[asdfasgasdgasdg]

Negative. There is very little good scientific evidence that it is important to breastfeed. But even if we stipulate that mothers must breastfeed, many working women pump milk during the day if they don't have unlimited paid time off after birth. In such cases bottles must obviously be used. And many women cannot produce enough breastmilk, and must supplement with formula. And many other possible reasons why bottles must be used.

Anyway, one thing we can say for sure: if it's not your kid and you weren't specifically asked for advice, don't tell someone they should have been breastfeeding.

[Ovah]

> There is very little good scientific evidence that it is important to breastfeed.

I wish you would back up such a strong statement. In medical school we were taught the complete opposite. From my notes:

- there's a x36 decreased risk of Sudden infant death syndrome if the child has been breast fed a single(!) time compared to no breast feeding.

- no breast feeding vs only breast feeding: x15 risk of pneumonia, x11 risk of diarrhea

- x14 lower risk of premature death compared to no breast feeding

Other pros include: optimal composition of nutrients, doesn't constipate, creates a connection between the mother and child.

While formula may be nutritionally complete, it does not include immune component. Breast milk literally contains antibodies that a new born is able to pick up and use.

[daleharvey]

Emily Oyster wrote good books about how a lot of the popular claims around giving birth / raising children have quite a severe lack of data that supports those claims. For breastfeeding in particular there isn't much data to separate whether breastfeeding is actually helpful at all vs being in an economical position that would allow someone to breasfeed.

https://fivethirtyeight.com/features/everybody-calm-down-abo...

[rp3]

Did this author even read the papers she cites?

> In the first camp — the randomized trial camp — we have one very large-scale study from Belarus. Known as the PROBIT trial, it was run in the 1990s and continued to follow up as the children aged.

And then later

> The researchers analyzed the impacts of breastfeeding on allergies and asthma; on cavities; and on height, blood pressure, weight and various measures of obesity. They found no evidence of nursing’s impacts on any of these outcomes.

If you go to the PROBIT trial, you see it clearly stated that they did find an impact from nursing:

> Conclusions: Our experimental intervention increased the duration and degree (exclusivity) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life.

[daleharvey]

> Infants in the treatment group — who, remember, were more likely to be breastfed — had fewer gastrointestinal infections (read: less diarrhea) and were less likely to experience eczema and other rashes. However, there were no significant differences in any of the other outcomes considered. These include: respiratory infections, ear infections, croup, wheezing and infant mortality.

Apparently so, did you read the post you are criticizing?

[rp3]

The author made it seem like breastfeeding had no impact, but rather they just cherry-picked the conditions to look for from the study, making no mention of things that were impacted.

[daleharvey]

The author did not make it seem like that, they explicitly pointed out otherwise, the 5th paragraph:

> This is not to say that there aren’t some benefits to breastfeeding. In poor countries where water quality is very poor, these benefits may be very large since the alternative is to use formula made with contaminated water. In developed countries — the main focus of the discussion here — this isn’t an issue. Even in developed countries, there are a few health benefits of breastfeeding for children in the first year of life (more on this below).

[sacrosancty]

Huh? That's consistent, isn't it? No impact on cavities, height, blood pressure, etc. but an impact on GI tract infection and eczma. Well, those don't sound like serious problems so maybe it's not worth it.

[Ozzie_osman]

John Hopkins has a bunch on this: https://www.hopkinsmedicine.org/health/conditions-and-diseas...

I think the general consensus (WHO, CDC, American Pediatrics, etc) is that breastmilk is beneficial and reduces the risk of things like asthma, digestive issues, SIDS, etc, but there are a lot of questions of whether it needs to be exclusive and for how long it needs to be to get the benefits.

[bpodgursky]

> there's a x36 decreased risk of Sudden infant death syndrome if the child has been breast fed a single(!) time compared to no breast feeding

I'm a supporter of breasfeeding but there's approximately a 100% chance that this is correlational and not causal; wealthier parents with time and resources to breastfeed also have lower SIDs prevalence because they drink less, smoke less, are less obese, have less drug use while pregnant and generally practice safer sleep habits.

[sgerenser]

I’m not a doctor, but these stats sound completely ridiculous. Would love to see the source material.

[Ovah]

Which of the stats do you think sounds ridiculous? SIDS for example is pretty rare to begin with (33.3 deaths per 100,000 per Google). At the end of the day I'm guessing the advice maybe saves a few lives on a population level, but only gives a slight statistical advantage to a proactive parent.

I wish I had links to actual publications. I copied the numbers from a lecture given by a senior obstetrician.

[asdfasgasdgasdg]

The effect sizes are implausibly large. Breastfeeding would not be a live debate if the causal effect was that large. For example, a 36x risk of SIDS is really just too much to believe. This lit review: https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/apa.13...

Doesn't mention any studies with effect sizes larger than 4x. And it is concerning habitual breastfeeding or other feeding treatments. If breastfeeding a single time provided a 36x safety factor, these kinds of results would be impossible. A 14x reduction in infant mortality is similar far beyond the reasonable belief.

Personally I wouldn't toss out a claim like that without strong evidence to cite.

[sgerenser]

Breastfeeding once reduces SIDS risk by 36 times? If that’s even remotely accurate, which I doubt, I’m 100% sure it’s correlation not causation. People who breastfeed are much more likely to be higher income, more informed about keeping toys and blankets out of the crib, have baby sleep on their back, etc.

[avar]

> People who breastfeed are much more likely to be higher income.

The median income of a breastfeeding mother is probably at least 1/10th of US median per capita GDP. E.g. Rwanda has some of the highest breastfeeding rates in the world.

[stkdump]

So the study (is there a study?) that found this result included Rwanda, and found that Rwandan kids suffer less from SIDS?

[mulmen]

Correlation doesn’t imply causation. Can you speak to the causal link that would make any of these statements compelling?

[Ovah]

I'm neither an obstetrician nor a researcher in that field. But if I had to guess, this Wikipedia paragraph sumarizes things nicely regarding infection: "Passive immunity is also provided through colostrum and breast milk, which contain IgA antibodies that are transferred to the gut of the infant, providing local protection against disease causing bacteria and viruses until the newborn can synthesize its own antibodies." https://en.wikipedia.org/wiki/Passive_immunity

I'd have to read up to even speculate about the SIDS risk.

[notshift]

Do you have a source for the claim that breastfeeding is no better than formula? I don't have a study to the contrary off hand, but everything I've read/studied has agreed conclusively that breastfeeding is the preferred option and has tangible developmental effects. Multiple books and a couple of college courses on early human development.

The conclusion that formula is for sure just as good as breast milk would also be shocking given that breast milk was designed by evolution over millions of years to be exactly what the developing baby needs. The human body does a lot of miraculous things that our technology isn't yet quite capable of matching (or even fully understanding).

[rtlfe]

This article links to some studies. https://www.vox.com/2016/1/11/10729946/breastfeeding-truth

Edit: this one somebody else linked is better. https://fivethirtyeight.com/features/everybody-calm-down-abo...

[notshift]

The second article you linked cites several studies. I looked at each of them and pretty much all of them conclude that breastfeeding is better than bottle, except the childhood obesity one, which found no effect (I wouldn't expect breastfeeding vs bottle to have an effect on weight or height).

The first study cited only looked at height, weight, and blood pressure after breastfeeding, which are not the variables I would expect to see gaps in for breast fed vs bottle fed (other metrics are much more important, in my opinion)

The second study cited concluded that breastfeeding "had a significant reduction in the risk of 1 or more gastrointestinal tract infections (9.1% vs 13.2%; adjusted OR, 0.60; 95% CI, 0.40-0.91) and of atopic eczema (3.3% vs 6.3%; adjusted OR, 0.54; 95% CI, 0.31-0.95), but no significant reduction in respiratory tract infection (intervention group, 39.2%; control group, 39.4%; adjusted OR, 0.87; 95% CI, 0.59-1.28).".

The third study had similar results: "Our experimental intervention increased the duration and degree (exclusivity) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life."

The fourth linked study on IQ concludes: "These results, based on the largest randomized trial ever conducted in the area of human lactation, provide strong evidence that prolonged and exclusive breastfeeding improves children's cognitive development."

If these are the best studies that an article whose goal is to debunk the breastfeeding narrative can find, it looks like a clear win for breastfeeding to me.

[asdfasgasdgasdg]

In most cases, I wasn't able to tell which study you were referring to. I was able to correlate study 4 tho:

> The fourth linked study on IQ concludes: "These results, based on the largest randomized trial ever conducted in the area of human lactation, provide strong evidence that prolonged and exclusive breastfeeding improves children's cognitive development."

https://pubmed.ncbi.nlm.nih.gov/18458209/

The study was cited with criticisms of its method and strong reason to believe the study result is implausible. The effect size is far too large: there is no way that EBF causes a 24 point jump in IQ, when observed correlated effects are so much smaller. That effect is so large that it would be immediately and apparently obvious who was breast fed. In fact, you could guess someone's EBF status simply by knowing how smart they are. Intelligence would be multimodal around who was breastfed and not.

I'm not sure exactly what they screwed up when running the study. Possibly an overreliance on the power of random cluster trials? After all, if you run 31 clusters in total, then it wouldn't be too surprising that you find weird statistics, since N=31, not the number of human participants. But whatever the case, the whole thing is completely compromised because the result is so implausible.

Anyway that's the best and only random study of EBF and intelligence if 538 is to be believed. Which means we essentially have no randomly controlled evidence at all that EBF improves intelligence.

[notshift]

Ah, fair enough. I was mostly skimming the linked article and clicking through to the referenced studies. You're right, you'd certainly have to throw out that particular IQ study in that case.

[elzbardico]

Given the lack of adequate maternity leave (along with the lack of other worker protection stuff common in civilized countries) it is understandable that a ideology of the bottle would be very popular in the good old US.

[asdfasgasdgasdg]

My wife breastfed both our kids. We have plenty of maternity leave. I have no "ideology" of the bottle, nor anything against breastfeeding -- if you like it, go for it. I just happen to have a considered opinion about the scientific evidence available.

[sgerenser]

U.S. has higher breastfeeding rates than France. Does France have even worse maternity leave than the U.S.?

[donw]

> There is very little good scientific evidence that it is important to breastfeed.

American scientists in the 1950s pushed all manner of highly-processed food products on the public because they had "figured out" nutrition.

Except for micronutrients, probiotics, most of what we understand now about biological pathways, etc.

Barring overwhelming evidence from replicated experiments -- "peer review" is and has always been garbage -- I bias hard to "what we have evolved to do by instinct is probably the best course of action".

That'd be breastfeeding. It's counterproductive to shame mothers that use formula for any number of legitimate reasons, but "prefer breastfeeding if at all possible" is an entirely reasonable statement.

It would also help if infant formula in the US wasn't absolute garbage by law, compared to what's commonplace in Germany and Japan.

[MandieD]

Quality infant formula is also cheap in Germany compared to the US. I thought it was just having a decade of being a dual engineer couple before baby that made me wonder why on earth there are formula theft rings in the US, but no, a box of the brand-name stuff (Hipp) capable of feeding a baby for 5-7 days is about 12 EUR not on sale.

[donw]

Depends on grade here in Japan. The top-of-market stuff is 17 EUR (2200 JPY) per large can, bottom of the market is maybe half that?

[sgerenser]

How is infant formula in the U.S. different than in Germany or Japan?

[retrac]

https://www.cdc.gov/breastfeeding/about-breastfeeding/why-it...

There's quite a lot of evidence that breastfeeding improves health outcomes for newborns. Reduces the rate of gastrointestinal infections, etc. Regarding the probable mechanism of action for that, breast milk provides an ongoing source of antibodies from the mother to baby. You won't find that in formula.

That said, evidence about the benefits of exclusive breastfeeding, is much weaker. And a fixation on breastfeeding exclusively can easily result in underfeeding if formula isn't used when all signs suggest it should be. A hungry baby is the worst outcome here, of course.

[jimmygrapes]

Kinda weird place and context to ask, but... OK look I'm not an academic. I have my degrees but for the most part it was "use APA/MLA/etc. for full points". Nothing published, plenty researched enough to publish if the circumstances were better. That said, I don't know enough about how much weight is given to biological history. Breastfeeding was not an option for the vast majority of mammalian history, as far as I understand. Wet nurses or surrogate mothers notwithstanding, babies of all kinds have needed and thrived on a mother's milk. Just because we cleverly figured out alternatives in the last 0.0001% of human history doesn't mean it's better, to me. Maybe I'm wrong. I don't know.

[jimmygrapes]

Can't edit to clarify but I meant to say that breastfeeding was not an option in the sense that there were no other choices. In case anyone cares.

[fipar]

I’m only replying on the Internet, I’ve never given anyone baby advice (or any other, for that matter) I wasn’t asked for.

That said, breastfeeding is the only way babies were fed for almost all of our species time here. IMHO, if anything needs scientific evidence in its favor before I believe it’s good are alternatives to breastfeeding.

[MandieD]

To be fair, high infant mortality was a sad fact of life before modernity, and it wasn’t all diseases. “Failure to thrive” was a common cause of death.

My aunt, born in 1941, was switched to formula after failing to nurse well. Despite those infant formulas being nowhere nearly as good as modern ones, she still grew up to be academically bright and athletic, and her younger sister, my mother, was witty and socially gifted.

If my grandmother hadn’t had that option, maybe my aunt would have eventually gotten the hang of it before my grandmother’s milk dried up, but being undernourished for however long that took might not have led to a woman who could get a geology degree - or any child who survived to adulthood.

[magicalhippo]

> There is very little good scientific evidence that it is important to breastfeed.

So you're saying the WHO and UNICEF are basing their recommendations[1] on very weak evidence?

Even when they think the benefits outweigh the risks[2] of nasty pollutants in the breast milk?

[1]: https://www.who.int/news-room/fact-sheets/detail/infant-and-...

[2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569122/

[cocothem]

Interesting response. Let me just say that in general I would prefer the people around me to mention an alternative way of doing things (related to raising babies or anything really) along with some reasons if available. Not preach, just mention. So that they make sure I am aware of it. Maybe there is that one case where I find out about something I wasn't aware of. And then I wish we could all say "yes I know" or "I wasn't aware of that, will dig" or "that's a myth, here's why" and continue either on that topic or change the subject with no harmed feelings.

[asdfasgasdgasdg]

No mother in the United States is unaware that other people would prefer her to breastfeed. In general, what you say is true, but only for alternatives you haven't already considered thoroughly.

And it will become annoying to be constantly confronted with a viewpoint about your most intimate choices. Like relatives repeatedly asking an intentionally childless couple when they will have kids.

[MandieD]

Or possibly worse: asking a childless couple who desperately want kids but haven’t had it work out when they will have kids.

I’ve had to train a couple of young men to never ask a follow up question to a “no” when they ask if a female colleague has kids (and that actually, that’s a risky question to begin with.)

Nothing burns it into their little brains quite like hearing, “don’t ask anything that could be translated as, ‘so what’s your sex life like?’”

Worst: when a slightly older new male colleague, within 15 minutes of meeting me, asked if I had kids, then upon a negative answer, replied “why not?!”

[meepmorp]

Have you, or you and a partner, had a child and dealt with people's opinions about breastfeeding?

I don't mean this in a hostile way, I just want to know if you're talking from experience or not.

[cocothem]

we had a child, was breastfeed for a long time but also had to supplement with formula very early on. yes we dealt with other people's as well of each of us' differing opinions on every matter under the sun related to how to raise a baby. I still want to know all the information available, so that I can make informed decisions.

[martingoodson]

There is good evidence that breastfeeding is protective against Sudden Infant Death Syndrome. There is a dose-response relationship, which is good evidence for causality.

The risk is cut by about half, depending on how long breastfeeding continued for. This effect is not explained by socioeconomic factors.

https://pubmed.ncbi.nlm.nih.gov/29084835/

[bitshiftfaced]

> There is good evidence

Is there? How were the controls selected in that study? Were they from people who were called on the phone, meaning the controls were from a group of people willing to talk to strangers about something as as deeply personal as having a child die of SIDS?

In this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2351639/

The controls were visited by the same home-visiting nurse, and it found no correlation.

[jimbob45]

It seems to be the case that some breastfeeding is beneficial. However, I’ve been unable to figure out where the line is drawn after much internet research.

Some places say six weeks gets you most of the benefits, others say twelve years minimum. You’re right though that the studies are less conclusive than some would like you to believe.

[Ovah]

Even a single breast feeding session provides some benefits. According to my med school notes a single meal reduces the risk of SIDS by x36 compared to no breast feeding. https://www.mayoclinic.org/diseases-conditions/sudden-infant...

[asdfasgasdgasdg]

Where on this page is there support for your "reduce risk of SIDS by x36" claim? Or that a single session is enough?

[Ovah]

Sorry for the confusion. The x36 I copied from a lecture given by a senior obstetrician. The link was to provide background info on SIDS.

[b112]

/years/weeks/ right?

[sgerenser]

Maybe it was hyperbole. Some hardcore breastfeeding advocates say it should be done until the kid is 3 or 4 years old.

[fouc]

Historically women that cannot produce enough breastmilk would ask other women to do the breastfeeding.

[XorNot]

Not entirely true: goats milk was the nearest substitute in recent history. My wife's great grandfather was fed with goats milk from an infant age.