Risks of Artificial Feeding 
(Studies done mostly in affluent societies)

• Neurologic Outcome • SIDS • Insulin Dependent Diabetes • Cow milk Allergy and Intolerance • Respiratory Illness • Otitis Media • Risks for the premature baby • Childhood Cancer • Gastrointestinal Disease and Infections • Urinary Tract Infection • Malocclusion • Formula as a heavy metal cocktail • Other Contamination due to bottle feeding • Allergy •Miscellaneous • Breastmilk as "antimicrobial" • Risks to the Mother • Risks to Society

Risks to infant and child

Review: 1. Walker M. A fresh look at the risks of artificial feeding. J Hum Lact 1993;9:97-107 2. Cunningham AS, Jelliffe DB, Jelliffe EFP. Breastfeeding and health in the 1980’s: a global epidemiologic review. J Pediatr 1991;118:659-66

Cognitive Development: CD (review): Andraca I, Uauy R. Breastfeeding for optimal mental development. Simopoulos AP, Dutra de Oliveira JE, Desai ID (eds): Behavioral and Metabolic Aspects of Breastfeeding. World Rev Nutr Diet. Basel, Karger, 1995;78:1-27

CD (review): Gordon N. Nutrition and cognitive function. Brain and Development 1997;19:165-70

CD-1: Morrow-Tlucak M, Haude RH, Ernhart CB. Breastfeeding and cognitive development in the first 2 years of life. Soc Sci Med 1988;26:635-9

CD-2: Taylor B, Wadsworth J. Breastfeeding and child development at five years. Dev Med Child Neurol 1984;26:73-80

CD-3: Lucas A, Morley R, Cole TJ, Lister G, Leeson-Payne C. Breastmilk and subsequent intelligence quotient in children born preterm. Lancet 1992;339:261-4

CD-4: Nettleton JA. Are n-3 fatty acids essential nutrients for fetal and infant development. J Am Diet Assoc 1993;93:58-64

CD-5: Rogan WJ, Gladen BC. Breastfeeding and cognitive development. Early Hum Dev 1993;31:181-93

CD-6: Silver LB, Levinson RB, Laskin CR, Pilot LJ. Learning disabilities as a probable consequence of using chloride-deficient infant formula. J Pediatr 1989;115:97-9

CD-7: Willoughby A, Moss HA, Hubbard VS, Bercu BB, Graubard BI, Vietze PM, et al. Developmental outcome in children exposed to chloride deficient formula. Pediatrics 1987;79:851-7

CD-8: Wing CS. Defective infant formulas and expressive language problems: a case study. Language, Speech and Hearing Services in Schools 1990;21:22-7

CD-9: Crawford MA. The role of essential fatty acids in neural development: implications for perinatal nutrition. Am J Clin Nutr 1993;57(suppl):703S-10S

CD-10: Temboury MC, Otero A, Polanco I, Arribas E. Influence of breastfeeding on the infant’s intellectual development. J Pediatric Gastroenterol Nutr 1994;18:32-36

CD-11: Pollock JI. Longterm associations with infant feeding in a clinically advantaged population of babies. Dev Med Child Neur 1994;36:429-40

CD-12: Makrides M, Neumann MA, Byard RW, Simmer K, Gibson RA. Fatty acid composition of brain, retina and erythrocytes in breast and formula fed infants. Am J Clin Nutr 1994;60:189-94

CD-14: Anderson GJ, Connor WE, Corliss JD. Docosohexaenoic acid is the preferred dietary n-3 fatty acid for the development of the brain and retina. Pediatr Res 1990;27:87-97

CD-15: Neuringer M, Connor WE, Lin DS, Barstad L, Luck S. Biochemical and functional effects of prenatal and postnatal fatty acid deficiency on retina and brain in rhesus monkeys. Proc Natl Acad Sc USA 1986;83:4021-5

CD-16: Florey C Du V, Leech AM, Blackhall A. Infant feeding and mental and motor development at 18 months of age in first born singletons. Int J Epidem 1995;24 (Suppl 1):S21-6

CD-17: Wang YS, Wu SY. The effect of exclusive breastfeeding on development and incidence of infection in infants. JHL 1996;12:27-30

CD-18: Greene LC, Lucas A, Livingstone BE, Harland PSEG, Baker BA. Relationship between early diet and subsequent cognitive performance during adolescence. Biochem Soc Trans 1995;23:376S

CD-19: Riva E, Agostoni C, Biasucci G, Trojan S, Luotti D, Fiori L, et al. Early breastfeeding is linked to higher intelligence quotient scores in dietary treated phenylketonuric children. Acta Pœdiatr 1996;85:56-8

CD-20: Niemelä A, Järvenpää A-L. Is breastfeeding beneficial and maternal smoking harmful to the cognitive development of children? Acta Pœdiatr 1996;85:1202-6

CD-21: Rodgers B. Feeding in infancy and later ability and attainment: a longitudinal study. Devel Med Child Neurol 1978;20:421-6

CD-22: Horwood LJ, Fergusson DM. Breastfeeding and later cognitive and academic outcomes. Pediatrics 1998;101:p. e9

CD-23: Paine BJ, Makrides M, Gibson RA. Duration of breastfeeding and Bayley’s mental developmental Index at 1 year of age. J Paediatr Child Health 1999;35:82-5

Neurologic Outcome

N-1: Lanting CI, Patandin S, Weisglas-Kuperus N, Touwen BCL, Boersma ER.Breastfeeding and neurological outcome at 42 months. Acta Paediatr 1998;87:1224-9

SIDS:

SIDS-1: Mitchell EA, Scragg R, Stewart AW, Becroft DMO, Taylor BJ, For RPK, et al. Results from the first year of the New Zealand cot death study. NZ Med J 1991;104:71-6

Insulin Dependent Diabetes:

Working Group on Cow’s Milk Protein and Diabetes Mellitus of the American Academy of Pediatrics. Infant feeding practices and their possible relationship to the etiology of diabetes mellitus. Pediatrics 1994;94:752-4

JD-1: Karjalainen J, Martin JM, Knip M, Ilonen J, Robinson BH, Savilahti E, et al. A bovine albumin peptide as a possible trigger of insulin-dependent diabetes mellitus. N Eng J Med 1992;327:302-7

JD-2: Mayer EJ, Hamman RF, Gay EC, Lezotte DC, Savitz DA, Klingensmith J. Reduced risk of IDDM among breastfed children. Diabetes 1988;37:1625-32

JD-3: Virtanen SM, Räsänen L, Ylnen K, Aro A, Clayton D, Langlholz B, et al. Early introduction of dairy products associated with increased risk of IDDM in Finnish children. Diabetes 1993;42:1786-90

JD-4: Virtanen SM, Räsänen L, Aro A, Lindstrom J, Sippola H, Lounamaa R, et al. Infant feeding in Finnish children <7 yr of age with newly diagnosed IDDM. Diabetes Care 1991;14:415-17

JD-5: Gerstein HC. Cow’s milk exposure and type I diabetes mellitus. Diabetes Care 1994;17:13-9

JD-6: Kostraba JN, Cruickshanks KJ, Lawler-Heavner J, Jobim LF, Rewers MJ, Gay EC, et al. Early exposure to cow’s milk and solid foods in infancy, genetic predisposition, and risk of IDDM. Diabetes 1993;42:288-95

JD-7: Pérez-Bravo F, Carrasco E, Gutierrez-Lopez MD, Mart'nez MT, Lopez G, Garc'a de los Rios M. Genetic predisposition and environmental factors leading to the development of insulin-dependent diabetes mellitus in Chilean children. J Mol Med 1996;74:105-9

JD-8: Gimeno SGA, De Souza JMP. IDDM and milk consumption. Diabetes Care 1997;20:1256-60

JD-9: Hammond-McKibbon D, Karges W, Gaedigk R, Dosch H-M. Immunological mechanisms that link cow milk protein and insulin dependent diabetes: a synopsis. Can J Allergy and Clin Immunol 1997;2:136-46

Cow milk Allergy and Intolerance:

CM-1: Høst A. Importance of the first meal on the development of cow’s milk allergy and intolerance. Allergy Proc 1991;12:227-32

Respiratory Illness:

RI-1: Pullan CR, Toms GL, Martin AJ, Gardner PS, Webb JKG, Appleton DR. Breastfeeding and respiratory syncytial virus infection. Br Med J 1980;281:1034-6

RI-2: Chiba Y, Minagawa T, Mito K, Nakane A, Suga K, Honjo T, Nakao T. Effect of breastfeeding on responses of systemic interferon and virus-specific lymphocyte transformation with respiratory syncytial virus infection. J Med Virology 1987;21:7-14

RI-3: Wright AL, Holberg CJ, Martinez FD, Morgan WJ, Taussig LM. Breastfeeding and lower respiratory tract illness in the first year of life. Br Med J 1989;299:946-9

RI-4: Porro E, Indinnimeo L, Antognoni G, Midulla F, Criscione S. Early wheezing and breastfeeding. J Asthma 1993;30:23-8

RI-5: Burr ML, Limb ES, Maguire JM, Amarah L, Eldridge BA, Layzell JCM, Merret TG. Infant feeding, wheezing, and allergy: a prospective study. Arch Dis Child 1993;68:724-28

RI-6: Pisacane A, Graziano L, Zona G, Granata G, Dolezalova H, Cafiero M, et al. Breastfeeding and acute lower respiratory infection. Acta Pœdiatr 1994;83:714-18

RI-7: Beaudry M, Dufour R, Marcoux S. Relation between infant feeding and infections during the first six months of life. J Pediatr 1995;126:191-7

RI-8: Okamoto Y, Ogra PL. Antiviral factors in human milk: implications in respiratory syncytial virus infection. Acta Pœdiatr Scand Suppl 1989;351:137-43

RI-9: Downham MAPS, Scott R, Sims DG, Webb JKG, Gardner PS. Breastfeeding protects against respiratory syncytial virus infections. Br Med J 1976;2:274-6

RI-10: Wright AL, Holberg CJ, Taussig LM, Martinez FD. Relationship of infant feeding to recurrent wheezing at age 6 years. Arch Pediatr Adolesc Med 1995;149:758-63

RI-11: Yue Chen. Synergistic effect of passive smoking and artificial feeding on hospitalization for respiratory illness in early childhood. Chest 1989;95:1004-07

RI-12: Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW. Relation of infant diet to childhood health: seven year followup of cohort of children in Dundee infant feeding study. Br Med J 1998;316:21-5 (also shows higher blood pressure in formula fed children)

RI-13: Oddy WH, Holt PG, Sly PD, Read AW, Landau LI, Stanley FJ, Kendall GE, Burton PR. Association between breastfeeding and asthma in 6 year old children: findings of a prospective birth cohort study. Br Med J 1999;319:815-9

RI-14: César JA, Victora CG, Barros FC, Santos IS, Flores JA. Impact of breastfeeding on admission for pneumonia during postneonatal period in Brazil: nested case-control study. Br Med J 1999;318:1316-20 RI-15: Pisacane A, Impagliazzo N, De Caprio C, Criscuolo L, Inglese A, da Silva MCMP. Breastfeeding and tonsillectomy. Br Med J 1996;?:? RI-16: Lopez-Alarcon M, Villalpando S, Fajardo A. Breastfeeding lowers the frequency and duration of acute respiratory infection and diarrhea in infants under 6 months of age. J Nutr 1997;127:436-43

Otitis Media:

OM-1: Saarinen UM. Prolonged breastfeeding as prophylaxis for recurrent otitis media. Acta Pediatr Scand 1982;71:567-71

OM-2: Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective cohort study. J Infect Dis 1989;160:83-94

OM-3: Duncan B, Ey J, Holberg CJ, Wright AL, Martinez FD, Taussig LJ. Exclusive breastfeeding for at least 4 months protects against otitis media. Pediatrics 1993;91:867-72

OM-4: Owen MJ, Baldwin CD, Swank PR, Pannu AK, Johnson DL, Howie VM. Relation of infant feeding practices, cigarette smoke exposure and group child care to the onset and duration of otitis media with effusion in the first two years of life. J Pediatr 1993;123:702-11

OM-5: Harabuchi Y, Faden H, Yamanaka N, Duffy L, Wolf J, Krystofik D. Human milk secretory IgA antibody to nontypeable Hœmophilus influenzœ: Possible protective effects against nasopharyngeal colonization. J Pediatr 1994;124:193-8

OM-6: Aniansson G, Alm B, Andersson B, Hokansson A, Larsson P, Nylén O, et al. A prospective cohort study on breastfeeding and otitis media in Swedish infants. Pediatr Infect Dis J 1994;13:183-8

OM-7: Paradise JL, Elster BA, Tan L. Evidence in infants with cleft palate that breast milk protects against otitis media. Pediatrics 1994;94:853-60

OM-8: Sassen ML, Brand R, Grote JJ. Breastfeeding and acute otitis media. Am J Otolaryn 1994;15:351-7

OM-9: Dewey KG, Heinig J, Nommsen-Rivers LA. Differences in morbidity between breastfed and formula fed infants. J Pediatr 1995;126:696-702 (risk also increased in FF infant for diarrhea)

OM-10: Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States. Pediatrics 1997;99:e5

Risks for the premature baby:

P-1: Lucas A, Cole TJ. Breastmilk and neonatal necrotizing enterocolitis. Lancet 1990;336:1519-23

P-2: El-Mohandes AE, Picard MB, Simmens SJ, Keiser JF. Use of human milk in the intesive care nursery decreases the incidence of nosocomial sepsis. J Perinatol 1997;17:130-4

P-3: Daniels L, Gibson R, Simmer K. Selenium status of preterm infants: the effect of postnatal age and method of feeding. Acta Pœdiatr 1997;86:281-8 (M:23)

P-4: Uauy RD, Birch DG, Birch EE, Tyson JE, Hoffman DR. Effect of dietary omega-3 fatty acids on retinal function of very low birth weight neonates. Pediatr Res 1990;28:485-92 (M:18)

P-5: Lucas A, Morley R, Cole TJ, Lister G, Leeson-Payne C. Breastmilk and subsequent intelligence quotient in children born preterm. Lancet 1992;339:261-4 (CD: 3)

P-6: Bishop NJ, Dahlenburg SL, Fewtrell MS, Morley R, Lucas A. Early diet of preterm infants and bone mineralization at age five years. Acta Paediatr 1996;85:230-6

P-7: Carlson SE, Rhodes PG, Ferguson MG. Docosahexaenoic acid status of preterm infants at birth and following feeding with human milk or formula. Am J Clin Nutr 1986;44:798-804

P-8: Foreman-van Drongelen MMHP, van Houwelingen AC, Kester ADM, Hasaart THM, Blanco CE, Hornstra G. Long-chain polyunsaturated fatty acids in preterm infants: status at birth and its influence on postnatal levels. J Pediatr 1997;126:611-8

P-9: Bier JB, Ferguson AE, Morales Y, Liebling JA, Oh W, Vohr BR. Breastfeeding infants who were extremely low birth weight. Pediatrics 1997;100:p e3

Childhood Cancer:

CC-1: Schwartzbaum JA, George SL, Pratt CB, Davis B. An exploratory study of environmental and medical factors potentially related to childhood cancer. Med pediatr Oncol 1991;19:115-21

CC-2: Davis MK, Savitz DA. Graubard BI. Infant feeding and childhood cancer. Lancet 1988;2:365-8

CC-3: Freudenheim JL, Marshall JR, Graham S, Laughlin R, Vena JE, Bandera E, et al. Exposure to breastmilk in infancy and the risk of breast cancer. Epidemiology 1994;5:324-31

CC-4: Shu XO, Linet MS, Steinbuch M, Wen WQ, Buckley JD, Neglia JP, Potter JD et al. Breastfeeding and the risk of childhood acute leukemia. J Nat Cancer Institute 1999;91:1765-72

Gastrointestinal Disease and Infections:

GI-1: Koletzko S, Sherman P, Corey M, Griffiths A, Smith C. Role of infant feeding practices in the developement of Crohn’s disease in childhood. Br Med J 1989;298:1617-8

GI-2: Greco L, Auricchio S, Mayer M, Grimaldi M. Case control study on nutritional risk factors in celiac disease. J Pediatr Gastroenterol Nutr 1988;7:395-8

GI-3: Duffy LC, Byers TE, Riepenhoff-Talty M, La Scolea L, Zielezny M, Ogra PL. The effects of infant feeding on rotavirus-induced gastroenteritis. A prospective study. Am J Pub Health 1986;76:259-63

GI-4: Hanson LA, Lindquist B, Hofvander Y, Zetterstrom R. Breastfeeding as a protection against gastroenteritis and other infections. Acta Pediatr Scand 1985;74:641-2

GI-5: Ruiz-Palacios GM, Calva JJ, Pickering LK, Lopez-Vidal Y, Volkow P, Pezzarossi H, et al. Protection of breastfed infants against Campylobacter diarrhea by antibodies in human milk. J Pediatr 1990;116:707-13

GI-6: Cruz JR, Gil L, Cano F, Caceres P, Pareja G. Breastmilk anti-Escherichia coli heat labile toxin IgA antibodies protect against toxin-induced infantile diarrhea. Acta Pediatr Scand 1988;77:658-62

GI-7: Gillin FD, Reiner DS, Wang C-S. Human milk kills parasitic intestinal protozoa. Science 1983;221:1290-2

GI-8: France GL, Marmer DJ, Steele RW. Breastfeeding and Salmonella infection. Am J Dis Child 1980;134:147-52

GI-9: Haffejee IE. Cow’s milk-based formula, human milk and soya feeds in acute infantile diarrhea: A therapeutic trial. J Pediatr Gastroenterol Nutr 1990;10:193-8

GI-10: Lerman Y, Slepon R, Cohen D. Epidemiology of acute diarrheal diseases in children in a high standard of living rural settlement in Israel. Pediatr Infect Dis J. 1994;13:116-22

GI-11: Howie PW, Forsyth JS, Ogston SA, Clark A, Du V Florey C. Protective effect of breastfeeding against infection. Br Med J 1990;300:11-6

GI-12: Duffy LC, Riepenhoff-Talty M, Byers TE, La Scolea LJ, Zielezny MA, Dryja DM et al. Modulation of rotavirum enteritis during breastfeeding. Am J Dis Child 1986;140:1164-8

GI-13: Haddock RL, Cousens SN, Guzman CC. Infant diet and salmonellosis. Am J Pub Health 1991;81:997-1000

GI-14: Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States. Pediatrics 1997;99, June 1997;e5 (also for otitis media)

Urinary Tract Infection:

UT-1: Pisacane A, Graziano L, Mazzarella G, Scarpellino B, Zona G. Breastfeeding and urinary tract infection. J Pediatr 1992;120:87-9

Malocclusion:

MA-1: Labbock MH, Hendershot GE. Does breastfeeding protect against malocclusion? An analysis of the 1981 child health supplement to the national health interview survey. Am J Prev Med 1987;3:227-32

MA-2: Palmer B. The influence of breastfeeding on the development of the oral cavity: A commentary. J Hum Lact 1998;14:93-8

Formula as a heavy metal cocktail:

HM-1: Koo WWK, Kaplan LA, Krug-Wispe SK. Aluminum contamination of infant formulas. J Parenteral Enteral Nutrition 1988;12:170-3

HM-2: Davidsson L, Cederblad, Lonnerdal B, Sandstrum B. Manganese absorption from human milk, cow’s milk and infant formulas in humans. Am J Dis Child 1989;143:823-7

HM-3: Dabeka RW, McKenzie AD. Lead and cadmium levels in commercial infant foods and dietary intake by infants 0-1 year old. Food Additives and Contaminants 1988;5:333-42

Other Contamination due to bottle feeding:

C-1: Mytjens HL, Roelofs-Willemse H, Jaspar GHJ. Quality of powdered substitutes for breastmilk with regard to members of the family Enterobacteriaceœ. J Clin Microbiol 1988;26:743-6

C-2: Biering G, Karlsson S, Clark NC, Jonsdottir KE, Ludvigsson P, Steingrimsson O. Three cases of neonatal meningitis caused by Enterobacter sakazakii in powdered milk. J Clin Microbiol 1989;27:2054-6

C-3: Westin JB. Ingestion of carcinogenic N-nitrosamines by infants and children. Arch Environmental Health 1990;45:359-63

Allergy:

A-1: Lucas A, Brooke OG, Morley R, Cole TJ, Bamford MF. Early diet of preterm infants and development of allergic or atopic disease: randomized prospective study. Br Med J 1990;300:837-40

A-2: Kajosaari M, Saarinen UM. Prophylaxis of atopic disease by six months' total solid food elimination. Acta Pediatr Scand 1983;72:411-14

A-3: Ellis MH, Short JA, Heiner DC. Anaphylaxis after ingestion of a recently introduced hydrolyzed whey protein protein formula. J Pediatr 1991;118:74-7

A-4: Saarinen UM, Kajosaari M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet 1995;346:1065-69

A-5: Saylor JD, Bahna SL. Anaphylaxis to casein hydrolysate formula. J Pediatr 1991;118:71-4

A-6: Marini A, Agosti M, Motta G, Mosca F. Effects of a dietary and environmental prevention programme on the incidence of allergic symptoms in high atopic risk infants: three years' followup. Acta Pœdiatr 1996;Suppl 414 vol 85:1-19

Miscellaneous:

M-1: McJunkin JE, Bithoney WG, McCormick MC. Errors in formula concentration in an outpatient population. J Pediatr 1987;111:848-50

M-1a: Abrams CAL, Phillips LL, Berkowitz C, Blacket PR, Priebe CJ. Hazards of overconcentrated milk formula. JAMA 1975;232:1136-40

M-1b: Potur AH, Kalmaz N. An investigation into feeding errors of 0-4 month old infants. J Trop Pediatr 1995;41:120-2

M-1c: Green HL, Moyer VA. Improper mixing of formula due to reuse of hospital bottles. Arch Pediatr Adolesc Med 1995;149:97-9

M-1d: Coodin Fj, Gabrielson IW, Addiego JE. Formula fatality. Pediatrics 1971;47:438-9

M-1e: Wilcox DT, Fiorello AB, Glick PL. Hypovolemic shock and intestinal ischemia: a preventable complication of incomplete formula labeling. J Pediatr 1993;122:103-4

M-2: Specker BL, Tsang RC, Ho ML, Landi TM, Gratton TL. Low serum calcium and high parathyroid hormone levels in neonates fed "humanized" cow’s milk-based formula. Am J Dis Child 1991;145:941-5

M2a: Jochum F, Fuchs A, Menzel H, Lombeck I. Selenium in German infants fed breastmilk or different formulas. Acta Paediatr 1995;84:859-62

M-3: Kramer MS. Do breastfeeding and delayed introduction of solid foods protect against subsequent obesity? J Pediatr 1981;98:883-7

M-4: Dick G. The etiology of multiple sclerosis. Proc Roy Soc Med. 1976;69:611-5

M-4b: Pisacane A, Impagliazzo N, Russo M, Valiani R, Mandarini A, Florio C, Vivo P. Breastfeeding and multiple sclerosis. Br Med J 1994;308:1411-2

M-5: Birch E, Birch D, Hoffman D, Hale L, Everett M, Uauy R. Breastfeeding and optimal visual development. J Pediatr Ophthalmol Strabismus 1993;30:33-8

M-6: Makrides M, Simmer K, Googin M, Gibson RA. Erythrocyte docosahexaenoic acid correlates with the visual response of healthy, term infants. Pediatr Res 1993;34:425-7

M-7: Sullivan SA, Birch LL. Infant dietary experience and acceptance of solid foods. Pediatrics 1994;93:271-77

M-8: Cochi SL, Fleming DW, Hightower AW, Limpakarnjanarat K, Facklam RR, Smith JD, et al. Primary invasive Hœmophilus influenzœ type b disease: A population-based assessment of risk factors. J Pediatr 1986;108:887-96

M-9: Arnold C, Makintube S, Istre GR. Day Care Attendance and other risk factors for invasive Hœmophilus influenzœ type b disease. Am J Epidemiol 1993;138:333-40

M-9a: Takala AK, Eskola J, Palmgren J, Ronnberg P-R, Kela E, Rekola P, Mäkelä PH. Risk factors of invasive Haemophilus influenzae type b disease among children of Finland. J Pediatr 1989;115:694-701

M-10: Michaelsen KM, Johansen JS, Samuelson G, Price PA, Christiansen C, Skakkebœk NE. Serum bone Gla protein (BGP, Osteocalcin) in infants: Values positively correlated with human milk intake. Mechanisms Regulating Lactation and Infant Nutrient Utilization. (Picciano MF, Luml;nnerdal B, editors). Volume 15 of Contemporary Issues in Clinical Nutrition, pages 419-23.

M-11: Jones EG, Matheny RJ. Relationship between infant feeding and exclusion rate from child care because of illness. J Am Dietetic Assoc 1993;93:809-11

M-12: MacFarlane PI, Miller V. Human milk in the management of protracted diarrhea of infancy. Arch Dis Child 1984;59, 260-65

M-13: Osborn GR. Stages in development of coronary disease observed from 1,500 young subjects. Relationship of hypotension and infant feeding to œtiology. Watson Smith Lecture, delivered to the Royal College of Physicians of London, January 11, 1965.

M13a: Bergstrom E, Hernell O, Persson L., Vessby B. Serum lipid values in adolescents are related to family history, infant feeding, and physical growth. Atherosclerosis 1995;117:1-13

M-14: Keating JP, Schears GJ, Dodge PR. Oral water intoxication in infants. Am J Dis Child 1991;145:985-90

M-14a: Bruce RC, Kiegman RM. Hyponatremic seizures secondary to oral water intoxication in infancy: association wiht commercial bottled drinking water. Pediatrics 1997;100; p e4

M-15: Finberg L. Water intoxication. (editorial). Am J Dis Child 1991;145:981-2

M-16: Shannon MW, Graef JW. Lead intoxication in infancy. Pediatrics 1992;89:87-90

M-17: Nako Y, Fukushima N, Tomomasa T, Nagashima K. Hypervitaminosis D after prolonged feeding with a premature formula. Pediatrics 1993;92:862-3

M-18: Uauy RD, Birch DG, Birch EE, Tyson JE, Hoffman DR. Effect of dietary omega-3 fatty acids on retinal function of very low birth weight neonates. Pediatr Res 1990;28:485-92

M-19: Hahn-Zoric M, Fulconis F, Minoli I, Moro G, Carlsson B, Buttiger M, et al. Antibody responses to parenteral and oral vaccines are impaired by conventional and low protein formulas as compared to breastfeeding. Acta Pœdiatr Scand 1990;79:1137-42

M-20: Arnon SS, Damus K, Thompson B, Midura TF, Chin J. Protective role of human milk against sudden death from infant botulism. J Pediatr 1982;100:568-73

M-21: Mason T, Rabinovich E, Fredrickson DD, Amoroso K, Reed AM, Stein LD, et al. Breastfeeding and the development of juvenile rheumatoid arthritis. J Rheumatol 1995;22:1166-70

M-22: Hasselbalch H, Jeppesen DL, Engelmann MDM, Fleischer-Michaelson K, Nielson MB. Decreased thymus size in formula-fed compared with breastfed infants. Acta Pœdiatr 1996;85:1029-32

M-22a: Hasselbalch H, Engelmann MDM, Ersbøll AK, Jeppesen DL, Fleischer-Michaelson K. Breastfeeding Influences thymic size In late Infancy. Eur J Pediatr 1999;158:964-7

M-23: Daniels L, Gibson R, Simmer K. Selenium status of preterm infants: the effect of postnatal age and method of feeding. Acta Pœdiatr 1997;86:281-8

M-24: Pettitt DJ, Forman MR, Hanson RL, Knowler WC, Bennett PH. Breastfeeding and incidence of non-insulin-dependent diabetes mellitus in Pima Indians. Lancet 1997;350:166-8

M-25: Routi T, Runnemaa T, Lapinleimu H, Salo P, Viikari J, Leino A, et al. Effect of weaning on serum lipoprotein (a) concentration: the STRIP baby study. Pediatric Research 1995;38:522-27

M-26: Bergstrome E, Hernell O, Persson L., Vessby B. Serum lipid values in adolescents are related to family history, infant feeding and physical growth. Atherosclerosis 1995;117:1-13

M-27: Von Kries R, Sauerwald T, von Mutius E, Barnert D, Grunert V, von Voss H. Breastfeeding and obesity: cross sectional study. Br Med J 199;319:147-50

M-28: Hokansson A, Zhivotovsky B, Orrenius S, Sabharwal H. Apoptosis induced by a human milk protein. Proc Natl Acad Sci USA 1995;92:8064-68

M-29: Hokansson A, Andréasson J, Zhivotovsky B, Karpman D, Orrenius S, Svanborg C. Multimeric alpha lactalbumin from human milk induces apoptosis through a direct effect on cell nuclei. Exps Cell Research 1999;246:451-60

M-30: Fitzpatrick M, Mitchell K, et al. Soy formulas and the effects of Isoflavones on the thyroid NZ Med J 2000;113:?pages

M-31: Lambertina W, Freni-Titulaer MD, Cordero JF, Haddock L, Lebron G, Martinez R, Mills JL. Premature Thelarche In Puerto Rico. Am J Dis Child 1986;140:1263-7

M-32: Tulldahl J, Pettersson K, Andersson SW, Hulthén. Mode of Infant feeding and achieved growth In adolescence: early feeding patterns In relation to growth and body composition In adolescence. Obesity Research 1999;7:431-7

M-33: Erickson PR, Mazhari E. Investigation of the role of human breastmilk in caries development. Pediatr Dent 1999;21:86-90

M-34: Setchell KDR, Zimmer-Nechmias L, Cai J, Heubi JE. Exposure of infants to phyto-oestrogens from soy-based infant formula. Lancet 1997;350:23-27

Breastmilk as "antimicrobial":

AM-1: Yoshioka H, Ken-ichi I, Fujita K. Development and differences of intestinal flora in the neonatal period in breastfed and bottle fed infants. Pediatrics 1983;72:317-21

AM-2: Hernell O, Ward H, Bläckberg L, Pereira MEA. Killing of Giardia lamblia by human milk lipases: An effect mediated by lipolysis of milk lipids. J Infectious Diseases 1986;153:715-20

AM-3: Andersson B, Porras O, Hanson LA, Lagergard T, Svanborg-Edén C. Inhibition of attachment of Streptococcus pneumoniœ and Hœmophilus influenzœ by human milk and receptor oligosaccharides. J Infectious Diseases 1986;153:232-7

AM-4: Bell LM, Clark HF, Offit PA, Slight PH, Arbeter AM, Plotkin SA. Rotavirus serotype-specific neutralizing activity in human milk. Am J Dis Child 1988;142:275-8

AM-5: Schroten H, Lethen A, Hanisch FG, Plogmann R, Hacker J, Nobis-Bosch R et al. Inhibition of adhesion of S-Fimbriated Escherichia coli to epithelial cells by meconium and feces of breastfed and formula fed newborns: mucins are the major inhibitory component. J Pediatr Gastroentero Nutr 1992;15:150-8

AM-6: Walterspiel JN, Morrow AL, Guerrero ML, Ruiz-Palacios GM, Pickering LK. Secretory anti-Giardia lamblia antibodies in human milk: protective effect against diarrhea. Pediatrics 1994;93:28-31

AM-7: Torres O, Cruz JR. Protection against Campylobacter diarrhea: role of milk IgA antibodies against bacterial surface antigens. Acta Pediatr Scand 1993;82:835-8

AM-8: Pickering LK, Morrow AL, Herrera I, O'Ryan M, Estes MK, Suilliams SE, et al. Effect of maternal rotavirus immunization on milk and serum antibody titers. J Inf Dis 1995;172:723-8

AM-9: Grover M, Giouzeppos O, Shnagl RD, May JT. Effect of human milk protaglandins and lactoferrin on respiratory syncytial virus and rotavirus. Acta Pœdiatr 1997;86:315-6

AM-10: Delneri MT, Carbonare SB, Silva MLM, Palmeira P, Carneiro-Sampaio MMS. Inhibition of enteropathogenic Escherichia coli adhesion to EHp-2 cells by colostrum and milk from mothers delivering low birth weight neonates. Eur J Pediatr 1997;156:493-8

Risks to the Mother

Ovarian Cancer:

MO-1: Hartge P, Schiffman MH, Hoover R, McGowan L, Lesher L, Norris HJ. A case control study of epithelial ovarian cancer. Am J Obstet Gynecol 1989;161:10-6

MO-2: Gwinn ML, Lee NC, Rhodes PH, Layde PM, Rubin GL. Pregnancy, breastfeeding and oral contraceptives and the risk of epithelial ovarian cancer. J Clin Epidemiol 1990;43:559-68

MO-3: Rosenblatt KA, Thomas DB, and the WHO collaborative study of neoplasia and steroid contraceptives. Lactation and the risk of epithelial ovarian cancer. International J Epidemiol 1993;22:192-7

Osteoporosis:

MO-4: Aloia JF, Cohn SH, Vaswani A, Yeh JK, Yuen K, Ellis K. Risks factors for postmenopausal osteoporosis. Am J Med 1985;78:95-100

MO-5: Melton LJ, Bryant SC, Wahner HW, O'Fallon WM, Malkasian GD, Judd HL, Riggs BL. Influence of breastfeeding and other reproductive factors on bone mass later in life. Osteoporosis Int 1993;3:76-83

MO-6: Cumming RG, Klineberg RJ. Breastfeeding and other reproductive factors and the risk of hip fractures in elderly women. International J Epidemiol 1993;22:684-91

MO-6a: Blaauw R, Albertse EC, Beneke T, Lombard CJ, Laubscher R, Hough FS. Risk factors for the development of osteoporosis in a South African population. S Afr Med J 1994;84:328-32

MO-6b: Krieger N, Kelsey JL, Holford TR. O'Connor T. An epidemiologic study of hip fractures in potmenopausal women. Am J Epidemiol 1982;116:141-8

Endometrial Carcinoma:

MO-7: Petterson B, Hans-Olov A, Berstrom R, Johansson EDB. Menstruation span-a time-limited risk factor for endometrial carcinoma. Acta Obstet Gynecol Scand 1986;65:247-55

MO-7a: Rosenblatt KA, Thomas DB, and the WHO collaborative study of neoplasia and steroid contraceptives. Prolonged Lactation and endometrial cancer. Int J Epidemiol 1995;24:499-503

Breast Cancer:

MO-8: Layde PM, Webster LA, Baughman AL, Wingo PA, Rubin GL, Ory HW and the cancer and steroid hormone study group. The independent associations of parity, age at first full term pregnancy, and duration of breastfeeding with the risk of breast cancer. J Clin Epidemiol 1989;42:963-73

MO-9: Ing R, Ho JHC, Petrakis NL. Unilateral breastfeeding and breast cancer. Lancet July 16, 19977;124-27

MO-10: McTiernan A, Thomas DB. Evidence for a protective effect of lactation on risk of breast cancer in young women. Am J Epidemiol 1986;124:353-74

MO-11: Yuan J-M, Yu MC, Ross RK, Gao Y-T, Henderson BE. Risk factors for breast cancer in Chinese women in Shanghai. Cancer Res 1988;58:99-104

MO-12: Yoo K-Y, Tajima K, Kuroishi T, Hirose K, Yoshida M, Miura S, Murai H. Independent protective effect of lactation against breast cancer: a case-control study in Japan. Am J Epidemiol 1992;135:726-33

MO-13: Reuter KL, Baker SP, Krolikowski FJ. Risk factors for breast cancer in women undergoing mammography. Am J Radiol 1992;158:273-8

MO-14: United Kingdom National Case-Control Study Group. Breastfeeding and risk of breast cancer in young women. Br Med J 1993;307:17-20

MO-15: Newcomb PA, Storer BE, Longnecker MP, Mittendorf R, Greenberg ER, Clapp RW, et al. Lactation and a reduced risk of premenopausal breast cancer. N Eng J Med 1994;330:81-7

MO-16: Tao S-C, Yu MC, Ross RK, Xiu K-W. Risk factors for breast cancer in Chinese women of Beijing. Int J Cancer 1988;42:495-98

MO-17: Siskind V, Schofield F, Rice D, Bain C. Breast cancer and breastfeeding: results from an Australian case-control study. Am J Epidemiol 1989;130:229-36

MO-18: Romieu I, Hernandez-Avila M, Lazcano E, Lopez L, Romero-Jaime R. Breast cancer and lactation history in Mexican women. Am J Epidemiol 1996;143:543-52

MO-18b: Furberg H, Newman B, Moorman P, Millikan R. Lactation and breast cancer risk. Int J Epidemiol 1999;28:396-402

Weight loss:

MO-19: Dewey KG, Heinig MJ, Nommsen LA. Maternal weight loss patterns during prolonged lactation. Am J Clin Nutr 1993;58:162-6

Risks to Society

S-1: Thapa S, Short RV, Potts M. Breastfeeding, birth spacing, and their effects on child survival. Nature 1988;335:679-82

S-2: Short . Breastfeeding (contraceptive effect). Scientific American 1984;250:35-41

S-3: Bitoun P. The economic value of breastfeeding in France. Les Dossiers de l'Obstetrique. 1994;#216 (available on request)

S-4: Radford A. The ecological impact of bottle feeding. (available on request)

S-5: Gross BA. Is the lactational amenorrhea method a part of natural family planning? Biology and policy. Am J Obstet Gynecol 1991;165:2014-9

S-6: Kennedy KI, River R, McNeilly AS. Consensus statement on the use of breastfeeding as a family planning method. Contraception 1989;39:477-96

Compiled by Jack Newman, MD, FRCPC. Revised: May 2000.

Protocol to increase intake of breastmilk by the baby (“Not enough milk”)

Most mothers have lots of milk or could have had lots of milk if they had gotten off to a good start and had good hands-on help. The problem is often that the baby is not getting the milk that is available. Sometimes mothers seem to have a lot of milk which flows very quickly at the beginning of a feeding, but the baby fusses or falls asleep when the flow slows down later in the feeding. Although the following symptoms are not necessarily due to the baby’s not getting enough milk flow from the breast, this Protocol can be used to help resolve concerns about:

• The sleepy or “lazy” baby. Babies are not lazy, incidentally. They respond to milk flow and if flow is slow, they tend to sleep at the breast especially if they are under a few weeks of age. Babies also seem to want to “use the mother as a pacifier”. Yes, sucking is pleasurable for the baby, but if the baby gets better milk flow and is truly “full” often the baby won’t want to just suck at the breast.
• The baby who pulls or fusses at the breast.
• The baby who is fussy or “colicky” (see also the information sheet on Colic in the breastfed baby).
• Frequent or long feedings or the baby who does not seem to wake up for feedings.
• Jaundice (see also the information sheet on Breastfeeding & jaundice).
• A too-rapid milk flow, “Over-active letdown”, babies choking or coughing at the breast or breasts that don’t seem to drain adequately.

To Ensure the Baby Drinks as Well as Possible:

1. Get the best latch possible. In order to accomplish this it is best to get help from someone who knows how to help mothers with breastfeeding. Anyone can look at the baby at the breast and say the latch looks good. We tend to teach the latch differently from most others. Naturally we think our approach is very effective and often is. A baby latched on well is on the breast asymmetrically, covering more of the areola with his lower lip than his upper lip, with his chin in the breast but not his nose, and his head is slightly tipped backwards compared to the rest of his body. When the baby is latched on well, the mother has no pain, and the baby gets milk well from the breast. See the information sheet Latching On and the video clips at the website ibconline.ca. Get good “hands-on” help.
2. Know how to know a baby is getting milk. When a baby is getting milk, he will have an open mouth wide - pause - close mouth type of suck. He is not getting milk just because he has the breast in his mouth and is making sucking movements. When he is sucking and not getting milk his chin moves down and up rapidly with no pausing of the chin at the maximum opening—this means “I am not getting milk flow into my mouth”. If you wish to demonstrate this to yourself, put your index finger into your mouth and suck as if you were sucking on a straw. As you draw in, your chin drops and stays down as long as you are drawing in. When you stop drawing in, your chin will come back up. This pause that is visible at the baby’s chin represents a mouthful of milk when the baby does it at the breast. Actually the baby does this pause when he gets milk from finger feeding or a bottle too. The longer the pause, the more milk the baby got, so it is obvious that the frequently advised “feed the baby 20 minutes on each side” makes no sense. A baby who drinks very well (as opposed to sucking without drinking) for say, 20 minutes straight, will likely not take the other side. A baby who nibbles (doesn’t drink) for 20 hours will come off the breast hungry. You can see video clips of babies drinking (or not) at the website ibconline.ca.

   Note that when baby stops sucking, “taking a break”, this is not the pause we are referring to. Note also that it is normal for babies not to suck continuously without a break. Just ensure that when he begins to suck again he is also drinking.

3. Compressions. Once the baby is sucking without drinking, use the technique of breast compression to increase the flow of milk to the baby. Babies react in two ways to slow flow. They either fall asleep at the breast or they pull at the breast. Some babies do one thing at one feeding and another at another feeding. Some will both fall asleep and pull at different times during a single feeding. When the baby is sucking without drinking, start compression, but be sure to do them while the baby is sucking but not drinking. Keep the baby on the first breast until he doesn’t drink even with compressions (so that there is no pausing-type of suck even when you compress). See the information sheet Breast compression. You can also see a mother using breast compression at the website ibconline.ca.
4. Switch sides. When the baby no longer drinks even with compression, switch sides and repeat the process. Keep going back and forth as long as the baby gets reasonable amounts of milk. Of course once the baby has fed well, there is no harm in letting him “nibble” at the breast until he pulls off.

When the above techniques don’t work well enough…

5. Herbs. Take fenugreek and blessed thistle. These two herbs seem to increase milk supply and increase the rate of milk flow, which is actually more important. Because herbs are not standardized, we recommend mothers take enough fenugreek that she notices its scent on her skin. Often 3 capsules each of fenugreek and blessed thistle (or 20 drops of the tincture) taken 3 times daily will help and should work within 24-72 hours. If they have not worked by 72 hours and the mother smells of fenugreek, they probably won’t work. For other herbs that may help increase milk supply, see the information sheet Herbs for increasing milk supply.
6. Lying down to breastfeed. In the evening, when babies often want to be at the breast frequently and/or for long periods of time, get help to position the baby so that you can feed him lying down. (Note: mothers have less milk in the evenings, but less does not necessarily mean “not enough”). Let the baby breastfeed and maybe you will fall asleep. Babies who fuss at the breast when the flow is slower in the evening may be content to suckle at the breast when lying side by side with the mother. Or rent videos and let the baby breastfeed while you watch. See the information sheet Safe Co-sleeping.

Still having difficulty?

7. Domperidone. This is a medication that increases the rate of milk flow to the baby by increasing the milk supply. It is not a magic bullet and won’t cure all problems. It must be used in conjunction with the other steps in this Protocol. Sometimes it can be useful even if your milk supply is already substantial (as when the baby does not yet know how to latch on). See the information sheets (2) on Domperidone general information.
8. Supplementation. It is not always easy to decide if a baby needs supplementation. Sometimes applying this Protocol for a few days and continuing with it will get the baby gaining more rapidly. Sometimes more rapid growth is necessary and it may not be possible without supplementation. If practical, get banked breastmilk to use as a supplement (for more information see www.hmbana.org). If not available, infant formula may be necessary. However, sometimes slow but steady growth is acceptable. The main reason to worry about growth is that standard growth is a sign of good health. A baby who grows well is usually in good health, but not necessarily so. Neither is a baby who grows slowly necessarily in poor health, but physicians worry about a baby growing more slowly than average. Growth charts are, however, frequently interpreted poorly. A baby who follows the 10th percentile is growing normally and as he should. Too many people, and surprisingly even some physicians, believe that only babies on the 50th percentile and above are growing normally. This couldn’t be more false. Growth charts were developed on information gathered on normal babies. Somebody has to be smaller than 90% of all other babies (on the 10th percentile)—somebody normal.
9. Lactation aid. If it is decided that supplementing is necessary, the best way to do it, even if you are supplementing with breastmilk, is with a lactation aid at the breast. Our lactation aid is made with a #5 French, 36 inch or 93 cm long feeding tube leading from a bottle of supplement and it is used once the baby has fed only after doing steps #3 and #4 above and the baby has fed on at least both sides. Why is a lactation aid better than a bottle, cup, syringe, or spoon?
   • Babies learn to breastfeed by breastfeeding.
   • Mothers learn to breastfeed by breastfeeding.
   • The baby continues to get milk from the breast thus helping to increase the milk supply.
   • The baby won’t reject the breast.
   • There is more to breastfeeding than breastmilk.
10. Solids. If the baby is older than about 3 or 4 months and supplementation appears to be necessary, formula is not necessary and extra calories can be given to the baby as solid foods. Yes, you can give solids to a baby of 3 or 4 months of age. The statement by Health Canada, the Canadian Paediatric Society, the American Academy of Pediatrics, UNICEF, the World Health Organization, and almost all paediatric societies around the world encourage exclusive breastfeeding to about 6 months. This means that if the baby needs extra calories and is also getting formula he is still not exclusively breastfed. Formula is basically a liquefied solid. But it’s not the formula that is the biggest problem. It’s the bottle. If the baby gets bottles when the milk flow from the breast has slowed because of a decreased supply, he will figure out pretty quickly where the food comes from and start rejecting the breast. Bonding is important, but hunger comes first. So formula can be given, but mixed with the baby’s solids. This works fine. First solids can include mashed banana, mashed avocado, mashed potato or sweet potato etc—as much as the baby will take without forcing. Note however, that giving the baby solids at 3 or 4 months of age when everything is going well and the baby is gaining well is not recommended. Solids should normally be started when the baby is showing a definite interest in eating solids (usually around 6 months of age, but not always, sometimes this occurs before six months and sometimes after). See the information sheet Starting solid foods.
11. Late onset slow weight gain. If your baby was gaining weight well for a few months and no longer is, see the information sheet Slow Weight Gain After Early Good Weight Gain. Reasons for a decreased milk supply are listed there. Fix what interfering factors fit your situation and follow this Protocol

Protocol to Manage Milk Intake, 2009© 
Written and revised (under other names) by Jack Newman, MD, FRCPC, © 1995-2016 
Revised by Jack Newman MD, FRCPC, IBCLC and Edith Kernerman, IBCLC, 2008, 2009©

Dr. Jack Newman shares his thoughts about immediate post partum infant weight loss

10% weight loss is meaningless. So is 7%, and 9.234342%. Percentage weight loss should not be used, as it is now being used, as an indication for automatic supplementation. There is no scientific basis for any such notion. In the first place, scales are different, and there is often a significant difference between scales in delivery, in postpartum and in the doctor’s office. Even if there is weight loss, before suggesting supplementation...

Observe a breastfeeding. If the baby is breastfeeding well, there may be an error in the scale. Reassure the mother and follow the baby closely. If the baby is not breastfeeding well, then:

1. Fix the way a baby is Latching On. The asymmetric latch (baby’s chin is touching breast, but nose is away from the breast) is better than what we have been teaching for some years now (symmetric latch, with baby’s nose and chin touching breast).
2. Teach the mothers how to know the Is my baby getting enough milk?. When a baby is actually getting milk (he is not getting milk merely because he is on the breast and making sucking motions), you will see a pause at the point of his chin after he opens to the maximum and before he closes his mouth, so that one suck is (open mouth wide-->pause-->close mouth). If you wish to demonstrate this to yourself, put your index or other finger in your mouth and suck as if you were sucking on a straw. As you draw in, your chin drops and stays down as long as you are drawing in. When you stop drawing in, your chin comes back up. This pause that is visible at the baby’s chin while the baby is on the breast, represents a mouthful of milk. The longer the pause, the more milk the baby got. Once you know about the pause you can cut through so much of the nonsense mothers are being told. For example, twenty minutes on each side makes no sense at all. A baby who does the pausing type of suck for twenty minutes straight likely will not take the other side. A baby who nibbles, without drinking, without the pause, for 20 hours will still come off the breast hungry.
3. Once the baby does not drink on his own (nibbles only), teach the mother compression of the breast, to keep the baby drinking, not just sucking.
4. Once the baby is not drinking even with compression, switch sides and repeat the process. Do not tell a mother to feed just one side!
5. Fenugreek and blessed thistle, 3 capsules of each 3 times a day, often help with milk flow.

Often these steps alone will get the baby drinking well and gaining weight well, especially if it is within the first week or so, but often even after. Supplementation should be suggested only if these measures do not work. They often do!

Dr. Jack Newman shares his thoughts about immediate post partum infant weight loss. 
Written by Jack Newman, MD, FRCPC ©2004 
This handout may be copied and distributed without further permission, on the condition that it is not used in any context in which the WHO code on the marketing of breastmilk substitutes is violated.