On 8 March 2017, major news outlets reported that breastfeeding potentially poses a risk of infant starvation, and parents ought to be warned of that danger.

The articles were based on a blog post written by a woman named Jillian Johnson — who wrote that she possibly had a problem producing milk because of a hormonal imbalance called polycystic ovary syndrome, or PCOS —  and published by an organization called the Fed is Best Foundation. That post (with the title: “If I had given him just one bottle, he would still be alive”) chronicled in detail how her infant son Landon refused to stop crying or feeding, and quickly died of starvation and dehydration despite being breastfed almost constantly.

Her post read, in part:

Jarrod and I wanted what was best for Landon as every parent does for their child. We took all of the classes. Bought and read all of the books. We were ready! Or so we thought….every class and book was geared toward breastfeeding and how it’s so important if you want a healthy child. Landon was born in a “Baby-Friendly” hospital. (What this means is everything is geared toward breastfeeding. Unless you’d had a breast augmentation or cancer or some serious medical reason as to why you couldn’t breastfeed, your baby would not be given formula unless a prescription was written by the pediatrician.)

Because they were so determined to do everything right, Johnson wrote, they were reluctant to give him a bottle, thinking that the crying was normal: 

I still have many, many days of guilt and questions – what if I would’ve just given him a bottle? And anger because how would I have known. I remember when Stella was born, and she was always quiet. I kept asking the nurses what was wrong with her. They said nothing. She’s doing what she’s supposed to. Sleeping. Eating. And it was then that I realized that it wasn’t normal for a newborn to cry as much as Landon did. He was just crying out from his hunger. But I didn’t know. I should’ve known.  I still struggle daily feeling as though I failed him.

According to FedIsBest.org’s mission statement, they are not against breastfeeding, but instead exist to push back against a pervasive narrative (“the breast is best”) that new mothers are somehow failing their infants if they cannot or will not breastfeed, but instead resort to formula feeding: 

The most recent data shows alarming trends in infant feeding, namely a rise in hospitalizations for feeding complications in exclusively breastfed newborns who don’t receive enough breast milk, including increasing rates of jaundice, hypoglycemia, and dehydration, which can threaten a newborn’s brain. All mothers who wish to breastfeed should be supported in doing so while ensuring their child receives all the nutrition they need to remain healthy and safe. However, through our research, clinical practice experience and the countless stories we’ve received since launching this campaign, we have found that mothers often feel immense pressure by society and by current breastfeeding protocols to only breastfeed their newborns, even when they do not have enough milk to do so. When they do, they often cannot gauge if their infants are getting enough. While mothers and health professionals are taught that it is rare to have insufficient breast milk, insufficient breast milk production affects at least 1 in 5 women in the first days of an infant’s life. Without enough milk, infants can starve, and starvation can cause brain injury leading to preventable cognitive and developmental delays and an increased risk of seizure disorders.

However, with each iteration of the story, the message seemed to be less about advocating for new mothers to listen to their instincts, and more about the potential dangers of breastfeeding. This is misleading, as data and policy guidance on infant feeding is extensive both in and outside the United States. For example, the American Academy of Pediatrics policy on the topic is unambiguous:

The American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Medical contraindications to breastfeeding are rare … It has been calculated that more than 900 infant lives per year may be saved in the United States if 90% of mothers exclusively breastfed for 6 months. In the 42 developing countries in which 90% of the world’s childhood deaths occur, exclusive breastfeeding for 6 months and weaning after 1 year is the most effective intervention, with the potential of preventing more than 1 million infant deaths per year, equal to preventing 13% of the world’s childhood mortality.

Similarly, WHO policy guidelines say that breastfeeding is preferable whenever possible:

Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhoea or pneumonia, and helps for a quicker recovery during illness. These effects can be measured in resource-poor and affluent societies….

Nor should her post or subsequent articles about the topic frighten new parents away from formula, which indeed was developed for situations such as these, in which either a mother cannot or will not breastfeed her infant, or if there is evidence that the baby needs a supplement because the mother is producing insufficient breastmilk. (Before formula, use of so-called “wet nurses” was widespread, but fell out of favor in part because of the idea that babies absorbed the personalities of the women they nursed from.) 

Landon’s death was something of an outlier, but not unheard of. While breastmilk is widely considered the ideal way to feed an infant, experts agree that the value of baby formula (much like parental instincts) should not be discounted.

Sources:

Barfield, Wanda D.   “Infant Mortality in the US: Where We Stand.”
    Centers for Disease Control Division of Reproductive Health.   October 2016.

Bever, Lindsey.   “She Listened to Her Doctors — And Her Baby Died. Now She’s Warning Others About Breast-Feeding.”
    The Washington Post.   8 March 2017.

Stevens, Emily et al.   “A History of Infant Feeding.”  
    The Journal of Perinatal Education   18(2): 32–39.   Spring 2009.

Chen, Aimin and Walter J. Rogan.   “Breastfeeding and the Risk of Postneonatal Death in the United States.”
    Pediatrics.   5 May 2004.

Heymann, Jody et. al.   “Breastfeeding Policy: A Globally Comparative Analysis.”
    Bulletin of the World Health Organization.   18 April 2013.

Heymann, Jody et. al.   “Breastfeeding Policy: A Globally Comparative Analysis.”
    Bulletin of the World Health Organization.   18 April 2013.

American Academy of Pediatrics.   “Policy Statement: Breastfeeding and the Use of Human Milk.”
    March 2012.