"Sure, you can speak of the benefits of breast-feeding," explains Dr. Gartner. "But it's really just as accurate -- maybe more accurate -- to speak of the risks of formula-feeding. Unfortunately, the large volume of medical literature we now have that demonstrates this is written from the perspective of proving the 'advantages' of breast-feeding -- as if formula-feeding were the gold standard. But when you read the literature the other way around -- as it should be read, really -- the results are rather startling."

These "startling" results were crystallized in the AAP's exhaustively researched 1998 Policy Statement on Breast-feeding and the Use of Human Milk. For the first time, parents can easily access a readable, comprehensive overview of all the most current medical literature related to infant feeding. Summarizing the results of their study, the AAP Policy Statement notes that infants who are not breast-fed "in the United States, Canada, Europe, and other developed countries, among predominantly middle-class populations" see an increased incidence and severity of such diseases as diarrhea (a malady from which approximately 500 American children aged 4 and under lose their lives each year), lower respiratory infection, otitis media (ear infections), bacteremia, bacterial meningitis, botulism, urinary tract infection, and necrotizing enterocolitis. The AAP goes on to say that a number of studies now indicate that breast milk may lower babies' risk for sudden infant death syndrome, insulin-dependent diabetes mellitus, Crohn's disease, ulcerative colitis, lymphoma (cancer), allergic diseases, and other chronic digestive diseases.

"More than 1,000 childhood deaths per year in the United States could be prevented through breast-feeding," says Dr. Allan Cunningham, associate professor of pediatrics at the State University of New York Health Science Center, Syracuse and the author of scholarly articles on the mortality risks of bottle-fed babies in the United States. "This includes infants who die from a wide variety of illnesses such as diarrheal diseases like rotavirus, as well as pneumonia and bacterial meningitis. Although the 'Back to Sleep' campaign has made a large dent in the number of babies who die each year from crib death, my estimate is that you roughly double the statistical risk of a baby dying of SIDS if you formula-feed. This is something parents just aren't made aware of."

Dr. Cunningham has published research in leading pediatric journals indicating that for every 1,000 bottle-fed infants in the United States, 77 hospital admissions would result. The comparable figure for breast-fed infants was determined to be five hospital admissions. And Naomi Baumslag, M.D., MPH and Dia Michels note in their book, "Milk, Money and Madness" (Bergin and Garvey, 1995): "Even where bacterial contamination can be minimized, the risks of bottle-feeding are not inconsequential. Bottle-fed infants raised by educated women in clean environments, to this day, have significantly greater rates of illness and even death ... In a study that analyzed hospitalization patterns for a homogeneous, middle-class, white American population, bottle-fed infants were 14 times more likely to be hospitalized than breast-fed infants."

A May 1995 study reported in the Journal of Pediatrics, "Differences in Morbidity Between Breast-fed and Formula-fed Infants," examined "whether breast-feeding is protective against infection in relatively affluent populations." The study followed two groups of babies, each of whom was either breast-fed or formula-fed exclusively for the entire first year of life. The babies were matched for characteristics such as birth weight and parental socioeconomic status, and the study was controlled for the use of daycare. The results of this research revealed that, in the first year of life, the incidence of diarrheal illness among formula-fed infants was twice that of breast-fed infants and the number of prolonged ear infections (more than ten days in duration) was 80% higher in formula-fed infants. Breast-fed infants experienced 19% fewer ear infections overall.

In a study reported in the April 1999 issue of Pediatrics, researchers looked at the frequency of only three illnesses during the first year of life: lower respiratory tract illnesses, otitis media, and gastrointestinal illness. Infants in the study were healthy at birth and were classified as never breast-fed, partially breast-fed, or exclusively breast-fed, based on their mother's feeding choice during the first three months of life. According to the study's authors, "Frequency of office visits and hospitalizations for the three illnesses was adjusted for maternal education and maternal smoking, using analysis of variance." The results of the research revealed that there were 2,033 excess office visits, 212 excess days of hospitalization and 609 excess prescriptions for these three illnesses alone per 1,000 bottle-fed infants compared with 1,000 exclusively breast-fed infants.

To Dr. Dettwyler, more familiar illnesses, such as ear infections, represent an important aspect of the risks of formula-feeding which shouldn't be overlooked. "In this country we have just become accustomed to repeated ear infections in our babies. Although we can treat these problems with antibiotics, we should be asking ourselves how this affects our babies' quality of life," says Dettwyler.

Dr. Wight agrees. "We are accepting as normal, abnormal amounts of unnecessary illnesses such as otitis media, lower respiratory illness, gastroenteritis, diabetes and allergies, among others."

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