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.
(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.