ARE MOTHERS THAT CHOOSE TO ARTIFICIALLY FEED AT A DISADVANTAGE?

Published May 17, 2020, 1:22 p.m. by Moderator

Introduction:


There has been a lot of debate on whether artificial feeding/bottle feeding/formula feeding poses health risks to children’s health. Research indicates that non-breastfeeding children are more subject to elevated prevalence of contagious illnesses, along with higher risks of infant obesity, Type one and Type two Diabetes, leukemia, and higher levels of infant mortality. Research also indicates that mothers who do not breastfeed, are more inclined to breast cancer, endometriosis, increased belly fat, Type 2 Diabetes, acute coronary syndrome, high blood pressure, and abnormal cholesterol levels. Obstetricians are exclusively placed to advise expectant mothers about the associated benefits of breastfeeding and to make sure that mothers and babies receive appropriate pre-natal and post-natal care.


It is a mother’s prerogative to choose whether to breastfeed or to formula feed. However international health organizations such as World Health Organizations (WHO), American Medical Association (AMA), American Academy of Paediatrics (AAP), and American Dietetic Association endorse breastfeeding as the paramount choice for newly born infants. Breast milk has antibacterial and healing properties which enhances an infant’s immunity. It also lessens the probabilities of chronic illnesses and inhibits allergies.


Brown, Isaacs, and Lechtenberg proposed a breastfeeding program for mothers. They advise that babies need to be breastfed exclusively on breast milk for the first six months and then gradually weaned within the next 12 months. Breastmilk is the most appropriate nourishing option for infants. Breastfeeding or formula feeding decisions are largely driven by the level of comfort, health concerns, and way of life. Infant baby formula is the appropriate substitute for mothers who are unable to produce enough breastmilk. Feeding the baby formula guarantees that the nutritional needs of the baby be met. The decision to choose between breastfeeding or formula feeding is up to the parents, health practitioners can only advise and make recommendations. This paper will examine existing literature that clearly shows a link between lack of breastfeeding and increased incidences of childhood obesity (Brown, Isaacs and Lechtenberg 23, 2013).


Rationale:


Recently released statistics by the World Health Organisation (WHO) indicate that the number of obese children across the world has sharply increased from 30 million in the 1990’s to 41 million in 2016.  There are 9 million obese children in Africa. The World Health Organisation (WHO) estimates the number to rise to 75 million by 2025.  Childhood obesity raises the cost of health care because of the associated risks that accompany child obesity. Childhood obesity increases the risk of heart diseases later in adulthood. Research indicates that child obesity between ages 10 and 13 years will probably progress to adulthood. Therefore it is very important to find the link between child obesity and lack of breastfeeding to prevent childhood obesity and to decrease infant mortality and illnesses in adulthood. The World Health Organisation (WHO) recommends breastfeeding as a measure to prevent child obesity (World Health Organization, 2019).


Methodology:


My database searches followed an iterative routine that involved searching continuously until we located articles that matched our subject matter. The searches were conducted during April 2019 and May 2019. My search criteria limited our article search to articles that were no older than 10 years and articles that were freely available or open-source. I looked for literature relating to the relationship between childhood obesity and breastfeeding. Search phrases used included “breastfeeding and child obesity journals,” “advantages of breastfeeding over artificial feeding journals,” and “breastfeeding research journals.” Online search engines were used to narrow the search so I employed a “bottom-up” search approach where I searched for general breastfeeding articles and using the references therein to try and access the cited article.


Some of the journal articles were only available for registered members and were inaccessible. I decided to review the age limit and started looking for articles published in the last 20 years. I retrieved most of my articles from public health and medical journals. We retrieved journals from the United States National Library of Medicine National Institutes of Health, International Journal of Sciences: Basic and Applied Research (IJSBAR), World Health Organisation website, BMJ Publishing Group, Journal of Human Growth and Development and the Journal of Health.


Findings


The 4 articles used in our literature review originated from Germany, Brazil, Iran, and the United States. The following findings appeared in the literature. Many of the studies indicated that breastfeeding plays a very essential role in preventing childhood obesity and the development of adult obesity:


The first article to be reviewed is titled ‘Breastfeeding and obesity: cross-sectional study’ by Kries et al. The scientists researched to analyze the relationship between breastfeeding and child obesity. They wanted to confirm the preventive attributes of breast milk concerning child obesity. The researchers discovered a clear connection between the duration an infant is fed on breast milk and the frequency of childhood obesity. Their research concluded that breastfeeding helps reduces the prevalence of child obesity. The results of their study showed the frequency was lowest when the infants were breastfed exclusively for more than a year and highest among infants who were breastfed for only two months (Kries et al. 3, 1999).


The researchers collected information from the school health examination of almost 135,000 students aged between 4 and 5 in Germany. For a mini sample of around 13,000 students, the researchers’ collected additional information such as height, weight, eating habits, and lifestyle factors from their parents through a questionnaire. The total number of children who participated in the final survey was 9357 children. The study established that extended breastfeeding is a valuable preventative measure against childhood obesity and that breastfeeding is important in reducing the prevalence of heart diseases and other associated side effects of obesity (Kries et al. 3, 1999).


The second article to be reviewed is titled ‘Infant Growth during the First Year of Life’ by Ferreira et al. whose objective was to analyze the relationship between breastfeeding and child obesity in the first 12 months of life. The study monitored the weights of 85 infants and analyzed their relationship with body weight. The body weights were measured in the sixth and twelfth months. The results showed that almost 77% of the infants had normal body weights by age one while the rest showed body weights that were not consistent with the World Health Organisation weight standards for infants aged 1 year. The study could not detect any visible relationship between breastfeeding and body weight. The researchers concluded that the body weighs were determined by the infants’ genetics rather than breastfeeding (Ferreira et al., 2015).


The third article to be reviewed is titled ‘The Risks of Not Breastfeeding for Mothers and Infants’ by Alison Stuebe. This article highlights the risks that are associated with a lack of breastfeeding. The research indicated that children who are not breastfed are more subject to elevated prevalence of contagious illnesses, along with higher risks of infant obesity, Type one and Type two Diabetes, leukemia, and higher levels of infant mortality. The research also indicated that mothers who do not breastfeed, are more inclined to breast cancer, endometriosis, increased belly fat, Type 2 Diabetes, acute coronary syndrome, high blood pressure, and abnormal cholesterol levels. The article cites the World Health Organisation recommendation that infants be breastfed for at least two years. It also points out the inherent benefits of breast milk such as antibodies and healing properties. Furthermore, breast milk protects against bacterial and viral infections (Stuebe 6, 2009).


The fourth article to be reviewed is titled ‘Relationship between Breastfeeding and Obesity in Childhood by Vafa et al. In this study the Iranian researchers’ analyzed data collected from 511 first graders aged 7 years. The objective of the research was to establish the relationship between the weight statuses and the association of feeding patterns, weight at birth, and birth order with the Basal Metabolic Index. The researchers collected data on the weights and heights of both the pupils and their mothers. They also collected data on feeding patterns; breastfeeding or formula feeding and the time at which supplementary diets were introduced to the child’s diet. They also collected birth weight and birth order (Vafa et al. 2, 2012).


The results indicated that the prevalence of underweight children was 7.6% while that of overweight children was almost three times at 19.7%. The researchers found no clear relationship between the duration of breastfeeding with the BMI. They also discovered that children who had been introduced to supplementary foods early had considerably greater mean BMI. In terms of birth order and birth weight, the researchers established that the two parameters were considerably related to childhood BMI. The researchers concluded that child obesity in the case of the pupils was as a result of nutrition rather than breastfeeding (Vafa et al. 2, 2012).


Discussion


The articles reviewed herein are contradictory, to say the least. The first article titled ‘Breastfeeding and obesity: cross-sectional study’ by Kries et al suggests a clear relationship between breastfeeding and child obesity while the other articles showed no clear relationship. The sample used in the article was much bigger than the other studies. Kries et al used a sample of 9357 children while the others had samples of 511 and 85. The small sample sizes in the comparative case studies could have made it difficult to establish a clear relationship between obesity and breastfeeding.


The one thing that all articles have in common is that breastfeeding is the basis of healthy child development. Research indicates that breastfed babies have better overall health than babies only fed on infant formula. Breastfeeding is the first line of defense for infants whose body immunity is largely undeveloped.  Riordan and Wambach explain that the vital antibodies in breast milk protect the child from infections such as diarrhea, pneumonia, influenza, and other respiratory problems (Riordan and Wambach 78, 2016). Breastfeeding helps in boosting the child’s immune system. Breastfeeding accomplishes this function by enhancing the body’s protective mechanisms and inhibiting the proliferation of viruses and bacteria (Clark 565, 2004). Brown, Isaacs, and Lechtenberg contend that breast milk protects infants against asthma, obesity, diabetes, and unexpected infant deaths (Brown, Isaacs and Lechtenberg 45, 2013).


The second benefit of breastfeeding is the nourishing components of breast milk such as proteins, lactose, fat, minerals, and vitamins, and protein. Breast milk is much easier for babies to digest than infant formula. Breastfed babies have fewer instances of digestive problems.


The third benefit of breastfeeding is the reduction of costs. Breast milk does not cost anything to the parent. Nutritious instant baby formula is very expensive and it increases the cost of maintaining a baby. Breastfed babies are much healthier and require less frequent visits to the hospital compared to formula-fed babies. Breast milk does not have additional costs such as storage and preparation. Breast milk is always fresh and does not require any additional preparation which exposes the child to a higher risk of infections.


However, breastfeeding also has its shortcomings.  Breastfeeding is a personal choice that is guided by the level of comfort or discomfort. Some women feel pain when breastfeeding or are uncomfortable with breastfeeding. This pain is usually worse during the weeks preceding childbirth. The pain lasts for about sixty seconds during the breastfeeding episodes. Mothers who experience pain during breastfeeding should seek medical help to ease the pain or find the underlying reason behind it.


The second shortcoming of breastfeeding is the time factor. Sometimes it’s a challenge to schedule regular feeding intervals, especially for working mothers. It is obvious that for a child to reap the benefits that come with breastfeeding the mothers have to be committed to it. (Brown, Isaacs and Lechtenberg 55, 2013). Constant child care makes it difficult for mothers to engage in other activities. Breastfed babies need to be fed more regularly than formula-fed babies since breast milk is easily digested. Regular feeding is draining to the mother who has to breastfeed the child several times a day.


Application in Midwifery


Midwives should advise breastfeeding mothers to avoid foodstuffs that might harm the child as they will be transferred during breastfeeding (Clark 34). Food containing mercury should be especially avoided. Breastfeeding mothers might have to reduce their intake of fish which normally have higher levels of mercury. Mothers should also avoid women's need to avoid food containing mercury and limit the consumption of mercury fish intake.  Breastfeeding mothers should limit their caffeine intake to a maximum of 300 mg every day. Caffeine is known to cause irritability and anxiety in some babies (Brooke et.al. 796, 1989)


Midwives should be conscious of the mothers' health conditions. Breast surgery and intake of medicines might bring complications to the child (American Academy of Pediatrics Committee on Drugs 777, 2001). Illnesses such as HIV/AIDS or those associated with chemotherapy make breastfeeding hazardous to the health of the child. Midwives should advise the mothers on the effects of drugs on the health of the child. Breastfeeding should be avoided if the mother has a health condition that will pose a risk to the child.


Midwives should also advise mothers that when to commence formula feeding and introduction of supplementary. Formula feeding also has its benefits over breast milk. Formula feeding can be done by any primary caregiver. It allows fathers to participate in feeding the baby which relieves the burden on the mothers unlike in breastfeeding where the mother is the only principal caregiver. Formula feeding accords the mother’s flexibility to engage in other activities as the baby can be left under the care of someone else (Brown, Isaacs and Lechtenberg 56, 2013).


Another benefit of formula feeding is that there is no time limitation. The baby can be fed regularly without any problems. Baby formula is digested slower than breast milk. Formula-fed babies have longer feeding intervals. Additionally, mothers who use formula do not have to worry about eating foods that might harm the babies.  On the other hand, formula feeding comes with drawbacks. The formula has protective deficiencies present in breast milk and so do not boost the child’s immunity. Baby formula is costly and not all parents can afford it. The cheapest in baby formula is powdered baby formula while the highest-priced is ready-to-feed.


The baby formula might also result in digestive disorders such as constipation and bloating.  Clark explained that formula-fed babies have stronger bowel activities and more gas on breastfed babies. Clark (71). According to Riordan and Wambach state that formula feed cannot equal the density of breast milk (Riordan and Wambach 71, 2016).


Conclusion:


The research reviewed herein indicates that lack of breastfeeding hampers the baby’s immunity and that can lead to health problems for the child and its mother. The results linking child obesity and breastfeeding were minimal at best. Child obesity has its foundations in breastfeeding but other additional factors such as diets, lifestyles, and genetics also play a role in child obesity.  Breastfeeding is very beneficial for babies. To breastfeed or formula feed is ultimately the mother’s choice. Mothers should seek medical advice before choosing to exclusively formula feed their babies. Breastfeeding should be highly recommended for mothers especially during the first 12 months of a child’s life. Breast milk boosts the child’s immunity which gives the baby a better fighting chance over infections.


 


References


American Academy of Pediatrics Committee on Drugs, 2001. Transfer of drugs and other chemicals into human milk. Pediatrics, 108(3), p.776.


Brooke, O.G., Anderson, H.R., Bland, J.M., Peacock, J.L. and Stewart, C.M., 1989. Effects on birth weight of smoking, alcohol, caffeine, socioeconomic factors, and psychosocial stress. Bmj, 298(6676), pp.795-801


Brown, J.E., Isaac, J., Krinkle, B., Lechtenberg, E. and Murtaugh, M., 2013. Nutrition through the life cycle. Cengage Learning. Stamford. Pg, 371.


Ferreira, P., Lea, V., da Silva, M., Mukai, A., Rodrigues, C., Bertoli, C., Nascimento, V. and Leone, C. (2015). Infant Growth during the First Year of Life. [online] Available at: https://doi.org/10.7322/jhgd.103017 [Accessed 9 May 2019].


Kries, R., Koletzko, B., Sauerwald, T., Mutius, E., Barnert, D., Grunert, V. and Voss, H. (1999). Breast feeding and obesity: cross sectional study. [online] Available at: https://doi.org/10.1136/bmj.319.7203.147 [Accessed 9 May 2019].


Labbok, M.H., Clark, D. and Goldman, A.S., 2004. Breastfeeding: maintaining an irreplaceable immunological resource. Nature Reviews Immunology, 4(7), p.565.


Stuebe, A. (2009). The Risks of Not Breastfeeding for Mothers and Infants. [online] PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/ [Accessed 9 May 2019].


Vafa, M., Eshraghian, M., Moslehi, N., Afshari, S. and Hossini, A. (2012). Relationship between Breastfeeding and Obesity in Childhood. [online] PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489946/ [Accessed 9 May 2019].


Wambach, K. and Riordan, J. eds., 2016. Breastfeeding and human lactation. Jones & Bartlett Learning.


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