What are the risks of exclusive formula feeding?

[catsypug]

I've just been reading through some very interesting and amusing old threads about mothers who don't breastfeed (started by Milkgoddess)

A couple of times 'the ignorance about the risks of formula feeding' was mentioned - the word 'risks' is a little worrying. Not sure whether it was just emotive language from a staunch pro breastfeeder, or there are real serious risks

If it's the immunity building/correct nutrients issue, then in my experience - I was BF and I had asthma, eczema and sinus problems as a kid. I BF my DD for 4 months and she developed terrible eczema due to an egg allergy. My DH and his siblings never had a drop of breast milk on their lips and they are all strapping healthy beings.

Thanks - just really want to make sure that not breastfeeding this time round is definitely the right decision for an already knackered mum

if it feels right to you to FF, then do it. happy mum, i say.

FWIW, i was FF and have nothing 'wrong', same with both ds's. I am BF-ing dd now, (my third)and i actually really enjoy it. it doesnt make me more tired, and i enjoy the time to sit with her and feel close.

catyspug, good question But quantifying risk for an individual person is impossible. So no one can say that if you ff, your baby will experience x, y or z, or that because you were breastfed, you should not have experienced a, b or c.

Here are some hints of sorting it out in your head:

• every 'benefit' of breastfeeding is actually a 'risk' of formula feeding. So if bf babies get x per cent less diarrhoea/gastroenteritis/ear infection or whatever else, the stat is really that ff babies are at increased risk of this (and the percentage risk is not the same as the percentage benefit...this is a maths thing that I can't explain, sorry, 'cos I can't get it straight for myself!

• ff babies are more likely to spend time in hospital in the first months of life, and partial formula feeding (that is, partial breastfeeding) has a partial effect - more ff = more hospitalisation. There is a lot of research confirming this, in the UK and elswhere

• all good studies control for social and other factors, so it is the method of feeding that is compared, not the backgrounds or the family of the babies concerned

• 'serious' risks are not quantifiable and may be multi-factorial. I mean, cot death is a serious risk, but it is rare. Ff increases the risk of cot death - but it is not the only factor. The same applies to childhood cancer and breast cancer in the mother - serious conditions increased by the use of formula, but ff is not the only factor

• 'minor' illness increases with formula feeding, but these minor illnesses are not life-threatening in the UK and babies normally make a total recovery (though that's not to downplay the misery of, say, an ear infection which can be painful and recurrent)

• some so-called 'benefits' of breastfeeding are reduced if the breastfeeding does not last for long, or if it is only partial breastfeeding. For instance, someone might say a baby was breastfed, but in reality, the baby was breastfed for a few months only, and formula was used alongside the breastfeeding. This introduces an increased risk. The less formula, the better

• no one can say with any certainty that ff has had no effect on them or an individual baby; maybe the lack of a few IQ points might have made a difference, maybe a health effect has yet to appear (say, with breast cancer, which increases if you were ff yourself) as infant feeding can have life-long effects

None of this is, I hope, scare-mongering. I believe parents should be trusted with as much information as they need. People on the whole can understand that what they see around them or observe from direct experience is not the same as research which looks at many. many people longer-term. Our own experience is powerful, but in research terms, it is only one very small sample!

Hope this helps

Just to add, catyspug, the asthma and eczema points you raise are ones where there is not much truly robust evidence linking protection from them with bf, because it is so difficult to study large groups of exclusively breastfed babies...and if there is protection, then it is probably dependent on excl bf. We really don't know, though.

I am not sure about the sinus problems.

Thanks Tiktok I didn't realise there was so much more to it.

I was wondering why I knew quite a few people and kids who had been BF and who seemed quite sickly with allergies and the like - plus two little boys I know who have terrible recurrent ear infections - all were exclusively breastfed - I wondered whether although Breastmilk is natural and right and obviously superior to 'packet food' formula, it wasn't the liquid gold it was bandied about to be and what's in your genes is in your genes, no matter what you eat or drink - kind of like the hereditory cancers and other diseases.

I did really enjoy BF my DD once all the problems with it had stopped, but when I stopped I realised I preferred not BF. I definitely felt an increase in energy - not being my babies sole source of food - I looked better and enjoyed having a break from her now and again.

But my life is in a very different place now to what is was when I only had her. It's only yesterday that I finally made up my mind - I've had a terrible pregnancy, so unenjoyable it's put me off being pregnant again which is something I thought I would never think - I've really neglected my 2.5yo in these last few weeks because of all the illnesses and exhaustion and I want my energy back up quickly. I honestly think cracked nipples, mastitis and low energy would send me into depression (I have not much support from family and DH is tied to his work for the foreseeable future)

I'm in 2 minds again

I am not sure how to respond, catyspug - anyone who tries to convince someone that their baby will never get ill if they breastfeed is clearly delusional and I have never come across anyone like this! I hear the phrase 'liquid gold' and I don't think it means 'babies won't ever get ill', but rather that it admires the way the human body produces the exactly appropriate food for the young of our species

The little boys you knew who had recurrent ear infections might have been a lot worse if they had been formula fed, who knows? The evidence linking formula to ear infection is pretty strong, and not controversial. It is also 'dose related' - the more formula, the more ear infections (and the more breastfeeding, the fewer).

Breastfeeding doesn't have to be painful, and it doesn't have to go on longer than you can bear it, so it is not something you have to decide on now if you don't want to.

There is no doubt about it, though, that formula feeding puts babies at risk of a number of conditions, and the effect of these is not known. However, most babies grow adequately on formula and do not become seriously ill, and for some mothers, using formula is a more 'comfortable' option, especially if they have had a poor experience with breastfeeding. Avoiding postnatal depression is really important, too.

Support from the family certainly helps with breastfeeding, and without this, it can be more difficult to do.

So over to you

"anyone who tries to convince someone that their baby will never get ill if they breastfeed is clearly delusional"

Yes - I've not heard anyone say that breastfeeding is a guarantee of good health. But I've heard many people report having heard someone say it or imply it.

Odd really.

I have previously mentioned the risks and so if it was me then I will try to explain risks in objective rather than emotive way.

A history of allergies/excema often runs in families and I understood that breastfeeding protected against allergies DURING the weaning period when you are introducing the new foods whereas you would have stopped before weaning or just as weaning is about to start.

I am reading a book called Sucessful Breastfeeding by the Royal College of Midwives. It is very informative. In brief the issues around formula feeding are:

Composition, Formula is composed differently, Formula has less calories, more protein, less fat and varying levels of carbohydrate. Higer levels of protein in formula have been linked to increased allergies and a 1.5 - 2% increased risk of developing insulin dependent diabetes. There are also vitamins, minernals and other trace elements available in breastmilk which are unavailable in formula milk. For example 70% of available Iron is absorbed in breastmilk but only 10% in formula.

Errors in manufacture and preparation leading to bacteria or other contamination.

Controlling intake, Breastfed babies can control their intake whereas mothers control bottlefeeding.

Protection against viral, parasitic and bacterial pathogens.

Breastmilk has loads of enzymes, anti-iflammatory agents and growth factors not present in formula.

Bottle feeding has been associated with:-

Increased risk of

gastrointestinal problem(5 times more commom)
respiratory problems
ear infections (3-5 times more common)
urinary infections, necrotising entercolitis,
atopic disease in families with a history
increased risk of SIDS and diabetes
reduced cognitive development
decreased visual acuity
reduced IQ

....for babies

For mums the risk of not breastfeeding means more than doubling the risk of osteoportic hip fracture and increased risk of breastcancer.

Also while a baby feeds for 6 feeds per day your periods are unlikely to return and therefore a woman is more likely to conserve iron and have free contraception.

In terms of the economics, the costs of the NHS of extra admissions, visits to GP and prescriptions has been quantified, if 300 UK towns acheived breastfeeding rates of 90-95% as in Norway or Finland the National Health Service would save £67 million per year.

It's up to you though, risks are risks not certainity, after all we all know some smokers who live to 90 but others who haven't been as lucky!

When we discuss smoking tobacco we don't say that not smoking has benefits, we say that smoking has risks. This is because not smoking is the Biological Norm, smoking is the artificial influence that impacts on health.

As such, breastfeeding is the Biological Norm, and not breastfeeding (using formula) is the artificial influence. So, breastfeeding imparts no benefits, it gives babies (and mothers) optimal health in respect of thier own genetic predisposition. To not breastfeed (use formula) reduces the possible health and development of the baby and mother.

So, breastfeeding does not reduce your risk of developing breast cancer, not breastfeeding increases it. Breastfeeding doesn't protect your baby, not breastfeeding leaves them without the protection that nature has designed them to get.

Diane Wiessinger puts it better than I can!

Monkies

(and before anyone jumps on me, I'm not comparing formula to tobacco!)

Neither was I comparing bottlefeeders to people who smoke. That's a great article Monkies!

Poobah, have you got a linky for that economics info please? - about the savings to the NHS. (I'm very interested in that stuff.)

Yes, when the issue of formula feeding is explained in economic terms, it puts a whole different perspective on things. I'm sorry I haven't a link but it's in a book called Sucessful Breastfeeding published by the Royal College of Midwives.

Thanks Poohbah, might try to get hold of a copy.

Terrific article Monkies.

Oh crap!

Thanks everyone for all the really informative replies and for posting the interesting article.

When I originally asked what the risks of FF were I was kinda hoping for responses of the 'nothing, don't worry - you just do what you want' flavour so that my conscience wouldn't be too irked! This is all extremely guilt inducing and really does make you feel like you're opting to feed your new baby poison if you don't want to breastfeed.

If only the other option to breastfeeding was just as good

I don't know what to do. When I finally decided this week I wasn't going to BF this time round I felt liberated. (not BF hadn't really been an option up to this point)

It has really been a horrendous pregnancy that I just want OVER (6 weeks to go and counting), we don't have ANY support this time and I am also in sole charge of a 2.5yr old, at weekends as well as all week mostly due to my DH having his own business.

I had a hard time with mastitis and cracked nipples the first time before finally getting the hang of it and enjoying it, but it did make me feel lacking in energy until I stopped and I must admit, stopping after 4 months made me feel liberated. I'm not as healthy this time as I was the first time round and feel like the baby would be sucking out all my remaining life force!

I'm now thinking of doing the colostrum and then seeing how I feel....but sadly, I know deep down that I would really like not to as well.

catsypug - I hope you don't mind me saying this, but do you think the tiredness you felt with breastfeeding last time, and that you are anticipating again this time might be more a mental than a physical thing? I think one of the emotionally hardest things about breastfeeding is the sense that your baby is solely reliant on you. I've heard so many people describe having a sense of 'space' when they stopped breastfeeding. I'm wondering if there would be any other way of you finding that sense of space as a mum while breastfeeding? What is your situation at home? Do you have help? Can you have any time for yourself? What about expressing? Have you had any success with that in the past? I studied and/or worked all the way through my pregnancies and picked up the threads very quickly after the births, even after my last baby, who is only 22 months younger than my middle one. Going to tutorials and writing essays gave me head space that stopped me feeling as though my whole life was just being a lactating mum - it gave me psychological space that was really valuable(not physical space as I took my baby with me to tutorials). I'm sure other mums here have their own ways of finding that sense of freedom that keeps them going through those intense, early weeks with their baby.

Hope you don't mind me putting this thought forward.....

catyspug, no one can 'make' you feel anything. No one has said you are opting to feed your baby 'poison' and it is not up to anyone here to say 'feel good' or 'feel bad' or 'feel anything' about your choices....the responsibility rests with you to do what you feel is best, and it's no one's business to comment on your choice (unless you actually invite them to do so - and even then, I'd hold back because when people ask for comments they don't always really and truly want 'em!).

The health effects of infant feeding are only one factor in this choice - you asked about the health risks of formula and they were shared with you. Clearly, this was a factor that weighed with you, as you asked about it.

Facing up to making choices that other people voice their disapproval of - whatever they are - is part of being a grown up person. Sounds as if you breastfeed, you will face the disapproval of some of your family, or at least their lack of support. If you formula feed, you won't feel that from your family, but there may be an 'inner voice' disapproving of it - I don't think you will get any disapproval from anywhere else.

So it has to be up to you, to 'own' your choice and to 'own' your feelings

Yeah you're right - it isn't anybody elses responsibility to make the choice but me.

The initial elation I felt this week at making my no-BF choice has quickly been replaced with heavy guilt and worry.

My situation is not one of disapproval or approval from family - it's one of having no family around me at all to help. Parents have just retired to Spain and I barely see them. In-laws are in Scotland. My DH isn't around - he has his own company and it's a full time commitment at the moment so we don't see him from early morning to late at night and not at weekends either. Just moved to new area so no close friends nearby. My DD is only at nursery from 1-3pm, 3 days a week. We don't have the money to pay for support.

I've been in and out of hospital throughout this pregnancy with bronchitus, sinusitus, suspected blood clots on the brain - I now have SPD and anaemia and I'm just totally fed up! I think what you've said about 'space' Sabire is totally what I'm feeling. I suppose at the moment I'm feeling like I want that distance and freedom asap and not bf would give me this.

But, it's also been a while and I suppose there is a lot of detail I have forgotten - maybe because of how my health has been recently I am making BF out to be much worse than it actually is

I guess I need to see how I feel at the birth I think

Yep - keeping an open mind is good. You don't have to decide now

Bf support does not cost anything.

With a dh so off the scene and no family support, bottle feeding could be harder work than you think....once bf gets going and working well, it is less of an 'imposition' than formula feeding, which needs preparation, shopping, cleaning and sterilising.

More food for thought

catsypug - I feel for you. I've been ill with some sort of liver problem since January and I've had sinusitis on and off for months so I know how low it brings you. Sinusitis sounds so trivial to other people but it really grinds you down when it goes on and on. I actually stopped bf my toddler in January because I was on my knees with exhaustion (wish I hadn't now tbh as it didn't really make much difference physically). I think health problems can make you so depressed - you lose confidence in your ability to cope with the normal day to day things involved in being a mum.

Do you have a decent GP? I think you need to see your doctor and talk about what you can do to improve your general health. Maybe some physio for the SPD and a referral for your sinusitis. How good is your diet? Have you tried Spatone or Floradix for your anaemia? I'm also wondering whether you might be suffering from antenatal depression - it would be completely understandable given your worries about your health, your lack of family support and the fact that you're spending so much time parenting along because your dp is out of the house so much. Perhaps you could talk to your hv and see about getting in touch with some other mums locally who could provide some moral support after the birth? Would the suggestion that you contact your local branch of the NCT give you an attack of the horrors? I know it's not for everyone but some people find the support they get through it fantastic.

Anyway - hugs to you - hope you feel better in yourself soon. I'm sure that once you feel physically stronger things will fall into place.

Catsypug - I had SPD and it must be very difficult trying to pick up or run after a toddler with SPD. The great news is that it does go quite quickly after the birth, mine felt better as soon as my waters broke. I had no support and a hubby with depression who was trying to set up a business when I gave birth so also sympathise with that aswell. I didn't know about them then but there is a charity called Homestart, they have volunteers who can offer practical help, google them, and give them a call.

The first four months were difficult but then everything suddenly got much easier so I wonder if that happened with you and then you linked everything being easier to bottlefeeding?? Perhaps not but breastfeeding itself does get easier after about that time so you got the problems but not the joys if you like so have been left with a negative perception.

Floridix is really good but also delaying your periods by breastfeeding will help your anaemia.

Good luck with whatever you do!

Why not plan to bf for 2 weeks and see how it's going at the end of that time?

I think Sabire's point about having some space is really important.
I found b/feeding first baby hard work for a lot of reasons. With second one,I had a 3 year old, my dh went abroad when baby was 3 weeks old (only returing for a week every six weeks)and I was moving house.

I'm not trying to say i was so great for managing but I did find it so much easier second time around. I had to express once a day from baby being 1 week old to get on with moving house and to see a physio regularly as I had a very bad shoulder and back.

Oddly, these two things did seem to give me some space of the sort Sabire mentions which was good as I am not a person who can sit on a sofa for hours on end. I just wantto get on with stuff. (I had five people around for dinner about 10 days after he was born!)_

cats, i suffer from antenatal depression. this is my third time round, so i know where you are coming from.

regardless of your decision - i was on the fence myself with this one, no.3, because i'm in the same boat, but will give BF a go for at least the fortnight that DH is home and off on leave and then take it from there - please see your GP or midwife with your concerns.

i had dreadful sinusitis with DD2 AND awful acid reflux. between the two, i was waking up once an hour, when i was able to fall into sleep at all, often with full blown panic attacks from choking on my own acid or my sinuses clogging up, not to mention having to try to sleep in a recliner.

i also had terrible anaemia and even Spatone gave me diarrhoea. i couldn't take hte prescribed tablets at all.

i was SO exhausted when i went into labour with DD2. i worked full time until a few days before i had her.

i know where you're coming from!

i gave it a bash, however, and she was so much easier to feed than DD1. she took to it really well, although she did chew my nipple from bad latch, a kind NCT counsellor spent the night at our place and helped me get her on at every feed all night.

she saved it for us. and although i had to go back to work when DD2 was 4 months, we did BF successfully till then, whereas without just that one night of help, i almost certainly would have thrown in the towel.

getting treated for AND and PND made all the difference for me.

please see your GP with your concerns about how you are feeling.

how about just thinking along hte lines of, if you decide to try, that is, 'i'll just do it today and see how it goes'?

i wish you luck.

Cats, let's put this into some perspective. I'm the youngest of four. My older brother and oldest sister were BF. My youngest sister and I were FF. There is nothing to choose between the four of us in terms of health or intellectual ability except that my BF sister is the only asthmatic in the family. Oh and the fact that I'm 6'5" (obviously really cracking formula back in the 60s).

I realise that this will seem very simplistic to some but this is an incredibly emotive issue and, whilst I have no doubt that BF is very beneficial, it is worth bearing in mind that millions of people have been exclusively FF with no ill effects whatsoever.

With our 2 DDs my DW BF DD1 four four weeks until we simply had to give in and supplement her diet with formula. She was simply too rubbish at BF and was losing dramatic amounts of weight. She took to it immediately and all three of us cheered up as a result of which we now have a strong, healthy, happy 3yo.

If you can BF even a bit it's probably a good plan. If not then for God's sake don't beat yourself up about it (and don't let anyone else have a dig at you either.)