I'm not sure why this study from 7 years ago is being dug up because it's not a particularly good, interesting, or definitive study. Some problems with it:
1. Small sample sizes.
2. Significance was only found in one subset of the population. Given enough ways to divide up groups of people, you will almost always get false positives.
3. Not an experimental design.
4. The study did not control for simple factors like income or the health of the parent.
I suppose the point being made is that enough time has passed for the study to have been properly validated; as the parent comment points out, lots of issues have been found with it.
> as the parent comment points out, lots of issues have been found with it.
I'm not familiar with the research here so I can't say either way. But a preliminary google scholar search turned up a lot of articles which seem to suggest that breastfeeding has a bunch of positive impacts on numerous intelligence and general well-being metrics.
The article itself has been cited 209 times according to google scholar [1], and this study [2] (cited 400+ some odd times) seems to accept some of the propositions made in this paper as givens.
Anyway, I think it would have been interesting if the null hypotheses here weren't rejected. I kind of expect evolution to have optimized human breastmilk over alternatives for infant development.
A single data point isn't science. It -might- be news, if it was a super recent data point (though, obviously, requires peer review and replication). This is neither.
Our study also helps provide a framework for future mechanistic studies on
I realize that repeat studies are important generally in science. But, many studies (particularly health related) seem to have such a result built into their design. If you get a result, it will just be preliminary and require a larger sample study moving on.
Is there a mechanism in science for actually taking these preliminary results and validating/falsifying them more conclusively? Does a result like this make a larger scale study this team's top priority for the next study? Will these results convince another team to do the full study?
Otherwise, it feels like there's something structurally wrong. If the study is designed as a non-conclusive prototype or framework, what's the point unless it leads to other studies?
I wish there was a sort of Snopes/Politifact/Rotten Tomatoes for science - an independent body that queried the top scientists in each field, and used this to quantitatively map the current state of the art and the consensus (or lack thereof) around that field's theories. Instead of e.g. 'the current state of CRISPR research' or 'P vs NP' being something that lived implicitly in the minds of the few researchers that keep up to date with all the relevant papers, it could be explicit on the site for all to see (including journalists, who would finally have an easy way to avoid putting their foot in their mouth with another 'Scientists show that lung cancer causes smoking!' headline). Even if all that could be said in a given area was 'Correlation has been shown, causation has not, a study is underway to try to establish this, and 60% of randomly queried researchers in the area believe causation will be proven' then that would still be super valuable. The result "99% of climate researchers and meteorologists believe climate change to be manmade" is a great result, but it would be much more hard-hitting if it came from an institution that was already considered to be reliable.
You can find that information in review papers. Once information has solidified enough one of the main researchers will write an account of the current state of the field.
I'm really grateful that those review papers are being made, but they're not a very accessible source for non-experts. How do I find them? How do I know if a given review paper is exhaustive or not? If it's still relevant or has been superseded by another one? What I'm suggesting is to generalize the work being done to create review papers into a resource that is easy to find, authoritative and continuously updated.
This mechanism already exists in some way with top journals and peer-reviewing. Their credibility relies on their capability to select the most important and proven papers.
I agree this is a weak, small study but I'm not sure I agree with your point 4. Obviously this all depends on having a large-enough sample size to start with, but if the groups are properly randomized they shouldn't have to control for income/health of parents (since it's not correlated with the independent variable).
> In the trial of interest here, mothers elected to breastfeed but varied in their success in expressing milk and, therefore, in the need for supplementary feeding. According to randomisation before breastfeeding commenced, these infants were given one of three supplements: a nutrient enriched preterm formula (PTF), a standard term formula (TF; used in the 1980s for feeding preterm infants) or banked breast milk (BBM; provided by unrelated donors and unfortified).
Since the mothers self-selected breastfeeding, the study makes the assumption that banked breast milk (from a random donor) is equivalent to fresh milk from the mother.
(Not saying these links aren't equally or more flawed, but it's avenues of causation ignored.)
Wouldn't a valid study require randomized instruction to mothers about whether to breastfeed? Is that ethical? Compliance is equally tough: breastfeeding can be incredibly difficult for some moms/babies. Further, couldn't the difficulty in breastfeeding also be correlated to the effects -- could children reject breastmilk based on the mother's health or otherwise based on the "quality" of the milk?
Please forgive if I'm asking questions that are well understood -- by no means am I claiming to be knowledgeable in this field. But I do have kids and went through hell with one of them on this, so I'm very interested in the research.
As a recent parent I would love it if there was more realistic health information for parents about the benefits of breastfeeding. As best I can tell from metastudies (which I'm totally unqualified to read), the scientific answer right now is: there may be some effect, but if so it's too small to reliably measure and may be swamped by other interventions. (I could be wrong! That's why I want better info.)
(Compare to, say, the advice to have infants sleep on their backs to prevent SIDS, or the HPV vaccine, which have clear and measurable health impacts at a population level.)
This matters because breastfeeding has costs that tend to be ignored. Just from personal experience, it pushes disproportionate work onto my wife in a way that's hard to correct for and detracts from parenting. And given that she's working full time, it's also a huge investment of resources -- if you take her work time into account, we're spending tens or hundreds of dollars a day for this. And many women get injuries and infections, soldiering through months of agony for that health benefit that may or may not exist.
Setting aside the health of the parents (and we shouldn't, that's an easy trap), breastfeeding uses a lot of resources that could go toward other interventions for the child. Maybe it's all worth it? But I wish there was a better conversation about the tradeoffs.
Yeah, breastfeeding can take 4-6 hours a day. It's no simple thing. And if the mother is working, it's hard. Even pumping milk takes time.
Women who can afford to breastfeed exclusively are at least middle class, usually upper-middle class. That comes with a whole set of advantages and other correlations. Studies that try to figure out breast feeding advantages have to try and control for these things, but it's hard.
Here's what we know for sure: Breast feeding reduces infections in the child. It's a small, but detectable amount. And I do mean a small amount. Between six mothers that exclusively breast feed an infant for six months, on average one of those children will have one fewer infection during that time.
Everything else is up in the air, and if it has an effect on anything else (like intelligence) it's tiny. Save your energy for reading to the child and playing games with them, which definitely helps intelligence.
I have to disagree your assumption about breastfeeding being usually upper-middle class. Maybe you're just talking about the US? But in Argentina at least (maybe more of Latin America too), it's common to see lower/middle-class women breastfeeding on the city bus.
the stats in the US are a bit twisted, in small part due to our terrible family leave offerings, but largely due to WIC providing formula to low income families that end up formula feeding to go back to work (lol if these types of jobs provide actual time to pump, even if they could pump) or because they don't get anywhere near as much support with breastfeeding difficulties.
Also, teach your babies a subset of ASL, for words like "more", "eat", "drink", "milk", "water", "done", "diaper change", and "sleep". They can form word associations before they are able to speak intelligibly, and it really helps the parent figure out why TF the kid is crying.
I taught my daughter about 100 words of ASL (English with and ASL lexicon, to be honest about it). Turned out super useful since she was a late talker (my second child, who I also tried to teach ASL was an early talker and thought ASL was stupid).
In my opinion, it's mostly useful because it's super cute. Typically kids who can sign 'milk' or 'more' can also indicate with grunts, grabs and reaching what the problem is. But it's super cute.
Turned out super useful since she was a late talker
That might not be a coincidence. There's some evidence that kids who use sign language tend to talk later. Maybe because there's less incentive to verbalize. It's not a language delay, though.
Save your energy for reading to the child and playing games with them, which definitely helps intelligence.
Are you sure? It was my understanding that there is pretty much no intervention that provably increases IQ. Some interventions have small effects for several years but none persist past 3-4 years post intervention.
- Except getting rid of things that low IQ, like reducing exposure to lead, not drinking or smoking while pregnant etc...
To me, this is the craziest development in our understanding of gestation. We live very close to a hospital with a popular birth center, and someone I know came to our house when they were in labor to see if they'd need to check in. Less than an hour before the kid was born, they were on my couch drinking a beer.
I guess I'm all for it? But compared to when our kids were born, it was jarring.
Ehhh... yeah, you're right, in that there's no known single prescription/intervention for increasing intelligence. But we do know that among siblings there's a correlation between being the first child and being the most intelligent. It seems parental bandwidth is important. So maybe not necessarily reading (as I said), but just spending time with them.
Also, side note, IQ is garbage and not a good measure of intelligence.
My wife and I looked very carefully into this, and we came to the same conclusion.[1] We decided that the very real costs were not worth the tenuous benefits.
Deciding to bottle feed made life way easier. My wife has trouble getting to sleep, while I can fall asleep in economy class on a 90 minute flight even before taking off. Our daughter woke up every 3 hours like clockwork for more than a year. My wife would've gone crazy if she was the one who was charged with feedings.
Medical professionals are socialized to always err on the safe side. No doctor or nurse ever got fired for scheduling an MRI or CAT scan "just to be safe." They approach breastfeeding the same way--the studies are inconclusive, so just do it to be safe.
[1] Like every engineer, I feel totally qualified to opine on scientific studies regardless of the field.
I am an exclusive pumper due to multiple difficulties, and it is an exquisite form of torture. At this point I am continuing due to some combination of sunk cost fallacy (but I spent $500 on pumps and supplies! formula would cost extra money now!) and for minor health benefits on my end - the ship has sailed on baby benefits in my mind.
For the first six weeks, even if the baby was sleeping, I had to pump every 2-3 hours, which means 5 min setup/teardown+15 minutes pumping so only sleeping 1.5 hours sometimes. I was screwed if the baby woke up right after I go to sleep after pumping no matter what my partner was doing, unless I wanted to sleep multiple rooms away with earplugs. It wasn't until 3-4 months that I could go 8 hours in the night without affecting my supply (some lactating folks are not lucky on this front). I still wake up drenched in milk since it's a bit longer than recommended. Better than crying over spilling 3oz of milk all over myself because I fell asleep while pumping though...plus my poor nipples at that point.
Right now several months out, I have to lug all my pumping gear around if I am out for more than 3-4 hours. I also have to plan out my schedule to make sure I can pump at all. So many days I've sat in Bay Bridge traffic in my car and people in cars next to me double taking. People think that pumping in bathrooms is logical even though it is disgusting af and there is nowhere to sit. Lots of people dish out judgment about pumping vs breast or think I'm feeding formula and just pile it on. Thankfully I am doing a combination of SAHP and WFH so I don't have to deal with judgmental bullshit about not being as productive while pumping (20 minutes x 5-6 times a day right now). I'm pumping right now ;)
Pumping is not some easy replacement for the breast and doesn't make it any easier on the lactating parent. I really regret we couldn't get bfing at the breast to work and that I had a traumatic delivery so lactating in the first place wasn't a guarantee, this is what I have to deal with.
You need to pump at some regular frequency to maintain milk supply. Most doctors recommend pumping every 4-5 hours, which means getting up very early to pump. Also, milk production continues in your sleep and many women can't go a full 7-8 hours without pumping because of the pain.
You are talking about breastfeeding. The article talks about breast milk. In the case the distinction is not clear, many mothers use breast pumps.
>WHO can now say with full confidence that breastfeeding reduces child mortality and has health benefits that extend into adulthood. On a population basis, exclusive breastfeeding for the first six months of life is the recommended way of feeding infants, followed by continued breastfeeding with appropriate complementary foods for up to two years or beyond.
The WHO isn't a great source for breast feeding, because of weird political and historical reasons.
In the 1960s, Nestle started pushing formula hard in developing countries in Africa. And by "pushing," I mean they hired people to dress as nurses and tell women that they should use formula because it was healthier than breast milk. They also gave women free samples, knowing that if they used the samples in the beginning, the women would have a hard time getting their milk to come in later, "hooking" them on the formula.
What made it worse is that the formula was very, very expensive to these people, and often didn't have any instructions printed in a language the mother could read (assuming they were even literate in any language), causing the formula to be routinely under-dosed. Oh, and they often didn't have access to safe drinking water, which is kind of important for formula.
We don't know how many babies died because of Nestle's actions, but it was probably in the millions.
This led to the huge Nestle formula boycott of the 70s. The WHO started pushing breast feeding hard, and created a whole panel to do it, made up of breast-feeding advocates who viewed it as a kind of panacea. That wouldn't have been a problem normally because strong believers in breastfeeding were probably needed to counteract the corporate push towards formula, but there was a big complication: AIDS. In 1981 the first cases of HIV transmission by breast milk were reported, and by the mid-80s, doctors knew for certain that HIV could be transmitted by breast feeding. But the breast-feeding advocates in the WHO wouldn't accept the facts. Even in the 90s the WHO was "debunking" that "myth" in their literature to third-world mothers.
We don't know how many babies died because the WHO told HIV-positive mothers that they should breast feed, but it was probably in the millions.
To this day, the WHO promotes breast-feeding heavily (which is fine, they should) but they play up the benefits of it more than is really scientifically defensible. Their breastfeeding outreach isn't run by impartial people, but by true-believers in the power of breastfeeding. So take their info with a grain of salt.
Moreover this study, plus others, have suggested a strong relation on IQ and breastfeeding (this study 8 IQ points, one cited by 23-and-me is 7 points per copy of a certain gene 0-14 points).
> RESULTS: Before matching, breastfeeding was associated with better development on almost every outcome. After matching and adjustment for multiple testing, only 1 of the 13 outcomes remained statistically significant: children’s hyperactivity (difference score, –0.84; 95% confidence interval, –1.33 to –0.35) at age 3 years for children who were breastfed for at least 6 months. No statistically significant differences were observed postmatching on any outcome at age 5 years.
It is extremely difficult to perform good studies about breastfeeding in the U.S., because breastfeeding rates are highly correlated with other factors. For example over 90% of babies in California are ever breastfed. That figure is around 60% in West Virginia, Louisiana, and Mississippi. Breast feeding rates also vary dramatically by race (black mothers are far less likely to breastfeed). Breastfeeding rates are also much lower among younger mothers and single mothers. So it's very easy to design a study that shows nothing more than that kids of wealthier, white married couples tend to be healthier.
It's easy to pick out 1 or 2 studies that show no result on this topic, but that'd be cherry-picking. Google scholar gives 1,750 results on "breast milk iq" in just 2017.
My wife is a pediatrician who recently wrote a letter to the Washington Post about this. While she routinely recommends breast feeding, she pointed out that the many costs, or even just personal preference, can justify formula instead. For instance, maternal stress alone probably has a big impact on child welfare. As a result, the weird undercurrent of shame for mothers who don't breastfeed is unwarranted. She sees mothers who are brought to tears because they can't breast feed, when in reality it shouldn't be a big deal, even if it's just a personal choice.
It's barely worth it. There is a marginal improvement from breast milk but it's not strong enough to justify the level of breast milk promotion over formula.
This study does not control for maternal IQ or socio-economic status. Later studies show that much of the link between breastfeeding and cognitive development is due to confounding effects (in particular, higher SES mothers are more likely to breastfeed): http://bmjopen.bmj.com/content/3/8/e003259
> Conclusions Much of the reported effect of breastfeeding on child neurodevelopment is due to confounding. It is unlikely that additional work will change the current synthesis. Future studies should attempt to rigorously control for all important confounders. Alternatively, study designs using sibling cohorts discordant for breastfeeding may yield more robust conclusions.
> RESULTS: Before matching, breastfeeding was associated with better development on almost every outcome. After matching and adjustment for multiple testing, only 1 of the 13 outcomes remained statistically significant: children’s hyperactivity (difference score, –0.84; 95% confidence interval, –1.33 to –0.35) at age 3 years for children who were breastfed for at least 6 months. No statistically significant differences were observed postmatching on any outcome at age 5 years.
The linked study also yields some odd results:
> In the total group %EBM correlated significantly with Verbal IQ (VIQ); in boys, with all IQ scores, TBV and WMV. VIQ was, in turn, correlated with WMV and, in boys only, additionally with TBV. No significant relationships were seen in girls or with grey matter.
A meta-study that adjusted for maternal IQ only (but not socioeconomic status, which independently correlates with higher rates of breastfeeding) found a very small effect on IQ: https://www.ncbi.nlm.nih.gov/pubmed/26211556
> We included 17 studies with 18 estimates of the relationship between breastfeeding and performance in intelligence tests. In a random-effects model, breastfed subjects achieved a higher IQ [mean difference: 3.44 points (95% confidence interval: 2.30; 4.58)]. We found no evidence of publication bias. Studies that controlled for maternal IQ showed a smaller benefit from breastfeeding [mean difference 2.62 points (95% confidence interval: 1.25; 3.98)]. In the meta-regression, none of the study characteristics explained the heterogeneity among the studies.
I know you are critiquing the study rather than making a general statement about the topic, but shouldn't we be challenging the effects of formula rather than the effect of a lack of breast milk? People are highly skeptical of Soylent, and I suggest they look at the ingredients of standard formula and consider the business interests involved before they decide to give it to a newborn. This study on breast feeding is a red herring.
"Both exclusivity and duration are important, because dose response is well established for breast milk benefits.3–5" [1]
So the author cites findings that how-long you breastfeed for or amount of breastfeeding you do has an effect (e.g. once a day vs twice a day) that's a big unexplained phenomenon (which could NOT be explained by maternal IQ, SES, etc).
To quote this author's interpretation of the literature "Although the topic is controversial, and a recent systematic review identified heterogeneity between studies, among the 4 studies with the least bias (each >500 subjects, controlled for maternal IQ, breastfeeding recall duration <3 years) breastfeeding improved performance on IQ testing by 1.76 points (95% confidence interval, 0.25–3.26), suggesting a small but durable impact of breastfeeding on intelligence.10"
(Again 2017, fully aware of the difficulty of controlling [1])
Now does this case-closed prove breastmilk bumps IQ? No, it proves my original claim that this is hotly contested.
1. Breastfeeding: What Do We Know, and Where Do We Go From Here?
> So the author cites findings that how-long you breastfeed for or amount of breastfeeding you do has an effect (e.g. once a day vs twice a day) that's a big unexplained phenomenon (which could NOT be explained by maternal IQ, SES, etc).
It could be explained by maternal IQ and SES, e.g. if higher IQ mothers were more likely to stick to optimal breastfeeding practices.
> Now does this case-closed prove breastmilk bumps IQ? No, it proves my original claim that this is hotly contested.
That may well be true, but the fact that the issue is "hotly contested" after decades of research is telling. If the effect was significant (practically, rather than statistically), you'd expect it to be pretty well established after decades of research. Instead, in properly controlled studies and meta-analyses, even where the effect exists, it is small (1.76 IQ points in your example, 2.62 in a study by Horta).
Yep, there are no good experimental designs for breastmilk that are also ethically ok.
What is really interesting about this study is that it is based on a a cohort of pre-term babies in randomised and blinded study from the 1980s [1] - where they randomised between formula and donor breast milk. You can read the conclusions easily from the link, but essentially the donor breast milk fed babies did far worse than the formula fed ones, both overall and in subset analysis. Their conclusion is that preterm babies are in need of adequate nutrition, and, reading between the lines, donor breast milk does not provide this.
Where the paper gets confusing is when we start to look at the analysis of the mother's breast milk, which occurred in a follow-up study in the 90s [2]. Of course, this was not randomised, and was parental choice. The 90s paper showed a significantly higher IQ in those fed with mother's breast milk. I say this is confusing because the later papers mention that the trial is randomised (the result of which showed a negative effect for breast milk, albeit donor), while they are actually comparing two groups in an observational study (mother's breast milk vs not).
So actually, we go back to the usual 'can we correct for everything' in an observational study? We should be very cautious drawing conclusions from observational studies - there are nice examples of these studies showing the exact opposite of the randomised study - for example in this trial which set out to show anti-oxidants prevented cancer [3], they managed to show simultaneously that the obversational findings directly contradicted the randomised findings.
A better study is the cluster-randomised study [4] in Belarus, but even this study has many flaws - it was cluster-randomised, those randomised to receive teaching on the benefits of breast milk also received a lot more input and support from their midwives and hospitals in general. There was a significant difference in IQ between groups, though the measurement was not blinded. There was a trend, but no significance in the difference between teachers rating of the groups.
Another study looking at sibling pairs didn't find a difference between siblings who had and hadn't been breastfed - this is still an observational study, but being siblings it controls for a few more things. [5]
Anyway, there are lots of issues in breast-feeding research. Another is comparing 1st to 3rd world, where other issues, particularly infection risk becomes important. Formula milk contains iron, which is pretty important in cognitive development. Breast milk does not contain any. This may have been an evolved mechanism to protect from infections, given that (almost) all infections require ready access to iron, and may explain the increased risk of serious infections in 3rd world countries.
To sum up, I don't personally believe there is good enough evidence to recommend breast feeding over formula feeding. For a parent it should come down to individual situations. Our first child was slightly micrognathic, which made breast feeding very painful. In retrospect we pursued breast feeding for far too long, and it was causing stress in both mother and child, which I doubt is beneficial to psychological health. Our second kid would only take breast and was easy to feed. Our third took breast without a problem, but was left hungry so needed topped up with formula.
There are at this time 112 comments on this page. I searched for "emotion" and got zero hits, and only one comment mentioned "bonding." A problem with any scientific assessment of the human condition is the narrow focus, and these studies only take into account a few variables out of thousands.
Emotional bonding between mother and child is a huge factor in breastfeeding -- that's common sense that doesn't require scientific validation, although it would be very interesting to see studies from that perspective.
I'd call it handwaving rather than common sense. What does emotional bonding even mean? Are bottle fed children more emotionally distant and less clingy? Remember: in the 1970s, only 25% of children were ever breastfed. Are Gen X-ers emotionally distant compared to boomers and millenials?
I recall articles that say that current teenagers and young adults have closer relationships with their parents then previous generation. However, much more changed in the child raising then just breastfeeding.
Parents that bottle feed (bm or formula) can still bond with their babies. I exclusively pump, and it made me really happy to see that my male partner was able to feed the baby and do a lot of skin-to-skin/holding time in the early days. I love cuddling with my kid too. Bottle didn't change that at all.
What's amazing is that people even feel the need to study whether breastmilk is superior to processed alternatives -- would a zoologist ever recommend baby mammals receive any food other than their mother's milk to facilitate optimal development? Why do humans think they're any different?
Sorry, this comes across as ... really ignorant. Of course there is a need. Some people have to make the decision whether to breast feed or not (e.g. because of medication the mother is taking) and ideally they need this kind of information to make an informed decision.
Let me clarify, I'm not saying that it shouldn't be studied.
My point is this -- people can be convinced by "studies" and people in white coats that formula is similar or possibly better than breastmilk (see the last 50 years of medicine before they came back around to recommending breastfeeding). Studies are obviously important, but logic can't be thrown out the window just because a "study" purports to show something -- if you're going to make a counter claim why something like formula is better or even comparable to breastmilk (as scientists and doctors did for A LONG TIME), you have to have an OVERWHELMING amount of evidence, the burden of proof is on you, you basically have to disprove evolution to prove that formula is in any way comparable to breastmilk from a healthy, well-fed mother -- and good luck disproving evolution!
would a zoologist ever recommend baby mammals receive any food other than their mother's milk to facilitate optimal development?
Why, yes. I'm not a zoologist, but I know giving a replacement milk is the best solution when the mother either is absent for whatever reason, cannot produce milk, or cannot produce enough quality milk. This is why we have milk for infant cats and dogs, actually. Otherwise, the animal would die. There is a similar nutrition for birds (as they don't produce milk) and it is common for folks to buy pigmy goats as an infant and bottle feed them.
Why do humans think they're any different?
We don't. Replacement breast milk saved lives, and these sorts of issues were the original use of infant formula. When applied to current society, it still saves lives and helps to keep folks from financial ruin because some countries (like the US) don't really give mothers time off work to properly breast feed, and it is usually difficult to pump milk at work. At some point while pumping, people usually have to supplement formula as well. As a side note, I was one of the babies that would have died without a wet nurse, as my mother had gall bladder surgery before I was 6 weeks old (fairly major surgery in '78) and could not breast feed.
That's the reason maternity wards have fridges full of donated milk so that at least during the first days/weeks/months of life, especially for those born prematurely, the replacement milk is actual breast milk.
The point about maternity leave is a good one. Obviously countries should have a maternity leave that is longer than the breastfeeding period. That the US doesn't is pretty terrible imho. (This isn't an employer expense in all those countries that have it, it's usually a tax funded system)
And that's a great program, mostly because of the initial health benefits. I do understand breast milk is the best first option, even if you are basically running a modern wet nurse program. But it doesn't seem to replace the need for formula after the initial time frame which is many months afterwards.
Assuming the mother has the time and has no circumstances such as medication or illness that prevents her from breastfeeding why is there a need for formula after the initial time frame?
Because babies breast feed for months, ideally anyway. The hospital breast milk is really important for premature babies (cuts down hospital stays), and is really healthy for newborns regardless. But babies ideally breast feed for at least 6 months (The pediatric society might say much longer than that, easily googleable and telling of my own laziness on searching).
Assuming there are absolutely no medical or circumstantial reasons to use formula (such as the complication with work in my original reply and public acceptance of breast feeding in public), there aren't many reasons. You know, except being able to be away from your child for any length of time in the first months. But this simply isn't reality, nor is breast milk always enough (my mother simply couldn't produce enough milk for my little brother to stay healthy, and his asthma was already a concern). Some women die in childbirth as well. Not to mention psychological concerns (I refuse to have a child. Pregnancy and breast feeding are the stuff of nightmares for me). We need the option there just to make sure all babies have nutrition.
And the more folks push, the more acceptable it is to shame non-breastfeeding mothers. That really freaking bothers me.
I'd say the conditions you listed are wholly acceptable, lack of milk, psychological concerns etc. I fully support women who choose to formula feed.
I've found though that most people push formula more than anything. My partner and I have just had our first baby, she's fully breastfed and barely a day goes by where people ask whether we're supplementing with formula as breast milk does not contain the right or enough nutrition for them.
I side with breast milk first and and foremost if it's a viable option as I'm less inclined to believe large formula manufactures such as Nestle really have the best of interests.
The opposite is actually also true: many people push breast feeding at all costs, and formula is to be avoided for ideological reasons as you stated. Pediatricians hate these people, because it is super important for the newborn to get enough, and many moms can't do it with breast feeding alone. Hence the questions "are you supplementing?" It makes sense why these questions would be common during the first month or two, because hungry babies are such a bad thing.
If the baby is purely breast fed and getting enough milk, you have to probably have add some extra iron to their diet around month 6 or so.
We had to start supplementing early, my wife could never get her production up enough to fully feed the baby. Our pediatrician was relieved we were ok with supplementing, a lot of moms in SoCal aren't and it's a super big issue. They (the pediatricians) seem to be at battle with breast feeding ideologues, people really need to be pragmatic.
I agree pragmatism is the best way forward. As long as production is up though and the baby is putting weight on well I personally wouldn't push for formula nor would my partner.
I think the problem we found with our personal situation was from day one anything that occurred such as baby crying,fussing, not sleeping was attributed directly to poor breast milk by both people we knew and strangers. My partner felt forced to move to formula but luckily with support from our midwife her supply came in well and both baby and mother are happy.
Choices and support are the most important things but if supply,will,health and the option allow a mother to breastfeed I think the benefits do outweigh formula.
Strange, are you in the states? There is a huge push right now for breast feeding in most USA hospitals.
Doctors are pattern matchers, your newborn symptoms could have been in their experience the baby not getting enough milk. If it wasn't the pediatrician, well, they are your best source for the baby's health, everyone else isn't qualified (including nurses, midwives, etc...).
Also, it takes a while for the milk to come in after the baby is born, it is an incredibly tricky process of getting the baby fed where nature doesn't do us many favors. The baby probably was hungry, the milk probably came in later than they wanted, but all is still ok. Finally, you know what goes into baby with formula, with breast milk it is much harder to tell, making the job of determining if the baby is getting enough much more difficult.
Breast feeding has benefits sure, but they aren't so much that it is worth starving the baby. It is a serious tightrope to walk, especially in the first few weeks before production comes in completely (if it does at all, many women have problems).
In Spain. It's been a nice discussion, I do disagree with the statement of you know what goes into a baby with formula. At the end of the day weight gain is the best indicator not to mention the problems of formula fed babies being more prone to sicking up feeds (which makes it hard to 'measure' how much they get).
You can use weight (output) in both cases. But with formula, you also have a good idea of what the input is. Later on you can pump breast milk to get a better idea of input, but that doesn't work well at the beginning.
If you have a colic baby, all bets are off, of course.
In Dallas, Texas, we face the opposite. My wife wasn't able to breastfeed for a variety of reasons. Even when you tell someone that breastfeeding wasn't medically possible for us, people still want to give you advice on how we should have done things differently and how breastfeeding is so much better. There are a lot of women who seem to think that using formula is a hair short of child abuse and are very vocal about it in America, which leads to all kinds of neuroses in those who can't or don't wish to breastfeed.
This could be a cultural difference from here in Spain. Sorry that you both had go through that. Perhaps the common thread we've both faced is that people will judge and interject with whatever you do for your children.
May I ask, where do you live? Where I am at, people push breastfeeding. I find your situation odd. Like if people were pushing soda over water. That does not make sense in this day and age.
You mis-interpreted my statement -- I never said there weren't extenuating circumstances, or that there NO place for formula, in fact I believe it's a necessary evil for many people given their life situation, but that doesn't make it comparable to breastmilk from a healthy, well-fed mother if it's available.
"What's amazing is that people even feel the need to study whether breastmilk is superior to processed alternatives "
Well it would be great to know just if they're different at all. You seem to think it's 'obvious' that breastmilk is always better; I don't see a logical reason to think so, or at least not so strong that it shouldn't be studied.
Yes, the research does show that breastmilk is better. My wife nursed our children until they were 15 and 18 months old, respectively. I'm not some pro-formula-campaigner. But I don't see any reason for naturalistic fallacy-based reasoning, either.
I applaud your wife for investing her time an energy for breastfeeding your children for so long, almost no one breastfeeds that long anymore -- that investment will pay dividends for your children for the rest of their lives.
But I have to ask, how is evolution not an "obvious" reason that breastmilk is a superior source of nutrition for baby mammals? Why would every mammal do best on their mother's milk but somehow humans do better on processed junk food powder that didn't exist until 60 years ago?
Because evolution is not an optimizing process? It easily gets stuck in local optima. Look at what a clusterfuck the 'design' of the human body is: from the susceptibility to all sorts of diseases, to the mechanical problems with the spine as support of our whole body weight, to plain weirdness like the appendix.
Your argument seems to revolve around the difference between humans and other mammals, with that I would agree - I don't see a reason it'd be different. But your argument also relies on the assumption that for other mammals the mother's milk is better. That's the whole question to be investigated - is it really so? If so, what is it in breast milk that is better? And once we figure that out, how can we put that into something that can more easily be manufactured and used, so that all women can get the advantages that breast milk provides? It's not like 'nature' is some magical thing that imbues mystical powers on matter. It's all physics and chemistry. We don't understand everything about it, maybe we only understand a tiny part of it; so that's why we have to do the research.
The truth isn't obvious. In the 1930s, 1940s, 1950s, it was 'obvious' to many people including doctors that bottle feeding with evaporated milk or formula milk was more scientific, more hygienic, and better all round.
>By the 1940s and 1950s, physicians and consumers regarded the use of formula as a well known, popular, and safe substitute for breastmilk. Consequently, breastfeeding experienced a steady decline until the 1970s (Fomon, 2001)
This is exactly what I'm talking about though, evolution was already proven long before the 1930s, and yet doctors went against an obvious evolutionary truth that breastmilk from a healthy, well-fed mother is superior to processed formula all because a few "studies" proved it?? (cough studies funded by formula companies cough)
Well I would tend to agree but I think in many cases the alternative wasn't mother's milk exactly but that of a wet nurse. Perhaps they thought this was a vector for infection.
Evolution primarily serves the population, not the individual. Mother cats reject their runts, for instance. That's bad for the kitten - kills it but benefits the rest of them.
We tend to care about the individual more than the population, so we treat sick children instead of letting them die. Since nature isn't always helping, maybe natural food isn't always the best option.
Agree is not teleological, it was not my intention to imply it is.
There is some polemic about the gene idea (1), but it seems to me that the discussion is more about semantics, and, that from an information point of view, it's the gene the minimum unit that is "learning" about the environment.
The shape and behaviour of a molecule is depending of the constituent atoms. I suppose, you could express it the other way, but at the end of the day, is the most fundamental units what give us the most useful explanations.
Definitely strikes me as semantics but if you view "the population" as a bunch of very mature Chromosome pairs (human beings), then what's the difference?
Natural selection can send a specific gene mutation into an immediate dead end, but presumably across all mutations, it's a net positive for the entire population as they become generally better adapted.
This originated from Dawkins (The Selfish Gene) but, IIRC, is more of "evolution can be understood in terms of the gene". And there are criticisms of that, like that it doesn't take in to account phenotypes.
Nature "learns" by trial and error while humans have the capacity to reason about things. In the long run intellect will win (although in most cases we are far far from that point).
I think GP means to that for many problems, the time span for finding a local optimum in an evolutionary way ("nature") is longer than in a scientific way ("human trial and error + reasoning").
Of course, there are probably species that burn through a few generations per hour but these are not really suited to solving problems that mammals can.
>I think GP means to that for many problems, the time span for finding a local optimum in an evolutionary way ("nature") is longer than in a scientific way ("human trial and error + reasoning").
For some problems regarding the functioning of living things yes, but for other problems evolution doesn't apply, and nature (aka the universe) can "strike" before science had the time to find anything to protect against them (e.g. a meteor hit).
And for other problems still, science might be the one that created them (e.g. nuclear annihilation, global warming, etc).
>Of course, there are probably species that burn through a few generations per hour but these are not really suited to solving problems that mammals can.
No, but some of them could e.g. mutate and kill all humans or enough to destroy civilization.
The work of Karl Popper suggests than human knowledge also progresses in an evolutionary manner, by conjecture and refutation. So something resembling natural selection must be going on in our brains.
>The work of Karl Popper suggests than human knowledge also progresses in an evolutionary manner, by conjecture and refutation.
Human knowledge in general might, but I'm talking about how humans take action and shape the world around them vs how evolution does.
Conjecture and refutation are not like random mutations -- that's just the "survival of the fittest" part of evolution, which is not the actual mechanism and which applies to everything (after all, anything that survives is fitter that what didn't).
Breastfeeding makes it harder for women to escape traditional gender roles at home (dads can get up in the middle of the night to feed the baby a bottle, but can't breastfeed; pumping isn't much easier than just breastfeeding). It also makes it more difficult when mothers return to work. It's also just inconvenient and unpleasant for a lot of women.
Obviously, before anyone makes that sacrifice, it makes a lot of sense to study whether it has any corresponding benefits.
Giving birth is a gender role, a biological gender role. Breast feeding, what the breasts are biological designed for in women, is not a gender role, it is a biological role. Having children requires sacrifice for both parties.
Do you think most men want to go sit in an office all day doing menial tasks to support their family? Since office work is fairly split evenly by gender, do you think men want to go work on oil rig or construction site all day to support their families?
Gestation and feeding are social roles originally assigned to women due to their biological capabilities. But technology has decoupled the feeding role from the lactating capability. It will soon also decouple gestation from natural pregnancy.
And judging by the fact that women have rushed into the work force while men have not rushed home, I do think it's fair to say that people would rather be sitting in an office than chasing a toddler around the house.
Well, because there aren't always options for folks to avoid pregnancy nor get an abortion. I'd have been sterilized before I was 20 if it were an option to me. I've not had the unfortunate experience of being pregnant, though, and I'm 39 now. Happily childless.
And because some folks have kids first, then find out how horrible it is. The first child doesn't always seem horrible, so they have another.
And because even happy parents find a lot of the work involved absolutely horrible. I'm not sure if anyone gets joy out of waking in the middle of the night to feed the baby, change an overflowing diaper of shit, and/or deal with spit up and so on. Older children keep doing pretty disgusting things for years to come.
Even jobs taking care of folks are considered low-rung, crappy jobs with horrible pay.
Just because I'm childless doesn't mean I'm not aware of what others go through, nor does it mean that I've not taken care of children or infants. 'Tis part of the reason I'm childless.
Edit: Besides, me being childless is exactly why I'm qualified to answer part of this question. I understood that, for most of my life, I had to hope that the birth control methods available to me didn't fail (basically condoms, since I can't tolerate hormonal birth control and couldn't afford to be sterilized, if I could even find a doctor).
Seeing what other go through and taking care of others children is not the same as raising and caring for your own children. Regardless of how much you want to disagree with me, an individual's opinion without children holds little weight.
Its equivalent to taking relationship advice from the neckbeard down in his mother's basement.
That's like asking "why would you buy clothes if you think doing laundry is the worst job in the world?" Having kids is great, but taking care of babies and small children is often tiring, boring, dirty, and thankless. Some people like it and that's great for them. But we've also got this massive cultural hangover where we tell women how great and wonderful the job is because for the longest time, we didn't give them the choice not to do it.
Speaking of laundry, it increases by quite a bit. So yes, their comparison is a good one, though it understates the drudgery of taking care of children.
If you laser focus on "breast feeding" yes the male cannot do that. If, however, you look at it from a "breast milk" standpoint, the male absolutely can take care of that!
I certainly had no problem warming up refrigerated breast milk at odd hours of the night for all three of my children.
I think everyone should pump and freeze. At the very least you'll be more comfortable. The bonus is that you can make your significant other feed the kid!
Men can do almost everything associated with the traditional gender role of motherhood, save gestation and breastfeeding. And if any man actually wanted to do those things, we'd be working on the technology I'm sure.
I'm not sure what your point is. Men already become parents all the time. And it's true that motherhood and fatherhood are very important jobs that collectively we really should not be trying to "escape" from. I'm pretty sure the whole point of the push for paternity leave is to let people embrace these roles rather than run away from them.
We're not talking about parenthood in the abstract, but rather traditional gender roles. I.e. where it's the woman that gestates and breastfeeds the baby, and then stays at home and takes care of it. Women have been aggressively trying to escape that gender role ever since we made it possible for them to do so. The vast majority of mothers work, women have far fewer kids than before, etc. Men, meanwhile, have not rushed to take on those supposedly wonderful and fulfilling duties.[1]
We can conclude from these observations that the traditional female gender role isn't all that great, and that there is a lot of value in technology (for now, formula, but soon, artificial wombs) that reduce the need for anyone to do that work.
[1] There is an increased push for paternity leave because dads want to spend more time with their newborns, which is different from wanting to embrace traditional female duties. And a huge part of that push is to set the stage for women to escape their traditional gender role. Dad being more involved from the beginning means that, in the long term, it will be easier for dad and mom to share child-rearing duties. It's harder to do that when, e.g. the child reflexively runs to mom any time it needs something.
Why not? I've never wanted children. I'm female. I'm tired of being told I should want to be a mother, have children, or anything of the sort. I don't WANT children. I have absolutely no desire, and comments like that make me wish I were male so I wouldn't have to deal with it.
Legs are natures' intended way to get around. I don't get why people even wonder if processed alternatives like cars or bikes might be superior to running.
Isn't that what GP is saying though? Cars and bikes are superior to running in the fact that they take you to the destination faster. But a person running everywhere will undoubtedly have better development of their leg muscles than a person driving around (assuming no other physical activity). So, at least in the context of leg muscle development, running is superior to cars and bikes.
Even if you take it as a given that it has a positive impact, it's useful to study to better understand the scale of the impact. When evaluating multiple interventions and not having the resources to do all of them, it's useful for policy makers to better understand the cost/benefit analysis and make informed decisions.
We shouldn't do it because we already know? How do we already know, based on what?
We don't know what a Zoologist might recommend in 10 years when new results are found from studies like these. That's exactly why studies like this are done, so we all learn.
Never said there weren't extenuating circumstances, but that doesn't make formula in any way comparable to breastmilk from a healthy, well-fed mother, only that it's a necessary evil sometimes.
My wife went through undue torture and stress due to all the breastfeeding virtue signaling. She was simply unable to produce enough despite her best efforts. My kids are 12 and 7 now and both have proven to be quite intelligent.
Yeah, I havent seen any anecdotal evidence of the contrary, and I have seen multiple cases in my own family of kids not being raised on breast milk and they all fared well later in life.
Surely it depends on the health and diet of the mother. My understanding is that there is little benefit to breast milk over formula unless water supplies are poor quality and definitely formula is better when the mother is malnourished.
While this comment has been downvoted at the time I write this, it has some good points. First, malnourished women still make pretty decent breastmilk, although there's a point at which that is no longer true. Second, it is abusive to institute practices like routinely separating mother & infant at birth, which dramatically impacts breastfeeding success for the worse. Formula is expensive and breastmilk is free (although it certainly takes time and effort, and pumping isn't free). Fostering dependence on a commercial product when it's not necessary and the parties involved are poor is really immoral. When you have a choice between formula and diapers and bus fare to your job... what do you choose? Your breastmilk has dried up and letting the kid starve is not an option. (Plenty of moms in this situation do water down the formula a bit to try to stretch it a little longer, and this has its own harms, but they're reasoning that missing the bus is the first step on a path to homelessness which is also a great harm.)
What country are you talking about? Are you familiar with WIC? In the US there's no woman from sea to shining sea who should be going without formula unless she sold it to buy drugs! And if WIC won't provide enough, there's literally thousands of churches and other charities out there falling all over each other to help infants in need.
Some people choose not to breastfeed because it is a pain in the butt (or, rather, pain in the breast). If they are educated on why breast milk is a better choice then more people will choose to breast feed.
I sure hope you aren't implying that those that choose formula are uneducated on the matter. I can assure you that isn't generally true.
When my kids were born I was kind of shocked at the level of pressure put on my wife to breastfeed. Advocates made formula feeding sound like borderline abuse.
There are many reasons why someone might choose formula feeding (and some reasons are better than others) but the last thing breastfeeding advocates should be doing is making new moms that are on an emotional rollercoaster to begin with, feel like they are a failure and bad mother if they can't or won't breastfeed.
I am not implying that. Education is different from pressure. Some people apply a lot of pressure, which I too think is ridiculous because of how hard it is to breastfeed. You are not a bad mom because you are not breastfeeding. I think the pressure is a separate issue.
To be more clear, specifically what I am talking about is that I know some women who have chosen not to try because they have heard it is very hard, and maybe some additional facts of its benefits (not just pressure from people that condescend) might have convinced them to try, or convince some women to do it longer. Everybody says it's good, we all know it's good. But nobody likes to do something just because someone else said it's good for them. They want to know why.
Why would it matter what a zoologist recommends? Do they have evidence to back up their recommendation or are they just guessing? That's all that matters.
It's funny to me that everyone shits on Soylent and how obviously bad it is and yet needs a PhD to figure out if they should breastfeed instead of giving their newborn "formula". Have any of you looked at the ingredients in formula? It's garbage.
Even George Costanza knows it's okay to eat garbage if it's on top.~
People in general are way too picky about what they shove down their gullets. It's just chemicals, and the chemicals in formula are close enough to natural milk that it won't kill fragile human babies. Likewise, the chemicals in Soylent are close enough to food that you can quaff it in lieu of eating.
The only problem is determining which chemicals are actually important, which is somewhat difficult, because yadda yadda yadda unethical human experimentation....
But that wire-mom vs. cloth-mom monkey experiment should also suggest that there's more to breastfeeding than just nutrition.
Sightly offtopic, but recent or prospective parents on HN may appreciate the book "Expecting Better" by Emily Oster, which takes a critical economists eye to advice and studies about pregnancy. Sort of in the vein of Freakonomics.
Apart from claims of positive IQ impact, breastfeeding has many other proven benefits (as widely reported by WHO and in Sweden): "Breastfed children are at a lower risk of infections such as acute otitis, gastroenteritis, and respiratory tract infections. ... Women who have breastfed also receive health benefits through a somewhat reduced risk of developing breast and ovarian cancer and diabetes type 2."
to all expectant mothers nervous about whether you should breast feed or not, it's definitely a huge and important decision, so i have devised an experiment you can undertake right now to try to gather more data so you can make an informed decision.
ask your husband* to suck your nipple then gauge reaction, offer a favorite bottle as an alternative just to be sure.
1. Small sample sizes.
2. Significance was only found in one subset of the population. Given enough ways to divide up groups of people, you will almost always get false positives.
3. Not an experimental design.
4. The study did not control for simple factors like income or the health of the parent.