> I'm always highly dubious about this research as I don't see how it would allow for reverse causality - i.e., a mother who is feeling overwhelmed or poorly bonded is less likely to put the effort in to breastfeed and also more likely to snap and abuse her child, so it seems to me far more likely that it's the other internal and external stresses that bring about both the non-breastfeeding and the abuse, rather than breastfeeding itself being protective against abuse.  (I suppose that's technically not reverse causality, but I can't think of the correct name for it - hopefully you get the point.)
> 

There is no doubt some of this going on but some one the mechanisms by which formula feeding might make a mother more vulnerable to abusing or neglecting her child are well understood. In particular, there is very good evidence that women who formula feed are more reactive to stress and the link between stress and abuse and neglect is robust. There is also good evidence that physical proximity os associated with maternal sensitivity and attachment and also associated with breastfeeding. And then there's all the hormonal stuff that is demonstrated in animal models to impact behaviour. Very difficult to account for maternal stress in epidemiological studies. The largest study on maternal abuse or neglect and infant feeding was by Strathearn in Australia. They adjusted for the usual correlates for infant feeding (age, education, socioeconomic status etc) and included one measure of potential maternal stress/attachment- whether the pregnancy was planned or not. Big difference in risk of maternal neglect (to 16 years) between infants breastfeed for a short time (<3mo from memory) and those bf for longer.

> To disentangle the two, I suppose what you'd need would be an RCT in which a vulnerable, high-risk group of women were randomised to receive either breastfeeding support and promotion, or an equal amount of time spent on general discussion of parenting topics without breastfeeding promotion, and the results compared.  I'm curious as to whether anyone knows of any such research?  Or, alternatively, has any of the published research showing a formula-feeding/child abuse association figured out a clever way to allow for the possibility of the above confounder?
> 


That would be a nice study- actually if we got the PROBIT people to look at this then we'd be getting close. I wonder whether they have considered it?
We did have a RCT of maternal proximity and maternal sensitivity and attachment- low income mothers given baby sling or no. Had a big impact.

We need more research but there is most certainly a plausible pathway by which formula feeding could make women more likely to abuse or neglect their children- they lack the hormonal and physical scaffolding that breastfeeding provides to support maternal attachment and sensitivity.

Karleen Gribble
Australia

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