Comment:  "Yeah, it would be reall neat if formula was totally permitted.
Then
children like my 13 yr old son who had to have formula because I laid dying
in a hospital could have died from malnutrition."

Response: We need to remember that formula is nothing more than cow's milk,
slightly modified.  Without formula, we would simply use canned cow or goat
milk (with a vitamin supplement), or we would move forward and establish
human milk banks at every hospital offering maternity care.

I agree that "formula" is an improvement over canned milk, but the name
"formula" blinds us to the fact that it's not a big improvement.  Donor
human milk is safer, far better, and is an infinitely renewable resource for
every community.

Please remember--as a general rule, formula does not save lives.  When
mother's milk is not available, there are many options.  When human milk is
not available, there are still many options, though they are inferior in
quality and safety to human milk.  The differences among these several
options are all small compared to the difference between them and human
milk.

Looking at normal populations of babies, we have to recognize that, although
formula is slightly better than canned milk, calling it "formula" may
contribute to a false sense of security and lead to its overuse.  Our
falsely inflated perception of its scientific quality causes us to choose
and use it when we should not.  Since it is clear that formula causes
increased rates of morbidity (illness), physiological damage (lower
intelligence, higher incidence of diabetes), and mortality (death from
infection, SIDS, and accidents) than normal, we should maintain the same
cautious level of awareness before using it that we would with canned animal
milk.

Specialty formulas, for babies with inborn errors of metabolism or other
unusual medical conditions, are a different matter. In these cases, formula
may cause less brain damage and death.  This would be an appropriate and
considered use, either as an adjunct to or a replacement of human milk, of a
specific formula.

Do I continue to use and recommend infant formula when a supplement is
needed immediately and no human milk is available?  Yes, I do.  Although
there is no scientific evidence that as a limited use supplement, regular
formula has any advantages over canned animal milk, substituting hydrolyzed
formula for regular formula, even for brief exposures, may decrease the
likelihood of initiating or worsening a lifetime of atopic disease and
autoimmune dysfunction in a young infant.  This is only hypothetical, and if
our rates of asthma deaths in children, autoimmune diseases in all age
groups, and the potential for severe eczema to impact a child's developing
personality and socialization weren't all such concerns, I would not be
grasping at this straw.  But they are, and I do, even though I retain some
skepticism as to the level of hydrolyzation actually achieved.  The
hydrolyzed formulas will still cause the same high rate of infections in
babies that regular formula and canned milk do, due in large part to a lack
of immunological protection in all formulas and canned animal milks.  It's a
cost which has to be recognized and accepted as integral to that method of
feeding.

For the long term, if a baby were to be denied human milk, I would still
recommend animal milk formula if it were available.  If it weren't
available, then canned animal milk with added carbohydrate and vitamins
would do.  Only if a baby demonstrated an absolute intolerance (failure to
thrive, or worse) to animal milks (including hydrolyzed animal milks) would
I recommend trying soy formula.  At that point, the barriers to obtaining
human milk for this child should be revisited.

Arly Helm, MS, Nutrition and Food Sciences; IBCLC

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