So, since breastfeeding is the normal way that infants are fed and providing human milk is what is considered the 2nd best option and since I remain completely unconvinced that a 5% weight loss is something that requires changing the lining of the infant gut, here is the research it would require for me to be convinced that providing cow's milk with additives is a safe alternative to leaving well enough alone until a bigger weight loss occurs:

1)  Research that shows that:
a) Babies who lose more than 5% in a baby friendly environment, whose mothers are provided with assistance to recognize their infants cues, assistance with breast compressions and switch nursing if their babies are less responsive, and if their babies are exhibiting hunger cues after those measures -- are also assisted with hand expression end up being at higher risk of going on to lose 10 weight loss than babies who do not lose 5% in the same environment

b) If it is definitively shown that baby friendly measures are not sufficient to prevent an increase in risk among babies between 5 and 10% weight loss, then I would want to see if those babies who lose more than 5% and receive all of the above and receive human donor milk are at less risk of weight loss.

2) In the unlikely event that there is some magical property of formula that prevents weight loss in ways not possible through use of human donor milk, then I would want to see a long term risk analysis of dose response:

a) doses of human milk by day
b) doses of human donor milk by day
c) doses of formula by day
d) doses of solids by day 

This data could then be aggregated to distinguish between infants who had the brief dosage of formula early on, followed by exclusive breastfeeding compared to those who had brief dosages of formula early on and went on to have much less breastmilk than those who did not.

For the entire first two years of an infants life

Then a 60 year study of the incidence and the severity of both infectious and chronic diseases for the mother and her infant.

I would not be satisfied of the safety without a sample size of at least 10,000 in order to be able to identify severe but infrequent diseases.

Sincerely, 
Susan E. Burger, MHS, PhD, IBCLC

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