Breast is best

Why breastfeeding gives newborns the best start in life

Why breast is best

Decades of research confirm that breast milk is the best food for infants. Experts worldwide have long recognised that breastfeeding is the preferred method of infant nutrition.^1-5 The main advantages of breastfeeding are:

Breast milk contains the correct balance of nutrients required for optimal growth and development.^1-5
In addition, breast milk supplies these nutrients in forms that are readily absorbed by the infant’s immature digestive system for use by the body.⁶

Breast milk does not place a burden on a baby’s still-developing digestive system or kidneys.
The infant’s immature digestive system is limited in its capacity to break down foods into usable forms. To overcome this limitation, breast milk contains several enzymes that facilitate digestion. These include amylase, which helps break down starches, and lipase, which aids in fat breakdown.^8,9 Compared with cows’ milk, breast milk is lower in protein and electrolytes, such as sodium and chloride.^10,11This avoids an excessive burden on the infant’s immature kidneys, which are not yet very efficient in excreting excess electrolytes and by-products of protein metabolism from the body.^12,13

Breast milk contains antibodies and other immunologic factors that help prevent infection in the infant.^14-19
The mother’s yellowish first milk, colostrum, is especially rich in substances that bolster immunity to disease. Mature milk also contains a variety of anti-infective substances that provide passive immunity to infection.^14,16Breast milk, especially colostrum, is rich in living white blood cells from the mother’s immune system, including lymphocytes, macrophages, and neutrophils.^14,17,18These cells help destroy bacteria, viruses, and other disease-causing microorganisms.^14,18Breast milk also contains humoral substances, or protective factors made by the maternal immune system that are soluble in milk. These include the following:

Secretory IgA. This important immunoglobulin protects the lining of the infant’s intestinal tract against harmful viruses and bacteria that enter the intestine^14,15,19
Bifidus factor. This substance (or group of substances) promotes the growth of protective bacteria (called bifidobacteria) in the infant’s intestinal tract, helping prevent the proliferation of disease producing bacteria^20,21
Lysozyme. This enzyme, which survives passage through the infant’s stomach, helps kill harmful bacteria in the infant’s intestine^14,15
Lactoferrin. An iron-binding protein, lactoferrin inhibits the proliferation of harmful bacteria in the intestine, it is thought by depriving these micro-organisms of the iron they need for growth^14,15
Nucleotides. These low molecular weight substances are thought to enhance immune function and encourage the growth of protective bacteria in the infant’s intestinal tract.^22,23
Lipids. Some of the lipid (or fat) molecules in breast milk may help inactivate harmful viruses²⁴

Breast milk contains AA and DHA, which have an impact on brain, vision, and psychomotor development.
AA is a precursor of prostaglandins, substances that have a diversity of roles in modulating intercellular and intracellular responses. DHA appears to have a role in neurologic and visual development. Breastfed infants perform better on visual acuity tests and psychomotor tests than do infants fed infant formula devoid of AA and DHA ^25,27

Breastfed babies are more resistant to certain illnesses than bottle-fed babies. ²⁸
Some experts have attributed the lower incidence of gastrointestinal infections observed in breastfed infants to the protective factors found in breast milk. ^2,14However, incorrect or unhygienic preparation techniques may also be a factor contributing to gastrointestinal infections in bottle-fed infants. ²⁹ Some reports suggest that breastfed infants may have a lower risk than formula-fed infants of developing type I diabetes, Crohn’s disease, or lymphoma later in life ^30-32

Breastfeeding involves close physical contact between a mother and child.
This intimate contact is believed to play an important role in the development of a strong mother-baby relationship.² Of course, mothers who choose formula feeding also can enjoy close physical contact and emotional bonding with their infants

Breastfeeding is convenient for the mother.
Breast milk is always ready to use and requires no preparation or storage

The World Health Organisation and the Department of Health recommend exclusive breastfeeding for the first six months of life.

References

Work Group on Breastfeeding, American Academy of Pediatrics, Breastfeeding and the use of human milk. Pediatrics 100:1035–1039, 1997.
Nutrition Committee of the Canadian Paediatric Society and the Committee on Nutrition of the American Academy of Pediatrics, Breast-feeding: A commentary in celebration of the International Year of the Child, 1979. Pediatrics 62:591–601, 1978.
The Surgeon General’s Report on Nutrition and Health: Summary and Recommendations. DHHS (PHS) Pub. No. 88-50211. Washington, DC: Public Health Service of the United States Department of Health and Human Services, 1988.
Nutrition Committee of the Canadian Paediatric Society, Infant feeding practices revisited. CMAJ 122:987–989, 1980.
ESPGAN Committee on Nutrition, Guidelines on infant nutrition: I. Recommendations for the composition of an adapted formula. Acta Paediatr Scand (Suppl 262):1–20, 1977.
Ellis LA, Picciano MF, Milk-borne hormones: regulators of development in neonates. Nutr Today 27:6–14, 1992.
Blackburn ST, Loper DL, Maternal, Fetal, and Neonatal Physiology: A Clinical Perspective. Philadelphia: WB Saunders Co, 1992, pp 410–423.
Lindberg T, Skude G, Amylase in human milk. Pediatrics 70:235–238, 1982.
Jensen RG, Clark RM, deJong FA et al, The lipolytic triad: human lingual, breast milk, and pancreatic lipases: physiological implications of their characteristics in digestion of dietary fats. J Pediatr Gastroenterol Nutr 1:243–255, 1982.
George DE, DeFrancesca BA, Human milk in comparison to cow milk, in Lebenthal E (ed), Textbook of Gastroenterology and Nutrition in Infancy, 2nd ed. New York: Raven Press, 1989, pp 239–261.
Fomon SJ (ed), Nutrition of Normal Infants. St. Louis: CV Mosby, 1993, pp 91–99, 103–105, 121–127, 147–149, 184–186, 192, 208, 254, 409–418.
Ziegler EE, Milks and formulas for older infants. J Pediatr 117(Suppl):S76–S79, 1990.
Ziegler EE, Fomon SJ, Potential renal solute load of infant formulas. J Nutr 119: 1785–1788, 1989.
Lawrence RA, Breastfeeding: A Guide for the Medical Profession, 3rd ed. St. Louis: CV Mosby, 1989, pp 118–147.
Goldman AS, Goldblum RM, Protective properties of human milk, in Walker WA, Watkins JB (eds), Nutrition in Pediatrics: Basic Science and Clinical Application. Boston: Little, Brown and Company, 1985, pp 819–828.
Goldman AS, Garza C, Nichols BL et al, Immunologic factors in human milk during the first year of lactation. J Pediatr 100:563–567, 1982.
Smith CW, Goldman AS, The cells of human colostrum. I. In vitro studies of morphology and functions. Pediatr Res 2:103–109, 1968.
Pitt J, Breast milk leucocytes. Pediatrics 58: 769–770, 1976.
Hanson LÅ, Ahlstedt S, Andersson B et al, The immune response of the mammary gland and its significance for the neonate. Ann Allergy 53:576–581, 1984.
György P, A hitherto unrecognized biochemical difference between human milk and cow’s milk. Pediatrics 11:98–107, 1953.
Petschow BW, Talbott RD, Response of bifidobacterium species to growth promoters in human and cow milk. Pediatr Res 29:208–213, 1991.
Uauy R, Dietary nucleotides and requirements in early life, in Lebenthal E (ed), Textbook of Gastroenterology and Nutrition in lnfancy, 2nd ed. New York: Raven Press, 1989, pp 265–280.
Carver J D, Pimentel B, Cox WI et al, Dietary nucleotide effects upon immune function in infants. Pediatrics 88:359–363, 1991.
Welsh JK, Skurrie IJ, May JT, Use of Semliki forest virus to identify lipid-mediated antiviral activity and anti-alphavirus immunoglobulin A in human milk. Infect Immun 19:395–401, 1978.
Jørgensen MH, Hernell O, Lund P et al, Visual acuity and erythrocyte docosahexaenoic acid status in breast-fed and formula-fed term infants during the first four months of life. Lipids 31:99–105, 1996.
Makrides M, Simmer K, Goggin M et al, Erythrocyte docosahexaenoic acid correlates with the visual response of healthy, term infants. Pediatr Res 33:425–427, 1993.
Agostoni C, Trojan S, Bellù R et al, Neurodevelopmental quotient of healthy term infants at 4 months and feeding practice: the role of long-chain polyunsaturated fatty acids. Pediatr Res 38:262–266, 1995.
Kovar MG, Serdula MK, Marks JS et al, Review of the epidemiologic evidence for an association between infant feeding and infant health. Pediatrics 74(Suppl):615–638, 1984.
Eiger MS, Rausen AR, Silverio J, Breast vs. bottle-feeding. Clin Pediatr 23:492–495, 1984.
Mayer EJ, Hamman RF, Gay EC et al, Reduced risk of IDDM among breast-fed children. Diabetes 37:1625–1632, 1988.
Davis MK, Savitz DA, Graubard BI, Infant feeding and childhood cancer. Lancet 2: 365–368, 1988.
Koletzko S, Sherman P, Corey M et al, Role of infant feeding practices in development of Crohn’s disease in childhood. BMJ 298: 1617–1618, 1989.

Work Group on Breastfeeding, American Academy of Pediatrics, Breastfeeding and the use of human milk. Pediatrics 100:1035–1039, 1997.
Nutrition Committee of the Canadian Paediatric Society and the Committee on Nutrition of the American Academy of Pediatrics, Breast-feeding: A commentary in celebration of the International Year of the Child, 1979. Pediatrics 62:591–601, 1978.
The Surgeon General’s Report on Nutrition and Health: Summary and Recommendations. DHHS (PHS) Pub. No. 88-50211. Washington, DC: Public Health Service of the United States Department of Health and Human Services, 1988.
Nutrition Committee of the Canadian Paediatric Society, Infant feeding practices revisited. CMAJ 122:987–989, 1980.
ESPGAN Committee on Nutrition, Guidelines on infant nutrition: I. Recommendations for the composition of an adapted formula. Acta Paediatr Scand (Suppl 262):1–20, 1977.
Ellis LA, Picciano MF, Milk-borne hormones: regulators of development in neonates. Nutr Today 27:6–14, 1992.
Blackburn ST, Loper DL, Maternal, Fetal, and Neonatal Physiology: A Clinical Perspective. Philadelphia: WB Saunders Co, 1992, pp 410–423.
Lindberg T, Skude G, Amylase in human milk. Pediatrics 70:235–238, 1982.
Jensen RG, Clark RM, deJong FA et al, The lipolytic triad: human lingual, breast milk, and pancreatic lipases: physiological implications of their characteristics in digestion of dietary fats. J Pediatr Gastroenterol Nutr 1:243–255, 1982.
George DE, DeFrancesca BA, Human milk in comparison to cow milk, in Lebenthal E (ed), Textbook of Gastroenterology and Nutrition in Infancy, 2nd ed. New York: Raven Press, 1989, pp 239–261.
Fomon SJ (ed), Nutrition of Normal Infants. St. Louis: CV Mosby, 1993, pp 91–99, 103–105, 121–127, 147–149, 184–186, 192, 208, 254, 409–418.
Ziegler EE, Milks and formulas for older infants. J Pediatr 117(Suppl):S76–S79, 1990.
Ziegler EE, Fomon SJ, Potential renal solute load of infant formulas. J Nutr 119: 1785–1788, 1989.
Lawrence RA, Breastfeeding: A Guide for the Medical Profession, 3rd ed. St. Louis: CV Mosby, 1989, pp 118–147.
Goldman AS, Goldblum RM, Protective properties of human milk, in Walker WA, Watkins JB (eds), Nutrition in Pediatrics: Basic Science and Clinical Application. Boston: Little, Brown and Company, 1985, pp 819–828.
Goldman AS, Garza C, Nichols BL et al, Immunologic factors in human milk during the first year of lactation. J Pediatr 100:563–567, 1982.
Smith CW, Goldman AS, The cells of human colostrum. I. In vitro studies of morphology and functions. Pediatr Res 2:103–109, 1968.
Pitt J, Breast milk leucocytes. Pediatrics 58: 769–770, 1976.
Hanson LÅ, Ahlstedt S, Andersson B et al, The immune response of the mammary gland and its significance for the neonate. Ann Allergy 53:576–581, 1984.
György P, A hitherto unrecognized biochemical difference between human milk and cow’s milk. Pediatrics 11:98–107, 1953.
Petschow BW, Talbott RD, Response of bifidobacterium species to growth promoters in human and cow milk. Pediatr Res 29:208–213, 1991.
Uauy R, Dietary nucleotides and requirements in early life, in Lebenthal E (ed), Textbook of Gastroenterology and Nutrition in lnfancy, 2nd ed. New York: Raven Press, 1989, pp 265–280.
Carver J D, Pimentel B, Cox WI et al, Dietary nucleotide effects upon immune function in infants. Pediatrics 88:359–363, 1991.
Welsh JK, Skurrie IJ, May JT, Use of Semliki forest virus to identify lipid-mediated antiviral activity and anti-alphavirus immunoglobulin A in human milk. Infect Immun 19:395–401, 1978.
Jørgensen MH, Hernell O, Lund P et al, Visual acuity and erythrocyte docosahexaenoic acid status in breast-fed and formula-fed term infants during the first four months of life. Lipids 31:99–105, 1996.
Makrides M, Simmer K, Goggin M et al, Erythrocyte docosahexaenoic acid correlates with the visual response of healthy, term infants. Pediatr Res 33:425–427, 1993.
Agostoni C, Trojan S, Bellù R et al, Neurodevelopmental quotient of healthy term infants at 4 months and feeding practice: the role of long-chain polyunsaturated fatty acids. Pediatr Res 38:262–266, 1995.
Kovar MG, Serdula MK, Marks JS et al, Review of the epidemiologic evidence for an association between infant feeding and infant health. Pediatrics 74(Suppl):615–638, 1984.
Eiger MS, Rausen AR, Silverio J, Breast vs. bottle-feeding. Clin Pediatr 23:492–495, 1984.
Mayer EJ, Hamman RF, Gay EC et al, Reduced risk of IDDM among breast-fed children. Diabetes 37:1625–1632, 1988.
Davis MK, Savitz DA, Graubard BI, Infant feeding and childhood cancer. Lancet 2: 365–368, 1988.
Koletzko S, Sherman P, Corey M et al, Role of infant feeding practices in development of Crohn’s disease in childhood. BMJ 298: 1617–1618, 1989.

Breast is best

Why breastfeeding gives newborns the best start in life

Why breast is best

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