I would argue that we have plenty of evidence to suggest that formula is not safe.  Nothing is "safe".  Just about anything can kill you. 

The question is weighing risks.  There more than enough evidence to suggest that formula is riskier than mom's own milk before six months of age and continues to be riskier even after that. And I'm sure every single one of you can come up with cases of those exceptions when an individual mother's own milk WAS riskier than formula.

If we could buy human milk at the grocery store we would not be having this discussion because women who needed to "supplement" their own milk would be able to purchase human milk.  Thereby, the pressure to introduce solids for a slow gaining baby would be removed.  

The question is whether or not milk from another species that is adulterated to resemble human milk more closely is more harmful than an incredible array of solid foods that might be introduced to a baby under six months.  Given the huge degree of variability of what is introduced to babies under six months and the conditions under which they are prepared - I am sure that this issue will continue to be a hot topic for a very long time to come.  

Personally, I think this is far less important than the question of how poorly most health care practitioners support management of breastfeeding between three to six months.  I was prepping for a Gold Conference talk I'm giving and I realized that the vast majority of the cases I did growth charts for were mothers of babies who were having trouble between three to six months.  

I routinely encounter some health care practitioners who MISS big red flags for faltering feeding that were evident before the three month mark.   As a result mom's supply sinks and formula is used when I might not have been necessary or may have been less necessary.  I also routinely encounter health care practitioners who recommend feeding and sleeping schedules that CAUSE faltering growth during the three month interval.  So then a lot of formula ends up being used for an iatrogenically induced low supply.  There is also the opposite - babies who are drinking too much breast milk because they are regurgitating.  Either mom starts supplementing with more and more breast milk and then moves on to formula or their health care practitioners start recommending cereal. Thus, the underlying cause of the problem is never really addressed - the cereal or the formula is merely a bandaid. Just like all the drugs that are now used to treat our obesity crisis instead of the really much harder and multipronged strategies that would be required to prevent this crisis to begin with.  

I just find it very rare when anyone in the US health care system actually sits down and watches full feedings and listens completely enough to really tease out what sorts of underlying problems are occurring during this 3-6 month time interval.  So I am convinced that many of the reasons for suggesting a mother supplement with solids (as opposed to a baby grabbing solids off mom's plate) or formula could be prevented if women had more attentive thorough care earlier in the process.  

Susan Burger

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