On letting go of guilt

Look to your right. See that little “ask me anything” box? That links you to a site called Formspring, which is pretty rad in the sense that you can literally ask me anything, completely anonymously, and I will answer you. Sometimes it takes me a few weeks to actually remember to check the darn site, but eventually, I will get around to it.

The cool aspect of this feature for me is that often, the questions people ask me on Formspring become fodder for future posts, and in these dog days of late-late-late pregnancy, I just don’t have the mental fortitude to come up with my own creative ideas. The other day, someone inquired if I had any tips on getting over the guilt of formula feeding, and I was shocked to realize that I’d never actually written a post specifically about this. And dammit, it’s high time I did.

Ironically, this issue has been on my mind quite a bit lately, as I work my ever-expanding ass off on my book, which deals with all the emotions surrounding our feeding experience; and as I sit here, 37 weeks pregnant, still ambivalent/confused/conflicted/undecided about how to feed Fearless Child #2. What is this thing we refer to as “formula feeding guilt”? Is the very fact that we feel it evidence that we should feel guilty, as Jack Newman and numerous others believe? Is it true that no one can “make” us feel guilty, and that if we think we have something to feel guilty for, we probably do?

If it’s not obvious from this blog, I don’t think guilt is a controllable emotion. Maybe it’s because I’m Jewish; guilt is built into our genetic code, and even if you believe more in nurture than nature, the Jewish mother stereotype is spot-on (and as my husband and I were just discussing, sometimes dads can be just as effective in inducing this potent emotion – my father-in-law is a guilt zen master). Guilt is something I feel comfortable with; it’s an old friend, at this point in my life, and a highly effective tool that I am already using to discipline FC. Who needs time outs when a simple “do you want to make mommy sad?” can get the job done?

Seriously, it works. And you should try it, if simply for the sake of experiment, because that is the crux of my argument on formula feeding guilt: it’s a highly effective tool. Advertising executives know this. Politicians know this. Advocacy groups know this. It’s time we did, too.

This might sound odd, coming from me, but it’s okay to feel guilty about your parenting decisions. It means you care. It means you know enough to realize what society expects from you, and what you expect from yourself. It means you are lucky enough to have options, to have been given the luxury of making a decision.

Now, when it comes to formula feeding, things get a tad more complicated. Ask me if I think anyone has a reason to feel guilty for using formula, and the answer will be a resounding hells-to-the-no. And I can say that with a clear conscience, because I have spent two years looking at all the studies, research, politics, commentary, internet chatter, etc. My stance is that breastfeeding is a personal choice, like any other. No more, no less.

But just because there’s no good reason for you to feel guilty, does not mean that you won’t. You will feel guilty because you want the best for your child, and everything we are told is that breastfeeding is the superior choice. You’ll feel guilty because you wanted to breastfeed, and you feel like you failed. You’ll feel guilty because you’ll read something three months down the line about someone even worse off than you who “persevered” and is still happily nursing her two year old. You’ll feel guilty because you’ll read articles that portray you as a victim of the system, someone who fell prey to the “booby traps”, and you’ll hate yourself for being so naive and weak, because every other mom around you is nursing, and the booby traps didn’t catch them, so why you? You’ll feel guilty because you imagined yourself as a breastfeeding mom, and here you are with your bottles and expensive powdered food which apparently can now be spiked with bugs. Good, good times.

Or, you’ll feel guilty because you hated nursing, and turned to formula right away. Or because you never even tried. You’ll feel guilty because you hate your body so much, hate how large and out of control you felt through the nine months of pregnancy, and can’t handle the thought of not having that control back at the soonest point possible. You’ll feel guilty because someone hurt you, badly, many years ago, and now the thought of feeding someone from your breast makes you want to scream… and you already feel guilty about being abused, despite years of trying to work past it, so the guilt just builds, and builds. You’ll feel guilty because you’re putting your own needs before your infant’s.

If you are formula feeding, there’s a good chance that at some point, you will feel guilty. Because guilt is closely related to self doubt, and self doubt is part of being a parent. Of being a good parent. Self-doubt means you are flexible, that you are a thinker, that you question your decisions. It means you are not dogmatic, that you have empathy, that you are human. It means you are educated and responsible, because you have listened and read and absorbed enough to realize what the “right” choice supposedly is.

So… back to the original question: how do you get over the guilt you feel about formula feeding?

You don’t.

Don’t even try. Rather, you claim that guilt as a badge of honor. You taste it; roll it around on your tongue, and spit out the bitter parts. Suck out the kernel of truth that’s hiding in there, the truth that negates all the hyperbole that reduces mothering to a pair of mammary glands and an over-simplified vision of what it means to love and nurture a child.

Do your research. Read studies. Talk to parents who have breastfed, and those that have formula fed, and hear what they have to say about their kids. Seek out others who have had similar experiences so that you know you are not alone. But don’t do these things to erase your guilt. Do them to seek the truth. Do them so you can viscerally, intellectually, and emotionally feel secure with the path you’ve chosen/been forced to walk down. Trust me, if you do this, you will feel better. The truth is comforting.

By consciously trying to “get rid” of the guilt, you are telling yourself that you have something legitimate to feel guilty about. You don’t. At the same time, you have a right to feel whatever you feel about your experience, and it’s tough to shut out those ominous voices when you are already riddled with regret and anxiety. The last thing you need is to feel guilty about feeling guilty. Even my grandmother, the Grand Pooba of Jewish Guilt, may she rest in peace, would agree with me on that one.

FFF Friday: “To hell and back.”

Joanne’s FFF Friday submission mentions the supplemental feeding system, of which I was enthusiastically singing the virtues in my last post. However, she brings up an important point- while I feel that the SNS is a great option for women whose milk has trouble coming in, or whose babies cannot latch in those valuable early days of infancy, it is not necessarily a viable long-term solution. Solving serious lactation issues can take an intense toll on energy, resources, and mental and/or physical health, and it is always okay to say enough is enough. Feeling like your child associates you with pain and frustration is an experience I’m well acquainted with, and I am so glad Joanne and her daughter were able to escape from that particular hell.

***

“To hell and back” is how my husband and I describe the first 8 weeks of our daughter’s life.  Sad but true.  As we prepared for her arrival, we knew it would be hard and exhausting but with the 10+ hours of classes we took – including a breastfeeding class for me – and all the books we read, we thought we knew what to expect.
Labor and delivery was awesome.  I walked into my OB’s office 2 days after my due date to find I was 5 cm dilated.  I checked into L&D to be induced and went into labor on my own 15 minutes later.  Six hours after I checked in, I was holding my darling, much awaited daughter.  
We started nursing soon afterward.  The nurse peeked at her and said she looked great.  I strained, listening for the gulping I was supposed to hear.  I didn’t really know what I was doing, but the nurse said all was well so I took her word for it.  In retrospect, I should have known something was wrong by the lack of discomfort while nursing, how lightly my daughter was sucking, and how hard it was to keep her awake.  At the time I kept replaying what the lactation instructor had said in my class: “It shouldn’t hurt if you’re doing it right.”  It didn’t hurt, so I figured we were on course.
My daughter was 4 days old when we took her for the first check-up since we were released to go home.  Immediately the alarms were sounded.  My daughter lost 13% of her birth weight.  We were referred to a lactation consultant.  We had numerous consults and phone calls.  Ultimately we learned that she sucked at sucking. She wouldn’t open wide enough, had a weak suck, fell asleep at feedings despite our best efforts to keep her going, and preferred to gum-and-chew rather than the proper trough-with-your-tongue method.  

Feedings were horrible.  We tried every position known to woman.  My daughter screamed and cried just being near me.  She fought and pushed away, but was fine with my husband.  At a week old she was starving and I hardly had any milk to speak of.  I was so heartbroken…and so exhausted.  The lactation consultant suggested nursing, eventually supplementing with formula, and pumping at every feeding. Then I was cleaning parts and bottles (by hand – no dishwasher), sleeping for maybe 40 minutes and starting the whole cycle over again every 2.5 hours.

Fenugreek and the pump helped my supply but it was also inadequately expressing and I began suffering from multiple, chronic plugged ducts daily.  I could barely function.  We were referred to Children’s Hospital when the regular LC decided there was nothing else she could do.  The craniofacial occupational therapist (with an emphasis in breastfeeding) was reassuring; she was sure we could turn it around and sent us home with a supplemental feeding tube.  While the tube was possible with 3 adults, it was barely an option with 2, and completely impossible solo with a screaming newborn who wanted nothing to do with nursing.  I was sure my daughter hated the very sight and smell of me.  

Toss in the fact that the same week my husband went back to work and our cat was emergency hospitalized for a week and almsot put to sleep.  Can anyone say post-partum depression?

By 8 weeks I was a wreck and I threw in the breastfeeding towel.  My supply tanked with all the stress and lack of sleep.  I returned the pump to the hospital, crying.  Giving the last bottle of breast milk mixed with formula killed me – I bawled.  And bawled more when she spit half of it up.  I felt like a complete failure and I mourned the loss of the breastfeeding experience I so desperately wanted.  

A few weeks later I had to return to work.  I became bitter that my whole maternity leave had been so miserable; nothing like my friends who were out at the park, going to see friends and family, and going on small adventures with their little ones – nursing with no problem, or formula feeding.  Things slowly started to get better after we turned to formula completely.  My husband took some feedings; I got more sleep; and my daughter was happier and stopped screaming around me.  
At work people kept asking if I was breastfeeding.  I felt compelled to defend myself in the face of their disapproving responses.  Several times I told our whole tale to people I barely knew, which was the only way most of them backed off.  To some I had tried hard enough to make it work…but not to everyone.  I started avoiding the topic of feeding at all costs so I wouldn’t have to hear how others thought I was in effect lazy and a bad mother.

Now my daughter is almost 18 months old.  She is a genius (of course!), beautiful and full of spirit.  She is my ultimate joy.  We adore each other; she often wants to sit with me or be near me…a far cry from the early months of her life.  While it wasn’t what I wanted, stopping breastfeeding and pumping was right for us.  I could not be the mother she needed had we kept up that impossible regimen.  I still mourn the loss of that breastfeeding relationship but I’ve cut myself some slack.  I did the best I could for my family and myself and in the end that’s all that matters!

***


Want to contribute to FFF Fridays? Send your story to formulafeeders@gmail.com.

And so it goes…

A dear friend of mine gave birth last week, after a long struggle to conceive. This woman has already been through so much, and I hoped she’d have the easiest birth and early motherhood experience possible to make up for the hell she’d been through up until this point.

Although the birth itself went pretty smoothly, I was disheartened to hear that breastfeeding was not going well. Apparently, while her daughter seemed to latch perfectly, her milk was still not in almost a week postpartum. She was doing everything right – she’d done the rooming in, nursing on demand drill; seen the LC in the hospital and had a private consultation as well; she was determined and excited to nurse. Her daughter was healthy and full-term, and the only health issue my friend had herself was a thyroid problem which all the “experts” has assured her wouldn’t affect breastfeeding.

But my friend’s little girl, who we’ll call Jane, had dropped 12% of her body weight, and had endured several days where she only had one wet diaper in a 12-24 hour period. She seemed to be getting sleepier and less interested in nursing, so my friend started pumping and cup-feeding her to avoid nipple confusion. When she asked her pediatrician if she should be concerned, the doctor told her she shouldn’t worry, that her milk would come in any day now, and as long as she was having any wet diapers, she’d be fine. This was contrary advice to everything my friend had read online – and while yes, Dr. Google is not the most reliable source of information, I had to agree that every physician I’d interviewed would assert that what her daughter was experiencing were warning signs of dehydration. And as my friend said, it was easy for the doctor and LC to say “wait and see” – it wasn’t their newborn dropping weight and growing weaker.

She was on  her way to see another LC when I spoke with her, and I was really torn. I think she wanted me to tell her that she should just switch to formula, but I couldn’t. I asked her if she wanted to breastfeed, and she said yes, she did, but she wasn’t sure if it was just because of pride or guilt…”Everyone keeps saying it’s the best thing I can do for my child,” she told me. On the other hand, she didn’t want to keep stressing over this one issue; she wanted to enjoy the child she’d gone to such great lengths to conceive and carry to term.

The problem was, I didn’t think this was a lost cause. If she wanted to breastfeed, then my concern was to get her to a place where this dream would be possible. And I felt so frustrated at her pediatrician and LC who had told her not to introduce formula, because her daughter had a “virgin gut”; who scared her off bottles because of nipple confusion but didn’t even mention the possibility of a Supplemental Nursing System (SNS) which has been shown to work really well in situations like these. As we discussed in the post on dehydration in newborns, these things tend to be a viscous cycle. The baby isn’t getting enough to drink; she’s growing too weak to nurse efficiently; this affects the supply/demand system so important to establishing a new mom’s supply… and so it goes.

The refusal of dogmatic breastfeeding “supporters” to consider using formula in the short term to fix the immediate situation and allow nature to sort itself out, just kills me. There’s an argument that in tribal cultures these problems “don’t exist”. That may indeed be true, but we live in the society we live in, and there are problems inherent in our system that DO complicate nursing. Most lactivists would be the first to admit this. Inductions and c-sections, hell, hospital births in general, can stymie the breastfeeding relationship. Our “bottle feeding culture” gives us a much steeper learning curve than those in cultures where breastfeeding is the norm.

It’s high time we acknowledged the reality of what we are facing as new moms trying to breastfeed. Stop blaming the freaking formula companies and work on educating our medical professionals (and I mean doctors, nurses, and lactation consultants) about the myriad of problems that women may face in the initial weeks of breastfeeding, so that these problems can be addressed and fixed. Instead, we ignore them, deny they can happen, and let women who wanted to nurse feel they have no alternative but to switch to formula, creating a cycle of guilt and regret… these are the women who end up here, needing to work through their conflicted feelings.

This afternoon, my friend updated me that they had started supplementing, but now Jane is refusing to latch altogether. And I worry. I worry that this won’t be salvageable. I worry that if things continue to deteriorate, she will be made to feel that it was the one or two bottles of formula which destroyed her nursing relationship. That the voices which said “virgin gut” and “just wait” and “nipple confusion” will haunt her. I worry that she will end up like I did, hating myself, hating those that I felt lied to me, that made me feel like a bad mom….

I worry. And I don’t want to worry about my friends. Or myself. Or any of you.

Something has got to change, people. Seriously.

FFF Friday: “This time around, I am succeeding.”

I love, love, LOVE this FFF Friday submission from Summer. Her story supports a theory that I’ve often pondered – that the all-or-nothing mentality of infant feeding might be doing more harm than good. I think her attitude and perspective is amazing and shows how there are numerous definitions of breastfeeding “success.”

***

I feel pretty morally impervious in the breastmilk vs. formula wars, and I want to use my unique vantage point to share how formula is a rich and wonderful blessing and gift to so many of us.

I am one of those earth mamas you read about sometimes.  I co-sleep, babywear, and wear funny shoes.  I knew immediately when I was pregnant, dreamed accurately the sex of my babies (a toddler son and a two month old daughter), planned for and had two completely drug-free natural childbirths and didn’t tear even with a 95th% headed baby.  I read dozens of books and websites before my son was born, and I trusted that breastfeeding would work just like the books and lactation consultants said it would.  But a few days after getting our son home, I could tell something wasn’t right.  My son couldn’t sleep and he cried a lot. In desperation, I stripped off our tops and held his naked chest to mine and cried while instructing my husband to find another lactation consultant.  I MUST have been doing something wrong if this wasn’t working, right?

After six torturous weeks of pumping some eight hours a day, taking every galactagogue and medication I could (even though the prescription Reglan made me anxious and restless), taking my son to feeding therapy, visiting a LC every week or so, and getting the same results (less than one ounce of milk, total, whether I was pumping or feeding) and the same crap advice (breast is best, so keep pumping!), I finally realized that breastfeeding was NOT a sane choice for our family.  Whatever illusion I was helping to promote to the powers that be, the truth was that my son was 95% formula fed, and his mother was working a 40 hour week for the remaining 5% of his nutrition. 

When I finally decided to let go of the breastfeeding dream, I was pissed off. Not at my boobs for not working, because I had actually done everything I could.  Not at my son for having a weak suck.  But at the guilt-mongerers and holier-than-thou moms and dads who refused to admit that breast-feeding is not always a good idea.  They would say it was hard, but worth it.  I would think, so you’re implying I’m aselfish wimp?  There was no acknowledgment that breastfeeding might not work, with the exception of rare cases where women had undergone breast augmentation surgery.(Implication: you know about THOSE women, as though breast surgery was an immoral choice.) Even advice on formula feeding was layered with the guilt trips – breast is best, but I guess some people have to feed their kids this crappy, substandard way.

After letting go of breastfeeding, our family was able to find a formula that worked well for our son.  We settled into a routine and all got to sleep better. My son got through his dysphagia with the help of bottle therapy.  He grew and learned and was obviously bright and awesome.  But the breast is besters wouldn’t let up with the routine about how much healthier and smarter breastfed kids would be. Even when all our breastfeeding friends suffered wave after wave of illness while our son remained well.  They gloated about how their kid would be smarter, even as my son started talking and signing at 4.5 months.  I got the rude stares and the rude questions from strangers. At first I was really bothered by the rudeness and superiority. But after time and sleep, I started to notice that the causeheads’ warnings were not playing out.  I read articles suggesting that parenting style and the freedom of a mother to stay home with her child played a much bigger role than breastfeeding itself in the much-touted breastfeeding advantage studies.  I began to appreciate
the positive parts of our feeding choices.  Like how I could make eye contact while bottle-feeding but not breastfeeding my son, and how my husband got to feed him more easily, and how I never had to worry that he was starving.

Then came my daughter’s birth.  I had hoped that my lack of milk with my son was some sort of fluke, but it was not.  When my milk “came in,” which never involved engorgement for me with either child, I had only half an ounce total. I cried into my baby wrap while I went downstairs and got out a bottle and the formula powder I had bought just in case.  Not because I hate the bottle, but because nursing was great!  Unlike my son, my daughter was born with a strong suck, and all the torture I put myself through with him meant I totally had latching down this time around.  We were champs, all except there not being milk.  I so wanted to be one of those mothers who gets to feed her baby at the breast until the baby sighs contentedly and sleeps. Instead, I thought, here we go again!

I knew that this time I would not take the pumping advice, since I knew that pumping had absolutely no effect on my milk production for some reason.  That would keep me sane, I figured.  But this time I would go for the big gun: Domperidone.  When I called the birth center to ask for a prescription, the nurse who answered asked me if I was anemic.  When I replied in the positive, she told me that if I took iron to get my hemoglobin up, the milk might come in.  Well, I did, and the milk supply more than doubled.  I was getting an average of an ounce of milk at a time, which was amazingly awesome to me, after my first experience.  It seemed as though I was usually making around 1.5 oz every three hours, which was not a lot, but it was enough to keep
my daughter interested, enough to keep going.  Domperidone did not increase my supply much, though I felt a lot better knowing that at least prolactin was not going to be my problem.  I nursed my daughter on demand and formula fed her afterward on demand, and I began to look into all sorts of galactagogues to get just a tiny bit more, to keep nursing going a bit longer.  It was so wearing, this pressure to do everything I could to keep breastfeeding.  I felt as though I was throwing pills at an abyss, some invisible enemy that stood between me and making milk.  All the while, I was grateful for formula for standing in the gap so my baby could thrive and grow.

Fast forward to today, more than two months into my nursing relationship with my daughter.  I found out just last week that I have IGT, insufficient glandular tissue, even though I wear a C/D cup, even though my hormones and girl parts are all healthy.  Apparently I am just one of those women for whom a full supply is physically impossible.  I can’t tell you how relieved I am to know what’s been going on, behind the scenes as it were, all this time.  

So now I’m one of those people that aren’t supposed to exist, if you read the rulebook of extremism.  I’m a nursing mother who relies on formula to feed her baby, and it’s totally not my fault.  I have done EVERYTHING (all the drugs- in fact, I’m still on Domperidone and will be for a long while-, all the herbals, oatmeal, stout beer, pumping, relaxation, compression, latch, supplemental nursers, feeding therapy, you name it) possible to make nursing work.  The first time around I “failed” in the sense that I did not reach my personal goal of breastfeeding my son for about a year.  I failed because formula and breastfeeding were set up as an either/or, and because I kept getting the wrong advice – pumping does not miraculously make me have more glandular tissue, but it is darn tiring and incredibly discouraging when you pump for thirty minutes and get so very little milk.  
This time around, I am succeeding. I’m succeeding in breastfeeding because I have the knowledge and support (and drugs) I need to keep going, to not get discouraged, to not wear myself out for no reason.  And in large part, I am succeeding at breastfeeding with my daughter because of formula.

Owing to my experience with my son, we knew right away which formula suited us best and which bottles and nipples would work best and how to set up a bottle prep system that would be the least stressful for us to maintain.  My daughter nurses, then gets formula. She prefers nursing, so we are going to try a supplemental nurser soon.  What makes this breastfeeding relationship easier, besides having more knowledge and an accurate diagnosis for my supply problem, is that I no longer have any guilt about formula feeding.

I don’t read my daughter a list of health and advertising disclaimers before I give her formula, but I do pray grace over it, as is our family’s custom at meals.  I don’t have enough milk, but I can cuddle and love my baby just as well when she drinks her formula milk as when she drinks my milk (and yes, they are both milk!). 

Look, here’s how “breast is best” sounded to me at the beginning of my mothering experience: “Breastmilk is the best food in the whole world, and formula is kind of like what we feed lab mice.”  Now, here’s how it sounds: “Breastmilk is like Dom Perignon champagne, one of the best in the whole world, but formula is still good sparkling wine, like a nice Chandon from California, or even a higher quality but less precious French champagne.” Get it?  There is cause to celebrate with both ways of feeding.  They are both good, because feeding the baby with love is what matters.  For some of us, formula is best when it comes to meeting that goal.
***
Join the catharsis: send your formula feeding/breastfeeding story to formulafeeders@gmail.com, and I’ll post it for an upcoming FFF Friday.

Studies of Note: Type 1 Diabetes & Atopic Dermatitis

Two interesting studies came out in the past few weeks, neither of which got much publicity, and were reported with tremendous caution in the fear of sounding “anti-breastfeeding”. However, considering atopic dermatitis(AD)  and Type 1 diabetes are two of the most feared “risks” of formula feeding, I think these studies deserve a little attention. True, the AD one was funded by a formula company (Danone Research) , but it’s a fascinating study all the same, and the authors were uber-conscious of the bias inherent in their funding, and reported their findings accordingly. And as I’ve stated on the blog numerous times before, I really don’t see all that much difference in bias between a study funded by formula companies, and one that is conducted, analyzed and reported by a renowned breastfeeding advocate. Both of these circumstances require a bit of skepticism and hyper-analyzing on the part of the consumer, but for some reason, the latter scenario is seldom seen as anything but altruistic.

Anyway, on to the studies at hand. The first, Dietary Intervention in Infancy and Later Signs of Beta-Cell Autoimmunity, appears in the prestigious New England Journal of Medicine. Beta-cell autoimmunity is associated with Type 1 diabetes in genetically-susceptible individuals; the theory is that exposure to complex proteins in infancy heightens risk of beta-cell autoimmunity. So, the researchers wanted to see if using a casiein hydrolysate formula (the kind us parents with milk-or-soy-protein-intolerant kids are so fond of) rather than a regular, cows-milk based formula, would prevent this beta-cell autoimmunity from occurring.

Interestingly, at least from the free abstract (money’s tight, y’all, so you’ll have to excuse my inferior research here), it sounds as if this study used primarily breastfed kids whose mothers sometimes supplemented. I’m not sure what the dosage situation was – if these were occasional bottles or an everyday thing; if they included exclusively formula fed babies as well, etc. But the important part remains the same – there was a statistically significant difference (although the difference was relatively small, as they tend to be in most of these infant feeding studies) in outcome between the regular formula kids and the hydrolyzed group when it came to developing the autoantibodies which are associated with Type 1 diabetes, favoring the casien hydrolysate formula. (There was no significant difference in the number of actual cases of type 1 diabetes, however, between the control and test group). So if you are someone with a family history of Type 1 diabetes, it may be worth it to consider a formula like Alimentum or Nutramigen, or at least talk to your doctor about the pros and cons of these types of formula. I’m a believer in them for totally unscientific reasons – they gave me my son, and saved his gut, and I will be eternally grateful for that, so I will gladly admit a ginormous positive bias towards any study showing them in good favor.

Next up, the study funded by European formula company Danone, published in the Journal of Allergy and Clinical Immunology (the link will bring you to the full text of the study, if you’re interested). This one is pretty cool, too. Atopic dermatitis (an itchy, uncomfortable skin condition, the prevalence of which is rising in Western nations) is related to allergies in some cases, but those are mostly in kids with a family history of AD. The majority of cases are in babies with no family history of the condition, so these researchers focuses on a group with low-risk of AD for more useful results from a public health perspective. They hypothesized that using a prebiotic-enhanced formula would help reduce the risk of AD:

Because there is a broad consensus that the intestinal microbiota plays an important physiological role in the postnatal development of the immune system, many attempts have been made to influence the intestinal microbiota and herewith the occurrence of atopic manifestations by dietary interventions. A heavily marketed strategy for primary prevention is dietary supplementation of potentially beneficial bacteria (probiotics) as a tool to redirect the immune system away from atopy.

They took a group of 1130 infants from various European cities/medical centers with a low risk of AD. Some were exclusively breastfed; those who were not were randomly assigned to receive either a normal formula or one supplemented with prebiotics. The results were actually kind of dramatic, as these things go.
They found that using a prebiotic-enriched formula “reduces the incidence of AD up to the first birthday in infants at low risk for atopy by 44% compared with the control group and down to a level similar to that of fully breast-fed infants. The severity of AD, however, was not affected significantly.”

So, the next time you hear that formula research isn’t worthwhile, you’ll have two studies to bolster your side of the debate. This isn’t a question of breast vs bottle; it’s about making bottle feeding the best it can possibly be for those who cannot or chose not to breastfeed. We have a right to know that prebiotics might be useful in protecting against AD, or that a baby at risk of Type 1 diabetes might fare better on a hydrolysate formula – as much right as we have to know that breastfeeding has a correlation with less incidence of gastrointestinal problems, or that receiving a formula freebie bag is associated with a shorter duration of exclusive breastfeeding…. don’t we?

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