Hold the guilt! New study finds benefits of breastfeeding dramatically overstated.

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Gee, who could have seen this coming?

I, and others, have been pointing out for years that although the benefits of breastfeeding are real, they are small and restricted to relatively unimportant risks like colds or episodes of diarrheal illness during the first year of life. To hear lactivists tell it, however, breastmilk has super powers and women who do not breastfeed are bad mothers.

Now a new study, Is Breast Truly Best? Estimating the Effects of Breastfeeding on Long-term Child Health and Wellbeing in the United States Using Sibling Comparisons by Colen and Ramey, confirms what the scientific evidence has shown all along. The benefits of breastfeeding are trivial.

This, in many ways, is the study that we have been waiting for. We have always known that breastfeeding varies among ethnic, cultural and economic groups and indeed, previous studies that corrected for these factors show that breastfeeding has only small advantages. The new study looks at breastfeeding vs. bottlefeeding WITHIN families by comparing siblings who were fed differently.

The authors explain:

Breastfeeding rates in the U.S. are socially patterned. Previous research has documented startling racial and socioeconomic disparities in infant feeding practices. However, much of the empirical evidence regarding the effects of breastfeeding on long-term child health and wellbeing does not adequately address the high degree of selection into breastfeeding. To address this important shortcoming, we employ sibling comparisons in conjunction with 25 years of panel data from the National Longitudinal Survey of Youth (NLSY) to approximate a natural experiment and more accurately estimate what a particular child’s outcome would be if he/she had been differently fed during infancy.

The paper is 55 pages long and packed with charts, graphs and statistical analyses. The authors analyzed the impact of breastfeeding vs. bottlefeed in the whole group, between different families, and within the same family.

What did the authors find?

In Table 3, we present descriptive statistics by breastfeeding status (yes/no) for the eleven outcomes of interest across three different subgroups – the full NLSY-Children’s sample, the sibling sample, and the discordant sibling sample. Results for the first two subgroups are remarkably similar. Mean levels of BMI, hyperactivity, math skills, reading recognition, vocabulary word identification, digit recollection, and scholastic competence as well as the percentage of respondents who are obese all appear to significantly (p < 0.05) differ between children who were breastfed and those who were not and are in the predicted direction, with breastfed children exhibiting better outcomes. When the sample is restricted to discordant siblings, mean scores across all eleven indicators of child health and wellbeing are comparable and differences between breast- and bottle-fed respondents are small enough to be attributable to random chance alone.

Here is a modified version of Table 3:

Breastfeeding siblings

I modified it to make it easier to read by color coding each group and by masking the number of individuals in each group. You can find the original chart here.

The authors explain:

Findings from the full sample (Model 1) suggest that children who were breastfed during the first year of life were significantly better off than their bottle-fed counterparts. Asthma was the only endpoint of interest that did not adhere to the expected patterning of results, in which breastfed children do better than their bottle-fed counterparts. Results from Model 2 demonstrate the consistency of our findings between the full and sibling subsamples. With the exception of one outcome (hyperactivity), regression coefficients remain remarkably similar between Models 1 and 2, standard errors increase only slightly, and the conclusions that can be drawn are virtually identical.

The most stringent test of the hypothesis that breastfeeding during infancy positively influences long-term childhood outcomes occurs when we include fixed effects for each NLSY79 mother, thus limiting comparisons to within rather than across families (Table 4, Model 3). What is most striking about these findings is the extent to which regression coefficients are attenuated, with a few even changing signs. Furthermore, none of the estimates maintain statistical significance (p < 0.05)...

In other words, there were difference between breastfed and bottle fed children in 10 of the 11 measured variables when looking at the overall group. Those differences persisted when comparing families in which all the children were breastfed to families where all the children were bottlefed. But when the authors looked within families, there was no significant difference between breastfed and bottle fed children.

Simply put, looking within families takes ethnic, cultural and socio-economic factors out of the picture. When you do that, you find no difference between breastfed and bottlefed children.

Colen and Ramey also looked at the impact of duration of breastfeeding and found the findings were the same:

…Findings from Model 1, which reflects the standard multiple regression approach, illustrate that each additional week of breastfeeding is associated with significant decreases in BMI, the odds of obesity, and hyperactivity as well as significant increases in parental attachment, math achievement, reading recognition, vocabulary identification, memory based intelligence (WISC), and scholastic competence. Results from Model 2, which is restricted to the sibling sample, are almost identical to those from Model 1, suggesting that selection into the sibling subgroup is not likely to bias our findings.

Finally, estimates from fixed effects regression models that limit comparisons to those occurring within, as opposed to between, families reveal a different story – one in which breastfeeding for longer periods of time does not necessarily result in better childhood health and wellbeing. When moving from Model 2 to Model 3, the coefficients for PIAT Math, PIAT Reading, PPVT, and scholastic competence decrease by 79%, 83%, 92%, and 88%, respectively. Moreover, the sign of the coefficient is not only reduced but actually changes direction for three additional outcomes (BMI, obesity, and WISC)…

Once again, it appears that breastfeeding improves a variety of health and educational outcomes, but when hold ethnic, cultural and socio-economic factors constant by looking only within families, the improvements not only vanish, but in some cases the breastfed children do poorly compared to their bottlefed siblings.

The authors summarize their findings:

Results from between-family comparisons suggest that both breastfeeding status and duration are associated with beneficial long-term child outcomes. This trend was evident for 10 out of the 11 outcomes examined here. When we more fully account for unobserved heterogeneity between children who are breastfed and those who are not, we are forced to reconsider the notion that breastfeeding unequivocally results in improved childhood health and wellbeing. In fact, our findings provide preliminary evidence to the contrary. When comparing results from between- to within-family estimates, coefficients for 10 of the 11 outcomes are substantially attenuated toward zero and none reach statistical significance (p < 0.05). Moreover, the signs of some of the regression coefficients actually change direction suggesting that, for some outcomes, breastfed children may actually be worse off than children who were not breastfed.

Colen and Ramey are mindful of the policy implications of their findings:

Efforts to increase breastfeeding that solely focus on individually based behavior change without addressing the economic and social realities women face and the difficult tradeoffs they are forced to make in the months following the birth of their child risk alienating and stigmatizing the very women they hope to help…

… A truly comprehensive approach to increasing breastfeeding in the U.S., with a particular focus on reducing racial and SES disparities, will need to work toward increasing and improving parental leave policies, flexible work schedules and health benefits even for low-wage workers, and access to high quality child care that can ease the transition back to work for both mother and child. Hopefully, this multifaceted approach will allow women who want to breastfeed to do so for as long as possible without promoting a cult of “total motherhood” in which women’s identities are solely constructed in terms of providing the best possible opportunities for their children and the risks associated with a failure to breastfeed are drastically overstated (Wolf, 2011).

Simply put, every mother should be able to breastfeed for as long she wants to do so, but there is no reason to make women feel guilty if they don’t want to breastfeed or don’t want to breastfeed for long. The benefits of breastfeeding have been dramatically overstated and it is time to correct our advice to mothers to reflect the real benefits of breastfeeding, not the imagined super powers that simply don’t exist.

  • CNNNNNN

    Breastfeeding beyond infancy is normal (natural) for homo sapiens (that is us.) Formula does not provide immunological properties, is known to cause caries, does not teach the infant to self-regulate food intake, causes gut issues, is often comprised of ingredients like GMO corn (should a newborn human be consuming corn?!) Some mothers cannot breastfeed; formula is for those parents. We are mammals…mammals make milk to feed their young.

    Also, my breastfed children that never used bottles or pacifiers have never had otitis media, a cavity, had a bacterial infection, an ER visit for infection AND my still-nursing 18 month old had a nasty cold, would not take water or food except she breastfed frequently. She stayed hydrated, eliminating the need for an expensive ER visit.

    My family has saved thousands in excess Doctor visits, ER visits and expensive formulas.

    Physicians (quacks) make serious coin from genital cutting, pushing artificial milk etc. They lose money from us breastfeeding mothers, especially the “extended breastfeeding” variety.

    That is why these types of studies are published; always follow the money!

    • Amy Tuteur, MD

      We are mammals. Mammals don’t use the internet. So why are you using it?

      • CNNNNNN

        Pitiful attempt at a red herring. 0/10 trolling effort. Also, you’re not even a licensed medical doctor, quack.

        • Amy Tuteur, MD

          And you are?

          • CNNNNNN

            …Not feigning medical licensing. Also, your bald-faced attempt at an ad hominem attack is having no effect.

            Yawn.

          • NoLongerCrunching

            It says right on Dr. Amy’s profile in the upper right corner that she resigned her medical license to be a stay-at-home mother. One is still a doctor even when their medical license expires. Thus, your bald-faced attempt at an ad hominem attack is having no effect.

            Yawn.

          • Stacy48918

            Ha! You’re really funny. As the one that used “quack” in their first post to turn around and accuse Dr. Amy of using an ad hominem like you actually knew what the term meant. Ha!

    • Poogles

      Well….at least your Disqus avatar is appropriate.

      • Poogles

        LMAO, I love that he/she changed their avatar from ” I am stupid” (or was it “I’m Stupid” – either way) to a lovely sunflower ;)

    • yarnbarf

      I was breastfed to one year and I’ve had constant ear infections well into my thirties. Anecdotal evidence is bullshit.

    • MaineJen

      Both my kids were breastfed. One has never had an infection or been on antibiotics in his life, and rarely gets sick. The other (and the one who breastfed until age two, incidentally) has had 4-5 ear infections and is currently on anitbiotics again for an infected blackfly bite (cellulitis, poor thing). What in the world are you going to do with my anecdata?

      It’s almost like…they are both individuals with different immune systems and health needs, and one thing (breastfeeding!) will not work to cure all of their ills.

    • Stacy48918

      And my daughter was formula fed and has had no ear infections, no sick doctor visits, no nothing. So what?

      If your child breaks their leg, will you take him to a “quack” or will you do what mammals do and just deal with it at home? Let “nature” heal it?

    • Guest

      Cold is infection!

      My daughter was FF and used a paci for 4 months (weaned herself of it). Thank god no constipation, no ear infections, no caries, no deficiencies and guess what FF babies regulate their food intake too! Simply they stop sucking when full and when their food need increases they just let you know by asking for more! While my friends’ babies (they are 7) all EBF, 3 had caries, 2 are suffering of constipation, around 6 of them had multiple ear infections and multiple ER visits, one had iron deficiency and calcium deficiency!

      Does this mean formula milk protected my baby or breast milk causes problems!! These things are multi factorial. it is not about the milk!

  • menuagain

    Yes, Primary CareDoc, I did read the study …. if you would like, I will send you another study recently published in the Journal of Medicine that ALLOWS for an alternative way to think vs. “breast-feeding is still the ONLY option”….. and doctor, if you do not realize that “anecdotal” experience has no credence … then exactly how did we get here in the first place … that’s how studies are conducted in the first place …. people are asked to participate and then the results are published …obviously you believe that only modern medicine is the correct way to think ……certainly we are fortunate to forge forward …..but please do not forget that your grandmother rubbed Bengay on your chest and it worked ! And Mag …how can we not get emotional …. hormones are involved …. and you just repeated the same scenario of child rearing as I did …only from a breast-feeding background …my daughter is 45 and has never had a cavity in her life …and please allow me to repeat …asthma runs in my family …very strongly ….I also have a wonderful bond with my children …. all I am trying to state doc and Mag, is that formula feeding is not poison … people grow up healthy and live long lives even though “according to you” were sadly bottle fed !

  • Mag

    This seems to be getting out of hand with emotions running amok. I breastfed my children for two years, exclusively for 6 months, which also included no pacifiers. Neither of them ever had any dental or health problems, no earaches, no ashtma, etc. We lived in a large city and the kids went to public schools. One of the kids, once only, at the age of 10, had an antibiotic, the only time ever an antibiotic was taken. Both are bright and slim. I am close to my children and there are no emotional or psychological issues with them. As young adults, both continue to be very healthy. I believe breastfeeding benefited their health status. I am a nurse in the US who works in a very busy University hospital in the maternity field. There surely are differences in maternal approaches to the issues of breastfeeding. Although I commend adoptive parents, same sex parents, and mothers who choose not to breastfeed in their parenting roles and advise them in formula intake, the benefit of pacifier use, etc., I also commend the breastfeeding mothers. They have chosen an often more difficult road, physically and financially. It is not easy being an exclusive breastfeeding mother. Theyget guilt thrown at them by others for “spending too much time with the baby,” “when are you going back to work,” and other such ill advised commentary. The benefits of breastfeeding newborns and infants is easily supportable from research. However, I personally watch over the mother baby couplet very carefully and do not hesitate to introduce a breastpump for a questionable supply issue or for separation due to NICU admissions. Not addressed in the article, was the benefits of colostrum and breastmilk to NICU admissions or pretermers. Yet and still, it is also preemptive to assume to know or to decipher all the psychological benefits in a close familial breastfeeding unit. It is what it is, especially by a hormonal initiated route. Whether one in the healthfield wants to believe that or not is revealing in itself. It is disheartening to hear words such as “breastapo.” Really, poor judgment on Dr. Amy’s part. Perhaps, if and when one of her sons become a father, and the mother chooses to exclusively breastfeed no matter the situation, Dr. Amy will not refer to her as being a “breastapo” controlled mother. Very surprising to use “breastapo” and “lactivists,” both disparaging words, against well educated and supportive and hard working Lactation Consultants. Fringe lunacy regarding breastfeeding and starving newborns, instead of providing formula when breastfeeding is not going well, is another topic altogether. Many women with flat nipples in fact don’t have flat nipples. Without a doubt, you must know the mother, the situation, and red flags. It is not easy to avoid making mothers feel guilty. However, they make the final choice. Similarly, people choose gambling, smoking, overeat, etc., also make lifestyle choices that can bring on feelings of guilt too. Supporting women reasonably and based on evidence derived from research is not a Gestapo tactic. It’s common sense, which makes the world go round better.

    • PrimaryCareDoc

      So….did you actually read the study she’s referencing here, or are just choosing to ignore it in favor of your anecdotal evidence?

  • menuagain

    Ok peeps …here goes:
    I’m a granny ….I did not breast-feed my 2 kids in the 60′s because A. I was 18 and scared and B. my gyno advised NOT to . However, I am an educated woman and I have always had a strong opinion on this particular subject. I read every word of this discussion ….from the docs and the moms ….. here is MY opinion (educated):
    breast-fed babies are NOT any healthier than formula fed. When I was growing up in the 50′s-60′s , not one, not ONE of my friends (baby-boomers, zillions of friends) had been breast-fed …guess what…we are ALL alive …and WELL …… oh sure …some got cancer …..some have heart disease …but we are in our mid 60′s for chris sakes ….. my children got the occasional cold and one has asthma …it RUNS in my family …uncles….grand-parents …you name it )I was LED (by studies similar to this one) .. that COLDS …are how we build up immunity ..sooo…what …that’s not true anymore …. hmmmmm…this is what I believe …..FIRMLY ….yes, breast-feeding is a wonderful bond between mom and baby …so are you telling me that cuddling your new born and singing whilst feeding a ba ba is not somehow JUST as bonding ….women are ridiculous because they buy into the current philosophy ..they can’t make up their own minds …that’s the real issue …. and as far as the transfer of good hormones from mum to baby …did you READ the literature people …. it states that everyone’s body is different …. perhaps the moms hormones are not quite on the up and up…… and as for the expense and convenience …that, in my opinion is the real issue …it IS convenient to breast-feed and costs nothing ….so, in conclusion, do so if you want to but STOP STOP STOP telling every new mother that they should for the health and longevity of their baby … it may very well have been true hundreds, thousands of years ago but why don’t we just all jump on a horse drawn cart and stop driving cars because the fumes are killing the planet ….WAKE UP !

  • Renee

    Someone needs to tell activists to QUIT lying about the effect of breast milk on the teeth of babies! It is not magic- it is SUGAR. Night feeding, and frequent snacking, after the teeth come in, leads to DECAY.

    I have learned that any food/drink other than water (EVEN BREAST MILK- which is mostly sugar) will breed bacteria for 45 min after eating/drinking. If you have a baby eating on demand, all day and night, there is little time without bacterial growth. This growth is what causes decay. Even IF you brush 2-3x a day, in an effective way (hard enough with a squirming toddler), that still leaves SO MANY hours where bacteria attack the teeth. (This is why kids with frequent bottles of juice/soda get “bottle mouth”)

    I have one kid that was FF in the standard way (until 12 mo), and another EBF in the same way they suggest- on demand, and at night, up until age 2 at least.

    FF kid- No dental issues. He even broke pieces off of his 2 front teeth by jumping head first into a porcelain tub at 12 mo. He is almost 4 now, his teeth are pristine.

    EBF kid- Needs 2 crowns, one root canal, (if we are lucky she won’t loose the tooth- its in the front so I want to try to save it), she needs caps on the rest of her teeth. This requires GA! On a 23# kid.

    Oh, she isn’t even 2 yet……The dental work will be done the week after her 2nd birthday :(
    She doesn’t even have all of her teeth yet!!!!!!!

    I brushed, and did everything recommended for both kids. Even fluoride drops, because its not in the water here in woo-ville. BOTH started going to the dentist as soon as they got one tooth, and every 6 mo after that. We are not slouches on dental at all.

    Yet- baby girl is having serious dental work a week after her 2nd birthday. Yet I am still being told its not the breast milk. No? What else can it be?

    Now I know why the crunchy AP group of moms non town is ALWAYS talking about their kids awful teeth. They just do not think B milk can be to blame, and do everything to pretend BF on demand to age 4 is in no way a problem. Kids of all ages without dental issues are the rarity in this group. Everyday someone asks what they can do to avoid a mouthful of crowns, root canals and such for their baby. (do not get me started on holistic dentistry….)

    IT IS NOT MAGIC PEOPLE, take heed.

  • Amy Tuteur, MD
  • Amy Tuteur, MD
  • J_in_the_Lou

    I breastfed both of my children – one for 30 months and the other for 18 months. One had three sets of tubes, at least 30 colds before age two, and has social and cognitive delays. The other has had one sick visit in 5 years, hasn’t had a cold in at least two years, and people stop us in public places and tell us they have never heard such a prolific vocabulary from a child so small.

    Maybe it is just kids are different, regardless of the feeding method.

    • Guset

      Yes everything: Intrauterine live, stress during delivery, genetics, food (other than milk), and environment everything affects us not just the milk.

  • Dr. Daniel Flanders
    • NoLongerCrunching

      Dude, I love breastfeeding; i did so with my three kids, and i’m an IBCLC. but I think the main point of the article is that studying discordant sibling pairs can give a better idea of the effects of BF than research with more compounding variables. In this study, it resulted in the measured benefits being present ONLY when subjects were not discordant sibs.

    • fiftyfifty1

      “It is almost as if the authors were rooting for a negative outcome at the onset of the study by picking outcome measures that were least likely to show any difference.”

      It’s very bold of you to accuse the researchers of cherry picking outcomes that they thought would show negative results. Do you have evidence to back up that accusation? Have you considered any other hypotheses beyond “researcher conspiracy” for why the researchers chose the outcomes they did? For instance you criticize them for not including offspring outcomes like schizophrenia, alcoholism and osteoporosis. Do you realize that these outcomes are not measurable with the current data set as these are diseases that will not manifest until adulthood and/or old age? Likewise you seem to think the researchers should have studied diarrhea. However, the researchers chose outcomes that they could measure at the time of the study. Recall for how often your child had diarrhea 2-11 years ago as a baby are not likely to be accurate, wouldn’t you agree?

      You then criticize the study for ignoring maternal outcomes. But if you think a little deeper about the design of the study you will soon realize that it’s actually *impossible* for a discordant sibling study to measure whether breastfeeding or formula feeding is better for the mother as by definition the mothers of discordant siblings have BOTH breastfed AND formula fed (so if they have an outcome, whether good or bad, which feeding method should get the “credit”?)

      Your attempt to discredit this study ends up discrediting you.

      • Dr. Daniel Flanders

        Thanks for your feedback. You seem quite passionate about the subject. I admire that :)

        • The Bofa on the Sofa

          Do you concede that she is correct in her comments, then?

          Will you add a correction to your original statement?

          • Dr. Daniel Flanders

            My intention, in writing that piece, was not to critically appraise the paper, but to criticize the conclusion that “the benefits of breastfeeding are overstated”. The data from the paper really doesn’t shed any new light on the matter since the equivocal findings re: breastfeeding and asthma/obesity/neurocog development are already pretty well established. To conclude that “the benefits of breastfeeding are overstated”, one would have to refute the many other proposed benefits of breastfeeding to both mom and baby.

          • The Computer Ate My Nym

            My intention, in writing that piece, was not to critically appraise the
            paper, but to criticize the conclusion that “the benefits of
            breastfeeding are overstated”.

            How do you criticize conclusions in an evidence based manner without critically appraising the paper?

          • Dr. Daniel Flanders

            The paper has been critically appraised elsewhere. In the piece I presume the data to be valid.

          • Dr. Daniel Flanders
          • anion

            Sorry, but it doesn’t seem decent to me at all; it seems they completely missed the point. Their final section is full of errors:

            “There were statistically significant differences in health, behaviour and academic outcomes in the full cohort, although there was an association between breastfeeding and asthma.

            It is unclear why this reverse trend was found in this study [it's very clear, actually: by using discordant siblings the authors of the study corrected for genetic/socioeconomic differences that may be--and likely are--responsible for the significant differences other studies how between breastfed & formula fed babies. That's the whole point of the paper], but it does not show that breastfeeding causes asthma or that bottle feeding prevents it.

            The study did not show a significant difference between siblings within a family who were breastfed [That's not what the study was looking at, either; it wasn't about differences between siblings who were breastfed, it was about differences between siblings who were fed differently]. This may be because genetic and environmental factors have more influence on these outcomes than breastfeeding at an individual level [that's exactly what the paper showed, isn't it? That genetic and environmental factors have a larger influence on babies than just feeding method, and that feeding method does not in fact make that big a difference when those other factors are taken out of the equation?].

            There are a number of confounding factors that were not adjusted for in this study, including the reasons for changing the feeding style within a family. There could have been maternal factors, such as breast disease, or an inability for the baby to breastfeed, such as a cleft palate. [Genuine question: Can anyone tell me what major or significant difference any of that could have made wrt things like intelligence or asthma? How are any of those things confounding factors, really? This seems to me like obfuscation, frankly; listing stuff that wasn't adjusted for even though that's totally unimportant. It's like criticizing a new airplane's safety record because the inventors failed to paint it blue, so the effect of its color on passenger feelings couldn't be adjusted for.]

            Another factor to consider is that women are only offered unpaid maternal leave in the US. [Not true, at all. Many places offer paid leave.] This could mean that the majority of women who can afford to take time off to care and breastfeed their baby are on a high income [That's why the analysis focuses on siblings, genius; to correct for those factors]. It could be the case that breastfeeding would still be of significant benefit for children born to women on a lower income in the UK [sure it could, it's just the study really doesn't show that or provide any reason to believe it' in fact the study kind of shows the opposite, doesn't it? You're just trying to get out of paying for infant formula for those mothers, IMO].

            Again, I’m not a statistician or healthcare professional, just a layman, and I could be reading the paper wrong, but it seems to me the NHS has completely missed the point.

          • anion

            ETA: My own children are “discordant.” I breastfed my first for only a couple of weeks, supplementing from the beginning because she was jaundiced and I had PPD. I breastfed my second almost exclusively until solids were introduced and continued to breastfeed until she was seventeen months old. Both are beautiful, intelligent, funny, and healthy. If anything, my younger is, and always has been, (how do I put this?) sturdier physically; my older child is so thin we can’t find clothes to fit her properly (though she eats like a horse). My youngest also had mild RSV at four months and is more prone to colds and breathing problems; she had a nebulizer which she used occasionally for years, whereas my oldest has rarely been ill.

            I wish now that breastfeeding has been easier with my first, because I loved doing it so much with my second. And I always advise my friends, when asked, to give breastfeeding a try. I never expected to love it as much as I did. But my own children certainly fit right in with the results of this study; aside from a few minor differences that can be otherwise explained (my oldest is built like my husband, long and lean, whereas my youngest is petite and a little short-waisted like me), they’re pretty much the same.

          • The Bofa on the Sofa

            So you agree, then, that the issues that the paper has identified as being not significantly different, are then not really significant differences?

            That would be great, because apparently other posters in this thread do not agree with you.

            I agree that these results are not really new, and but you need to tell the folks who are pushing heavily to demonize formula.

            ETA: The TL;DR response:
            Do you deny that breastfeeding advocates still try to use asthma/obesity/neurocog as reasons for choosing breastfeeding over formula?

          • Dr. Daniel Flanders

            Re: your first sentence. Yes – for those particular outcomes I agree here and I agreed in my piece. But Back to my point: that is too narrow a scope for a broad conclusion such as “The benefits are overstated”.

          • NoLongerCrunching

            Yes, I would much rather the media actually report what the authors concluded: that breastfed and formula fed siblings had similar results on several measures of health and academic achievement. But given that the media has themselves created the impression that formula fed babies will be sicker and dumber, I can see the argument for now saying “the benefits are overstated.”

          • Dr. Daniel Flanders

            I’d rather see responsible journalism cutting both ways.

          • Amy Tuteur, MD

            No, that’s what science requires.

            The null hypothesis is that there is no difference between breastfeeding and formula feeding. The papers that claim that there is a difference are filled with confounders.

            There is simply no question that the benefits of breastfeeding have been grossly overstated by the lactation community, by mainstream media and by bloggers. I hope you are not trying to perpetuate the error and the guilt that the error invokes.

          • Dr. Daniel Flanders

            If by hoping that I’m not perpetuating ‘the error’ you are asking me for my thoughts and feelings about breastfeeding promotion, then I’ll risk misinterpreting and quickly share them:

            I believe strongly in breastfeeding advocacy at the public health level. However, I do not agree with aggressively promoting any kind of infant feeding method (whether breastfeeding, bottle feeding, formula feeding etc.) directly to postpartum moms. Moms/families should feel free and empowered to make nutrition decisions for their babies without judgement or guilt. And when they make a decision, they should have access to the necessary information and support needed to carry out their plans. Meaning, if a mom chooses to breastfeed, she should have access to competent support, accurate information, and she should (hopefully one day) feel comfortable with her choice. And if a mom chooses to formula and/or bottle feed, she should have access to competent support, accurate information, and she should (hopefully one day) feel comfortable with her choice.

            I am happy to see that my post sparked some valuable discussion and I appreciate the opportunity to weigh in on your blog.

            All the best.

            DF

          • Dr. Daniel Flanders

            Good science requires appropriate statistical analysis:

            I agree that the discordant sibs analysis ‘failed to reject the nul hypothesis’. But, statistically speaking, that is not the same as ‘supporting the nul hypothesis’. The absence of evidence is not evidence of absence. We’re talking the difference between alpha and beta error in statistical analyses. I suspect (although I am not a statistician and would welcome clarification, correction, etc from an expert) that this discordant twin analysis does not have nearly enough power to satisfactorily ‘support the nul hypothesis’.

          • Amy Tuteur, MD

            Why is it so hard for lactivists to accept the fact that breastfeeding has few if any benefits in the developed world?

            Breastmilk is a product of the human body, and nothing about the human body is perfect. There is a tremendous amount of normal variation and a tremendous amount of abnormal variation. Why shouldn’t the same thing be true for breastmilk

            Some women won’t make enough. Some women have nipples that make it difficult for the baby to suckle. Some babies have a weak suck. Prior to formula those babies would have died.

            Evolution leads to survival of the fittest, not survival of everyone. The idea that breastmilk is “nature’s perfect food” makes as much sense as the idea that every conception will result in a baby. A great deal can go wrong along the way and often does. Why would breastmilk and breastfeeding be any different?

          • Dr. Daniel Flanders

            I cannot speak for lactivists and am therefore unable to comment meaningfully with regards to the questions and points you raise above.

          • KarenJJ

            http://www.thealphaparent.com/2013/07/meme-of-week-pediatric-fast-food.html

            Maybe take a look around yourself and see the perspective some of us are coming from. The culture of breastfeeding vs formula feeding can be poisonous. My baby didn’t regain her birthweight until she was 6 weeks old due to the nurses in the maternity ward refusing to give me formula to help top up my daughter (she lost 9.9% of her body weight the first 5 days) and refusing to give me information on pumping because I was “exclusively breastfeeding” (despite needing an electric breast pump in the first four days to try and get supply).

            I was a mess, my baby was going hungry and not sleeping (feed for an hour and a half, cat ap for 30 minutes and then continue feeding). I was failing at feeding my baby and I knew it. Formula feed at your detriment and breastfeed at all costs.

            I thought a few things were important and instead of cuddling my newborn I pumped breastmilk for these “benefits”. Some of these benefits were listed above by these researchers. Obesity and benefits to neurodevelopment. Also I was told about growth hormones and how they aren’t in formula and how breastmilk helps babies grow. I wanted to give my baby the best start in life.

            I didn’t give her the best start. I didn’t because of the push for breastfeeding for what appear to be marginal benefits. My daughter finally started thriving when I started supplementing at 3 weeks with formula and finally limped back to her birthweight at 6 weeks. I cannot begin to describe how depressing it is to have a starving baby that I was failing.

            My story is not the only one like this. Trying to get these stories heard by lactivists is incredibly difficult. I am all for a much more balanced approach and much more interested in women receiving ALL the information to make the decision that best suits their family’s needs.

            I am not a medical professional ( I’m a professional in a technical field) and I relied on the information from the nurses. I hope studies like this can make their recommendations more moderate and more in line with best interests of mothers and babies instead of trying to meet “breastfeeding targets” such as those my hospital had displayed proudly outside their well baby nursery.

          • The Bofa on the Sofa

            Why? When you have groups all over touting the great benefits of breastfeeding INCLUDING asthma, obesity, and neurocog, then they are clearly overstating the benefits.

            Yes, it begs the question of “overstated by whom” but you can’t deny that this includes breastfeeding advocates.

          • AllieFoyle

            No, it’s not necessary to disprove every proposed benefit to point out that the benefits are overstated. To overstate is to express too strongly or exaggerate. If there are, say, ten commonly touted benefits and it’s found that three of them don’t hold up to scrutiny then it becomes appropriate to say that the benefits have been overstated.

            There clearly are some benefits to breastfeeding, but you have to consider the whole picture. If the major benefits of breastfeeding are small in magnitude, time-limited, occur specifically in preemies, or accrue mainly during the first few weeks or months, don’t you have to weigh that against the costs of breastfeeding in terms of effects on things like income, career success, and maternal mental health–all of which clearly also have an impact on child well-being?

            Which benefits are you referring to when you mention “the many other proposed benefits of breastfeeding to mom and baby”? Do you feel that these purported benefits are of a sufficient magnitude to warrant recommending that women be universally pressured to breastfeed for extended periods, often at the expense of financial security, career advancement, and/or mental health?

          • Dr. Daniel Flanders

            In my post I provide the information that you are requesting in a table with associated literature references.

            I do not advocate for pressuring moms to breastfeed. I have articulated my thoughts about breastfeeding advocacy/promotion in response to Dr. Tuteur’s comment below.

            Best wishes,

            DF

        • auntbea

          Wow. How remarkably condescending. Fifty offered a serious methodological critique. She was not being “passionate” (though she is also that), she was being “analytical” and most likely “correct.”

        • Amy Tuteur, MD

          Remarkably condescending, especially considering that you are talking to another physician.

        • fiftyfifty1

          I would rather you address my analysis than patronize me, thanks.

    • The Computer Ate My Nym

      Your analysis of the paper suggests that you didn’t understand several critical aspects of the methods.

      First, you state that “… it was not the breastfeeding that increased the likelihood
      of developing asthma, it was the likelihood of developing asthma that
      increased the probability of the mother choosing to breastfeed her
      child.” The primary strength of this study is that it examined discordant siblings, i.e. children in the same family in which one was breast fed, the other bottle fed. That may not completely eliminate this particular bias, but it would notably reduce it. I would expect you to acknowledge this and explain why you felt family bias was still an issue.

      Second, many of the benefits you mention in your first table are benefits to the infant while it is an infant (i.e. reduced infection). This study specifically examined long term outcomes and makes no comment on possible benefits in infancy. I agree that it would be interesting to see if there are any long term differences in rates of infection.

      Finally, as mentioned earlier, determining maternal risk from this study would be virtually impossible. I would like to make one comment about your blanket statement that studies have shown breast cancer protection from breast feeding. This is not universally true.

  • The Computer Ate My Nym

    So the various people arguing that Dr. Tuteur wasn’t looking at the data for the benefits of breast cancer in the “mother friendly breast feeding initiative” thread don’t seem to have shown up here. I like to think that’s because they’re reviewing the evidence and reconsidering their positions, but…let’s just say that that may be an optimistic idea.

  • anh

    has anyone seen the thread on this on TFB facebook page? she lambasts the study and then asks in the comments how she might get access to it!!! She claims to be a public health scholar and how important it is to look at studies critically. yeah. Where was her ace analysis when the media was claiming a study showed an increase in IQ for breast fed babies, but when you actually looked at the study it showed that out of 8 different IQ tests, only two of them showed any kind of difference?
    the stupid over on her page is overwhelming

    • Anj Fabian

      Uh. Maybe ask one of her professors?

      But no, she goes all Jan Tritten and asks the internet.

      • Karen in SC

        goes “all Jan Tritten”….good one!

    • realitycheque

      Isn’t she a student? I have always had access to studies through my university’s library or online database.

      • LibrarianSarah

        Yes I am sure her school has access to, at the very least, CINAHL and if it is not in the databases she could get it through interlibrary loan. This woman is a grad school and she is crowdsourcing on Facebook something that only requires basic library skills. Nevermind the fact that she has the balls to criticize a study she hasn’t read. Classic Gina.

        The only reason I could see why she hasn’t went straight to the library to access this article is that she is no longer taking classes. Once you graduate/drop out you no longer have access to the library databases. But if she did drop outshe could no longer call herself a “public health scholar” now could she?

  • Allyoop

    I think because breastfeeding rates are up and formula sales have dropped, this is a way to swing the pendulum.

    • Awesomemom

      Yes, it is all a grand conspiracy by formula companies to get more money *roll eyes*

  • fiftyfifty1

    These discordant sibling studies are a good way of looking at the problem, but they are not free of confounding. Why one sibling gets breast and the other formula is not random. For example, a baby with cleft palate or an abnormal suck will be less likely to be breastfed. These babies are more likely to have co-existing problems such as learning disabilities or other health conditions (although of course many will not). Also family factors change with time. A mother may choose formula as a stressed teen, but later choose breast when her life has more resources. All of these potential confounding factors would skew the results to look as if breastfeeding were still better. What is notable is that DESPITE this potential for skew toward breastfeeding, the results did not show any statistically significant difference in outcomes.

    The best study, of course, would be a discordant sibling study where each child was *randomized* to breast vs. formula. Well actually the VERY BEST study would be a discordant identical twin study where each baby was randomized. But that’s never going to happen.

    • Ashley

      I’m with your train of thought, but I do need to mention that cleft palate children are NOT more likely to have learning disabilities. The last good large study of cleft palate children and their siblings that I can find was done in the 70s and even then, the siblings of the children with clefts were just as bright as the ones who weren’t. In some cases, they even did better. The only weakness was a bit with hearing and speech (but ear tubes are much more common now than they were). I have two bilateral cleft lip and palate children. They are every bit as bright as the children in their peer group. It’s a mouth problem and an ear problem; not a brain problem. My kids run circles around me, and they were formula fed. The horror!

      • fiftyfifty1

        Absolutely. Kids with isolated cleft lip/cleft palate have a mouth problem, not a brain problem. Therefore isolated cleft palate is not associated with learning problems (unless as you mention there are unrecognized/untreated hearing problems that go along with it which would be rare with access to first world medicine). The complicated factor is that cleft lip and palate are not always *isolated* as they were with your kids, but are sometimes part of syndromes of abnormalities, many of which do cause learning problems.

  • ngozi

    I also don’t appreciate the “formula is so much more expensive” line. I don’t know about other countries, but everywhere I have been in the US (which I have to admit, has been mostly southern states) the local WIC office is more than willing to give away formula. A baby about 4 months old that drinks formula only will get about nine 12 ounce cans of formula a month. There is very little you have to do to qualify for WIC. Basically all a person has to do is prove they have a baby (but your local WIC office might do things differently).

    • Rochester mama

      My 18 month old is more expensive to feed now than when he was drinking 34 oz of Similac a day. Granted he loves expensive fruit and veggies and I’m fortunate enough to afford his pineapple and baby spinach habit.

      • Mishimoo

        Blueberries and raspberries are the big favourites in our family. Luckily, the older kids love to eat frozen ones.

        • araikwao

          Ha ha, same here. My daughter went through a phase of eating a bowl of still-frozen raspberries for dessert each night

    • Meredith Watson

      If you are breast feeding you consume more calories and that food isn’t free. I did read once that it is slightly less expensive to consume more food than to buy formula but even so, breast milk isn’t completely free.

      • batmom

        Plus it’s only “free”, as Hanna Rosin observed, if a woman’s time is worth nothing. I’m fortunate as an academic to have had a long maternity leave (leave + summer free of teaching = good long break) but the hours of day I spent nursing him are hours where I wasn’t writing, researching, and so forth. Breastfeeding isn’t free because my time is valuable. Worth it, yes. Free, no.

        • Lion

          I loved the time breastfeedign – lying on the couch and reading or watching TV or pushing my older child on the swing while feeding in a sling. I work too and although I hated expressing, it was a nice break from work every few hours. Of course that wasn’t all the time – there were times I just wished a feed would end or that feeding wasn’t so constant, but overall, I did find it a relaxing activity.

        • LibrarianSarah

          Exactly, were my parents the only one who constantly said things like “If you are not making money you are spending money” and “there’s no suck thing as a free lunch?” Because I’m pretty sure that I heard those to sentences more than my own name growing up.

    • antigone23

      Last time I checked, you had to make below the poverty line and have almost zero assets to qualify for WIC.

      • fiftyfifty1

        Must depend on the state. Here it’s very easy to qualify. Assets not taken into account, just recent paychecks.

  • Ellen Mary

    Meh: I’m still saving money & reducing my risk of Breast Cancer (honestly my main motivation @ first). I’ve been BF for a decade of my life, nearly. Though a study like this might make me feel like I ‘wasted my time’, I still believe there are benefits this study did not adequately assess, to the microbiota, primarily.

    If it provides assurance to mothers choosing formula, that is fabulous, but I wouldn’t want it to condemn extended BF as providing an unfavorable risk v. benefit (if the benefits are trivial & the societal perception of risk is exaggerated). I also would not want it to provide marketing ammunition to the formula industry, whose principal players still do use underhanded marketing techniques.

    • Durango

      What’s underhanded about sending you a free sample? You didn’t use it, did you? If people are glad to get the sample, they will use it, if they aren’t, they won’t. Don’t you think other parents are also intelligent enough to make the decision for themselves? Even my kids can recognize advertising and can make decisions about whether they want the product or not.

      • AlisonCummins

        The logic as it was taught in university human nutrition classes in the 1980s is thus:*

        Initiation and growth spurts are typically difficult and stressful times in breastfeeding. During a growth spurt, the baby cries more often and is feeding every twenty minutes. The mother feels terrible, she feels like a bad mother, she’s exhausted, she believes she doesn’t have enough milk (true) and is desperate to nourish her baby. If she has formula lying around the house, she will use it. This sabotages breastfeeding since the baby will nurse less often and the mother’s milk supply will not increase to meet the new demand. This reinforces the perception that her milk supply is inadequate and that the baby requires formula, and she will continue to use it and may abandon breastfeeding at this point. The six-week growth spurt is in fact a common time when exclusive breastfeeding, or breastfeeding at all, is abandoned. Not having formula or bottles in the house can buy a little time for the mother’s milk to catch up with the growth spurt so they can get through this stressful time and go on with exclusive breastfeeding for several more months.

        When I worked in the retail (NOT health) sector, I would often talk to mothers of five-to-six week old babies who were starting to supplement because breastfeeding had been fine but now they didn’t have milk any more. I would empathise and remind them of what they had been taught in their prenatal classes about growth spurts. If they could get through the next three or four days — cut back their work commitments, perhaps get a friend or the baby’s father to spend some time at home with her and feed her so she could just lie around in bed and feed the baby and let her milk catch up — the rest was going to be easy.** The baby would start sleeping longer at night and would start grinning at her. This particularly difficult week did not represent motherhood or breastfeeding forever.

        Some of the premises may be wrong here, more recent research may supersede them, the narrative may be overly simplistic, this only addresses healthy mothers and children where exclusive breastfeeding was already well-established in the first month. Fine. But your question was about the logic, and the logic is that there’s a genuine developmental hurdle to be gotten over and that simply having formula available in the house increases the chances that breastfeeding will be given up when it doesn’t have to be.

        *I have been given crap on this site before for explaining the logic, so no need to give me more crap again, thank you.

        **I have been given MAJOR crap on this site for recounting what I said in the eighties/ early nineties. It’s fine. I heard you the first time.

        • Elizabeth A

          I’m not going to give you crap. My breastfeeding relationship with my first was saved by a visiting nurse with a simplistic narrative, and I really wanted to breast feed and remain grateful to that nurse for helping us do that. She was a welcome contrast to the LC who inspected my nursing bra, insulted my mother, and insisted I pump every two hours ’round the clock.

          Not all situations fit the narrative you’ve given, as you know. We’re all well-served by uncomplicated optimism until we’re suddenly not served anymore. Annoying fact of life, there.

      • Ellen Mary

        I felt threatened enough that I left it in the car. And I have nursed two other children into their toddler years. I don’t see what is wrong with waiting for me to come into the store if they wish to hunt down my address to send a free sample, they could also see I live right near a store that sells formula.

        • PrimaryCareDoc

          You felt threatened enough that you left it in the car? I really don’t understand. Did you think the formula would come alive in your house, eager to hunt you down and kill you? That it would possess you, forcing you in a hypnotic state to formula feed your child?

          • ngozi

            HA!! Classic!!! You should write for television!!

          • The Bofa on the Sofa

            Sounds like the premise for a Steven King novel.

          • AlisonCummins

            She’s probably one of those paranoid, irrational women who don’t leave candy around the house when they’re on a diet, too.

          • The Bofa on the Sofa

            I don’t think that is anywhere near a fair comparison, though. If you aren’t formula feeding, and don’t have any intention to do so, is a can of formula all that tempting?

            A diet means you are trying to change your eating habits. If it involved candy, that can be tempting. But she isn’t trying to give up formula feeding or anything.

            It would be like if a cigarette company send me a pack of smokes out of the blue. I wouldn’t fear it, I would throw it in the trash. Seriously, it’s that easy.

          • AlisonCummins

            Which is what she did, right?

          • The Bofa on the Sofa

            No, she left it in the car because she was threatened by it.

          • PrimaryCareDoc

            Oh, that’s not paranoid. That’s just common sense!

          • Young CC Prof

            To be fair, 3am feedings ARE a hypnotic state. I sometimes do things I can’t remember in the daytime, or can’t sort out which night it was.

        • Guesteleh

          I’m not being snarky when I say this is strange. You are someone who is clearly committed to breastfeeding, so why the fear of the can? You won’t use it, right? So what’s the big deal?

      • ngozi

        Sometimes you can supplement with formula and pump breast milk to increase supply. That has actually helped me to continue to breastfeed, not stopped it.

      • Trixie

        I will say that both hospitals I used were super pushy about how I *must* take the samples home (breastfeeding was going great and there was no need for it). It sure seemed like they were trying to win a contest for how many bags they could hand out.

        • ngozi

          But ultimately it was your choice to take them. You could have thrown them away. What would the hospital have done if you had, called the police?

          • Trixie

            Oh, sure it was my choice, I asked them to give mine to an FF mom. They acted like it was as important as checking whether I had a car seat. It was just weird.

        • Jessica S.

          We didn’t leave our hospital with anything extra, except the baby obviously. And although they didn’t hassle me about not breastfeeding, and provided formula when we asked, that was about all they did. I had to cajole one of the nurses to find a slow flow nipple, as the fast flow was almost drowning the boy. :) But for every story like mine, there’s equally one like yours, it seems. I wonder what influences the difference? Marketing? Philosophy? Dept heads?

        • anh

          Then there was my “baby friendly hospital” that wouldn’t give me a pacifier and when I was begging for formula because my daughter would latch, suck for like 30 seconds, fall asleep, scream when put down, repeat and I hadn’t slept for close to 3 days I was told that good mothers breast fed and didn’t I want to be a good mother? (meanwhile not a single damn one of their lactation consultants figured out my daughter had a tongue and lip tie and COULDN’T latch and the pain was just in my head and nipple ridges were normal)

        • The Computer Ate My Nym

          We left the hospital with a couple of cans of powdered formula, just in case. It sat on top of the refrigerator for the kid’s entire babyhood. I have no idea what happened to it after that. Since I turn out to be one of those women who can produce enough milk for an entire foundling hospital with no pain at all and small one loved breast feeding it was never relevant. Sigh. My only win in the NCB olympics. Too bad it came after I’d proved my un-fitness to live by needing a c-section to survive birth.

          • Young CC Prof

            We got a can free from somewhere or other during the later part of my pregnancy. I was planning to breastfeed, but was happy to see it, because, OK, if we suddenly need formula, here it is. No need to make a grocery store run under adverse conditions.

      • PeaInThePodSCAM

        What is underhanded is that somewhere like Pea in A Pod had their sales ladies chat you up like they were genuinely interested in what you were having, when you were due, etc. Then low and behold without you signing up for any sales, email lists, etc, they pulled your name off of your credit card and you begin getting formula mail, gerber life insurance mail and cord blood banking mail. I shrugged at the generic gerber and cord blood junk mail but when the formula junk mail was gender and trimester specific I thought my OB had sold me out! Then I determined it was Pea in the Pod and boy did I let them have it! If I EVER set foot in that store or its sister stores then I will use cash only and tell those snotty fake friendly ladies to keep their nose on their face! I mean! I didn’t sign up for anything willingly. They stole my information and sold it under the guise of being friendly, I had no way to opt out of that.

        • AlisonCummins

          []

    • Elizabeth A

      Hand that can over to a food bank and move on?

      The microbiota thing bugs me. If we were seeing meaningful long-term differences between formula-fed and breast fed individuals, it would make sense to look at gut flora to examine potential mechanisms for that difference. But we’re NOT seeing such a difference. If there’s no different to account, there’s nothing to account for or ameliorate. So why put pediatric subjects through that testing?

      I have heard a lot about how breast feeding longer might have spared me my breast cancer. I was diagnosed at age 36, about 1.5 years after weaning my youngest. It seems to take a lot of breast feeding to make a small difference in overall risk.

      Breast feeding didn’t save me money either – it sort of booted me from a more lucrative career from the one I have now. That was an okay choice for me, but I won’t pretend it wasn’t far more expensive then formula.

      • Young CC Prof

        Pretty unlikely that longer breastfeeding would have prevented you from getting cancer. Diagnosed that young, very likely you were born with a predisposition, even if you don’t have one of the recognized breast cancer genes.

        Also, the link just isn’t that strong. On a population level, more breastfeeding probably means less cancer. On an individual level, most people who were going to get cancer get it either way. (And almost everyone who wasn’t going to get it won’t get it either way.)

        • Elizabeth A

          I absolutely agree. On an individual level, we will often really never know. I tend towards the explanation that cancer is a cellular-level accident, caused by the complex interactions of a multitude of factors that we usually aren’t able to isolate or explain.

          Which has never stopped anyone from grasping at possible reasons to believe that it won’t happen to them.

          • Medwife

            There’s a decreased risk of breast cancer if you breastfed before age 30. I gave birth a month before my 30th birthday. Whew!

          • nomorequestionscatherine

            I gave birth 3 hours after my 30th birthday. I guess I’m doomed.

        • Durango

          When we do breast cancer risk tests, we ask age of first period and if the woman has had a baby (as far as pregnancy related questions go, there are others). Neither the Gail nor the Tyre-Cusick risk assessments include any mention of breastfeeding. Translation: when trying to calculate 5-year and lifetime risk of getting breast cancer, breastfeeding is not taken into consideration.

          • Durango

            Adding a “for what it’s worth” to my comment…

      • The Bofa on the Sofa

        The microbiota thing bugs me. If we were seeing meaningful long-term differences between formula-fed and breast fed individuals, it would make sense to look at gut flora to examine potential mechanisms for that difference. But we’re NOT seeing such a difference. If there’s no different to account, there’s nothing to account for or ameliorate. So why put pediatric subjects through that testing?

        Well, you gotta do something to justify your all-in commitment to breastfeeding.

      • AlisonCummins

        I think the best protection is to begin breastfeeding no later than your early twenties. One idea is that the semi-developed breasts of a woman who has gone through stage 1 of breast development (puberty) are more vulnerable to environmental insults than breasts that have also gone through the further stages of late pregnancy and breastfeeding. The more time you spend with semi-developed breasts, the greater your vulnerability to carcinogens. (This would be me.)

        • Elizabeth A

          Great! I’ll go back in time and have my kids ten years earlier. Where’s Dr. Who when I need him?

          • AlisonCummins

            There’s some discussion of whether it might be appropriate for women in their late teens to take hormone supplementation for a year or two to finish breast development. That way they could delay pregnancy without increasing their risk of breast cancer.

          • Certified Hamster Midwife

            You know, that was something in the book Brave New World — babies were grown in jars, and women would have hormonal supplements mimicking pregnancy starting at age 18.

          • The Computer Ate My Nym

            Where’s Dr. Who when I need him?

            Won’t help. You can’t cross your own time streams (whatever that means).

          • Mariana Baca

            She can’t go back in time, but Dr. Who could go back in time and warn her (as long as she didn’t meet Dr. Who in the past before).

          • Elizabeth A

            So what you’re telling me is I need to either slingshot around the sun at high warp, or find the Guardian of Forever. Or dig up a StarGate. Or trick out a DeLorean.

      • The Computer Ate My Nym

        I would strongly recommend genetic testing for someone diagnosed with breast cancer at age 36, no matter how much or little you breast fed. You may be at risk for other cancers and your children may be at risk. 36 is very young for a sporadic breast cancer case.

        • Elizabeth A

          We did the BRCA tests, and a more comprehensive panel I don’t recall the name of. At this point, I am out of genetic tests to take, and the findings have all been negative.

          The genetic counselors keep telling me that it’s possible that I have a genetic risk we haven’t identified yet, and also possible that I just have really hideous luck. They recommend that DD (now 4) begin receiving screening mammograms in her late 20s, and they are wibbly on the recommendations for my nieces (particularly my twin sister’s daughters – we have no idea whether we’re identical). My sisters (both in their 30s) receive regular screening mammograms now. Since the oldest of their daughters is currently 12, we’ll cross the bridge about screenings for them when we come to it.

          • The Computer Ate My Nym

            Good. Sorry if I was butting in with unwanted (and unnecessary) advice.

            No offense, but I’m hoping it’s just you having horrible luck because then your kiddo and nieces aren’t at risk…(Also, then you aren’t at higher risk of other cancers. No brca is good.)

          • Elizabeth A

            No offense taken. I’m hoping those things too.

      • LibrarianSarah

        My gut response to lay people who talk about gut microbes/flora is the same those who talk about quantum physics which is usually a massive eyeroll. The science on these issues are still in its infancy and the people who study them for a living still don’t know many of the details but some random dude on the Internet knows what does and doesn’t effect gut flora, how it impacts health and how you can utilize it to live the most healthy live ever. Sorry, sounds like bullshit that quacks feed the worried well to me.

    • Mariana Baca

      It is underhanded to provide free samples? Since when? Don’t want it? donate it or trash it. I don’t mind companies sending me free stuff, even if it is stuff I won’t use.

      E.g. I don’t have any need to have 1000 calories of food goodies given after a race that at most burned 300 when I’m dieting. But I like being able to pick among the group and choose the one thing I like. I ignore the rest or give it to someone else (like my spectators, sometimes :) ).

      • NoLongerCrunching

        I don’t really have a problem with companies offering free samples. I do have a problem with hospitals participating in marketing products, especially in a way that impacts babies. While I know in the scheme of things, formula is safe, I think hospitals should not be pushing mothers to take home samples of it. I was literally pressured by a nurse to take the bag, even when I said no, and I think that was wrong. Nurses should not have to use their professional time to do anything other than nursing care, not marketing. A nurse insisting that you take formula is basically a message that a medical professional wants you to feed formula. I would say the same thing if they were pressuring FF moms to take home breastpumps.

        • Mariana Baca

          I think feeding a baby can sometimes be an emergency and it is good to have samples around (or a breast pump, for that matter). If a mom’s milk dries up, her dentist gives her medication incompatible with bf, she is called away on an emergency and dad is left with baby, it might be helpful to have that sample around without running to the store. Same with samples of brand name children’s NSAIDs, or Band-aids, or any other medical branded thing a kid might need.

          My vet offers cat food samples, some in brands I do not use. I’ve been unable to get to the pet store due to weather/car troubles and have used those to tide me over for a day, and that was helpful.

          • VeritasLiberat

            Seconding this. In my case it was a kidney infection. The iv antibiotic the ER gave me was not compatible with breastfeeding, and the LAST thing I felt like doing after getting out of the ER was making an extra trip to the store for formula with a hungry baby in tow.

  • Guest

    I’m not sure if I’m asking an ignorant question here, but did they look at how long the breastfed children were breastfed for? Some people say they breastfed their baby if they did for 2 weeks (and they did breastfeed their baby), but you also get mothers who say they bottle fed their baby because they changed from breast to bottle at ten months or a year. I’m of course assuming that a baby breastfed for a year might be show something different to a baby breastfed for a week.

  • Kenji Sugahara

    Amy- unfortunately you are incorrect in your article. This is not a “groundbreaking” study as Evenhouse and Reilly did a study that used sibling comparisons to reduce sample selection bias. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361236/

    • Alexandra

      An excellent study – thanks for the link. Interestingly, your study found that the only factor that was still positively correlated with breastfeeding was cognitive ability. Though it was not found in the study being discussed here. It would be great to have a series of these kinds of family studies and see which results are repeatable. Still, an excellent start to this body of work.

      • Hannah

        “Interestingly, your study found that the only factor that was still positively correlated with breastfeeding was cognitive ability.”

        That’s also interesting because it would be in line with PROBIT ( http://www.ncbi.nlm.nih.gov/pubmed/18458209) and this study:

        http://www.ncbi.nlm.nih.gov/pubmed/21349903

        • KarenJJ

          I wonder if it’s anything to do with birth order? I do know a couple of families where the eldest was breastfed (or attempted) but subsequent babies weren’t. That’s what has happened to my “discordant sibling” children.

          • Lion

            But there are also families where mom tries to breastfeed the first, gets bad advice and gives up or finds it too difficult and give sup or has hormonal problems or serious latching problems etc and stops (or just doesn’t enjoy it and sotps stops – reason not really relevant), but then for whatever reason decides she wants to breastfeed the next one or two or three and getes better advice and help and support and does manage to breastfeed. (that is what happened with my mom – severely inverted both nipples, struggled for 2 weeks to feed me, stopped, had doctor shout at her for not trying hard enough, then while pregnant found La Leche League who helped her use a nipple puller while pregnant and she went on to breastfeed all my siblings without problems.

          • KarenJJ

            Oh absolutely. I know of those situations too. I just wonder whether birth order could be a confounding factor. And if, over many many cases, the correlation of birth order and IQ explains this or not. I’ve no idea. It could definitely swing either way.

    • Amy Tuteur, MD

      Welcome to the discussion, Dr. Sugahara. I was using the term “groundbreaking” to mean “innovative,” not to mean that it was the first study of its kind. Thank you for citing your paper, though, since it brings even more information into the analysis.

    • fiftyfifty1

      Yes, as well as the 2006 analysis by Der et al in BMJ.

  • MamaBear

    I breast fed my oldest for 3 days and didn’t breast feed my youngest at all. Both kids are intelligent, independent, healthy, and well adjusted. My daughter, now 5, can read at a 3rd grade reading level, and my son, 4, can do 1st grade Math. Other than a couple colds here and there, they have been healthy. My kids have had a string bound from the beginning. I don’t think formula has harmed them in any way. I have been saying for years the benefits of breastfeeding are overstated. I have worked at day cares and seen this. Doctors and CNM’S need to present this study so patients can truly make an informed choice.

  • ngozi

    I just wish that state WIC offices and LeLeche would stop telling mothers how easy it is to breastfeed. I am all for breastfeeding, and my youngest is currently getting breastmilk, but it is not easy. I have never read a breastfeeding book or received breastfeeding information that deals with:
    1) Mothers who don’t have help around the house. What I have read always seems to assume that all mothers have people making dinner and scrubbing toliets while they take all the time they need to breastfeed.
    2) Mothers that have to care for more than two children, and I am not talking about twins.
    3) The perils of pumping at work. No matter how I try, when I do that I end up getting breastmilk on my clothes. You can’t always pump somewhere that has a locked door.
    I just wish lactivist would be more understanding about breastfeeding challenges…all of them.
    I do have to admit, that while my local WIC office does spread all the breastfeeding woo, they don’t (in my experience, and the people I have talked to) make women feel guilty about not breastfeeding. The lactivist I worked with was nice, understanding, and didn’t freak out when I decided to start giving my baby some formula.

    • Josephine

      I feel like pro-breastfeeding information is absolutely RIFE with lies. I was told so very many times that despite my nipples being extremely inverted, they would “eventually come out over time – keep pumping!” Two long months of coming and they did not come out one damn millimeter.

      I also needed about two sets of hands to get my son latched on properly due to his latching challenges (very short tongue), my nipple shield refusing to stay on (probably because my nipples were so problematic), so despite them proclaiming I just needed to practice, practice, practice, that wasn’t even a real possibility.

      Why can’t they just say “these are things you can try…but they might not work out.”? It’s really made me feel considerably more hostile towards stuff like LLL.

      • Lion

        As far as I understand it, truly inverted nipples do cause a problem with breastfeeding, but that flat nipples are more common and that these do pop out. inverted nipples the connective tissue is quite tight (I’m just going on what I’ve read here, because I volunteer helping mothers with latching problems, I’m no expert) and either has to be susrgically cut or a mother neds to massage it and pull out on her nipples during pregnancy and prepare the nipples for breastfeeding (which wouldn’t be the case for a mother with nipples that poke out fine).

        • Young CC Prof

          For me, flat nipples were an unsolvable problem. I would carefully pop out my nipples, then bring the baby close. His hyperactive rooting reflex would flatten them again, and we’d start all over. Finally we’d get a latch–for five minutes. Then do it again. Feeding took an hour, and after a couple days he’d get hysterical at every failure. We tried a nipple shield, the smallest size. It was too big for his little tiny mouth, and his rooting reflex would knock it clean off.

          Then of course the hospital negligently failed to inform me of his discharge weight (12% loss) or monitor his bili appropriately, so we wound up getting readmitted a day later because he’d lost over 14% of his body weight and had scary bili and sodium numbers. If that ped appointment had been for the afternoon instead of the morning, he could have been permanently harmed or killed. We weren’t afraid of supplementing, we actually were a little, we just didn’t know how hungry he was.

          • NoLongerCrunching

            >Then of course the hospital negligently failed to inform me of his discharge weight (12% loss) or monitor his bili appropriately, so we wound up getting readmitted a day later because he’d lost over 14% of his body weight and had scary bili and sodium numbers. If that ped appointment had been for the afternoon instead of the morning, he could have been permanently harmed or killed.

            Omg. I’m glad you caught it, and I certainly hope they don’t routinely make such dangerous errors.

          • Young CC Prof

            Yeah, once I had the whole story I filed a complaint with them, and explained it to the (forget her proper title) supervisor of baby nurses in the maternity ward.

            Who gave me a fair amount of doubletalk, actually, trying to chalk everything up to him having been born at 37 weeks. (His gestational age was hardly a secret. If it was such a problem, perhaps you should have watched him more closely.) But I think I got across that they dropped the ball on my baby’s proper discharge procedure.

          • Mer

            I remember you mentioning this back when he was born, and sort of laughed at the irony compared to my situation. My son was born in Dec at 10 lbs and he lost 7% of his weight but was nursing nonstop so we asked for formula for supplementation, the nurse was a pain about it but the ped agreed with us. Then when we went in for a weight/bili/glucose check 48 hours after discharge (and 48 hours after the milk came in) he hadn’t gained any weight back, but hadn’t lost any more either, however, the PA seeing him freaked out and insisted that we needed to stop supplementing with formula and only breastfeed and pump then supplement with the pumped breastmilk. To this day I still have no idea what that was supposed to accomplish, unless she thought that he wasn’t getting enough from the breast on his own. We did another weight check in two more days, he gained 5 oz. Oh and his bili level was totally fine, it was 8.

            TLDR; my baby had the opposite problem, including being diagnosed for a problem he didn’t have.

          • Young CC Prof

            It really seems like even within the medical profession, newborn feeding advice comes with lots of myths, rumors and personal beliefs.

          • Jessica S.

            And IIRC, he didn’t really have a lot of wiggle room weight-wise to start, right? Wasn’t he teeny-tiny?

          • Young CC Prof

            He was not quite five pounds. And over 18 inches, so not a whole lot of “baby fat” there! At birth, his body was skinny like a five-year-old kid. (Now, after 8 weeks of constant feeding, he looks nice and chubby like a baby should.)

    • Tiff

      I agree! With my third child, my nipples were literally coming off and no one could figure out anything to help us. The only thing I was told was to “keep it up”. Keep it up? The pain was so awful that I would cry every time my baby latched on. It was a nightmare until we switched to formula. Skip to my fourth child, we’re still breastfeeding at nine months but it’s been anything but easy. It takes a ton of dedication and time. I had to withdraw from my college studies and am only able to start back because my baby has started solids. Any way, no, it’s not as easy as they sometimes make it sound.

    • Lion

      In my experience, and perhaps it is different as I’m in another country, La Leche League spend most of their time helping mothers by sharing information on how to overcome difficulties with breastfeeding, not pretending they don’t exist. I have attended quite a few of their group meetings and found that although there are some over zealous mothers who attend as members (not leaders) that the actual organisation and the leaders are quite sensible, accept that not everybody wants to breastfeed, give information and support and help to those who want to but are struggling, and ask those who aren’t struggling to be supportive and helpful to others. I’ve certainly had my fair share of running backwards away from the self definied lactivists who think breastmilk is as magic as kale and unicorn sprinkles, but I haven’t got this from the organisation itself – just the hangers on. I have no do ubt there are some who are like that in the organisation, but I think that for those who want to breastfeed and seek out the help, that they can be a real help and support.

    • Danielle

      I think a lot of conflicting things are said. On one hand, “don’t worry: it’s not hard,” because they don’t want people to assume that it will be rough and bail on the idea prematurely. It is not hard for some people.

      But they also offer a lot of information on how to deal with problems, and recommend lactation consultants. So they do admit freely that there are challenges; again, they want to emphasize that these can be overcome in many cases.

      That seems like a reasonable approach to me. The issue is that there is a thin line between encouraging people not to be discouraged, and pressuring them to feel they are not good enough if they want to stop. Individual lactivists range from pragmatic to fundamentalist in their approach.

      I do have one small grudge: I kept reading places that I needed to go take a long bath and relax to improve my milk supply. Dude, I felt like I could barely get a shower in. When was the long bath supposed to take place?

      • NoLongerCrunching

        Well, obviously while you were doing skin-to-skin simultaneously ;)

      • Mer

        Yeah, I’m laying here reading your comment, breastfeeding the baby, and unshowered for two days now wondering when I’ll get to take one. Really does make me grumpy that a lot of the advice for breastfeeding assumes the mom has copious spare time and only one child to care for.

        • ngozi

          ..and copious help around the house. I really hoot when they suggest you HIRE help. HARF!

      • Lion

        I climbed in the bath with the baby (when husband was home to help us in and out). That doesn’t help milk supply (removing milk does that), but it was relaxing and baby and I both got bathed daily that way. When I had two children we all bathed together, it was squashed, but we had great fun. Still now that my kids are bigger, if I climb in the bath, they sometimes just run in and join me. My son is getting a bit big for this now so I am going to have a little talk about privacy needs (mine), but we do still find it relaxing.

  • Elisabeth Graham

    I’ll stick with my own nut theory. Of 70+ babies that were born to me, or fostered by me only 2 were BF. The rest had formula(s). The big rule here was always bottle feed as if one were breastfeeding. Never, ever a bottle in the crib with baby. Cost was irrelevant – foster care paid for whatever the baby needed. One adoptive mother called me when she adopted a second child from a different home – she wanted to know what I had done with the first one to make him so secure!

  • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

    my top benefits from breast feeding: it cost me nothing, and it makes for less horrible baby poo.

    • Rochester mama

      I spent about 600$ trying to make breastfeeding work, not counting the insurance covered LC visits and biweekly trips to the Peds office for weight checks till I switched to full formula at 6 weeks and he started gaining real weight. I guess his poo was better on breast milk, cause there was hardly any of it.

    • MLE

      I spent a diaperload of money on breastfeeding.
      Between nipple shields (a necessity for it to work AT ALL), a pump, pumping supplies, bottles, a cover (a necessity for my modest nature), a pillow so I could breastfeed and work at the same time whenever possible, pediatrician visits for weight checks as Rochester mama mentions, drugs/doctor visits for mastitis, and lost productivity, yes it was quite costly.

      • Rochester mama

        My son had a horrible time feeding breast or bottle. He had a really weak latch and I went through 3 types of bottles and multiple nipples before finding one he could use and it was still a process to get him to eat. It was never painful for me, but his inability to get much milk out of the breast after my initial let down caused my supply to tank. He took about an hour to get two ounces out of bottle so adding in pumping to an 8-9 hour a day bottle feeding schedule just would not have worked. He is a normal toddler now and drinks from cups and feeds himself, but still can’t do straws??

        • Mac Sherbert

          Straws??? My baby could do straws at 7 months, but cousin’s couldn’t until his was around 2. No explanation as to why my mine did it so early, but you do get some weird stares when your little baby is stealing sips from your McDonald’s cup!

          My cousin’s child finally figured it out after she told him to suck on it like his pacifier. There are some new cups designed to teach babies how to use a straw….

          Kids are all different…some have weak latches and some are barracudas!

        • NoLongerCrunching

          What does your ped say? It may be worth getting him looked at by an ENT or craniofacial specialist (a real doctor, NOT a craniosacral therapist). What you are describing is atypical enough that I’d want an expert to evaluate him.

          • Rochester mama

            Rochester is home of the Mayo Clinic and that’s where we go. He was evaluated by a specialty Peds guy as opposed to his normal community Peds Dr. after bottle feeding was still rough, but they didn’t find anything, he was born at 38 weeks so they chalked it up to near term feeding issues and said it was more common in boys than girls. He did become more efficient as he got older, but at 8 months he still took like 45 minutes to eat 8oz and you had to hold the bottle just so or he would leak formula all over the place. He’s learning to talk fine and never had swallowing problems. It was definitely the case I felt more pressure to BF from the other moms than any doctor or even the LC, the LC was great at suggesting brands of bottles and nipples to try that were easier for babies having problems getting milk.

          • NoLongerCrunching

            Interesting! Thanks for sharing your experience. So he has trouble generating suction? Why do they think that is? Sorry for my curiosity; my degree is in speech pathology.

          • Rochester mama

            Yes, his suction is really weak. When he was a baby, he liked a pacifier, but you had to hold it in his mouth, he couldn’t suck hard enough to keep it firmly in if he moved positions. He can finally at 18 months uses a standard sippy cup with the rubber regulator on it, but for the longest time I had to take it off and just live with the fact he could fling milk everywhere if I wasn’t watching him closely.

          • MLE

            Straws are overrated. Once the box of milk was squeezed and milk shot out of the straw like a firehose, that went out the window.

          • Guesteleh

            He has apraxia of speech. Like Rochester Mama’s kid, he also had trouble sucking from a bottle. But he’s doing well now after three years of speech and occupational therapy.

          • Guesteleh

            I taught my son how to use a straw by putting it in his mouth and then squeezing the (plastic) cup. That forces liquid up the straw and they naturally start the suck-swallow process even after you release the pressure.

        • MLE

          I wish there was a stamp on babies to tell you what kind of nipple they would like. With all the mismatches out there between baby’s ability to latch and suck, and mom’s anatomy and supply, it’s amazing anyone falls for the “made to birth” line.

          • Jessica S.

            Yes! I also wish they came with indicator lights to explain things like “this is a phase” or “this should be taken seriously”. You know, like a “check engine” light!

          • MLE

            Patent that immediately! Some day it will happen… I’m always afraid I’m running to the doctor for the sniffles but somehow I will not be able to spot the signs of Extremely Rare and Deadly Illness.

          • KarenJJ

            My husband and I are both engineers. We thought babies needed a level indicator (for both inputs and future outputs – timing indication would also be handy) and indicator lights.

      • Anka

        Oh yeah…breast pads, overpriced nursing tops, several expensive nursing bras in an unorthodox size, expensive pump and bottles, fenugreek, blessed thistle, Domperidone, oatmeal, beer, a cheap breast pillow that turned out to fit a petite ten-year-old play-nursing her baby doll, a much more expensive My Brest Friend, a cover that we didn’t use because he refused to eat with it over his head….that’s just off the top of mine. Fortunately, the pediatrician visits (great) and lactation consultant visits (horrible and infuriating) were free thanks to the healthcare system, but the rest of it was NOT cheap. And, thanks to hypothyroidism-induced low milk supply, I never reached that goal of breastfeeding exclusively. I’m not buying or trying all that sh!t second time around, if there is one.

        • MLE

          Bahaha I forgot the nursing bras in letters of the alphabet that I had never dreamed of before…plus night bras to contain the pads, PLUS a waterproof mates pad for the times a pad was not enough. I swear more milk soaked into the bed than my son ever drank. And of course my supply tanked during the day. Not sure why that was…

          • ManaBear

            I couldn’t even find a nursing bra in my size anywhere, not even at the hospital’s breastfeeding boutique. I have a hard enough time finding regular bras (I wear 48B) and no place made a 48 anything in a nursing bra, unless you order online, but I refuse to buy bras without trying them n first. Plus I bought an electric pump in hopes I could feed that way. Breast feeding is many things, but free isn’t one of them.

          • MLE

            Where do you even go to find a nursing bra to try on??

          • An Actual Attorney

            Nordstrom. I had to get ones in DDDD. I learned. I have also heard that Nordstrom will convert a regular bra to a nursing bra.

          • Medwife

            I didn’t know that size existed!

          • Jessica S.

            I love Nordstrom. They are so great for so many things.

          • theNormalDistribution

            LOL. I’ve never heard of “DDDD”. Is that another name for “F”?

          • An Actual Attorney

            G actually. Before pregnancy, I was somewhere between a 36 B and 36 C. During I got to a 38 DD. Once my milk came in, I was 38 G/DDDD. My boobs entered rooms before I did.

          • theNormalDistribution

            Sweet jesus, that sounds horrifying. I’m a 30G now. If my body follows your lead when I get pregnant, my boobs will be bigger than my head.

          • An Actual Attorney

            It’s unlikely. My experience was atypical.

          • Young CC Prof

            Hmm. Some of us needed to buy the giant nursing bras just a few days after we got a positive pregnancy test. That was fun (NOT.)

          • Jessica S.

            I’m with you! Not fun.

          • MLE

            Haha! I definitely needed to upgrade earlyish, but I work from home so I…..didn’t. It got a little too freewheeling boobs a flappin’ in the third trimester so I broke down and made a purchase.

      • GiddyUpGo123

        Yeah, starting with the $400 pump that I had to buy because none of the cheaper alternatives were recommended by my lactation consultant, plus the supplemental nursing system that cost a fortune and all the bags and replacement tubes that went with it and the domperidone that cost a fortune, not to mention the burn pads I had to wear in my bra every day because my nipples looked like raw hamburger … Oh yes, those were the good ole days! Good thing the benefits to my baby were so huge! Oh, wait …

      • anh

        YES. So. Much. Freaking. Money!. Galactogogues, pumps, LCs, hours, tears, weight checks. sigh.
        I spent $200 on formula my daughter’s first year. She was a little goat and I could switch brands willy nilly and she never noticed. Her daycare provided Good Start, and I got so many free samples and giveaways that I only bought 12 cases of generic target brand. SO MUCH CHEAPER

      • Kelly

        I spent a lot of money as well. A nice pump, a deep freezer, the bags to hold the milk, extra pump stuff, and all the time I spent away from my family or ignoring them in order to pump, etc. Plus, my husband has flashbacks about the pump sound. I did all of this partly because I felt guilty about not providing it for her especially since I had an oversupply and ultimately I did it to save money. I wish I knew how much it really cost to try to nurse and then pump for almost a year because I am not sure how much I really saved. Now with my second child, I refuse to work as hard as I did the first time. I want to be available for both of my kids and to actually be able to parent them. I told my husband when I stopped nursing that we would be using more formula and that I refused to push myself as hard as I did the first time. I will stop pumping when it is too much for me and my family and I will not feel bad about it.

    • Jocelyn

      I definitely prefer breastmilk baby poo to formula baby poo. :)

      • KarenJJ

        Depends. My baby had the burning explosive green frothy poo while breastfed. It was unpleasant especially when it was shot out at me in the middle of the night during a nappy change and my reflexes were dulled form sleep deprivation… Formula fixed that one (and helped her gain weight).

        • MLE

          I am imagining something like this except without the protective eyewear.

          • KarenJJ

            That’s pretty much what the baby nursery was like, at least to my bleary 3am eyes…

        • ngozi

          I found out when my child was doing that, he was getting the watery foremilk instead of the creamier, weight producing hindmilk. When I stopped believing all the woo about not pumping and feeding your baby from the breast only and started pumping it solved the green frothy poo and the weight gain problem.

          • Elizabeth A

            I had a similar experience. Unforch, the pumping sort of made my oversupply problem permanent (until weaning).

            Let me just say that I really understand why cows complain if not milked on time.

  • KAndrews

    Bill and Melinda Gates Foundation has been on a probreastfeeding, promidwife slant lately. http://www.impatientoptimists.org/Posts/2014/02/Inside-the-Politics-of-Breastfeeding-Promotion

    • Guesteleh

      That’s because most of their public health advocacy is done in countries where breastfeeding can be a lifesaver. In developing nations diarrhoeal diseases kill thousands of babies each year and the foods that babies are weaned to are of very poor quality. Google “weanling’s dilemma.”

      • LMS1953

        Not to mention that those developing countries have the home birth gig down pat. Billy ought to build a hospital or two there where he would get a bit more bang for his buck.

        • Guesteleh

          These are rural countries with few resources that rely primarily on traditional midwives. Simply providing basic training to these midwives along with low-cost resources to address issues like PPH can drastically reduce maternal and neonatal mortality.

          Meanwhile, I found this blog and almost had a stroke because it pissed me off so much: http://www.africanbabiesdontcry.com/

          • LMS1953

            I clicked on it but I don’t have a clue what the point of the blog it. What pissed you off about it?

          • Guesteleh

            It’s called African Babies Don’t Cry. Because they’re so natcherall and close to the earth.

          • Anj Fabian

            Just call it:
            American Mommas Should Be More Like the Noble Savages.

          • Zornorph

            Mud-hut super moms.

        • The Computer Ate My Nym

          Build and provide funding for supplies, preferably an endowment that’s going to last…otherwise, all you have is an expensive building.

        • KAndrews

          So jealous that you call him Billy :)

      • KAndrews

        I know a little girl that got dehydrated and had a heart attack as a newborn in America. I can’t see how in mothers with very poor nutrient would do better

        • Trixie

          Because BF protects against diarrheal illness. If you have no hospital to take your dehydrated baby to you’d better keep contaminated water out of them, and formula/feeding without access to safe water is either expensive (must buy bottled water) or deadly.
          Just like breastmilk is lifesaving to preemies in the developed world, it’s lifesaving in the developing world at preventing illness. No, it isn’t perfect, and yes, the long term goal should be sanitation, but that doesn’t change the fact that BF can save lives now in those areas.

          • KAndrews

            The one I know is a CPM. No idea who funded her trip just that she goes over for a short period of time and trains midwives. Maybe I just have a problem with a group in a position of power only giving someone part of the info because they think they know what is best for them. My son could not breastfeed and it added so much more strain on us that Every spare moment I had I was trying to pump tiny droplets out. My son had failure to thrive and I was extremely traumatized and sleep deprived. My friends baby got dehydrated but there was so much pressure to “keep trying! It’s natural. She will take what she needs” that her daughter ended up having a heart attack and now has severe CP. Yes antidotal! But it doesn’t feel like that when you are watching her heartbreak. For the greater good I guess. I would be terrible in public policy.

          • Trixie

            I’m really sorry. That’s awful.
            I don’t think CPMs are being funded by Gates. I think the one you know is part of an awful program that goes to get “catches” overseas where they get to play hobbyist with people’s lives in an environment where there is even less chance of consequences. It’s immoral and should be illegal.

      • Lion

        I live in Africa. Here breastfeeding does save lives. Not just rural areas, but cities too, mothers over dilute formula to save money, don’t have access to electricity to boil water (and water must be boiled for safe drinking in most parts of the country I live in), aren’t able to sterilise bottles and teats or even wash them very well. Babies do die of diarrhea here, it is the biggest cause of death in children under 5 (I don’t have a citation, but this is what clinic posters tell us and we see in news reports about the biggest causes of death). Unfortunately there is a bit of a stigma that only poor people breastfeed becasue they can’t afford formula – and this does cost lives. However, there are other problems. Even those mothers who do breastfeed often give baby porridge from 2 weeks old and use all sorts of “traditional” medicines which can be quite harmful. HIV is rife and the department of health encourages mothers to breastfeed exclusively or formula feed exclusively as mixing the two can apparently increase the chances of baby getting infected with HIV, however, HIV positive mothers and babies (who test positive at birth but then negative later) are put on Nevirapene to reduce the chances of transmission. (I don’t have citations for this either, but this is the premise that our department of health uses in guiding their policies). Many of the middle class mothers who breastfeed donate milk to milk banks which goes to the government hospitals for the premature and sick babies to lessen the chances of them getting necrotising entercolitis (there isn’t enough to go to full term and healthy babies). I spend time volunteering to help mothers with latching problems and the other common hurdles of getting started with breastfeeding,

    • Trixie

      That’s because breastfeeding really does save lives in areas with poor sanitation and lack of access to safe water. Not really the same thing at all. And trained midwives are better than untrained midwives.
      Of course, the long term goal is better sanitation and hospitals, but breastfeeding and training midwives can save lives right now.

      • KAndrews

        I disagree. I know a midwife that goes to Africa to “teach” midwifery. She attended the death of her own granddaughter last summer and told me that she had a baby born not breathing for over an hour, but because the cord was attach it saved he lived (somehow??) I don’t think that is a service to them. Why can’t we just tell them the true goal. Because they are poor we have to limit the definition of “best”? Work on the water. Work on sanitation. Work on hospitals. Don’t tell them that the end all beat all is breastfeeding and midwives when it is not.

        • Trixie

          Okay but is she a DEM/CPM or a real midwife? Who funded the trip? Hopefully Gates foundation is funding evidence based training and not exploitative CPM vanity trips. And Gates is working on sanitation and water and hospitals. But if you want to save babies right now, this month or this year, in many places better midwives and exclusive breastfeeding are evidence-based ways to do that.
          It has no bearing on the BF/FF numbers in the first world.

  • NoLongerCrunching

    Breastfeeding does appear to reduce the risk of breast and ovarian cancer and Type II diabetes in mothers, and is associated with less risk of PPD (causation not established). http://archive.ahrq.gov/clinic/tp/brfouttp.htm#Report

    • Wendy

      Would taking birth control pills for the same amount of time have the same effect?

      • NoLongerCrunching

        According to http://www.ncbi.nlm.nih.gov/m/pubmed/15105794/

        Oral contraceptives cause “a reduction in the risk of endometrial and ovarian cancer, a possible small increase in the risk for breast and cervical cancer, and an increased risk of liver cancer” and “a reduction in menstrual-related symptoms, fewer ectopic pregnancies, a possible increase in bone density, and possible protection against pelvic inflammatory disease.”

        • Hannah

          I’d been wondering about this as I’m 25 and don’t need the pill as contraception but have been wondering if taking a low dose progetogen only pill would be beneficial health wise. This seems like a good place to put out that question.

          • Medwife

            Not gonna touch on if that is something you personally should do- good question for your provider- but the progestin only pills do not work by stopping your ovulation but primarily by thickening your cervical mucus. The health benefits and risks are different from the estrogen/progestin methods.

    • Guesteleh

      Breastfeeding reduces a woman’s lifetime exposure to estrogen, which is a carcinogen. Yes, the estrogen made by your own body causes breast and ovarian cancer. Other things that reduce estrogen and also breast/ovarian cancer risk are regular, high-intensity exercise and keeping your weight down, both of which also reduce exposure to estrogen.

      I’m only bringing this up because people wank on about natural products but meanwhile it’s your own body’s estrogen that can lead to cancer, and what could be more natural than that?

    • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

      From what I understand the reduction in risk is from suppressing periods. I don’t know if those four periods a year birth control pills would do the same thing or not…

    • Not for me

      BF exclusively for 5.5 then 5 mo for my 2 kids (pumped st work but supply went down so suppl with formula). PPD both times. Miserable. Luckily meds helped (doc okayed them while bf.)

      So bf doesn’t necessarily reduce chance of ppd.

      • NoLongerCrunching

        Respectfully, the paper showed a link, but causation could go in either direction; breastfeeding could reduce PPD, or PPD could reduce the amount of breastfeeding done.

        • Trixie

          My anecdotal experience is that I’m a much calmer and happier person on prolactin. I realize that’s not true for everyone.

    • Anka

      I know this is just my own personal anecdote plus some secondhand ones, but all but one person in my PPD support group were pushed over the edge into PPD territory because they had unsolvable milk supply issues and consequently lots of breastfeeding trouble that was minimized and criticized by lactation consultants and the widely available literature. We felt like failures and got no support for our actual situations, and generally felt that if we hadn’t gotten so much pressure at a valuable time, we might have been OK. In our cases, not breastfeeding, or working out a system where we breastfed less, would have reduced the chances of our PPD.

    • sarahh.rosanne@gmail.com

      Does it seem like a valid question to ask wether breastfeeding, particularly for extended periods, may have certain detrimental effects on the long term health of an infant versus introducing formula at a certain point, or cows milk when it becomes appropriate? Is the decreased risk for mother possibly at the expense of an increased risk to the child? I wonder specifically about hormones and toxins (ie pthalates etc.) that tend to affect the breast tissue. I’m somewhat, or maybe very, ignorant of the physiology of breastmilk production, as are my breasts. Could there be compelling reasons to limit breastfeeding to a certain duration even when the conditions were optimal (and desirable) for mother and baby to extend it beyond the point it would have been biologically necessary before the advent of suitable solutions? Curious.

  • Hannah

    “…but when hold ethnic, cultural and socio-economic factors constant by looking only within families, the improvements not only vanish, but in some cases the breastfed children do poorly compared to their bottlefed siblings.”

    I’m sorry, I may be being dim, but where does that come from? All the sibling discordant comparisons seem to be in the “right” direction for breastfeeding, albeit not statistically significant for this sample.

    Also the legend seems to indicate asterixes for statistical significance but I can’t see any. The abstract implies (by my reading) that one of the comparisons remained statistically significant, which one was it?

    • theNormalDistribution

      I was wondering the same things! Good thing I read your post before I posted my own.

      • Hannah

        Does anyone with more statistical knowledge than me know if it would be valid statistically to calculate the probability of 11 measures coming up “positive” with a null hypothesis? Obviously the calculation itself would be simple presuming a fifty-fifty chance if the underlying probability for each sibling is equal, but I’m not sure if it would be statistically irregular to do that kind of analysis.

  • The Computer Ate My Nym

    But no one has yet mentioned the biggest advantage of breast feeding…for the mother: Babies have three basic needs: input, removal of output, and attention and love Everyone does attention and love, so that leaves input and output to cover. If you breastfeed, you can bogart input leaving your partner responsible for removal of output…and never change a dirty diaper!

    • mom of 2

      Yeah, that’s how we roll. With both babies I never changed diapers when my husband was home.

    • Anka

      Ha! Now that my baby appears to be weaning himself at nearly eight months old (which many websites say is impossible, but I have low supply and he’s eating lots of solids and I don’t want to push it), my husband has been putting in more work than I am (he has always done the output management and the formula input, while I breastfed).

  • Staceyjw

    The differences are scant, we always knew this. Yet we have moms sourcing breast milk from strangers, because formula is poison, even with the very real dangers of contamination.

    I think this is a great way to study BF vs FF, without the confounders, as well as see how SEs, race, class, etc effect kids. I wonder if the lactivists will address this? I am sure they won’t. I can see the few honest ones moving the goal posts to focus on attachment only, as that isn’t measurable, and the rest ignoring it all together. What about the things that are WORSE with BF?

    I wish lactivists would spend their considerable efforts on the things the author mentioned: improving leave, health care, incomes across the board. I doubt that will happen- it’s easy to focus on forcing BF, not so easy to fix giant structural issues.

    I am sure there will be crickets, just like when stats for Hb are mentioned. The zealots only come here to argue opinion.

  • Bomb

    Here is my breastfeeding history… Don’t know where we’d fall in that study since all of the kids were breastfed at least a few months.

    My kid that was breastfed the least amount of time is thinner, a bigger ‘handful’ (which may translate to higher intelligence since she can pic locks and get into all kinds of trouble her sister can’t figure out), and is healthier (never catches the colds the rest of the house has) than her younger sister that was exclusive BF until she somehow got salmonella and had such bad complications she couldn’t even handle ‘nature’s liquid miracle’ which was at I think 9 months (she wouldn’t even try solids, and once she got sick that went right out the window until she was 13 months).

    I tell this story because of the utter hell I went through with DD1 spending thousands on LCs, shields, supplements, and countless nights crying myself to sleep because I was failing her. Then comes DD2 and I spend close to 12 hours a day BF everyday for 9 months just to keep her weight up. (Then she gets sick and we have to switch to the non hippiest most “unhealthy” formula a lactivist could conceive of, basically only made from corn and corn syrup! But the only thing that didn’t cause her to be hospitalized from raging diarrhea and dehydration.).

    Then comes DD3, NICU baby that is fed formula from day one, then BF once my milk came in. Always underweight, not meeting any milestones, finally at 3/4 months had my milk checked in a lab to find out it had virtually no fat and was 10 cals an ounce (formula is twice that).

    Wish I’d known that with DD1 so that we could have saved the money and anguish, with DD2 so that she wouldn’t have to spend literally half her life the first 9 months struggling to get enough nourishment, and DD3 so that she could have been properly nourished from day 1.

    TLDR, I’m all for breastfeeding, extended breastfeeding, public breastfeeding (I did it discreetly in half a dozen states for that matter), NOT okay with the lies, guilt, and judgement propagated by certain mothers and members of the BF community.

    • anion

      Baby formula made with corn and corn syrup? Did the lactivist work for Sweetums?

      • Bomb

        My point is that it would make a lactivist stroke out. It was prescribed by her gastroenterologist.

  • The Computer Ate My Nym

    Nice study, provides some good data for combating the pressure to breast feed or else. However, I do have some issues…
    1. They don’t analyze the data for what I tend to think of as the most compelling positive finding for breast feeding, i.e. the decease in infection. It seems to me likely that the effect would be short lived, i.e. only while the baby receives maternal antibodies, but could imagine that it could continue (i.e. maybe fewer ear infections later in life because less damage done by early infections?) So I’d be interested in someone examining that data, if it’s available.
    2. I don’t really like the yes/no distinction with no gradations for breast feeding/no breast feeding. It’s a little ambiguous to me what the cut off is for “no breast feeding”. If you breast fed for 4 weeks until your maternity leave was up and then bottle fed, how is that counted?
    3. Several variables were based on maternal report. Potential bias there, probably in the direction of favoring breast feeding, but could go either way.

    And…one final comment: can we now finally put to rest the “my kid is hyperactive/obese/autistic/whateverelse because I didn’t breast feed” meme?

    • The Bofa on the Sofa

      1. They specifically looked at LONG TERM outcomes. So even if a FF child has more colds, what is the long term impact?
      2. Yep, see my comment below

      • The Computer Ate My Nym

        That’s the question I’d like see examined: Does the observed (mild) decrease in infections in infancy translate into any advantage in later life? I could imagine a lower rate of infection later in life due to less colonization by pathogenic bacteria, less damage to underlying structures (i.e. scarring on the tympanic membrane, etc), but don’t know whether that would be seen or not. There might even be a higher rate of infection as kids lose their passive antibody protection and encounter infections at an older and potentially more vulnerable age.

        • Bomb

          Isn’t there some research that shows daycare kids and stay at home kids don’t have any long term differences in health even though daycare kids get sick way more often as infants/toddlers? That the home kids just catch up getting all the common viruses when they start elementary?

          Perhaps it is the same with breastfeeding vs not.

          • The Computer Ate My Nym

            I’m not sure. I do remember a study demonstrating that kids who go to daycare are less likely to get leukemia, probably due to earlier antigen exposure. So possible subtle differences due to different ages at time of exposure…in fact, I wonder what an evaluation of breast feeding versus leukemia would show.

          • Young CC Prof

            Maybe. Definitely, whenever you send your child out of the home, they’re going to get sick almost constantly the first year, and whether that’s age 3 or age 5 doesn’t make much difference. (Personally, though, I rather it not start at just a month or two old, due to the risk of more serious illnesses and vaccine-preventable diseases)

          • AlisonCummins

            I think trying to wait until a child is three before putting them in daycare or similar situation is ideal if it’s practical. The eustacian tubes are wider and change in angle and offer better drainage so that colds are just colds and not runny ears.
            This still only works for the first child though, who will bring home the daycare bugs for the younger ones anyway.

      • guest

        one example of a long-term outcome re: infection that we know of now is – cancer – specifically Hodgkin lymphoma (link to epstein Barr virus). I bet there are others, some known, some yet unknown…

      • Meredith Watson

        Would anyone mind explaining the transfer of immunity to the baby? I have always wondered whether it would give the baby protection against the diseases that the mom has been immunized against as a child or is it only protecting them against things the mom was very recently exposed to? or both?

        • Young CC Prof

          Most of the antibody transfer happens across the placenta before birth, rather than in breast milk. But anyway, yes, baby gets some antibodies to anything Mom is still immune to, but recent immunity is better. That’s why the CDC is now advising pregnant women to get a pertussis booster near the beginning of the third trimester even if they are already up to date, because it produces an antibody spike just when the mother’s body is pushing antibodies out to the baby before birth.

          • Meredith Watson

            Thanks Young CC Prof!

  • Jocelyn

    This makes me feel a lot better right now. Even after reading this blog for the better part of a year, and hearing over and over again that formula feeding is just fine, I STILL feel guilty about switching almost entirely to formula right now.

    My four-month-old daughter developed a bad rash and constipation about a month ago. Her doctor sent us to the allergist, who put me on an elimination diet (I had to cut out anything with milk, wheat, corn, soy, fish, shellfish, peanuts, tree nuts, eggs, or oats) and gave us some special amino acid formula to replace the milk-based formula I had been supplementing with. On this elimination diet, not only did I start dropping unhealthy amounts of weight, but my milk supply dropped to almost nothing. It got to the point that it was like, why am I even doing this elimination diet to make my milk okay for her to eat if I’m not even going to HAVE any milk for her to eat in the end?

    A week ago I switched her entirely to the special formula (and have now introduced soy formula, which she seems to be doing okay on – we’re still watching) and I went off the elimination diet. I went off it to try to eat enough calories to build up my milk supply. I’m eating more and pumping a ton, and so far, my milk supply is staying stubbornly low. I’m going to start nursing her again in a couple days (I’ve decided to add everything back into my diet but milk, since we think that’s what she’s allergic to), but I don’t have high hopes that my milk supply will ever recover.

    Several times in this whole ordeal I’ve thought about switching entirely to formula permanently, and aside from the worry of the cost of formula, the one thing that’s been stopping me is that I still feel guilty, even after all this time, because the “Breast is best” mantra has been shouted at me all this time. (Even the allergist chanted that phrase – “Breast is best! Breast is best!” at my daughter’s appointment.) The biggest thing for me is that I don’t want to somehow impair my daughter’s future cognitive function.

    (And I also want to add – I dealt with low supply issues with my first daughter, too, and one time when she was crying from hunger I googled “Is it okay to feed your baby one bottle of formula?” which brought up some site with that “virgin gut” crap. It scared me into not feeding her formula until she was 5 1/2 months old. She could have been spared hunger and I could have been spared a lot of stress if people would just stop exaggerating the difference between formula and breast milk.)

    Thank you for this, Dr. Amy. I feel a lot better now.

    • FormerPhysicist

      Good luck, I hope you and your daughter both feel better and are healthy. Enjoy however you feed her!

    • Sarah

      Your allergist ought to have read the Probit study. S/he might not have been quite so keen to chant breast is best at you then.

  • The Bofa on the Sofa

    The retrospective use of discordant siblings is interesting, because it really goes to the point of, parents doing what works best for them. Clearly, those parents chose the path for each child that worked best for them at the time, and what works best is a dynamic issue. However, the results of the study show that, just as people have been saying, there is no harm in doing what works best.

  • GiddyUpGo123

    Oh man, people are gonna be pissed … I can’t wait to see how the lactivist community tries to explain this one away!

    • YogaMathMelon

      Math is hard. I’m sure they don’t understand what the research is trying to say, especially if they themselves were FF. ;)

    • NoLongerCrunching

      Basically identify weaknesses (all studies have them; in this case, participant recall may be unreliable, definition of “breastfed” may be anything from exclusive to heavy supplementation which muddies the differences), and use those weaknesses to dismiss the whole study as garbage.

      • The Bofa on the Sofa

        I think there is a legitimate question about the murkiness of what constitutes “breastfed.” Then again, I think that really illustrates the whole point – in reality, breastfeeding is not about absolutes. and the concept of “exclusively breastfed for 6 months” is really artificial.

        A baby that gets a bottle of formula here and there but is otherwise breastfed is not exclusively breastfed, but who can say they aren’t breastfed? But oh no, can’t accept that. Formula has tainted their gut!

    • Meredith

      When I linked this to a friend who struggled trying to breastfeed and was quite open about her guilt over not being physically able to do so, she told me that “It’s just one study” and “Well, I don’t believe the benefits of breastfeeding are trivial” before refusing to discuss it at all. That was certainly an enlightening (and upsetting) experience for me…

      • The Bofa on the Sofa

        • Meredith

          That put a much-needed smile on my face. :)

      • sarahh.rosanne@gmail.com

        There was a time that I was suffering from PPD that was largely the manifestation of my guilt over being physically unable to breastfeed. If I had seen this study then, I wouldn’t have accepted it as having any validity. Breastfeeding was so deeply moralized in my mind as being the only acceptable way to nourish a baby. I believed for several years that I had adversely affected her health, even as she thrived physically and excelled developmentally. It took much reading, much experience, and also seeing many associated beliefs surrounding natural birth and alternative medicine unravel. It is also likely that there are people who actively seek to convince her that she is an inferior mother in order to elevate their own sense of status. Hopefully time will convince her that there is no reason to feel guilt.

        • Meredith

          I’m glad you did eventually come around to the realization that you had nothing to feel guilty about. I suppose when someone has a viewpoint that is so deeply engrained (even when it is ultimately damaging to them!), they treat facts that oppose their viewpoint as an attack on themselves. Oh well, it’s just one more reason to hate breastfeeding and NCB zealots, I suppose.

  • Jocelyn

    I just shared this on Facebook. I hope all of my friends with babies (and my children’s grandmas) see it.

  • PrimaryCareDoc

    Fantastic study! Thanks for the post and the analysis. Also, this study seems to support the anecdotes that parents of “discordant siblings” have been telling for years (myself included).

  • BeatlesFan

    Who wants to post a link to this study on The Alpha Parent’s FB page? I’ll bring the popcorn!

    • Rochester mama

      Once you fail one child the stench just infects the whole family that’s why the discordant siblings don’t show a difference : p

      • Alexandra

        Just being in the presence of formula reduces your IQ, don’t ya know? That’s why she repels formula feeding mothers so vigorously – she IS the Alpha parent!

  • anon13

    techqueen and nikkilee, come on down!!

    • The Bofa on the Sofa

      Oh, it’s been explained very clearly to them about how, as the quality of the studies go up, the benefits of BF disappear.

      They just deny it.

    • The Computer Ate My Nym

      Yeah, where are they? I’m pretty sure techqueen at least commented within the last 24 hours…

  • YogaMathMelon

    You mean that breast feeding won’t just magically make your child not obese their whole life? That you have to have the economic resources available to buy and prepare healthy foods to instill healthy eating habits? I’M SHOCKED.

    • Staceyjw

      It seems to be the opposite! I wonder if this is due to the nature of BF on demand, and the common use of BF as a soothing tool (often the sole soother). I know from experience that my FF DS sees food as a way to fulfill hunger, while DD also sees BF (and the milk she gets) as comfort.

      I am curious if this persists past infancy/toddlerhood, and am even more curious if extended BF makes this even more pronounced. Just looking at my DD, I can see the attitude towards food as different due to the extended BF. It also makes weaning much harder, in general, than with a bottle, unless the FF kid is also using it as a soother. I see whole forums dedicated to weaning BF, and not FF, and do think the comfort is key to this.

      • Mac Sherbert

        Yes. I’m having that exact scenario play out right now. My first weaned from ff easily, he had a pacifier. My BF baby never took a pacifier and I can’t wean her! Anytime, she gets tired or upset she wants Nona. My mom warned me to wean her early (before 12 months) because she loved it so much and of course Mom was right!

      • YogaMathMelon

        I have no idea…I used the ebil formula from day 1 with both my kids. ;)

  • Jessica S.

    I still think I’d be a millionaire now if my mom had breastfed me. I mean, what other factor could explain my lack of success and wealth?
    ;)

  • Irène Delse

    I love this kind of scientific creativity! Well done.

  • NoLongerCrunching

    Feeling dumb here… what is the difference between “siblings” and “discordant siblings”?

    • Amy Tuteur, MD

      Siblings: all the children in the family were either breastfed or bottlefed
      Discordant siblings: some children in the family were breastfed while others were bottlefed

      • Amazed

        That’s me! That’s me! Never had a lick of formula. That’s why I am a lot cleverer than my brother who didn’t have a lick of formula either (the stuff wasn’t around here at the time) but was exclusively fed powdered milk throughout his first month.

        Do you think if Mom had let him suck at her dry boobs for that first month, that would have made him cleverer? ‘Cause I happen to think it would have made him dead.

    • Jocelyn

      DIscordant ones argue a lot. (just kidding.) ;)

  • Mel

    A twisted correlation: When making claims about the benefits of breast-feeding, you can project whatever biases you hold on to the non-breast feeding group.

    The number of online posters who truly believe that my at-risk students are at-risk because of breast-feeding choices is astounding and absurd at the same time. I hate to be the bringer of bad news, but if a 16 year old mother breast-feeds and does nothing else, her baby isn’t going to magically jump into the middle class 20 years later……

    • Staceyjw

      People grab onto simple solutions to big problems. How much easier would it be if BF could solve the issues created by low SES?

  • Young CC Prof

    “A truly comprehensive approach to increasing breastfeeding in the U.S., with a particular focus on reducing racial and SES disparities, will need to work toward increasing and improving parental leave policies, flexible work schedules and health benefits even for low-wage workers, and access to high quality child care that can ease the transition back to work for both mother and child.”

    I say that all the freaking time. THANKS to Colen and Ramey!

    • http://thefresstyler.blogspot.com/ Hannah

      Even without the issue of breastfeeding, this is essential.

  • Alexandra

    Fantastic. All the other studies were hopelessly confounded – comparing within families is the only way to go…

    I could have been part of this study – my eldest refused to breastfeed despite all my crazy, guilt-ridden, sleep-deprived efforts. My second daughter latched on right away with no issues whatsoever.

    Too soon to tell, but in my opinion, they are both brilliant and perfect in every way. I may be biased though.

    • Mel

      You should be biased. That’s one of the benefits of being a parent. :-)

  • Elizabeth A

    A great big fat YES to the last section you quote. YES. THIS IS THE ISSUE. Breastmilk is not a substitute for economic resources, and if we want more women to breast feed, we have to make economic resources available to support that.

    • LMS1953

      But isn’t the point Dr Amy is trying to make is that the benefits are trivial. Would a cost/benefit analysis show that it is worth it? Money thrown at economic disparity often ends up being spent on less noble pursuits.

      • The Computer Ate My Nym

        Actually, recent studies have shown that children raised by married or effectively married lesbians have outcomes similar in every way to those raised by married heterosexual couples, with one exception: children of lesbians are less likely to be abused.

        • FormerPhysicist

          I’d love to see a study comparing lesbian parents with hetero ART parents – just to remove any oopsie babies. Most babies are loved not matter how planned or unplanned, but I’m curious…

          • The Computer Ate My Nym

            I’d expect the two groups to be pretty similar.

            Most babies are loved no matter whether they’re planned or not, but the unplanned ones are more likely to arrive in situations where the parents lack the mental or physical resources to care for them. Some of them will be fine anyway, others…won’t.

          • FormerPhysicist

            That would be my hypothesis, too.

          • theNormalDistribution

            I know what you’re trying to say and still for the life of me can’t figure out what ‘ART’ stands for.

          • Dr Kitty

            Artificial Reproductive Techniques?

          • Mer

            ART means assisted reproductive technology. The acronym covers all the various tools used to help couples get pregnant from Clomid to IVF.

      • Elizabeth A

        What I want is for children to grow, thrive, and reach a healthy adulthood. If breast milk helps that, yay breast milk, but the research we’re seeing suggests that no, breastmilk doesn’t help that. Economic stability and quality childcare help that, and families with those things are more able to breast feed.

        Better parental leave policies, and social investment in childcare and education, stand to make a huge difference.

        And I refuse to shit on other parents, as you appear to be inviting by the suggestion that money thrown at economic disparity often ends up spent on “less noble pursuits.”

        • Mac Sherbert

          I think what he means is the money meant to fix economic disparity often doesn’t do what’s it’s intended. I didn’t read that as looking down the parents that need it. Just often that money alone doesn’t bring them up. If you give a large sum of money to someone that doesn’t know how to invest it, use it to better themselves then when the money is gone they are still in the same situation they started. I think what we would all like to see are things that bring people out of poverty and keep them out of poverty.

          They need more than just money…education, training, things like that.

          • Elizabeth A

            A. I’m not talking about giving money directly to families, I’m talking about funding early education and child care.
            B. Poor people are not stupid. They generally know which six things they need most on any given day.
            C. If you give a large sum to anyone who has large needs, they will spend the money (not invest it) and wind up back at zero. That’s what “needy” means.
            D. Education and training are luxuries for people who aren’t busy putting food on the table and roof over their heads today.

      • Dr Kitty

        Having two parents is probably better than having one.
        I don’t think they have to be married heterosexual parents.

        A single parent living in a multigenerational family home is also a great set up.

        As are deeply committed co-parents who share parenting, but not a romantic relationship (say a gay couple and a lesbian couple who raise a child in a shared parenting situation).

        Non traditional, non nuclear families aren’t necessarily “worse”, they just aren’t traditional.

      • Staceyjw

        Gay households do just as well, often even better, than straight ones. There are too many confounders to assume heterosexual marriage makes a real difference, in and of itself, based on sex of the parents alone. Like BF, the differences are hard to measure accurately- and which comes first, the marriage or the stability?

        Considering that society privileges these types of families, and higher income families will have more traditionally married couples than lower ones, I can see some structural benefits. These differences could be based on the lower status of women. Men earn more, and have more status than women, so having one may increase income and stability. Take this and other privileges away and any benefit will disappear; if they truly exist in the first place, they are social differences not inherent ones, and subject to change as society does.

        Personally, I think 2 or more, parents that care, and can work of needed, will make life easier than having just one, but that they are male/female seems unlikely to be a real difference. I prefer polygamy for myself (though we don’t live this way, even though I want to) and think polyandry would be just as helpful for others preferring it. A close extended families also have huge benefits. More hands lighten the load, living in such small families is a historical anomaly as well.

        Just my 2 cents.

        I do wish this was true, we did all of these things, even waited until we had stability, career, and savings. But here we are back to being as poor as we were when we met- even worse off, as we don’t own a home anymore. Men without particular skills and college, were hit hardest in this particular downturn, so that advantage may have been wiped out for some.

        Modern economics

      • Staceyjw

        We “throw money” at economic disparity? LOL. Please elaborate, as I do not see this at all, and I live this reality and a formerly middle class mom. I do not see the itty bitty bit of assistance going anywhere but the bare necessities for the huge majority.

        Are you referring to the hundred or so the majority of SNAP recipients get, or the Medicaid, or maybe the $200-$400 in TANF for those with zero income? Do you mean the very few that ever get sec 8 after years on the wait list? Maybe Head Start, so kids aren’t totally behind, or free lunches? How about minimally available job training? I know- the child care help fir some with minimum wage jobs. And few get all of these. WOW, SO GENEROUS. with major cuts every year, I don’t see the cash coming to fix inequality

        These programs cannot even keep families housed, let alone flush with cash. How far do you think $7-9 and hour goes?

        Do you know how hard it is for even a middle class, educated family to pull themselves out of poverty, let alone people that lived this with all the disadvantages their entire lives? I guess we deserve it for picking a job that was eliminated, or for not being smart or well educated by poor schools? My DH KILLS himself at the only job available to him, I guess we don’t deserve to eat?

        WHY DO WE HAVE HALF A MILLION HOMELESS FAMILIES! MOST WORKING OR RECENTLY UNEMPLOYED IF WE TOSS CASH AT THEM?????

        My apartments are all working families (most in fast food or wal mart workers) and low income or disabled adults. There are little to no “less noble”pursuits, just a daily struggle to remain housed and safe. I guess the occasional movie, beer, or cable/Internet is a luxury and not noble enough for you?

        When every single things about being poor or working class is different, and lesser quality, even with married parents that care, I just do not see this. The schools are worse, neighborhoods more dangerous and full of criminals, druggies and offenders (they have nowhere else to go, neither do poor families.), good food is harder to get with less time to prepare it, time for self and career improvement is sucked up by 80 hour minimum wage jobs., and on and on……

        KEEP DREAMING that the poor are just money wasting mooches. How about tacking the real problems like an encouraged and subsidized disinvestment in American jobs, lack of funds do to corporations and mega wealthy people skirting taxes, an enormous budget for unneeded war but little to improve our actual society.

        I rant because I have seen your other posts. I am not sure what you think the solution is, but if you are libertarian I am sure it’s useless and likely to make shit worse.

      • Mishimoo

        Yay! Once again, I’m a statistical outlier.

    • Guesteleh

      I would argue that any financial resources put into breastfeeding are better spent on other initiatives with a bigger impact on children’s health. For instance, reducing the rate of prematurity in the African American community. That alone would drastically improve infant outcomes in the U.S.

      • Elizabeth A

        I absolutely agree.

      • Josephine

        Yes! Absolutely. Obviously breastfeeding is not quite the huge public health issue that it’s been made out to be, so why not spend some of that money on other, more pressing issues? More head start, more research on the prematurity issues you mention, more free or low cost vaccines.

        • theNormalDistribution

          Because breastfeeding puts women at home where they belong.

          • Josephine

            Of course! What was I thinking with my silly lady brain?

    • Josephine

      Eh. I’m a solidly middle class SAHM with lots of family support (and I realize just how very fortunate and privileged I am, believe me; I wish everyone could be in my shoes) and absolutely no amount of resources will make me want to breastfeed after all the stress, failture, and shame the first time around.

      Especially seeing as how the cost of my time, emotional stress, and additional calories (given that I’m having twins this time) almost cancels out the cost savings of breastfeeding anyway, I have zero interest. I suspect I’m not alone in that.

    • The Computer Ate My Nym

      If we want more children to succeed, breast fed or not, we need to make more economic and social resources available to mothers and children.

      • Jessica S.

        YES. I was thinking the same thing!