Dear Dr. Sanghavi,

It is true that babies fed formula in North America in the twenty-first
century will mostly do well.  That does not mean that the risks of
artificial feeding should be minimized.  Though most children will never be
in a serious auto accident, child safety seats are in wide use now because
of the easily documented effect on acute injury in auto accidents.  The
effects of artificial feeding are generally less acute, less defined, and
more manifold than the effects of inadequate child restraint, and are
therefore harder to assess.  That does not mean they are insignificant.  You
wrote:  "In a Canadian study, for example, the risk of diarrhea, colds, and
other infections per week of early infancy was 3 percent in formula-fed
infants, and 2 percent in those breast-fed."  Don't you wish more of the
medications you prescribe were supported by studies indicating as high as a
33% reduction in risk or symptoms?

I was alarmed at your mention of the dramatic cases of infant dehydration
due to insufficient milk.  These rare cases are presented as if the
alternative, infant formula, is manufactured with infallible quality control
and always prepared at the right concentration and freshness.  Parent
education, and health-care follow-up, are key to the prevention of infant
dehydration.  Many such cases could be prevented if before discharge parents
were shown a diaper with the ounces of water equivalent to a proper Day 4
wetting and told, "Your baby should put out __ or more of these between
_____day and ____day."  Discharge gift bags should never include formula --
that would imply that health care providers believe poor feeding is not
symptomatic of anything and requires no follow-up.  Perhaps what they should
include is pre-weighed, dated bags of 24-hour supplies of diapers, to assess
intake by measuring output.

You and your wife are to be applauded for the efforts you made to see that
your child was breastfed or breastmilk fed as much as you could manage.  The
impact of new parenthood, including sleep deprivation, does not discriminate
for or against members of the medical profession.  La Leche League warns
against bottle use in the early weeks because of its effect on the
establishment of proper suckling.  That does not constitute criticism of the
decisions you made about how to nurture your child who was already having
persistent trouble with suckling.  Please do not confuse "guilt" with
"regret" (thanks to anthropologist Katherine Dettwyler for spotlighting this
distinction).  You did what you could with the information and support you
had available at the time.

Breastfeeding is not a panacea, but it is the physiologic norm.  I am so
glad that you continue to encourage it in your practice, in spite of your
stressful personal experience with it.  All parents need information and
support to do their job.  Please don't hesitate to avail yourself and your
patients of the information and support La Leche League and the lactation
consultant profession have to offer.  Most of the people you encounter will
offer not guilt, but the resources parents need to do their job.

Sincerely,

Ruth Piatak, B.A., M.S., La Leche League Leader

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