Will Formula Feeding Harm My Baby?

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It is true that there are significant challenges to researching infant feeding, not the least of which are the ethical considerations of randomly assigning infants to an intervention that might well prove harmful. However, to go to the extreme of dismissing all infant feeding research is equally unethical. There are ways to strengthen study design despite the limitations imposed by necessary ethics. The questions to ask boil down to:

Are some studies better than others? How can you distinguish between a “good” study and a “bad” one?

How can we define a “good” infant feeding study, given that we cannot ethically—or practically—create the perfect research study? This requires using critical reading skills and analyzing the research study.

•    How is breastfeeding defined? Early studies, especially, tend to lump the baby who was ever breastfed with the babies who were exclusively breastfed. If there is even a chance that breastfeed is superior (or formula-feeding is inferior), then it is reasonable to think that the amount of breastfeeding or formula an infant is exposed to might make a difference, and to design the study to illuminate such dose-related differences.

The World Health Organization recommends that researchers clearly delineate between exclusive breastfeeding, predominant breastfeeding, full breastfeeding, partial breastfeeding, etc. The Centers for Disease Control distinguishes between “exclusive breastfeeding,” “partial breastfeeding,” and “exclusive formula-feeding” in its immunization studies.

•    What variables are controlled for—or accounted for afterwards. As Dr. Wolf points out, there are many confounding variables that could be affecting the outcome of a study. Better studies will account for the major variables.

•    Is there any funding bias evident in the research? Perhaps not too surprisingly, much of the infant feeding research is funded by formula companies who have a vested interest in the outcome. Better studies are funded by impartial sources.

Looking at the better studies, are there recurring trends in the results?

When you eliminate the poorly done studies, a much clearer picture emerges of the inherent differences between breastfeeding and formula-feeding. The differences may range from nearly insignificant to undeniably compelling, but it is a rare study indeed that points to formula-feeding as the less risky of the two.

Are there physiological explanations for what differences in feeding method appear as a result of these studies?

Recognizing potential differences in outcomes begs the question “If there are differences, what is the biological basis for the difference?”

One of the most obvious differences between breastfeeding and formula is the undeniable presence of an immunological network of protective mechanisms. An infant’s immune system is immature and not able to function independently for at least 6 months, when the first Peyer’s patches begin to form in an infant’s gut. Nature would not create such a vacuum without having a transitional mechanism in place: breastfeeding. Breast milk is full of living cells, most of which are disease-fighters set to seek and destroy invading pathogens. The mother’s breast works in concert with the baby and their collective environment to produce antibodies to anything the mother—or the baby—has been exposed to. Other components in the milk help create an environment in the baby’s gut that is inhospitable to potential disease-causing organisms. This is a dynamic system that responds to changes in the environment quickly.
Formula cannot do this.

What do the medical experts say?

Despite the absence of perfect random controlled trials comparing infant feeding outcomes, medical experts around the world are satisfied that there are differences that can’t be ignored. The World Health Organization, the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, the Association of Women’s Health, Obstetrics, and Neonatal Nurses, the American Dietetic Association, etc. all have declared breastfeeding to be critical to the health and well-being of the world’s children. These groups must see enough in the literature to convince them that formula-feeding is the riskier feeding choice.