Lactivists can’t comprehend that Fed Is Best is about safety, not formula

Safety first, message on the road

I’ve long thought that lactivists were being deliberately obtuse about the assertion that Fed Is Best. They repeatedly claim, with no plausible justification, that Fed Is Best means routine supplementation with formula for all infants.

I’ve recently revised my assessment. Maybe lactivists aren’t being obtuse; maybe they just don’t get it. There’s a critical difference between ‘fed is best’ and ‘breast is best’ and lactivists imagine the difference is formula. They’re wrong:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Fed Is Best is about safety; Breast Is Best is about process. The difference between the two is the difference between life and death.[/pullquote]

Fed Is Best is about safety; Breast Is Best is about process. The difference between the two is the difference between life and death. Seems simple, but it’s a difference that lactivists seem incapable of understanding.

For example, I’ve been participating discussion about insufficient breastmilk in a private group.

Someone asked me:

Truthfully Dr Amy, is it your professional opinion all neonates should be supplemented in order to prevent dehydration, brain injury and/or death?

I answered:

I view breastfeeding like vision; both have a natural failure rate. It would be malpractice for me to tell a mother who reports that her child doesn’t seem to able to see that she should ignore it since most children see just fine. Similarly, it is malpractice to tell a mother who reports that her child seems desperately hungry that she should ignore it since most babies don’t need supplementation.

I am no more in favor of universal formula supplementation than I am in favor of giving every new baby a pair of glasses. (emphasis added)


When I did my pediatrics rotation in medical school, the preceptor told me something I never forgot: when a mother tells you her baby is suffering, believe her!

So when a mother tells me that her baby is screaming from hunger, no one, regardless of any policy, should ignore her. It is up to the professional to make sure that the baby is fine, not simply insist that the baby must be fine since most babies are fine.

I thought I couldn’t possibly be clearer, yet this was the response:

To be honest, that doesn’t clarify it for me. I’m still not sure where you stand as I feel you contradict yourself. I don’t say that in an antagonistic way. I’m genuinely confused.

Confused? What could she possibly be confused about? It certainly can’t be the meaning of my words since I was very plain. I guess she’s confused because since she’s obsessed with breastmilk, she imagines that I must be obsessed with formula.

No, I am obsessed with safety. That’s why lactivists’ claims that “fed is best” means you can feed your infant McDonald’s are wrong. Fed Is Best advocates don’t believe that McDonald’s is safe for infants anymore than they believe that goat’s milk or homemade formula is safe for infants.

Meg Nagle IBCLC doesn’t get it either.


To say “nothing happens” with supplementing is incredibly hard for me to read because I’ve seen first hand the incredibly challenging situations women and babies find themselves in when their child has a reaction to formula. My friend’s baby was seriously ill in hospital for 3 months. She was routinely pushed to “fortify” (put formula) into her expressed milk. When she finally fell to this pressure he had a severe reaction and immediately threw it all up. She refused to allow this again. I’ve seen so many women in my office telling me the challenges they have faced trying to find a supplement that doesn’t make their baby have a serious reaction. So no. For many families supplement is a big deal and does cause further complications…

Situations? ONE baby who simply threw up? That was the “incredibly challenging situation?” A seriously ill baby wasn’t getting enough nutrition and Meg thinks the problem in that situation is that the baby threw up formula? Sure, formula might not have agreed with that baby, but it was worth trying since the only other alternatives might be malnutrition or an IV to administer TPN (total parenteral nutrition).

Does a baby who is not getting enough need to be fed? YES. Does a baby who is getting enough need to be supplemented? NO.


Fed Is Best advocates do NOT recommend routine supplementation with formula for every infant. Why would we when our concern is safety? Babies growing and thriving on breastmilk are safe. But babies who aren’t growing, who aren’t thriving, who are screaming from hunger even after being offered the breast repeatedly AREN’T safe. Those babies should be supplemented to assure they are adequately fed.

Meg, a baby vomiting up a bottle of formula is “an incredibly challenging situation”? Really? I’ve got news for you: a baby struggling with permanent brain damage from dehydration or hypoglycemia is more challenging. Most challenging of all is a baby who dies a preventable death because lactation consultants like you demonize supplementation.

Breast Isn’t Best. Fed is Best because Safety Is Best. It’s just that simple.