Shaughn Leach:  I think what I am trying to say is that on one hand I feel a need to advise
parents of the risks but then what do I say when it is medically required? I
would love to know what others say to parents in these situations.  What is
'right' to say and what isn't?

I look at it in a risk/benefit manner.  Formula *always* has risks.  These risks don't disappear just because formula is *necessary* in a given situation.  When human milk (from mom or donor) is available, there are no benefits (to the infant) to counterbalance the risks of formula.  When human milk is *unavailable*, or in the rare metabolic disorder where human milk is not indicated, formula use does not suddenly become *risk-free*, however now the risks are balanced by the benefit of providing nutrition and preventing starvation.

This is similar to the use of chemotherapeutic drugs in cancer.  If one is healthy, then use of a chemotherapy agent carries only risks, and is thus inappropriate.  If one has cancer, it is not the case that suddenly the agent loses risks, but that the benefits of treating the cancer now outweigh the risk.

Bottom line, the baby must be fed.  Ideally this is with human milk, ideally directly from mom's breast.  But in the case where this ideal cannot be reached, something must fill the gap.

~Spencer


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E. Spencer Joslin-Montlick, MD

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