting the feeding position right and feeling comfortable with it. You may find the first couple of weeks of breastfeeding uncomfortable and very tiring, until your supply settles down and the baby learns how to feed well, but as you gain in confidence, you become more relaxed. By the time your baby is a couple of months old, you will be quite an expert. The Health Promotion Unit at the Department of Health and Children also published useful guides on Breastfeeding your Ill or Premature Baby and Breastfeeding when out and about.

Other organisations who offer superb help with breastfeeding are:

Cuidiú - The Irish Childbirth Trust (www.cuidui-ict.ie) has trained breastfeeding counsellors available all over the country who can answer any queries one might have.

La Leche League (www.lalecheleagueireland.com) is a voluntary group to provide information and support to women who want to breastfeed their babies. Both Cuidiú and La Leche League organise breastfeeding support groups.

Now, I understand that there are instances where breastfeeding is not possible, and that’s grand. But in most cases, nursing your child is the best option in feeding your baby - and the help in succeeding with this route is more than plentiful. So I know that breast feeding in the beginning might not be the easiest way to feed your child, but for so many different reasons it’s by far the best for your baby…and you!