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Dear Editor,
     I am responding to the column of January 8th, 2002 by Dr. Barry Dworkin
on “The Hazards of Breastfeeding.”  Dr. Dworkin’s column reflects some
common misunderstandings about the appropriate goals and ethical obligations
of health care professionals to provide information and support to mothers
about feeding their children.  It is important that mothers have accurate
information so they can make informed choices, and then have adequate and
appropriate support so they can be successful overcoming any difficulties
they have while breastfeeding.
     First, Dr. Dworkin writes “The American and Canadian pediatric
societies advocate breastfeeding for the first 12 months of life.”  In fact,
the American Academy of Pediatrics recommends that all children in the US be
breastfed for a *minimum* of 12 months, and thereafter for as long as both
mother and child wish.  The World Health Organization recommendation, since
1979, has been that all children everywhere be breastfed for a minimum of
two years.  One year should be viewed as the minimum duration of
breastfeeding that all mothers and their health care professionals should be
striving to accomplish.
     Dr. Dworkin writes:  “There can be tremendous guilt if breastfeeding
does not go well, their baby is not gaining weight, not latching properly,
or their technique is poor. The stress from these problems can in themselves
make matters worse.”  I agree that mothers often feel guilty when they are
not able to accomplish their mothering goals.  Therefore, health care
professionals – including physicians, nurses, and board-certified lactation
consultants -- should be helping mothers breastfeed successfully.  The
solution to the ‘guilt problem’ is not to lie to mothers about the
importance of breastfeeding or the damage caused by formula.  The solution
is to fix the latch, figure out why the baby is not gaining well, and teach
the mother better techniques.
     Dr. Dworkin writes:  “[W]omen are bombarded with messages that lead
them to believe if they stray from breastfeeding they are potentially
harming their newborn child.”  Well, this is simply the truth, and I would
be delighted if I thought that most mothers understood this important
message and heard it early and often from their health care providers.  It
is extremely well documented that formula increases a child’s risk of death
and disease, not only in infancy or childhood but also throughout life, not
only in Third World countries, but in developed countries as well, and that
formula decreases average IQ scores.  A mother who uses formula IS
“potentially harming her newborn child.”  I would even go so far as to say
that every child who is formula-fed rather than breastfed suffers some
damage from formula use.  It may be necrotizing enterocolitis as a neonate,
death from SIDS, more ear infections in childhood, or the development of
diabetes, cancer, heart disease, or multiple sclerosis later in life.  Think
of how guilty a mother will feel when she finds out that her child has
suffered from something that could have been prevented or lessened by
breastfeeding!  And how angry she will be at her doctor for not telling her
that formula harms children.
     The real problem is that many health care professionals, out of a
misguided concern for how the mother ‘feels’ or ‘might feel’ if she chooses
to formula-feed, don’t make it clear enough to mothers that there are very
real costs to formula-use.
     Dr. Dworkin writes:  “If a mother is unable to breastfeed, and yes this
does happen, she should not be made to feel that she is a failure.”  I agree
with this.  Yes, there are some mothers, and some babies, who cannot
breastfeed.  I was unable to breastfeed my middle child after four months
due to multiple problems on both my side and his side.  We had to use
formula.  However, these situations are extremely rare.  With the proper
information, education, and support, the vast majority of mothers can
breastfeed.  Most bottle-fed children are not bottle-fed because the mother
couldn’t breastfeed them or because the child had some problem making it
impossible for them to breastfeed.  Rather, most children who are bottle-fed
are bottle-fed either (1) because no one clearly informed the mother of the
significant risks of formula, so she thought it was just a ‘life-style’
choice, or (2) because she experienced difficulties and she didn’t seek help
for them because she didn’t realize how important breastfeeding was, or (3)
she did seek help, but no health care professional was willing to invest the
time and effort to help her overcome the problems, because the health care
professionals themselves don’t realize how important breastfeeding is.

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