Interesting discussion.

In answer to your question, Sarah, about what I would advise a client, I don't actually give much advice.  I give a lot of information, I encourage the mom to decide based on her interpretation of that information and then I support her choices in a way that allows her to reach her breastfeeding goals.  If some of her goals are at odds with her other goals then I explain the risks and benefits of her choices and how they may affect her breastfeeding relationship.  I do stick to the science and I clearly state if I am giving my opinion.

I do believe that thoughtfully chosen donor milk is a universally healthier option than formula for a baby who is 6-12 months old, unless there is a metabolic disorder that makes breastmilk unsafe for the infant.  In my family, I serve whole foods and the ingredients in formula are so far from my idea of food that it would be my last choice to nourish a baby.  I would not, however, share this bias with a client unless I was specifically asked for my opinion on the subject.  I would share though, that formula feeding has proven risks.  Whether or not we know it has specific risks to the older baby is irrelevent if you consider, "first do no harm."  Formula is a manufactured food substitute; it contains ingredients known to negatively affect health, and no one has proven that it is safe for anyone.

We may not know that formula is specifically risky for supplementing the baby older than 6 months who is already eating other foods, but it isn't really a good food choice so it isn't harmless.  In absence of hard science, I would go with the more natural choice.  I don't need to know that formula has documented risks in this situation to decide that real food is better than artificial food.

We do have the evidence that real food is better for people than processed, manufactured substitutes and this supports my belief that donor milk is better than formula for babies.  The original premise of this discussion was to make donor milk universally available and formula less available.  I assume that this is with the caveat that formula would be available to babies who cannot thrive on breastmilk due to metabolic disorders.  I am not sure how we can make donor milk more available unless formula became more difficult to acquire. 

Laura Spitzfaden, LLLL, IBCLC

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