BREASTFEEDING MEDICINE Volume 10, Number 5, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2015.9989

President’s Corner

Substitutes for Breastmilk—Weighing the Risks Wendy E. Brodribb

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ecently, following unprecedented complaints by health authorities, an Australian recipe book for the babies and children’s market, co-authored by a ‘‘celebrity chef,’’ was withdrawn by the publisher just prior to its release.1 The recipe that caused most consternation was for a doit-yourself (DIY) baby formula that included chicken liver and bone broth. This ‘‘formula’’ was said to resemble the nutrients contained in breastmilk. However, analysis of the ‘‘formula’’ found excessive levels ( > 500% higher than the recommended intake) of vitamins A and B12, iron, and sodium and a protein level more than 200% higher than the recommended intake for infants. A chicken broth containing apple cider vinegar, said to be suitable for infants from birth to 6 months, was also included in the book. This is not an isolated instance. Similar liver-based substitutes for breastmilk and other recipes using raw animal milks with additives including carrot juice, different oils, vitamin drops, and yeast are easily available on the Internet. Some of these recipes may be nutritionally adequate for infant growth, but for many, limited data concerning their nutritional properties are provided, leaving mothers to take on trust the claims reported on Web sites and by the recipe proponents. Authorities in this case were very concerned about the health consequences (including death) for infants who were given this DIY infant formula, particularly if it was used as their sole form of nourishment. However, a proportion of mothers responding to the reports in social media supported the idea of using homemade infant formula, such as those mentioned above, for a variety of reasons. Some followed a whole foods, unprocessed diet themselves and did not want to subject their infants to any processed food, such as infant formula. (One Web site said that infant formula was not ‘‘real’’ food.) Others were using the DIY formula because of breastfeeding problems that had been attributed to an allergy to breastmilk. Still others were concerned about information they had heard about detrimental outcomes from infant formula compared with breastmilk, as well as the risk of contamination and recalls. With a fear about using manufactured infant formula, they turned to making their own ‘‘formula,’’ thinking it would be more beneficial for their infants. These are not the only women seeking alternatives to using infant formula if, for some reason, they are not breastfeeding. Milk sharing is a burgeoning industry in many countries. Often this milk sharing is via a regulated milk bank or between friends or relatives. In other situations

women seek to find and screen a donor or donors with whom they build a long-term relationship. However, desperate women are also turning to the Internet to either buy or find donor breastmilk. Although not all milk obtained in this manner is of concern, there is the potential for contamination during the expressing process, while being stored, and during transportation. There is also a risk that milk being provided to women is not human milk, or has been adulterated with other animal milk or water. Feeding an infant anything other than his or her mother’s milk direct from the breast increases the potential for risk. This increased risk applies whether the infant is being fed his or her mother’s expressed milk, donor milk from a milk bank, unregulated donor milk, infant formula, or DIY recipes for substitutes for breastmilk. As physicians, our primary aim must be to provide information and advice to enable women to make informed decisions about infant feeding, to support them in whatever their decisions are, and to assist them reach their breastfeeding and infant feeding goals. Breastfeeding women need our ongoing support and problem-solving capabilities throughout their breastfeeding journey. For women who decide not to breastfeed, or wean for whatever reason, we also have an obligation to discuss safe and nutritionally appropriate alternatives to breastmilk. If this alternative is donor milk, we need to discuss issues around the authenticity and provenance of the milk as well as safe transportation. If safe donor milk is not available, manufactured infant formula is still the most appropriate form of sustenance for the infant compared with many of the DIY infant formula recipes available. Although infant formula will always be a second or third best choice compared with a mother’s own milk, it does have a place in nourishing infants when the risk of other alternatives is greater. While we all want to encourage breastfeeding, demonizing the use of infant formula may, in fact, drive women to use more risky alternatives. Reference

1. www.aww.com.au/diet-health/health-news/2015/3/pete-evanspaleo-cookbook-bubba-yum-yum-will-be-published-despitehealth-warnings/ (accessed April 8, 2015).

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—Wendy E. Brodribb, MBBS, PhD, FABM President, Academy of Breastfeeding Medicine

Substitutes for breastmilk--weighing the risks.

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