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Revised: Thursday June 15 2017

Get the Facts

Babies don’t get to choose whether they are fed breast milk or formula, but you do. And since your choice can affect your child’s healthy development you need to get all the facts.

Make an informed decision about infant feeding:

  1. Discuss any questions or concerns about feeding baby with your health care provider
  2. Know the importance of breastfeeding/providing breast milk for baby, mother, family and community
  3. Be aware of health risks for baby and mother of not breastfeeding
  4. Risks and costs of formula
  5. Difficulty of reversing the decision once breastfeeding is stopped

If you make an informed decision to feed your baby infant formula, the following information can help you prepare infant formula safely.

About obesity

We don’t usually associate obesity with babies. However, recent studies show what babies eat and how they are fed can affect their risk of obesity later in life.
  
Research shows breastfed babies are at reduced risk for obesity later in life, compared to formula-fed babies.  In fact, the evidence suggests breastfed babies have 14 Ė 33% less risk of becoming obese later in life, compared to formula-fed babies. The longer babies are breastfed (up to 9 months), the lower their risk for obesity.

Why talk about waistline?

We don't measure babies' waistlines. However, we do measure adult waistlines because waistline measurement is an indicator of obesity-related health risks. Adults with waistlines above certain levels have been shown to have greater risks for type 2 diabetes, hypertension and heart disease. Obesity is a growing health concern - preventing it is important.

How does breastfeeding protect children from obesity?

While researchers are still investigating exactly how breastfeeding protects against obesity, they have identified at least two factors that may play a role:

  • The act of breastfeeding
    When you breastfeed, your baby is an active participant in feeding. Research shows breastfed babies suckle differently and are more able to control how much and how often they eat versus formula-fed babies who may be fed predetermined amounts of food at set times.
  • The composition of breast milk
    The composition of breast milk changes with your baby's needs. Researchers believe these changes in breast milk may explain some of the differences in growth and size of babies.

About the scientific research

What kind of scientific review was this?

These research findings are based on three systematic reviews/meta analyses of a number of research studies. The number of study subjects ranged from 69,000 to 298,900 people, which included infants, children, adolescents and some adults.  The studies reviewed were conducted in developed countries among children with no other medical condition.

Studies examined the relationship between breastfeeding and childhood obesity or between breastfeeding and obesity across all ages. Studying the effects of breastfeeding or formula feeding is complicated. There are many factors that influence the overall development of a child and many others that influence a child’s risk for obesity in later life.

The studies included here have made every effort to take into account these other factors that could have an influence, such as: birth weight, parental overweight, parental smoking, dietary factors, physical activity, socioeconomic status, age, sex, birth order and number of siblings.

About ear infections

Ear infections are very painful for children and can affect their long-term hearing. It is estimated that 44% of infants will have one ear infection (acute otitis media) before they are one year old.  Almost 70% of children under six years old have had an ear infection.

Research shows if infants are exclusively breastfed, that is, they receive no food or drink other than breast milk, the risk of an ear infection can be 50% less than if they are only fed formula. This protective effect lasts for as long as the mother is breastfeeding.

What causes ear infections?

Ear infections can begin as upper respiratory infections like the common cold. Swelling of mucous membranes (the moist lining in our mouths and nasal passage) and excess secretions (such as found with a stuffy or runny nose) can interfere with the eustachian tube that connects the back of the throat to the middle ear. This can pave the way for germs to spread into the ear, causing a sudden, full-blown infection.

How does breast milk protect children against ear infections?

Breast milk contains natural substances called immunoglobulins, which protect children against common bacteria and viruses that lead to ear infections. Breast milk also contains compounds that make it hard for invading germs to attach onto the cells of the throat.

About the scientific research

What kind of scientific review was this?

This was a systematic review of six studies (five cohort studies and one case-control study) with the number of children evaluated in the studies ranging from 289 to 15,113. The studies reviewed were conducted in developed countries among children with no other medical condition.

In the cohort studies, children were followed from birth to an average of 6 to 24 months. The case-control study examined children between the ages of 3 and 7 years.

The researchers examined the role of breastfeeding in the prevention of acute otitis media. All cohort studies were adjusted for other factors that could have an influence, such as: gender, number of siblings, family day care, nursery day care, number of children in the home, maternal age, parental race or ethnicity, birth order, maternal marital status and parental smoking.

About lower respiratory infections

Respiratory infection is probably the most common medical problem among infants and children. It is estimated about 3% of all infants are hospitalized with a moderate to severe respiratory infection, such as bronchitis, asthma and pneumonia.

Research shows infants who were exclusively breastfed, that is, they receive no food or drink other than breast milk, for four or more months, were 72% less likely to be hospitalized for a lower respiratory infection than if they were fed formula.

What causes lower respiratory infections?

Respiratory infections usually begin when an infant is exposed to germs (viruses or bacteria). These germs can be spread by breathing in droplets from another person’s infected cough or sneeze. Germs can also live on surfaces, such as countertops or door knobs as well as on hands and clothing.

Viral infections, like the common cold, occur frequently in infants and young children. Most often these illnesses stay in the upper respiratory tract (nose and throat) and create all the symptoms we associate with the common cold. Sometimes, the illness becomes more severe, for example, pneumonia and bronchitis may develop in the lower respiratory tract (lungs). The respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections. RSV occurs most often between two and eight months of age and can become a serious illness requiring hospitalization.

How does breast milk protect children against lower respiratory infections?

Breast milk provides an infant with immunoglobulins, proteins, enzymes and other disease fighting elements, active in preventing infections.

Many compounds in breast milk help to fight a respiratory infection.  Some of these components include SigA (an important immunoglobulin), lactoferrin (a whey protein) and lysozyme (an enzyme).

Lysozyme and lactoferrin work together to destroy invading viruses and bacteria. While lactoferrin takes away necessary nutrients from viruses and bacteria, lysozyme enzymes attack their cell walls. Immunoglobulins, such as SigA, bind the bacteria or virus preventing it from spreading throughout an infant’s body.

The more of these substances an infant receives, the better an infant’s body is able to fight off infections or reduce the severity of illness. Formula does not contain any of these naturally occurring compounds. So, although breastfed infants are still susceptible to viruses, this enhanced disease fighting ability may partially explain why breastfed infants are less likely to be hospitalized for a lower respiratory tract infection.

About the scientific research

What kind of scientific review was this?

This was a systematic review/meta analysis of seven studies. The analysis evaluated the risk of hospitalization in 3,201 breastfed subjects and 1,324 non-breastfed subjects. The studies reviewed were conducted in developed countries among children less than one year of age with no other medical condition.

The researchers examined the association between breastfeeding and hospitalization for lower respiratory tract diseases.

The studies were adjusted for smoking and socioeconomic status, both of which could influence the risk of having a lower respiratory infection.

What were the results of the review?

The review determined that exclusive breastfeeding for four or more months is associated with an overall 72% reduction in the risk of hospitalization for lower respiratory infections compared with infants who were formula-fed.

Is there an opportunity for more research?

There are many factors that could influence these outcomes besides smoking and socio-economic status.  There may be factors in the behaviour of women who exclusively breastfeed that influence the development of lower respiratory tract infections requiring hospitalization.  Further research could be done to investigate the role played by those factors.  There is also an opportunity to further investigate the effect of breastfeeding against the frequency of lower respiratory infections and not only the cases which result in a hospital admission.  Further research, however, may be limited by the fact that not all lower respiratory infections are reported.

About diarrheal infections

Breastfed babies are at lower risk for various infections, including diarrhea or gastrointestinal infections.

Diarrhea is common in infants and children. In the United States, it is estimated that in children under five years old, each child would have an average of at least one episode per year.

While a diarrheal infection is generally brief, it may also be accompanied by stomach pains, cramps, vomiting, loss of appetite, nausea and/or fever.

In left untreated, diarrhea can be dangerous. Diarrhea may cause dehydration which can lead to serious illness and hospitalization.

What causes diarrhea?

All breastfed babies naturally have loose stools. Diarrhea is different. It is caused by an infection and can be severe, with frequent watery stools.

A gastrointestinal infection or gastroenteritis (also known as ‘gastro’ or ‘stomach flu’) involves both the stomach and the small intestine and usually results in acute diarrhea. This type of infection in infants is most commonly caused by viruses or bacteria. The rotavirus is the most common cause of acute diarrhea among children between six months and two years of age.

How does breast milk protect children against diarrhea?

While researchers do not yet understand the exact way in which breastfeeding protects against these types of infections, there is evidence that specific compounds in breast milk may be the reason.  Some of these compounds include SigA (an important immunoglobulin), lactoferrin (a whey protein) and lysozyme (an enzyme).

Lysozyme and lactoferrin work together to destroy invading viruses and bacteria. While lactoferrin takes away nutrients from viruses and bacteria, lysozyme enzymes attack their cell walls. The immunoglobulin SigA coats the lining of the intestines and stomach to prevent any remaining viral/bacterial cells from attaching onto the cell walls of the baby’s gut.

The more of these substances infants receive, the lower their risk of having a gastrointestinal infection. This protective effect of breast milk appears to last up to two months after weaning. Formula does not contain any of these substances.

About the scientific research

What kind of scientific review was this?

This was a systematic review of 16 studies (12 prospective cohort studies, two retrospective cohort studies and two case-controlled studies) involving 5,473 children, 504 children and 331 pairs respectively. The studies reviewed were conducted in developed countries among children with no other medical condition.

The researchers examined the relationship between breastfeeding and development of gastrointestinal infections in children less than one year of age from developed countries.

The studies were adjusted for other factors which could influence a child’s risk of having a diarrheal infection, such as: gender, race, maternal education, family living standards, marital status, paternal social class and/or parental smoking.

What were the results of the review?

Evidence from the three higher quality studies that controlled for other factors, suggest breastfeeding is associated with a reduction in the risk of gastrointestinal infection.

Is there an opportunity for more research?

Yes, there is an opportunity to investigate further the extent breast milk protects against gastrointestinal infections. Future research should clearly differentiate between infants who were exclusively breastfed and infants who were ever breastfed. This is because studies examining other infections, such as otitis media (ear infection), found a connection between exclusive breastfeeding and lower rates of ear infections.

What were the results of the review?

The review determined breastfeeding is associated with a significant reduction in the risk of obesity, acute otitis media, lower respiratory tract infections, non-specific gastroenteritis.

Speak with a Public Health Nurse for more information about making an
informed decision when feeding your baby:

905-799-7700
Monday to Friday 8:30 a.m. - 4:30 p.m.
Caledon residents call free of charge at 905-584-2216



Make an Informed Decision | Breastfeeding in the First Weeks | Six Weeks to Six Months
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Revised: Thursday June 15 2017

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