Dear all:

One of the things that I have found interesting about the discussion of formula is that no one mentioned human donor milk, which is on the WHO list as an option.  This option is listed above formula.  

When I talk about risks or hazards of formula, I talk about categories of risks and what parents can do to minimize those risks when they have no other options but to use formula.  We can never remove all risks in life ever nothing is ever completely safe. 

It seems to me that the risks are:

a) bacterial contamination 
    i) in the container (e.g. powder)
   ii) during preparation (e.g. mixing with water) 
   iii) from inadequate cleaning of the feeding device
   iv) during storage after opening the container

b) chemical leaching
 i) from containers
 ii) from feeding devices

c) mechanical challenges
 i) aspiration from feeding device
 ii) inadequate skin to skin contact
 iii) overeating due to inappropriate flow

d) immunological suppression
   i) changes in gut lining
   ii) insufficient dosages of antibodies 
  etc..............

e) nutritional inadequacies
   i) missing nutrients (the many known and yet unknown components of human milk)
  ii) imbalances in nutrients (fatty acids, types of sugards, etc) 
  iii) malabsorption of nutrients (necessitating higher amount of iron and vitamin D to compensate
 
It seems to me that we can help parents with a)-c) with information that will help them make more informed choices about breastmilk substitutes and help them to consider minimizing the doses of these substitutes for d) and e).  

Best, Susan Burger

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