Breast vs. Formula: Infant nutrition

Great Debates
41

You know, I too would be curious to see what experts consider to be the “normal” weening age as well. I feel any such literature ought come from a disinterested party however…perhaps a biological/physiological researcher? If you find anything let me know.

I appologize too if I was persnickedy about the anedotal thing…just if I had a nickle for each time I mention an empirical article and someone comes back with a “but my uncle’s dog’s babysitter didn’t do that” as if one example contradicted all scientific understanding.

:slight_smile:

42

Regarding weaning age, here’s an article, also by Dettwyler, I found on the LLL web site. She cites a number of other scientists, so you might find it useful. http://www.lalecheleague.org/BA/Aug94p3.html

43

That’s kind of neat info Ellen, I would still like to see some sort of independent confirmation however…particularly from a study which didn’t rely so heavily on animal analogies. (If everything that was good for animals were good for humans, we’d all better switch to an euclyptus or termite diet.) :slight_smile:

44

Yum! :wink: I’ll keep looking.

45

re: the anecdotes to kill any decent study, read my LONG post - I also hate it when someone’s sister’s girlfriend’s cousin whatever whatever. Guess I’d best clarify when I’m trying to illustrate something rather than necessarily negate.

I also had another thought on my way home (as for other possibilities that aren’t necessarily addressed in the literature) - that being that its also possible that parents of kids with such disorders are more prone to extended bf as a kind of management/medication response. Also possible that such kids are more prone to resisting weaning, and parents then give up and keep going. Just proving to myself that the conclusions of researchers aren’t all there is in the world, including the research I personally think is reasonable. :slight_smile:

And, to top off for the moment (given the hour and the state of my immune system - cough cough…)… I wish I could easily put ALL the things I say to people in one post - but it would be HUGE. I’ve also pointed out to moms who are beating themselves over quitting that one of the largest studies I know of (retrospective, unfortunately) shows the most benefits in terms of overall health are in the first 3 days (50% of measureable difference between not ever nursed and nursed any period of time) and the next major margins are 3 weeks, 3 months, 8 months… after that, too small a sample. So ANY amount you give makes a lifetime’s difference. That gift just doesn’t stop giving, and quitting doesn’t retract the nursing you’ver already done. I don’t want to encourage people to quit when it gets tough, but only the individual knows how much they can bear - and unbearable is unbearable, period. (still find help, ask, learn, etc., but also get used to not being a perfect parent!)

So, yes, bfing isn’t perfect, as Ellen said, it is just normal. Hey, my son is prone to ear infections - it isn’t a magic bullet. Glad Ellen is checking refs for me. I’ll get back into this as I get better.

46

I’d like to share my story.
I nursed my first for 20 months (she is almost 3 now), and I am currently nursing my 4 mo old. Learning to bf the first time was hell. I have flat nipples and I totally engorged. My nipples bled and cracked, but I got through it thanks to a very supportive family. It seems to me that a lot of people think that it is normal to experience that and are afraid to try . There are things you can do to avoid such problems (proper positioning, etc.) If I had known then what I know now… Women need be given more information and help from the hour the baby is born. If you wait the problems stack up.
I also think that people are under the mistaken impression that if you have to use formula once you can’t go back. My first had formula several times until I could start pumping, and this one had formula twice while I was in surgery to no ill effect. You can go back. LLL can be overbearing about bottles and pacifiers and so on, but you have to take what works for you and leave the rest. If you talk to LLL leaders they have to follow certain guidelines from the organisation in the advice they offer. If you don’t like the group, WIC has a program of peer counselors. They are just other bf moms, and you may find them less hard line and intimidating.
I just wish more people would at least try breastfeeding. If it doesn’t work out, I understand, but why not at least give it a try? It’s good for baby, good for mom and good for the environment, not to mention your wallet. I think that the posters are attempting to encourage more people to try, not to bash those who can’t.
In order to help bf moms, companies should be required to provide a place & time for moms to pump, formula makers should not be allowed to bribe doctors and hospitals, and breastfeeding should be portrayed as normal and healthy by the media. The supreme court has ruled (sorry I have no cite) that nursing is a constitutional right, so if anyone askes you to stop, you can tell where to go. If you do get flak, call the local news stations and papers. They love doing those kinds of stories.
So, good luck to anyone trying out there and to all of you who have at least tried, Kudos.

That was my longest ever post. Whew.

47

I just read the OP and skipped the replies. Partly because I’m lazy, I admit, but also because the only experience or knowledge I have of this topic is the experience my wife had.

When our daughter was born, she wanted to breast-feed, and was encouraged to do so by our pediatrician. His exact words were, “That’s what your breasts are for.” Unimpeachable logic.

Problem was, it was a dismal experience. My wife wasn’t producing enough milk, so our daughter was always hungry (but had few ways of telling us). As a result, she pulled harder on the nipples, causing severe pain for my wife. My wife then got infected nipples. All this physical discomfort was compounded by feelings of inadequacy and frustration (self-inflicted, admittedly).

When my wife found all this stuff out, and switched to formula, at least our child was getting a full belly (and, let’s be honest, decent nutrition).

When our son was born eight years later, my wife never considered nursing. He was put on formula immediately. Granted, breast milk is the best thing for nursing children. Nature put breasts on women and those breasts produce milk for babies. Logic alone should demand the conclusion that it’s the best food for them, bar none. But as an alternative, formula is a good second choice.

My biggest beef is the advocates who act as though you’re dumping Lysol down your kid’s throat if you give them formula. Agreed, it’s not as good as breast milk, it’s not the best, but it is good for them, and there are cases where it is necessary to formula feed a baby.

Both my children are healthy and strong. We wish my wife could have breast-fed them. She really wanted to. But we’re also glad we had a healthy alternative.

48

Hedra:

I am the first to admit empirical evidence ain’t everything. Thus the slow steady march of science.

:slight_smile:

49

First, a quick observation: A common reason women cite for quitting breastfeeding is that they don’t have enough milk. The breast works in a marvelous supply and demand system, but it’s not instantaneous like, say, turning on a spicket. Often, women can be coached through temporarily feeling they’re “out” while their breasts respond to increased demand. (This often happens at predictible times in the baby’s life, the first being about six weeks.) As I’ve said before, truly not having enough milk is considered a rare condition.

For the record, let me again state that I offer this information to balance the testimony here, not to run down others’ efforts at nursing. Thank you, lunasea, (flat nipples ::shudder:: ) for saying *I think that the posters are attempting to encourage more people to try, not to bash those who can’t. * This is an emotional issue. I’ve been trying to put forth the opinion that it’s a much more viable proposition than many consider it to be. Challenge assumptions. Discover why people hold the opinions regarding nursing that they do. And, apart from a “fuck off” here and there, it’s been very enlightening!

Hedra, I’d like to say I’ve enjoyed your posts and your input! Your long post especially was filled with real-world examples and sounded much less dogmatic than I tend to come off as.

Avalongod, I haven’t looked around for more studies yet, but I’d like to ask about your problem with animal studies. They’re cited by an anthropologist, who studies human behavior and, to me at least, it seems to make sense to look to the animal world for clues to our animal-type behavior. (Eek that sounds bad! I just mean in a behavior that is identical to one performed by other mammals.) We have evolved, yes, and as I’ve been saying all along, societal pressures have changed the way we regard this basic behavior. But in regard to weaning, it seems to make sense when trying to determine a “natural” age for it, to look at things like when molars come in and such for clues.

My son weaned a few months ago; he’ll be 3 in July. He gradually stopped on his own. To those who think nursing an older child is weird, consider that I didn’t suddenly prop a 2-year-old who’d never nursed into my lap one day. He began as an infant and one day became the next and soon he was passing his second birthday. Thus nursing him that day was no different than the hundreds of days before it. :slight_smile:

50

Ellen:

I hope you don’t take my skepticism as a challenge, it is just part of science to be skeptical. Your posts, as well as hedra have been elightening, and though I don’t necessarily always agree, you have gotten me thinking (and what more can one hope for)? :slight_smile:

I come from the psychology/biology arenas (clinical psychology specifically, though I dabble in other sciences) where animal studies have long since led to dead ends. You might remember the Pavlov dog studes, Skinner’s rats, etc…which demonstrated some small-scale animal learning and ultimately was used to suggest all human learning occurs in these classical/operant contexts. Turns out you try to use these principles on humans and (generally speaking) they don’t work too well. These earlier Skinnerian theories of learning have generally been discarded (though they are still taught in Gen Psyche for historical reasons).

From biology we can see (and one of the things that makes biology so interesting) is that animal species engage in a variety of behaviors that are far different from one species to another. Thus if you note one species engages in a behavior, this does not mean another one will. This is something we refer to as external validity…basically put: Do the conclusions of one study really apply (or generalize) to the general human population. For instance if you notice that the African tree frogs climbs to the top of the tallest tree after a rain storm and sings as loud as he can to attract a mate, does this mean I should be doing this too? (perhaps I ought to give it a try!) Or if you note AFrican wilderbeests devour their placentas after giving birth, (they do) are we missing out on something there. Or if lion males slaughter the cubs of rival males in order to bring females into heat, should human males be slaughtering their rivals’ children? The point is that simply because one animal species engages in a given behavior doesn’t mean they all do/should.

Most of that anthropologists research focused on primates…so think of this. If you note that hyena females roll in the excrement of their rivals to show disdain, can we conclude that human females do this as well? Or if you note chimpanzee males like to stick their fingers into the vulvas of females to see if they are in heat, should I just willy-nilly probe my girlfriend whenever I am wondering if she might be ovulating (and chimps don’t wait until they are in private either).

This even goes for humans…because one group of humans does something, does not mean the rest do. IF you note some small South American tribes devour the brains of their dead, can you conclude all humans do? Or think about this…the UFO abduction stories you always hear about seem to take place with midWestern housewives missing front teeth…are these the folks you REALLY want to be standing in as our representatives to the aliens? :slight_smile:

So to sum up the issue is one of generalizability…the whole point of evolution is that animals end up different from one another. As a result it is impossible to generalize findings from one species to another.

One more example…would you be comfortable with your child taking a medication that had only been tested on rats and had never been tested on humans?

:slight_smile:

51

Damn sometimes you reread you post and only then notice the errors.

Obviously I should not have included hyenas when I was talking about primates. But the point still holds.

Also by the way, I hope you don’t think I am against breast-feeding, quite the contrary. Whenever I get married/have children I would hope my wife would breast feed (though obviously my say in that will not be the deciding vote)

I m just kinda curious about human weening literature.

52

Oh, one last thing (and I sincerely appologize for my scattered brains)

The other thing that made me skeptical about that anthropologist’s research was that she correlated weening with all kinds of stuff (gestation, skull size, etc) without really providing any rationalization why there ought be a causal link to any of those. (i.e. what does skull size have to do with weening)

Probably you could correlate weening length with length of the big toenail, or length of urine stream in males and come up with something too. (i.e. given the correlation between penile length and weening in primates, it is demonstrated that weening for humans ought occur at three weeks, well, for my kids it would be at thirty four years)

j/k

:wink:

53

Verrrry interesting Avalongod … but like you, you’ve given me something to think about but I don’t necessarily agree.:slight_smile:

I don’t come from a science background so I cannot argue scientific method in the least. (Just a pore humble journalist.) However, the behaviors you’ve just described all strike me as very species-specific; that is, adaptations that particular animals have developed or evolved to cope with their own particular circumstances. I wouldn’t roll in excrement because there’s been nothing in my evolutionary history that would call for that sort of adaptation. (Although Steve Martin shouting, “I throw dog poop on your shoes!” springs to mind … LOL, I can’t stop the movie projector in my head sometimes.)

Anyway, let me see if I can make this sound like I’m an educated woman. :wink: Mammals are a broad classification of animals. The nursing of young is the common element. In all the animals you mentioned, we share little with them in terms of biological classification. Except the chimp example. And who knows? Our evolutionary predecessors may have engaged in just that behavior – but our march away from purely instinctual sexual behavior to civilized practices has eliminated it from our repertoire.

Therefore, your examples strike me as hollow because they aren’t dealing with any sort of common element in our biological natures. Would you say that our biological responses are completely foreign to our mammilian cousins? Producing milk is not an intellectual exercise for women. It happens to us, just as it does to all mammals, as a consequence of giving birth. Therefore, it seems completely logical to me to view the identical physiological response in another mammal as relevent.

54

Stable carbon and oxygen isotopes in human tooth enamel: Identifying breastfeeding and weaning in prehistory
Lori E. Wright 1 *, Henry P. Schwarcz 2
1Department of Anthropology, Texas A & M University, College Station, Texas 77843-4352
2School of Geography and Geology, McMaster University, Hamilton, Ontario L8S 4M1, Canada

email: Lori E. Wright (lwright@tamu.edu)

Keywords
stable isotopes; carbon; oxygen; weaning; diet; breastfeeding; tooth enamel
Abstract
This paper investigates the utility of stable carbon and oxygen isotopes in human dental enamel to reveal patterns of breastfeeding and weaning in prehistory. Enamel preserves a record of childhood diet that can be studied in adult skeletons. Comparing different teeth, we used 13C to document the introduction of solid foods to infant diets and 18O to monitor the decline of breastfeeding. We report enamel carbonate 13C and 18O of 33 first molars, 35 premolars, and 25 third molars from 35 burials from Kaminaljuyú, an early state in the valley of Guatemala. The skeletons span from Middle Preclassic through Late Postclassic occupations, ca. 700 B.C. to 1500 A.D. Sections of enamel were removed from each tooth spanning from the cusp to the cemento-enamel junction. Stable isotope ratios were measured on CO2 liberated by reaction of enamel with H3PO4 in an automated carbonate system attached to a VG Optima mass spectrometer.
Within a skeleton, teeth developing at older ages are more enriched in 13C and more depleted in 18O than teeth developing at younger ages. Premolars average 0.5% higher in 13C than first molars from the same skeleton (P = 0.0001), but third molars are not significantly enriched over premolars. The shift from first molars to premolars may be due to the shift to solid foods from lipid-rich milk. After 2 years, when premolars begin to mineralize, the 13C in childhood diets did not change systematically. First molars and premolars are similar in 18O, but third molars average 0.7% lower than first molars (P = 0.0001) and 0.5% lower than premolars (P = 0.0003). First molar and premolar 18O is heavier, because breast milk is more enriched in 18O than is drinking water. Hence, many children continued to nurse during the period of premolar formation. Together, these results indicate that Kaminaljuyú children had begun to eat solid maize foods before the age of 2 years but continued to drink breast milk until much later. Am J Phys Anthropol 106:1-18, 1998. © 1998 Wiley-Liss, Inc.

Received: 14 May 1997; Accepted: 2 February 1998

55

It is fairly well documented that facial and skull development is directly related to the physical PROCESS of nursing. hence studies that show that the longer you nurse, the more likely your teeth will come in straight. (don’t know where I put THAT cite, but that was where I learned the term ‘malocclusion’ - rates of malocclusion go down as length of nursing goes up, with appraently no upper limit). jaw development, as well as the development of the bones around the TM joint are different as a result of heavy muscle use.

That said, it is hard to identify without considering multiple factors. Not impossible, just hard. Bone density is relevant (muscle exertion increases density), and bone development differences are quite evident with normal weaning periods for pigs, BUT overall cranial features (in pigs) are more closely tied to genetics than nursing/weaning. So cranial size is a question mark. Good nutrition overall optimizes cranial development, so if otherwise diet might be suboptimal, nursing WILL increase cranial size. (Check out any of the info on nutrition and breastfeeding for nutritional benefits of breastfeeding.) That may be the point in this case (didn’t review that cite), that since even the worst breastmilk is used more effectively than the best formula, breastfed infants will have larger average cranial size - they’ll be optimum for their genetics, the formula fed children will not. The margin might be small, and this isn’t an indicator of IQ, either. :slight_smile:

Medscape has a fair overview of the research available at the moment, at http://www.medscape.com/medscape/WomensHealth/journal/1996/v01.n09/w120.hamosh/w120.hamosh.html#TOC You have to go looking for the original articles, but all are referenced. (all 90-some) You’ll have to register to get in, but registration is free (unfortunately, I can’t check your cite from before because I am not paying $9.95 a day to search PsychINFO!). Us non-AP members got to pay.

56

I haven’t read through all these posts because 1) I don’t have time and 2) I don’t have time.( It’s nap time here at the Ujest household and the toddler has medicine related diarreha(sp?) and the baby has decided to not sleep at all. It’s a plot against me.)

I don’t think a woman should ever feel bad about whatever choice she makes to feed her child. Breast milk or bottle.Food is food.

A little over a hundred years ago formula was not an option as it didn’t exist. If it were not for the efforts of the man who founded Nestle’s Chocolate (I think the Mr. Nestle, but I’ve been wrong before) realized that there were women who could not feed their infants because of whatever reasons, developed the first infant formula.

I’ve always preferred Nestle over Hershey, now I know why.
(FTR, I breastfed my son 7 months before he decided to use me as a teething ring. I lasted nearly three months with my daughter before her graze all day habits kept me contained to the couch. Now that she’s on formula, I can gladly kick my husband out of bed at 3am to feed her or leave her at her grandma’s house overnight. I figured if I made it 6 months with her, I’d done my job, that was before she was born and revealed her slow eating habits. Then I did it on a day by day basis. I probably would have quit earlier, but it was winter and Michigan, and nothing really to do anyways.)

57

I sympathize with you Shirley, but food is not food. There’s quite a lot of evidence that formula is inferior to breastmilk. It’s not poison or Lysol or whatever someone said earlier – but the two are most assuredly NOT equal. Formula is adequate. And I do not intend to inspire guilt with this information. Here is an article you might want to take a look at:
http://www.breastfeeding.com/reading_room/what_should_know_formula.html

Nestle – Surely you’ve heard of the boycott of Nestle products because this company is in violation of World Health Organization guidelines for the distribution of artifical babymilk? The company may have its origins in creating the first formula, but the applause needs to die right there.

It’s been well-documented that Nestle (and to be fair, other formula companies) have gone into less developed companies with the direct intention of expanding their markets. The problem with this is, poor people in poor countries cannot afford the exorbitant cost of formula like we here in the United States can. But, like in the United States, the formula companies make free samples available. Women there see it as a more modern “First World” thing to do and give their babies bottles filled with the free formula. They’re hooked. And they can’t afford it – so, to stretch the formula they mix it improperly, and often with impure water. Babies sicken and die when they could have been nourished on their own mother’s milk! Milk which differs in composition not greatly from the milk of women living in richer countries with better diets, I might add.

This my friends is the god’s honest truth, well-documented. Nestle denies it (or at least they were the last time I looked); do a search and look at their web site.

Some sites for more information:
http://www.alternativeparenting.com/preglaborbirth/nestle.asp
http://www.infactcanada.ca/newsletters/spring95/boycott.htm
http://www.gn.apc.org/ibfan/thecode.html – the wording of the WHO code

58

Mr. Moderator Sir – On my computer this thread is too wide to fit the screen. Is it because of the long web site addresses? Can you fix it somehow? It makes it very hard to read!

Thanks.

59

I didn’t notice how long it was when I posted - too late!

Also, another study for min 2 yr bf:

Continued breastfeeding and child growth in the second year of life: a prospective cohort study in western Kenya.

Lancet 1999 Dec 11;354(9195):2041-5
Onyango AW; Esrey SA; Kramer MS
((20100325 NLM))

BACKGROUND: The value of postinfancy breastfeeding for growth and nutritional status is debated. We have investigated this issue in a longitudinal study.

METHODS: We prospectively followed up a cohort of 264 children in western Kenya for 6 months (mean age 14 months [range 9-18] at baseline) to investigate the nature of the association between breastfeeding and growth. Only 14 (5.3%) children had been weaned at baseline, and 173 (65.5%) were still breastfed at follow-up. For analysis, children were classified into three groups of breastfeeding duration as a proportion of the total follow-up period (0-49%, n=42; 50-99%, n=49; and 100%, n=173).

FINDINGS: In general linear models multivariate analysis, children in the longest-duration breastfeeding group gained 3.4 cm (p=0.0001) and 370 g (p=0.005) more than those in the shortest duration group, and 0.6 cm (p=0.0015) and 230 g (p=0.038) more than children in the intermediate group. The strongest association between breastfeeding and linear growth was observed in households that had no latrine and daily water use of less than 10 L per person.

INTERPRETATION: Our findings support WHO’s recommendation to continue breastfeeding for at least 2 years, especially in settings with poor sanitation and inadequate water supply.

Granted, I’m not in a poor sanitation location, and we drink plenty of water, BUT, that does not mean that there is no real benefit to continuing at this point, only that nutritional benefits are greatest in these cases. The evidence of other studies shows that certain immune factors increase the longer you bf, and also that digestion of carbos is aided by bf through 2 yrs, by which time the child is able to produce the chemicals needed for better digestion. You’d think that the body was designed to mesh with all systems, no? So if there’s a bunch of defecits (nutritional and immunological) that decrease over time, perhaps there’s something else that decreases over a similar period that compensates? Like gradual weaning over the course of a few years? Just a thought. It does seem to be the SIMPLEST answer. And isn’t that often the test applied here?

(also found another study about weaning age in the early-mid 1800s, but the source was a cemetary with a lot of kids in it, and while average weaning was 14 months, those were just the kids that died, so kinda suspect for validity across a healthy population.)

60

The problem with the arguements made by the breastmilk advocates is that it makes all of those who don’t breastfeed feel bad - and it is often NOT OUR FAULT. And we are SICK OF HEARING IT.

My son was adopted at six months. Until my daughter was born, he had no idea what breasts are for. He is not a disease ridden sociopath as a result of having spent his infancy on formula. And no much it is protested that “that’s not what we mean” that is what I hear, every time. Every time I feel bad that I could not do what was best for my son.

My experience when my daughter was born was that breastfeeding was encouraged, the hospital was more than supportive, my employer was willing to meet my needs with a pump. My experience was also that breastfeeding was one of the most difficult things I have ever done in my life and the first three weeks were a living hell. I would NEVER choose that experience for anyone else (but completely respect their right to choose it), nor would I make someone feel guilty for not making that choice.

Some of my friends agree with Ellen in that if society supported breastfeeding, it would be easier. I feel I was well supported, and it was still damn hard. BTW, my friends cannot say how they weren’t supported, since they all had the same experience of pediatricians, OBs, and hospital staffs encouraging breastfeeding, supportive spouses and families, and employers who went out of their way to make pumping possible. They have experienced the occational dirty look while breastfeeding at the mall. (I myself, needed a little bit of privacy).

And I, too, have had the non-supportive LLL experience - even gave two different chapters a chance and they both blew it. (Although I’m sure when the woman said “if you loved your child, you’d quit your job” she was just being supportive).

Being a mother in this society is hard enough - our children and society lay enough guilt on us (and we take plenty on without being asked).

If 21% of mothers are still breastfeeding after six months, that seems darn good to me in a society where 30% of new mothers are back to work by that time, where there are other kids to look after (and little of the extended family model found in other cultures), where formula is high quality and easily accessible (and, expensive as formula is, we are a wealthy country), where fathers are taking an active role in childrearing, and where - until very recently - the doctors said six months should be your goal. And I believe that number has been trending upwards over the past couple of decades - be patient, societial change takes time!