Breastfeeding

Risks of Formula Feeding

The rate of illness in formula fed infants is much higher than breastfed infants, especially the rate of infection. Breastmilk contains immunological properties that protect a breastfed infant from infection. Without this protection, a formula fed infant stands to have an abnormally high rate of illness throughout infancy. Below is a compilation of results from studies on the risks formula fed infants face.

I often get mothers saying, "Well I formula fed my infant and she's isn't sick all the time", and, "I know a mother that exclusively breastfeeds her child and he's sick all the time". Figures like the ones below aren't saying that EVERY child that formula feeds will get sick, nor that every breastfed infant will be protected from illness, just that there is a much higher percentage  of  formula fed infants who do suffer these illnesses, compared to breastfed infants.

Almost all of the figures below have been adjusted for confounding factors, and are for developed countries such as the US and NZ, not developing countries such as Afghanistan or Chile.

Formula fed infants are…

5 times more likely to have more than 1 illness. 8
*compared to infants exclusively breastfed for 5 months.

16 times more likely to have 3 or more illnesses. 8
*compared to infants exclusively breastfed for 5 months.

5 times more likely to need hospitalization. 19
*compared to breast-fed babies for the first 6 months of life.

6 times more likely to be hospitalized due to infection. 19
*compared to breast-fed babies for the first 6 months of life.

5 times more likely to have gastrointestinal illness. 10
*when compared to infants exclusively breastfed for the first 13 weeks of life.
*any infection of the digestive tract caused by bacteria, viruses, or parasites.

4 times more likely to have necrotising enterocolitis. 14
*compared to preterm infants who received donor human milk.
*necrotising enterocolitis is a condition where portions of the bowel undergo tissue death, it has a death rate of 20-30%.

4 times more likely to have diarrhoeal disease. 27
*compared to infants breastfed for 6 months or more.

4 times more likely to be hospitalized for lower respiratory tract diseases. 16
* compared to infants breastfeed for 4 or more months
* lower respiratory tract diseases include bronchiolitis, asthma, bronchitis, pneumonia, empyema, and infections due to specific agents (eg, respiratory syncytial virus).

4 times more likely to have pneumococcal disease. 26
*compared to breastfed infants.
*pneumococcal disease is a bacterial infection that can present as pneumonia, bacteremia, meningitis, middle ear infection, and sinusitis.

3 times more likely to have ear infections. 11
* compared to infants exclusively breastfed for six months.

2 times more likely to have conjunctivitis. 11
* compared to exclusively breastfed for six months.

85% more likely to have urinary tract infections. 11
* compared to exclusively breastfed for six months.

7 times more likely to have thrush. 11
* compared to infants exclusively breastfed for six months.

93% more likely to have from type 1 diabetes. 22
*compared to breastfed infants.

60% more likely to develop type 2 diabetes later in life. 24
*compared to breastfed infants.

80% more likely to develop a wheeze during the first 3 years of life. 7
*compared to breastfed infants.

63% more likely to develop asthma during their first 8 years of life. 4
*compared to children breastfed for more than 4 months.

60% more likely to have visible dermatitis. 25
*compared to infants breastfed for the first three months of life.

40% more likely to have allergic dermatitis. 25
*compared to infants breastfed for the first three months of life.

52% more likely to have from coeliac disease. 18
*compared to infants who were breastfed when gluten containing foods were introduced to their diet.

30% more likely to have acute myeloid leukemia. 24
*compared with infants breastfed more than 6 months.

10% - 30% more likely to become obese later in life. 24
*compared to breastfed infants.

2 times more likely to die from SIDS. 21, 24, 28
* compared to breastfed infants

30% more at risk of mortality in the US. 24
*compared to infants ever having been breastfed.

Note: I haven't included the risks to the mother of not breastfeeding, which involve increased risk of different cancers and osteoporsis. But I'll definitely include those figures at a later date.

Sources:

1.Relation between infant feeding and infections during the first six months of life.
http://www.ncbi.nlm.nih.gov/pubmed/7844664

2.Breastfeeding and Asthma in Young Children
Dell S, To T. . Arch Pediatr Adolesc Med 155: 1261-1265, 2001

3.Maternal asthma, infant feeding, and the risk for asthma in childhood.
Oddy WH, Peat JK, de Klerk NH. J. Allergy Clin Immunol. 110: 65-67, 2002

4.Breast-feeding in relation to asthma, lung function, and sensitization in young schoolchildren
http://www.jacionline.org/article/S0091-6749(10)00203-4/abstract#

5.Breast-Feeding Lowers the Frequency and Duration of Acute Respiratory Infection and Diarrhea in Infants under Six Months of Age
http://jn.nutrition.org/content/127/3/436.full.pdf+html

6.Breastfeeding and the risk of hospitalization for respiratory disease in infancy.
Bachrach VRG, Schwarz E, Bachrach LR. Arch Pediatr Adolesc Med. 157: 237-243, 2003

7.Prospective study of breast-feeding in relation to wheeze, atopy, and bronchial hyperresponsiveness in the Avon Longitudinal Study of Parents and Children (ALSPAC)
http://www.jacionline.org/article/S0091-6749(08)00618-0/abstract

8. Episodes of illness in breast-fed and bottle-fed infants in Jerusalem.
http://www.ncbi.nlm.nih.gov/pubmed/6469558

9.Prolonged and Exclusive Breastfeeding Reduces the Risk of Infectious Diseases in Infancy
http://pediatrics.aappublications.org/content/126/1/e18.full.html

10.Protective effect of breast feeding against infection – full text
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661904/pdf/bmj00160-0017.pdf

11.Protective effect of exclusive breastfeeding against infections during infancy: a prospective study
http://www2.cfpc.ca/local/user/files/%7B5BB531F4-3A35-4BDD-819D-011D3614CA69%7D/Arch%20Dis%20Child-2010-Ladomenou-adc.2009.169912.pdf – full text

12.Risk factors for severe acute lower respiratory tract infection in under-five children.
Broor S, Pandey RM, Ghosh M, Maitreyi RS, Lodha R, Singhal T, Kabra SK. Indian Pediatr 38: 1361-1369, 2001

13.Breast milk and neonatal necrotising enterocolitis.
http://www.ncbi.nlm.nih.gov/pubmed/1979363
*compared to exclusively breast-fed preterm infants.
Formula fed preterm infants born at more than 30 weeks gestation who were exclusively formula fed were 20 times more likely to have necrotizing enterocolitis, compared to infants born at more than 30 weeks gestation who were exclusively breast fed. 13
With the fall in the use of breast milk in British neonatal units, exclusive formula feeding could account for an estimated 500 extra cases of necrotising enterocolitis each year. About 100 of these infants would die. 13

14.Donor human milk versus formula for preventing necrotising enterocolitis in preterm infants: systematic review
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1756003/pdf/v088p00F11.pdf

15.Neonatal necrotising enterocolitis
http://bpsu.inopsu.com/publications/reports/nnec.html

16.Breastfeeding and the Risk of Hospitalization for Respiratory Disease in Infancy – GOOD!
http://archpedi.ama-assn.org/cgi/reprint/157/3/237.pdf – full text

Because respiratory disease is the leading cause of hospitalization in young children—and each such hospitalization in infancy costs on average $3500, with more than 250000 such admissions in 1996—clearly there are large financial implications to this report.
From this study, we estimate that for every 26 women who exclusively breastfeed for 4 months, one LRTD hospitalization might be avoided. Likewise, since early severe respiratory illness is a recognized risk factor for asthma, 67,68 breastfeeding may be important to the prevention of asthma, with its significant health costs. 9,46,69,70

17.A Longitudinal Analysis of Infant Morbidity and the Extent of Breastfeeding in the United States
http://pediatrics.aappublications.org/content/99/6/e5.full

18.Effects of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies. Akobeng A K et al. Arch Dis Child 91: 39-43, 2006
Continued breastfeeding limits the actual amounts of gluten received. Breastfeeding protects against intestinal infections - infections can increase the permeability of the infant's gut and therefore allow the passage of gluten into the lamina propria. Breastmilk IgA may reduce the immune response to ingested gluten, or immune modulation may occur through specific T-cell suppressive effects.
*compared to infants who were breastfed when gluten containing foods were introduced to their diet.

19.Infant feeding and Hospitalization during the first six months of life – full text
http://jpma.org.pk/PdfDownload/1261.pdf

19.Differences in morbidity between breast-fed and formula-fed infants.
http://www.ncbi.nlm.nih.gov/pubmed/7751991

20.Breastfeeding and the risk of sudden infant death syndrome.
http://www.ncbi.nlm.nih.gov/pubmed/8282468

21.The role of breastfeeding in sudden infant death syndrome. – meta-analysis, good!
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=11138219&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed. Pubmed_ResultsPanel.Pubmed_RVDocSum

22.Absence of breast-feeding is associated with the risk of type 1 diabetes: a case-control study in a population with rapidly increasing incidence.
Malcove H et al. Eur J Pediatr 165: 114-119, 2005

23.Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Saarinen UM, Kajosarri M. Lancet 346: 1065-1069, 1995
http://www.ncbi.nlm.nih.gov/pubmed/7564787

24.The Risks of Not Breastfeeding for Mothers and Infants – good!
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/

25. Risk factors for atopic dermatitis in infants at high risk of allergy: The PIAMA study.
Kerkhof M, Koopman LP, van Strien RT, et al. Clin Exp Allergy 33: 1336-1341, 2003
http://www.ncbi.nlm.nih.gov/pubmed/14519137

26.Risk Factors for Invasive Pneumococcal Disease in Children: A Population-based Case–Control Study in North America
http://pediatrics.aappublications.org/content/103/3/e28.full

27.How protective is breast feeding against diarrhoeal disease in infants in 1990s England? A case‐control study
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2065954/

28.Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries.
http://www.ncbi.nlm.nih.gov/books/NBK38333/#B106859

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