Breastfeeding

I have noticed a lot of argument about the advantages of breastfeeding what are your views, Dr. Robinson?

Breastfeeding is best for babies until 4 to 6 months of age. This does not mean that a baby who is bottle-fed will suffer disadvantage for the rest of their life. A bottle-fed baby will take more work but a perfectly healthy baby can be obtained by bottle-feeding.

The 4 main advantages of breastfeeding are:

Nutritional

Infection Prevention

Allergy prevention

Emotional.

NUTRITIONAL

Breast milk contains substances that are not in formulas. Gradually these are being measured and many are being put into formulas. It is not enough just to put the same amount of them into formula as is in breast milk. A good example of this is iron, which is needed to avoid anaemia and has other beneficial qualities. It was discovered that the baby’s gut would take up iron from breast milk at a greater rate than it will from any formula. Thus more iron has to be put into formula than is naturally in breast milk.

Poly-unsaturated fatty acids (PUFAs) are another example. PUFAs are essential because humans cannot manufacture them – they have to be eaten. Breast milk contains them in significant quantities while, until recently, formulas did not.As these PUFAs are found in brain as well as other tissues, and the brain grows rapidly in the first year of life, trials of supplementing baby formulas with PUFAs have been undertaken. Once again it is not simply a matter of putting in the same amount as is found in breast milk. The ratio of the PUFAs to other fatty acids that are found in formula is critical.

Science around the world is trying to make formulas as similar as possible to breast milk. This work is slow and clinical trials need to be conducted with each change. The cost of this work is reflected in the cost of baby formulas which makes them a much more expensive option than breastfeeding.

INFECTION PREVENTION

Breastfeeding will make a baby less likely to pick up infections than a bottle-fed baby. The reason for this is that breast milk contains a number of substances that fight germs (bacteria and viruses).

One class of these germ-fighters are live cells from the mother. There are several different types of cells. Perhaps the most important are called macrophages. Macrophages attack any germs that enter the baby’s gut helping to prevent infection such as gastroenteritis (“gastro”). The cells will be particularly effective if mother has recently had an infection that she has passed on to her breastfeeding baby. This is because they instantly recognise that it is the same germ and know how to fight it.

Another class of germ-fighters are called immunoglobulins. If we have an infection such as measles we generally never get it again. One of the reasons for this immunity is that the cells in our body that make immunoglobulins that circulate in our blood and help to destroy the measles virus. We keep the ability to make this immunoglobulin against measles for the rest of our lives. Immunoglobulins are present in mother’s breast milk and help protect the baby from infections to which she has been exposed.

There are other protective agents in breast milk. Do all these substances really help in practice? Yes – it has been shown that baby’s who are breastfed are less likely to develop gastroenteritis than bottle-fed infants. Also if a breast fed infant does catch ‘gastro’, they will recover more quickly if breast-feeding is continued.

ALLERGY PREVENTION

Exclusive breast-feeding might help prevent the development of allergic diseases such as cow’s mill allergy, atopic eczema and asthma. The reason for this potential protection is that until 4 months the baby’s gut allows whole proteins (taken in any form of food) through into the blood stream where they can cause allergic reactions.

Scientific studies on whether there is an actual benefit from exclusive breast-feeding in the first 4 to 6 months are contradictory with some showing that it does help prevent the development of eczema and/or asthma and other studies saying it does not. Part of the reason for this is that exclusive breast-feeding is rare – a recent British study found that only 1% exclusively breastfed for 6 months (The target they set). Breast-feeding alone does not supply sufficient nutrition after 6 months of age. The infant gut has matured enough to block the uptake of whole proteins by 4 months. Hence it is recommended that solids be started between 4 and 6 months.

EMOTIONAL

Another advantage of breast-feeding is the promotion of emotional attachment between mother and child.

All mammals are breastfeeders of their young and all develop a unique bond between mother and baby soon after birth. This bond is called emotional attachment.There are many accounts of how determined mother mammals are to protect their young. Human mothers are the same in most instances.

A number of studies in non-human mammals have shown that breast-feeding promotes the formation of this powerful bonding process. Are there consequences if this unique emotional attachment does not occur? Harlow showed that the answer in monkeys is “Yes”. He took the babies of monkeys away at birth and bottle-fed them. When they were returned the monkey mothers showed few “mothering instincts” and were often violent towards their babies. Of course in the wild, mammalian babies that are not breastfed die from starvation and dehydration.

In humans, where the baby is separated from mother and not breast fed (e.g. due to prematurity) the early studies suggested that emotional attachment was slower and more difficult to achieve.

This led to considerable concern among those in child health and welfare. But we came to realise that the emotional attachment did eventually occur in nearly all cases. Also the separation was part of the problem, not just the absence of breast-feeding. Most neonatal units now allow unlimited parental visiting of premature babies or any other baby that has to be there. It is hoped that this will foster emotional attachment.

Thus the conclusion is the same as it is for nutrition and infection prevention: emotional attachment is easier to achieve if breast-feeding is undertaken but it can be achieved along with adequate nutrition and infection prevention in babies that are bottle fed. It is just quicker and easier in breastfed babies.