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If you’re a new mom navigating infant feeding choices, you’ve likely felt intense pressure to breastfeed. From pediatricians and lactation consultants to family, friends, and the countless expert articles you may have read while preparing for your baby’s arrival, the message often feels universal: breast is best. But is breastfeeding always the best option for every parent and baby? In this post, I’ll explore infant feeding and examine the evidence behind common claims about breastfeeding versus formula feeding and discuss the benefits and downsides of each-so you can make an informed, guilt-free decision about how to feed your baby.
Part 1: The Case for Breastfeeding – Benefits, Evidence, and Challenges
Breastfeeding is often presented as the ideal method for infants, and many new mothers are encouraged to breastfeed exclusively. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. AAP also supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. Let’s break down the evidence behind the claims of breastfeeding’s benefits and explore the challenges many mothers face.
Evaluating Breastmilk Claims: What Does the Science Say?
Majority agree (believe) that breastmilk is the best possible nourishment for a baby, it’s always accessible, naturally designed for human infants, and has long been considered the gold standard. While this view is widespread, it’s important to look critically at the claims about breastmilk’s benefits to determine which are supported by solid evidence.
To do this, let’s turn to a highly respected source: the 2016 Lancet Review on breastfeeding in the 21st century, which is frequently referenced in discussions about infant feeding. This review outlines several “Key messages” regarding the advantages of breastmilk. By examining these claims, we can assess their scientific basis and clarify whether they hold up under scrutiny.
Ultimately, the goal is to help all mothers feel confident in their feeding choices. No one should feel inadequate or less than enough if breastfeeding isn’t their preferred option, regardless of the reason.
Understanding the actual evidence behind breastmilk’s benefits can provide reassurance and support for informed, guilt-free decisions.
Key Breastfeeding Claims and the Evidence Behind Them
“Children who are breastfed for longer periods have lower infectious morbidity and mortality, fewer dental malocclusions, and higher intelligence compared to those who are breastfed for shorter periods or not breastfed at all. This disparity reportedly persists throughout life. Growing evidence also suggests that breastfeeding might protect against overweight and diabetes later in life.”
Let’s break this down and look at the sources behind these claims:
1. Lower Morbidity and Mortality and Breastfeeding
In simple terms, this suggests that breastfed children get sick less often and have lower rates of death. This is a striking statement, but the science behind it isn’t as solid as it seems. The cited research refers to a randomized controlled study, but in reality, it’s a meta-analysis, and none of the included studies were randomized controlled trials. Out of 13 studies in the meta-analysis, none were from Western countries; all were conducted in places like Bangladesh, India, Gambia, and Ghana, contries with very different healthcare problems.
To avoid getting lost in the details, and verify accuracy of this statement, I focused on one study with the highest relative risk for death favoring breastfeeding: urban slums in Bangladesh, where newborns were dying from diarrhea.
So, if you live in the Western world and choose not to breastfeed, your child is not at increased risk of dying-period.
2. Fewer Dental Malocclusions and Breastfeeding
Another systematic review/meta-analysis suggests that breastfeeding reduces the risk of malocclusion (misaligned teeth).
However, it’s important to use common sense: children not breastfed are more likely to use pacifiers or suck their fingers, which can contribute to dental problems.
Interestingly, breastfeeding was also linked to higher rates of dental caries, but this is likely due to less attention to dental hygiene rather than a causal relationship.
3. Higher Intelligence and Breastfeeding
The claim that breastfed children have higher intelligence is based on a study showing a difference of 3 IQ points, which is about as meaningful as random measurement noise. When adjusted for maternal IQ, the difference drops to 2 points. It’s hard not to feel embarrassed for the publisher here.
4. Protection Against Allergies, Asthma, and Infections
- Other claims, such as fewer cases of eczema, food allergies, asthma, and ear infections—are actually not accurate according to the referenced Lancet review.
Most of these claims rely on systematic reviews and meta-analyses. Many clinician scientists are skeptical of such papers – and for good reason – if you can’t prove something-do a meta analysis.
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A scientific jargon for this is also “Garbage in-Garbage out!”
Health Benefits for Mothers: What Does the Science Say?
Breastfeeding is often said to provide health benefits for mothers, such as lowering the risk of breast cancer, improving birth spacing, and potentially reducing chances of diabetes and ovarian cancer. However, the evidence supporting these claims isn’t always straightforward.
These are bold claims, and from a clinician scientist’s perspective, they’re difficult to prove with certainty. When tracing the sources, the evidence often relies on systematic reviews and meta-analyses, sometimes referencing other reviews rather than original studies. This can feel like a game of telephone, where the original source becomes unclear after being cited multiple times.
For example, Chowdhury R, Sinha B, Sankar MJ, et al. conducted a systematic review and meta-analysis that suggested breastfeeding for more than 12 months was associated with a 26% lower risk of breast cancer and a 37% lower risk of ovarian cancer. Digging deeper, I examined one of the individual studies included in the meta-analysis. Most of these individual studies showed no significant association, and some weren’t even properly cited, making it hard to verify their findings.
However, a well-designed study published in the New England Journal of Medicine, which relied on women’s recall through surveys, found that breastfeeding was protective against breast cancer in premenopausal women but not in postmenopausal women. This is likely due to hormonal factors, similar to the protective effects seen with oral contraceptives.
Still, we shouldn’t assume breastfeeding is a guaranteed way to prevent breast cancer. It’s important to remember that breast cancer is common—affecting about 1 in 8 women over their lifetime.
My Scientific Verdict on Breastfeeding Benefits
From everything I researched (scientific facts), breastfeeding benefits have nothing to so with infant or mother disease prevention.
Rather, breastfeeding and breastmilk is natural, perfectly formulated for humans, always available, always warm, cost-effective, helps mothers lose weight, and generally may promote well-being.
The Real Challenges of Breastfeeding
While breastfeeding offers many benefits, it’s not without its challenges. For some mothers, the reality of breastfeeding can be physically and emotionally difficult:
- Physical Challenges: Problems like latching difficulties, sore nipples, engorgement, or a low milk supply can make breastfeeding painful and stressful. Some mothers may find breastfeeding uncomfortable or even impossible, and in these cases, continuing to breastfeed may cause more harm than good.
- Time and Frequency: Newborns often feed every 1-3 hours, which can be physically exhausting for mothers, especially when they’re recovering from childbirth. The demand for frequent feedings can leave mothers feeling tethered to their babies and limit their ability to rest or engage in other activities/work.
- Social and Emotional Pressure: There is immense societal pressure to breastfeed, and many new mothers feel they’re not “doing it right” if they struggle with breastfeeding. This pressure can lead to feelings of guilt, inadequacy, and stress, which may affect maternal mental health and the mother-baby bond.
For these reasons, breastfeeding may not be the right choice for every family, and that’s okay.
The important thing is to nourish your baby in the best way possible, whether that’s through breastfeeding, formula feeding, or a combination of both.
Key Takeaways
- Major organizations like the American Academy of Pediatrics recommend exclusive breastfeeding for about 6 months.
- Many commonly cited breastfeeding benefits rely on observational studies and meta-analyses, including the frequently referenced The Lancet 2016 review.
- In higher-income Western countries, choosing not to breastfeed does not put your baby at increased risk of death.
- The reported intelligence benefit of breastfeeding is small; reported at about 2–3 IQ points difference, which is largely irrelevant.
- Claims about protection against allergies, asthma, obesity, and certain maternal cancers are not scientifically proven.
- Breastfeeding has practical advantages, it’s natural, readily available, cost-effective, and convenient, but it can also present real physical, emotional, and logistical challenges for many mothers.
- “Fed is best” is a valid perspective. The ultimate goal is a well-nourished baby and a healthy mother.