I can't remember if the original posting re: frequent night nursers and
increased risk of ear infections distinguished between BM and ABM but
there is a different risk. The shape of the immature eustachian tube,
(short and straight in the child under 5 vs. long and twisting in the
adult) which opens in the back of the throat for all of us, will allow
any fluid up into the middle ear, particularly if the baby drinks lying
down. The wonderful thing about BM is that living cells come with it
(white blood cells, macrophages, lysozymes). So even when BM gets up
into that warm dark place, there comes with it cells that are programmed
to "seek and destroy" any bacteria within reach, thus minimum ear
infections.  ABM can't do that. Bacteria from the throat enjoy the ride
up into the warm, dark middle ear & have a feast on the lactose until,
ta-da!, an ear infection is under way. Any sugar will do, including
juice, koolaid, soda and all those other wretched drinks put in baby
bottles.

I worked with a full bilateral cleft lip/ cleft palate (hard & soft)
baby once who was able to have all his inital surgeries right on time
without postponement because he received EBM exclusively (the prominent
ENT had never had a cleft baby in his practice who was BM-fed - he
*always* expected to postpone surgeries 2-3 times and informed parents
accordingly. These babies in his clinic were on chronic antibiotic
therapy usually). Although this family evolved into an exclusive
pump-refeed system (the baby never directly breastfed because the ENT
adamently opposed use of an oral appliance even though there was a local
dentist with experience...), mom pumped for 6 months (she got into a
3X/day routine) and had a stash that kept the baby in EBM until 8-9
months old. He got his first middle ear infection *two weeks* after the
last of the EBM - to the day!!

BTW, at his first surgey (to close his lip) at 12 weeks, mom was already
on her 3X/day pump schedule and pumped her usual 8-9 ounces at 8 AM.
Baby went to surgery 1/2 hour later, came back at 11:30 am looking
"normal" (beautiful closure of the lip). The shock was profound - even
the medical staff was crying tears of joy. When mom went to pump at
12:00 noon - 1/2 ounce!! Her milk was "gone." This was the most clear
example I ever saw of how stress (even "good" stress) can negate the
milk-ejection reflex. I quickly reassured her that her milk was "still
there", that she just needed to immediately get back into her pumping
routine (I suggested returning to 6 X/day, or every 4 hours,
temporarily) - no matter the output - her goal was to pump for pumping
and routine's sake. Any milk obtained would be a "bonus" for now. Within
24 hours, the endocrine system would respond to the regular, familiar
pattern. She got only a few splashes at each pumping until morning the
next day when she obtained a few ounces, then by mid-day, pumping was
back to her usual robust 8-9 ounces. She was very insightful, and told
me that her shock came from "losing" the baby she knew (greiving the
loss of the cleft baby) and having to make milk for a "strange" baby. Of
course, it helped that he sounded, smelled, and acted like her familiar
baby! but such is the nature of attachment.

Katharine West, BSN, MPH, IBCLC(expired), FNP in-training
"The one thing more difficult than following a regimen is not imposing
it on others." Marcel Proust