» Breast Milk
want to give their babies the very best. When it comes to
nutrition, the best first food for babies is breast milk.
More than two decades of research have established that breast
milk is perfectly suited to nourish infants and protect them
from illness. Breast-fed infants have lower rates of hospital
admissions, ear infections, diarrhea, rashes, allergies, and
other medical problems than bottle-fed babies.
"There are 4,000 species of mammals, and they all make a
different milk. Human milk is made for human infants, and it
meets all their specific nutrient needs," says Ruth Lawrence,
M.D., professor of pediatrics and obstetrics at the University
of Rochester School of Medicine in Rochester, N.Y., and
spokeswoman for the American Academy of Pediatrics.
Health experts say increased breast-feeding rates would save
consumers money, spent both on infant formula and in health-care
dollars. It could save lives as well.
"We've known for years that the death rates in Third World
countries are lower among breast-fed babies," says Lawrence.
"Breast-fed babies are healthier and have fewer infections than
Although breast-feeding is still the best nourishment for
infants, infant formula is a close enough second that babies not
only survive but thrive.
Commercially prepared formulas are regulated by the Food and
The nutritional adequacy of commercially prepared formula is
also ensured by the agency's nutrient requirements and its
safety by strict quality control procedures that require
manufacturers to analyze each batch of formula for required
nutrients, to test samples for stability during the shelf life
of the product, to code containers to identify the batch, and to
make all records available to FDA investigators.
The composition of infant formula is similar to breast milk, but
it isn't a perfect match, because the exact chemical makeup of
breast milk is still unknown.
Human milk is very complex, and scientists are still trying to
unravel and understand what makes it such a good source of
nutrition for rapidly growing and developing infants.
More than half the calories in breast milk come from fat, and
the same is true for today's infant formulas. This may be
alarming to many American adults watching their intake of fat
and cholesterol, especially when sources of saturated fats, such
as coconut oil, are used in formulas. (In adults, high intakes
of saturated fats tend to increase blood cholesterol levels more
than other fats or oils.) But the low-fat diet recommended for
adults doesn't apply to infants.
The reason is that infants have a high energy requirement, and
they have a restricted volume of food that they can ingest. The
way to meet these energy requirements in a restricted amount of
food is to have a high amount of fat.
While greater knowledge about human milk has helped scientists
improve infant formula, it has become "increasingly apparent
that infant formula can never duplicate human milk," wrote John
D. Benson, Ph.D, and Mark L. Masor, Ph.D., in the March 1994
issue of Endocrine Regulations. "Human milk contains living
cells, hormones, active enzymes, immunoglobulins and compounds
with unique structures that cannot be replicated in infant
Benson and Masor, both of whom are pediatric nutrition
researchers at infant formula manufacturer Abbott Laboratories,
believe creating formula that duplicates human milk is
impossible. "A better goal is to match the performance of the
breastfed infant," they wrote. Performance is measured by the
infant's growth, absorption of nutrients, gastrointestinal
tolerance, and reactions in blood.
Human Milk for
The primary benefit of breast milk is nutritional. Human milk
contains just the right amount of fatty acids, lactose, water,
and amino acids for human digestion, brain development, and
Cow's milk contains a different type of protein than breast
milk. This is good for calves, but human infants can have
difficulty digesting it. Bottle-fed infants tend to be fatter
than breast-fed infants, but not necessarily healthier.
Breast-fed babies have fewer illnesses because human milk
transfers to the infant a mother's antibodies to disease. About
80 percent of the cells in breast milk are macrophages, cells
that kill bacteria, fungi and viruses.
Breast-fed 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 whatever
disease is present in their environment, making their milk
custom-designed to fight the diseases their babies are exposed
to as well.
Breast-feeding is good for new mothers as well as for their
babies. There are no bottles to sterilize and no formula to buy,
measure and mix. It may be easier for a nursing mother to lose
the pounds of pregnancy as well, since nursing uses up extra
calories. Lactation also stimulates the uterus to contract back
to its original size.
A nursing mother is forced to get needed rest. She must sit
down, put her feet up, and relax every few hours to nurse.
Nursing at night is easy as well. No one has to stumble to the
refrigerator for a bottle and warm it while the baby cries. If
she's lying down, a mother can doze while she nurses.
Nursing is also nature's contraceptive--although not a very
reliable one. Frequent nursing suppresses ovulation, making it
less likely for a nursing mother to menstruate, ovulate, or get
pregnant. There are no guarantees, however. Mothers who don't
want more children right away should use contraception even
while nursing. Women who are breast-feeding can use barrier
methods of birth control, such as condoms and diaphragms.
Hormone-containing methods are not first choice. These include
injections (such as Depo-Provera), implants (such as Norplant),
and birth control pills. A woman who breast-feeds should consult
her doctor about which type of contraception is appropriate for
her until the baby is weaned.
Breast-feeding is economical also. Even though a nursing mother
works up a big appetite and consumes extra calories, the extra
food for her is less expensive than buying formula for the baby.
Nursing saves money while providing the best nourishment
When Formula Is
There are very few medical reasons why a mother shouldn't
breast-feed, according to Lawrence.
Most common illnesses, such as colds, flu, skin infections, or
diarrhea, cannot be passed through breast milk. In fact, if a
mother has an illness, her breast milk will contain antibodies
to it that will help protect her baby from those same illnesses.
A few viruses can pass through breast milk, however. HIV, the
virus that causes AIDS, is one of them. Women who are HIV
positive should not breast-feed.
A few other illnesses--such as herpes, hepatitis, and beta
streptococcus infections--can also be transmitted through breast
milk. But that doesn't always mean a mother with those diseases
shouldn't breast-feed, Lawrence says.
"Each case must be evaluated on an individual basis with the
woman's doctor," she says.
Breast cancer is not passed through breast milk. Women who have
had breast cancer can usually breast-feed from the unaffected
breast. Studies have shown, however, that breast-feeding a child
reduces a woman's chance of developing breast cancer later.
Silicone breast implants usually do not interfere with a woman's
ability to nurse, but if the implants leak, there is some
concern that the silicone may harm the baby. Some small studies
have suggested a link between breast-feeding with implants and
later development of problems with the child's esophagus.
Further studies are needed in this area. But if a woman with
implants wants to breast-feed, she should first discuss the
potential benefits and risks with her child's doctor.
Tough but Worthwhile
For all its health benefits, breast-feeding isn't always easy.
In the early weeks, it can be painful. A woman's nipples may
become sore or cracked. She may experience engorgement more than
a bottle-feeding mother, when the breasts become so full of milk
they're hard and painful. Some nursing women also develop
clogged milk ducts, which can lead to mastitis, a painful
infection of the breast. While most nursing problems can be
solved with home remedies, mastitis requires prompt medical care
(see "Tips for Breast-Feeding Success").
Women who plan to go back to work soon after birth will have to
plan carefully if they want to breast-feed. If her job allows, a
new mother can pump her breast milk several times during the day
and refrigerate or freeze it for the baby to take in a bottle
later. Some women alternate nursing at night and on weekends
with daytime bottles of formula.
In either case, a nursing mother is physically tied to her baby
more than a bottle-feeding mother. The baby needs her for
nourishment, and she needs to nurse regularly to avoid getting
uncomfortably full breasts. But instead of feeling it's a chore,
nursing mothers often cite this close relationship as one of the
greatest joys of nursing.
If a woman is unsure whether she wants to nurse, she can try it
for a few weeks and switch if she doesn't like it. It's very
difficult to switch to breast-feeding after bottle-feeding is
If she plans to breast-feed, a new mother should learn as much
as possible about it before the baby is born. Obstetricians,
pediatricians, childbirth instructors, nurses, and midwives can
all offer information about nursing. But perhaps the best
ongoing support for a nursing mother is someone who has
successfully nursed a baby.
A breast-fed baby's digestive tract contains large amounts of
Lactobacillus bifidus, beneficial bacteria that prevent the
growth of harmful organisms. Human milk straight from the breast
is always sterile, never contaminated by polluted water or dirty
bottles, which can also lead to diarrhea in the infant.
Human milk contains at least 100 ingredients not found in
formula. No babies are allergic to their mother's milk, although
they may have a reaction to something the mother eats. If she
eliminates it from her diet, the problem resolves itself.
Sucking at the breast promotes good jaw development as well.
It's harder work to get milk out of a breast than a bottle, and
the exercise strengthens the jaws and encourages the growth of
straight, healthy teeth. The baby at the breast also can control
the flow of milk by sucking and stopping. With a bottle, the
baby must constantly suck or react to the pressure of the nipple
placed in the mouth.
Nursing may have psychological
benefits for the infant as well, creating an early emotional
attachment between mother and child. At birth, infants see only
12 to 15 inches, the distance between a nursing baby and its
mother's face. Studies have found that infants as young as 1
week prefer the smell of their own mother's milk. When nursing
pads soaked with breast milk are placed in their cribs, they
turn their faces toward the one that smells familiar.
Many psychologists believe the nursing baby enjoys a sense of
security from the warmth and presence of the mother, especially
when there is skin-to-skin contact during feeding. Parents of
bottle-fed babies may be tempted to prop bottles in the baby's
mouth, with no human contact during feeding. But a nursing
mother must cuddle her infant closely many times during the day.
Nursing becomes more than a way to feed a baby; it's a source of
warmth and comfort.
La Leche League, an international support organization for
nursing mothers, has chapters in many cities that meet regularly
to discuss breast-feeding problems and offer support.
If the mother cannot or chooses not to breast-feed, normal,
full-term infants should get a conventional cow's-milk-based
formula, according to John N. Udall Jr., M.D., chief of
nutrition and gastroenterology at Children's Hospital of New
Orleans. However, adverse reactions to the protein in cow's milk
formula or symptoms of lactose intolerance (lactose is the
carbohydrate in cow's milk) may require switching to another
type of formula, he says.
Symptoms that may indicate an adverse reaction to cow's milk
protein include vomiting, diarrhea, abdominal pain, and rash.
With lactose intolerance, the most common symptoms are excessive
gas, abdominal distension and pain, and diarrhea. Since some of
the symptoms overlap, a stool test may be necessary to determine
the culprit. Usually, lactose intolerance will produce acidic
stools that contain glucose. If the protein is the problem,
stools will be nonacidic and have flecks of blood.
The main alternative to cow's milk formula is soy formula.
The carbohydrates in most soy formulas are sucrose and corn
syrup, which are easily digested and absorbed by infants.
However, soy is not as good a protein source as cow's milk.
Also, babies don't absorb some minerals, such as calcium, as
efficiently from soy formulas. Therefore, according to the
American Academy of Pediatrics, "Healthy full-term infants
should be given soy formula only when medically necessary."
For a child who can't tolerate cow's milk protein, William J.
Klish, M.D., a Baylor College of Medicine pediatrician and
former chairman of the American Academy of Pediatrics Committee
on Nutrition recommends the use of hydrolyzed-protein formula.
Although hydrolyzed-protein formulas are made from cow's milk,
the protein has been broken up into its component parts.
Essentially, it's been predigested, which decreases the
likelihood of an allergic reaction.