The risk of HIV transmission requires risk assessment—not a shift to formula feeds

Papers p 1316

It is time that doctors, and everyone else, accepted breast feeding as the biological norm, in terms of both feeding and caring for human infants. Exclusive breast feeding for six months provides the newborn with all the essential nutrients for health and growth and anti-infective properties not present in breastmilk substitutes.1 The American Academy of Pediatrics recently stated, “The breast fed infant is the reference or normative model against which all alternative feeding methods must be measured.”2 Therefore our vocabulary needs to change,3 and we should be saying that formula fed babies have more diseases and poorer psychological development than normal babies, rather than that breast fed babies have less disease and higher intelligence. This longstanding view is, however, under threat from the fact that HIV may be transmitted from mother to child through breast milk.

For several decades we have known that artificially fed infants have much higher rates of morbidity and mortality than those who are breastfed. Breast milk contains immunoglobulins, phagocytes, T lymphocytes, enzymes such as lysozymes, and many other factors which help protect the infant against infections,4 including cells, antibodies, hormones, and other important constituents not present in infant formula. In this week's BMJ …