UberWiseOne: Your stats are not controlled for variables other than type of feeding, which is Miriam’s point about other risk factors.

Yes, breastfeeding is _associated_ with lower SIDS incidence; however, the association is correlation, not causation. (Stupid example but, kinda like carrying a purse is associated with having long hair if we include an entire population, not just its women, in the experiment.) When other risk factors (bedding, sleep position …) are taken into account, the difference in incidence of SIDS is insignificant for breast- vs. formula-fed babies.

http://pediatrics.aappublications.org/cgi/content/abstract/111/5/S1/1207 is the AAP journal article cited by Wikipedia.

I would speculate that families that choose to breast-feed, are also a families that have good access to good prenatal and postpartum education about sleep position and bedding.

By no means am I arguing against breastfeeding – loved it, kid thrived! I just think it’s only fair that people have access to the correct information when it’s available. Especially good is information that is quantified so that they can know how big a difference their decision makes.

It’s unfair to ask people to weigh “breast-feeding MIGHT reduce the risk of SIDS” against the myriad of other factors that might contribute to the decision.

Even tougher… I don’t see any numbers out there for the effect of combining breast- and formula-feeding. Does breast-feeding need to be exclusive in order to obtain quantifiable benefits? How much better is exclusive versus once a day? versus twice a day? And yikes, how about pumped versus straight from the breast?

As an aside, I was happy to see that the article controlled for type of bed-sharing. Bed-sharing with parents doesn’t seem to increase the risk of SIDS. I fell asleep nursing in bed all the time.

Kathy G, so well-said, thank you!

I think it is interesting that people have such a strong reaction to the phrase, “statistical risks of routine formula feeding.” Almost every parenting choice comes with some relative degree of risk. Carseats, shoes, baby-gates, if/where we do daycare, etc — it all has some degree of relative statistical risk. Each time I put my kids in the car to go anywhere, I am putting them at risk. Does it make me a bad mom? I hope not, but frankly it is my own decision to make as a mother.

As a woman who is still breastfeeding her 20 month old twins, I have to say that the risk of formula wasn’t what kept me going during the rough times… I just thought nursing was really important for our family — and that I knew it felt right for me as a mom. I feel strongly that I came to that decision because I was loved and supported by many women who were willing to gently share information with me and then RESPECT my instincts and choices as a mother — no matter what those choices may be.

We are lucky to live in a country where clean water and sanitary conditions are widely available — thus minimizing the statistical risks associated with formula. If another mom makes a different feeding decision for her family, who am I to judge her choice?

I really wish that we could begin to look at the many universals we share as mothers. We each have a hard job and experience our own share of struggles. I think if we could focus on love and support among moms (rather than the painful culture of comparison that I see everywhere), that the appropriate education and healthcare support (for things like breastfeeding, educated birth choices, etc.) would have to follow. Afterall, the only people who benefit from maternal factions are larger systems who can use that division to avoid acting in ways that benefit all mothers and children.

I appreciate the even-handed tone of this article, but look forward to a day when this type of mommy-comparison (no matter how well-written and well-intentioned) is unnecessary.

Just to touch on Kris’ comment above and to add to the discussion about the complexity of interpreting research findings…the Caspi and Moffit study used very reliable and valid measures of child IQ (the WISC and the WPPSI). However, the measures they used to assess maternal IQ are highly questionable – they included the WRAT (which is a brief test of word recognition, simple math calculation and spelling) and a “verbal ability” subtest of the SRA. Neither of these tests are considered to be useful measures of “intelligence” – and are not used in routine testing. Thus, the study did not provide a good estimate of maternal IQ and seemingly ignored the role of fathers’ IQ – thus, not really controlling for the confounding factor of parental IQ – which, of course, would impact the finding of the study. It seems almost impossible to control for all the potential confounds in a study on breastfeeding, formula feeding, and IQ. The only way to know that for sure, hypothetically, would be a study where women are randomly assigned to groups in which they are required to breastfeed exlusively or to formula feed – and that would obviously be totally unethical on all fronts!!

The idea that breastfeeding raises IQ can’t be so easily dismissed, though people tend to talk about it more than it deserves. See this article from the economist about a study that shows a link even when parental IQ is taken into account:
http://www.economist.com/science/displaystory.cfm?story_id=10097684

Here’s a quote:

What Dr Caspi and Dr Moffitt found was that the increase in intelligence associated with breastfeeding only happened to people who had inherited at least one copy of the C version of FADS2. (Most genes are present as two copies, one inherited from the mother and one from the father.) The effect did not depend on the social classes or IQs of the parents, nor on the birthweight of the child in question (low birthweight has been linked to lower IQ). And the difference in IQ was preserved into adulthood.

Sheri: I’m not against free formula samples for those who ask for them/need them. Just against handing them out to everyone regardless as part of standard “goodie bag” type arrangements.

Coco: It’s tricky language. I tried to phrase it to be clear I meant the aggregate risks to the health of the population if formula feeding is done routinely, as an assumed first choice. I do think on that level, talking about risks is appropriate, unless reducing SIDS, etc is a cool “bonus.”

But on the individual level, I would never presume to say what you interpreted it as, because there are so many things going into that decision and such varying contexts that you can’t out of context call it a risky choice; it is in fact a good and healthy option for many. If nothing else, compared to the absolute risk levels of any of these things, having a sane, happy parent comes way way first.

I don’t see that as contradictory with thinking that we actually could reduce our infant mortality rate noticeably by providing better (nonjudgmental) breastfeeding support in hospitals, for example.

I say this, by the way, as someone whose daughter experienced a high lead level at a age one–I know how to hold a contradiction in my head, where I can see on an individual level she’s not irreparably destroyed and I shouldn’t carry around a burden of guilt, but on the other hand I know the risk is real and if she had also been malnourished or ingested more it might have been much worse, so I fight for more education about it and more strict regulations, etc. (I am *NOT* comparing formula to lead paint–just the experience of the looking at the indiv/aggregate difference.)

I appreciate the intent of this article. As a nation, we can go much further in supporting breastfeeding. And really there is no doubt that when it’s an option, breast is best.

However, I disagree with the phrasing “statistical risks of routine formula-feeding”. The way that is phrased is problematic if that is on the list of what we as women should be doing to support breastfeeding. It implies that one is “risking” one’s child’s health by formula feeding and that is really not accurate. Maybe “statistical advantages/benefits of breastfeeding” would have been a better way to phrase it. I have heard too many women make statements indicating that they think formula feeding causes ear infections and the like. (I kid you not. That was in a published letter to a very well-known crunchy mom magazine.)

I appreciate Karen’s comment above and am glad you thought it was a point well-taken. Too many people in this country don’t understand how to interpret statistics, and that can cut both ways, no pun intended. I have no other source for this, so apologies if I’m wrong, but my midwife told me than many OBs, when a patient is having a planned C-section, choose to do it at my 39 weeks instead of 40 weeks because the statistical risk of stillbirth is lower at 39 weeks. That sounds like a good reason on the face of it. My midwife also said the difference is miniscule, so it’s completely pointless. Understanding the absolute risk is key to making good decisions sometimes.

Thanks for food for thought.

Yes, let’s talk about health risks but PLEASE can we use absolute rather than relative risk? Does it really matter if the risk of disease X increases from 1 in 10 000 000 to 10 in 10 000 000? OMG it’s TEN TIMES the risk. But, uhm, it’s still one in a million.

Babble editors: PLEASE insist on absolute risk statistics (perhaps in addition to relative risk).

SFmama…I totally agree. I had a horrible time breastfeeding as well, but also stuck with it. I too was amazed by how many strangers approached me and made comments about hoping that I was breastfeeding, or asking me if I was. I was taken off-guard at first to say the least. It is wonderful when people make positive comments without seeming judgmental about it…