Annotated Outline of the Risks of Formula
If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance).
This is not meant as a scare tactic. This is factual information about the risks of formula gathered and put into one article so it is easier to review and digest. When used properly, formula can save lives. Unfortunately, our society has put many barriers to breastfeeding and the reality is, many women cannot overcome these difficulties to breastfeed successfully. The goal is to make it easier for women to choose breastfeeding, which carries non of these risks. The goal is NOT to make women who feed their babies formula feel guilty.
Health Risks for Infants
- Ear Infections-Infants who are formula fed are 50% more likely to have ear infections than babies who receive only breastmilk (Duffy LC 1997; Duncan B, et al. 1993).
- Acute Infections-Babies have become very sick and some have died because of harmful germs in formula. Babies who are formula fed have a higher risk of death from illnesses such as diarrhea, bacterial meningitis, and acute lung infections such as pnemonia. Some formulas cannot be sterilized. Here is information about the specific organisms in formula known to be dangerous: EFSA, LaTrobe University (Arifeen S., et al. 2001; Barros FC, et al. 1995; Broor S. 2001; Bachrach VRG, Schwarz E, Bachrach LR. 2003; Cesar JA, Victora CG, Beaudry M, Dufour R, Marcoux S. 1995; Chen A, Rogan WJ.2009; Dewey KG, Heinig MJ, Nommsen-Rivers LA. 1995; Edmond KM. 2006; Kramer MS, Chalmers B, Hodnett ED, et al. 2001; Cochi SL, Fleming DW, Hightower AW, et al. 1986; Van Acker J., et al. 2001; Victora CG, Smith PG, Patrick J, et al. 1989; Weir E. 2001).
- Chronic Illness-Formula feeding is linked to higher risk for Type 1 diabetes, Type 2 diabetes, and bowel diseases such as celiac disease and inflammatory bowel disease & cardiovascular disease, including hypertension (Akobeng A K et al. 2006; Ivarsson, A. et al. 2002; Klement E, Cohen RV, Boxman V, Joseph A, Reif S. 2004; Malcove H et al. 2005; Martin RM. et al. 2005; Monetini L 2004; Owen GC, Whipcup PH, Odoki JA, Cook DG. 2002; Sadauskaite-Kuehne V., et al. 2005; Singhal A, Cole TJ, Lucas A. 2001; Young TK et al. 2002).
- SIDS-Studies have shown a link between SIDS and babies fed formula (Ford RPK, Taylor BJ, Mitchell EA, et al. 1993; Mitchell EA, Taylor BJ, Ford RPK, et al.1992
- Lower IQ-Children who are formula fed do not score as high on intelligence tests as their breastfed cohorts (Daniels M C, Adair L S 2005; Rao MR, Hediger ML, Levine RJ, Naficy AB, Vik T. 2002; Richards M, Hardy R, Wadsworth ME. 2002; Smith MM, et al. 2003).
- Environmental Toxins-Breastfeeding lowers the harmful effects on a child’s health from poisons in the environment like PCBs and dioxins. Toxic phthalates are found in formula. (Boersma ER, Lanting CI. 2000; Vreugedenhill HJI., et al., 2004).
- Allergies-Formula feeding is linked to higher incidence of eczema, allergies to food, inherited allergies and allergies which affect breathing such as hay fever (Hoppu U, et al. 2005; Kerkhof M, Koopman LP, van Strien RT, et al. 2003; Saarinen UM, Kajosarri M 1995).
- Asthma-Babies who are fed formula are 40 – 50% more likely to have asthma or wheezing (Dell S 2001: Oddy WH, Peat JK 2003; Oddy WH, Peat JK, de Klerk NH 2002; Wright AL, Holberg CJ, Taussig LM, Martinez FD 1995).
- Obesity-Children who are formula fed are nearly 40% more
likely to be obese than children who are breastfed – even after accounting for alternative variables that may explain why a person may be overweight (Armstrong, J. et al. 2002; Frye C, Heinrich J. 2003; Weyerman M et al. 2006). - Cancer-Children who have not been breastfed are more likely to get leukemia and other cancers than children who were given only breastmilk (Bener A, Denic S, Galadari S. 2001; Dundaroz R., et al. 2002; Guise JM et al. 2005; UK Childhood Cancer Investigators 2001).
- Nutrient Deficiency-Some formulas have been shown in postmortem reports to be linked to undetectable Thiamine levels. (Fattal-Valevski A., et al. 2005)
Maternal Health Risks
- Cancer-Increased risk of breast, ovarian & endometrial cancers for mothers who feed use formula instead of breastfeeding. (Armogida, Sheila A., Yannaras, Niki M., Melton, Alton L., Srivastava, Maya D. 2004; Chiaffarino F., et al., 2005; Martin R, Middleton N, Gunnell D, Owen C, Smith G. 2005)
- Obesity- Mothers who use formula tend to retain postpartum weight. (Baker JL, Gamborg M, Heitmann BL, Lissner L, Sørensen TIA, Rasmussen KM. 2008; Fernandes TA, Werneck GL, Hasselmann MH 2012; Kac G. et al., 2004; Okamura C. et al. 2006)
- Increased Stress & Anxiety-Mothers who feed their babies formulas have more anger and depression with correlative altered levels of cortison, prolactin & ACTH (Groer M W. 2005)
- Diabetes- Mothers who feed their babies formulas are not afforded the same protection against diabetes as mothers who breastfeed. Breastfeeding mothers enjoy a 15% risk decrease for each year they breastfeed. (Stuebe AM, Rich-Edwards JW, Willett WC 2005)
Some Links to Articles and Websites Relating to the Dangers of Infant Formula
Toxic Phthalates in Infant Formulas
Risks and Costs of Formula Feeding
What Should I know about Formula?
Working Together for a Toxic-free Future
Genetic Engineering & Infant Foods
Formula Feeding Doubles Infant Deaths in America
What Every Parent Should know about Infant Formula
Baby Friendly Hospital Initiative & the Risks of Formula Feeding
Commentary on formulas supplemented with DHA & ARA
The Unbottled Truth About Formula
Some Non-health related risks of formula
What if Breastfeeding Had no Benefits?
WIC’s Promotion of Infant Formula in the United States
Risks of Informal Breastmilk Sharing versus Formula Feeding
Academic Articles
Akobeng A K et al. Effects of breast feeding on risk of coeliac disease: a
systematic review and meta-analysis of observational studies. Arch Dis
Child 91: 39-43, 2006
Arifeen S, Black RE, Atbeknab G, Baqui A, Caulfield L, Becker S, Exclusive
breastfeeding reduces acute respiratory infection and diarrhea deaths
among infants in Dhaka slums. Pediatrics 108: e67, 2001
Armogida, Sheila A.; Yannaras, Niki M.; Melton, Alton L.; Srivastava, Maya D.
Identification and quantification of innate immune system mediators in
human breast milk. Allergy and Asthma Proc 25: 297-304, 2004
Armstrong, J. et al. Breastfeeding and lowering the risk of childhood
obesity. Lancet 359:2003-2004, 2002
Bachrach VRG, Schwarz E, Bachrach LR. Breastfeeding and the risk of
hospitalization for respiratory disease in infancy. Arch Pediatr Adolesc Med.
157: 237-243, 2003
Baker JL, Gamborg M, Heitmann BL, Lissner L, Sørensen TIA, Rasmussen KM. Breastfeeding reduces postpartum weight retention. Am J Clin Nutr. 88: 1543-1551, 2008
Beaudry M, Dufour R, Marcoux S. Relationship between infant feeding and
infections during the first six months of life. J Pediatr 126: 191-197, 1995
Bener A, Denic S, Galadari S. Longer breast-feeding and protection against
childhood leukaemia and lymphomas. Eur J Cancer 37: 234-238, 2001
Boersma ER, Lanting CI. Environmental exposure to polychlorinated
biphenyls (PCBs) and dioxins. Consequences for longterm neurological and
cognitive development of the child. Adv Exp Med Biol 478:271-287, 2000
Broor S, Pandey RM, Ghosh M, Maitreyi RS, Lodha R, Singhal T, Kabra SK. Risk
factors for severe acute lower respiratory tract infection in under-five
children. Indian Pediatr 38: 1361-1369, 2001
Cesar JA, Victora CG, Barros FC, et al. Impact of breastfeeding on admission
for pneumonia during postneonatal period in Brazil: Nested casecontrolled
study. BMJ 318: 1316-1320, 1999
Chen A, Rogan WJ. Breastfeeding and the risk of postneonatal death in the
United States. Pediatrics 113: 435-439, 2004
Chiaffarino F, Pelucchi C, Negri E, Parazzini F, Franceschi S, Talamini R,
Montella M, Ramazzotti V, La Vecchia C. Breastfeeding and the risk of
epithelial ovarian cancer in an Italian population. Gynecol Oncol. 98: 304-
308, 2005
Daniels M C, Adair L S. Breast-feeding influences cognitive development of
Filipino children. J Nutr. 135: 2589-2595, 2005
Dell S, To T. Breastfeeding and Asthma in Young Children. Arch Pediatr
Adolesc Med 155: 1261-1265, 2001
Dewey KG, Heinig MJ, Nommsen-Rivers LA. Differences in morbidity
between breast-fed and formula-fed infants. J Pediatr 126: 696-702, 1995
Duffy LC, Faden H, Wasielewski R, Wolf J, Krystofik D. Exclusive
breastfeeding protects against bacterial colonization and day care
exposure to otitis media. Pediatrics 100: E7, 1997
Duncan B, Ey J, Holberg CJ, Wright AL, Martines F, Taussig LM. Exclusive
breastfeeding for at least 4 months protects against otitis media.
Pediatrics 91: 867-872, 1993
Dundaroz R, Aydin HA, Ulucan H, Baltac V, Denli M, Gokcay E. Preliminary
study on DNA in non-breastfed infants. Ped Internat 44: 127-130, 2002
Edmond KM, Zandoh C, Quigley MA, Amenga-Etego S, Owusu-Agyei S,
Kirkwood BR. Delayed breastfeeding initiation increases risk of neonatal
mortality. Pediatrics 117: 380-386, 2006
Fattal-Valevski A, Kesler A, Seal B, Nitzan-Kaluski D, Rotstein M, Mestermen
R, Tolendano-Alhadef H, Stolovitch C, Hoffman C. Globus O, Eshel G.
Outbreak of Life-Threatening Thiamine Deficiency in Infants in Israel
Caused by a Defective Soy-Based Formula. Pediatrics 115: 223-238, 2005
Fernandes TA, Werneck GL, Hasselmann MH. Prepregnancy Weight, Weight Gain during Pregnancy, and Exclusive Breastfeeding in the First Month of Life in Rio de Janeiro, Brazil. J Hum Lact. 28: 55-61, 2012
Ford RPK, Taylor BJ, Mitchell EA, et al. “Breastfeeding and the risk of sudden infant death syndrome. Int J. Epidemiol. 1993;22:885-890, 1993
Frye C, Heinrich J. Trend and predictors of overweight and obesity in East
German children. Int J of Obesity 27: 963-969, 2003
Groer M W. Differences between exclusive breastfeeders, formula-feeders,
and controls: a study of stress, mood and endocrine variables. Biol. Res
Nurs. 7: 106-117, 2005
Guise JM et al. Review of case-controlled studies related to breastfeeding
and reduced risk of childhood leukemia. Pediatrics 116: 724-731, 2005
Hoppu U, Rinne M, Salo-Vaeaenaenen P, Lampi A-M, Piironen V, Isolauri E.
Vitamin C in breast milk may reduce the risk of atopy in the infant. Eur J of
Clin Nutr 59: 123-128, 2005
Ivarsson, A. et al. Breast-Feeding May Protect Against Celiac Disease Am J
Clin Nutr 75: 914-921, 2002
Kac G, Benício MHDA, Velásquez-Meléndez G, Valente JG, Struchiner CJ.
Breastfeeding and postpartum weight retention in a cohort of Brazilian
women. Am J Clin Nutr 79: 487-493, 2004
Kerkhof M, Koopman LP, van Strien RT, et al. Risk factors for atopic
dermatitis in infants at high risk of allergy: The PIAMA study. Clin Exp
Allergy 33: 1336-1341, 2003
Klement E, Cohen RV, Boxman V, Joseph A, Reif s. Breastfeeding and risk of
inflammatory bowel disease: a systematic review with meta-analysis. Am J
Clin Nutr 80: 1342-1352, 2004
Cochi SL, Fleming DW, Hightower AW, et al. “Primary invasive Haemophilus influenzae type b disease: a population-based assessment of risk factors.” J Pediatr 108:997-896, 1986
Kramer MS, Chalmers B, Hodnett ED, et al. Promotion of Breastfeeding
Intervention Trial (PROBIT): A randomized trial in the Republic of Belarus.
JAMA 285: 413-420, 2001
Malcove H et al. Absence of breast-feeding is associated with the risk
of type 1 diabetes: a case-control study in a population with rapidly
increasing incidence. Eur J Pediatr 165: 114-119, 2005
Martin RM, Ness AR, Gunnelle D, Emmet P, Smith GD. Does breast-feeding in
infancy lower blood pressure in childhood? Circulation 109: 1259-1266, 2004
Martin R, Middleton N, Gunnell D, Owen C, Smith G. Breast-Feeding and
Cancer: The Boyd Orr Cohort and a Systematic Review With Meta-Analysis.
Journal of the National Cancer Institute. 97: 1446-1457, 2005
Mitchell EA, Taylor BJ, Ford RPK, et al. Four modifiable and other major risk factors for cot death: the New Zealand Study. J Paediatr Child Health 28 Suppl 1:S3-8, 1992
Monetini L, Cavallo MG, Stefanini L, Ferrazzoli F, Bizzarri C, Marietti G, Curro
V, Cervoni M, Pozzilli P, IMDIAB Group. Bovine beta-casein antibodies in
breast-and bottle-fed infants: their relevance in Type 1 diabetes. Hormone
Metab Res 34: 455-459, 2002
Oddy WH, Peat JK. Breastfeeding, Asthma and Atopic Disease: An
Epidemiological Review of Literature. J Hum Lact 19: 250-261, 2003
Oddy WH, Peat JK, de Klerk NH. Maternal asthma, infant feeding, and the
risk for asthma in childhood. J. Allergy Clin Immunol. 110: 65-67, 2002
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Owen GC, Whipcup PH, Odoki JA, Cook DG. Infant feeding and blood
cholesterol: a study in adolescents and systematic review. Pediatrics 110:
597-608, 2002
Rao MR, Hediger ML, Levine RJ, Naficy AB, Vik T. Effect of breastfeeding
on cognitive development of infants born small for gestational age. Arch
Pediatr Adolesc 156: 651-655, 2002
Richards M, Hardy R, Wadsworth ME. Long-tern effects of breast-feeding in
a national cohort: educational attainment and midlife cognition function.
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Sadauskaite-Kuehne V, Ludvigsson J, Padaiga Z, Jasinskiene E, Samuel
U. Longer breastfeeding is an independent protective factor against
development of type I diabetes mellitus in childhood. Diabet Metab Res Rev
20: 150-157, 2004
Singhal A, Cole TJ, Lucas A. Early nutrition in preterm infants and later blood
pressure: two cohorts after randomized trials. The Lancet 357: 413-419, 2001
Smith MM, Durkin M, Hinton VJ, Bellinger D, Kuhn L. Influence of
breastfeeding on cognitive outcomes at age 6-8 year follow-up of very
low-birth weight infants. Am J Epidemiol 158:1075-1082, 2003
Stuebe AM, Rich-Edwards JW, Willett WC, Duration of lactation and
incidence of type 2 diabetes. JAMA 294: 2601-2610, 2005
UK Childhood Cancer Investigators. Breastfeeding and Childhood Cancer. Br
J Cancer 85: 1685-1694, 2001
Van Acker J, de Smet F, Muyldermans G, Bougatef A. Naessens A, Lauwers
S. Outbreak of necrotizing enterocolitis associated with Enterobacter
sakazakii in powdered infant formulas. J Clin Microbiol 39: 293-297, 2001
Victora CG, Smith PG, Patrick J, et al. Infant feeding and deaths due to
diarrhea: A case-controlled study. Amer J Epidemiol 129: 1032-1041, 1989
Vreugedenhill HJI, Van Zanten GA, Brocaar MP, Mulder PGH, Weisglas-
Kuperus, N. Prenatal exposure to polychlorinated biphenols and
breastfeeding: opposing effects on auditory P300 latencies in 9-year old
Dutch children. Devlop Med & Child Neurol 46: 398-405, 2004
Walker, M. J Hum Lact June 1993 vol. 9 no. 2 97-107
Weir E, Powdered infant formula and fatal infection with Enterobacter
sakazakii. CMAJ 166, 2002
Weyerman M et al. Duration of breastfeeding and risk of overweight in
childhood: a prospective birth cohort study from Germany. Int J Obes
advance online publication February 28, 2006
Wright AL, Holberg CJ, Taussig LM, Martinez FD. Relationship of infant
feeding to recurrent wheezing at age 6 years. Arch Pediatr Adolesc Med 149:
758-763, 1995
Young TK, Martens PJ, Taback SP, Sellers EA, Dean HJ, Cheang M, Flett B.
Type 2 diabetes mellitus in children: prenatal and early infancy risk
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