Breast or Bottle? Fifty years ago, if a mother asked her pediatrician whether breastfeeding or bottle-feeding was better, she would have received a simple and clear-cut answer: bottle-feeding was the preferred method. Starting around the 1940s, the general belief among child care experts was that breastfeeding was an obsolete method that put children unnecessarily at risk.

With bottle-feeding, the argument went, parents could keep track of the amount of milk their baby was receiving and could thereby ensure that the child was taking in sufficient nutrients. In contrast, mothers who breastfed their babies could never be certain just how much milk their infants were getting. Use of the bottle was also supposed to help mothers keep their feedings to a rigid schedule of one bottle every four hours, the recommended procedure at that time.

Today, however, a mother would get a very different answer to the same question. Child care authorities agree: for the first 12 months of life, there is no better food for an infant than breast milk. Breast milk not only contains all the nutrients necessary for growth, but it also seems to offer immunity to a variety of childhood diseases, such as respiratory illnesses, ear infections, diarrhea, and allergies. Breastfeeding for as little as four months reduces infections by an average of 45 percent, and the reduction in infection is 65 percent lower for six months of breastfeeding compared to formula-fed babies. Breast milk is more easily digested than cow’s milk or formula, and it is sterile, warm, and convenient for the mother to dispense. There is even some evidence that breast milk may enhance cognitive growth, leading to high adult intelligence (American Academy of Pediatrics, 2005; Kramer et al., 2008; Tanaka et al., 2009; Duijts et al., 2010).

Breastfeeding also offers significant emotional advantages for both mother and child. Most mothers report that the experience of breastfeeding brings about feelings of well-being and intimacy with their infants, perhaps because of the production of endorphins in mothers’ brains. Breastfed infants are also more responsive to their mothers’ touch and their mother’s gaze during feeding, and they are calmed and soothed by the experience. As we see in Chapter 6, this mutual responsiveness may lead to healthy social development (Gerrish & Mennella, 2000; Zanardo et al., 2001).

Breastfeeding may even be advantageous to mothers’ health. For instance, research suggests that women who breastfeed may have lower rates of ovarian cancer and breast cancer prior to menopause. Furthermore, the hormones produced during breastfeeding help shrink the uteruses of women following birth, enabling their bodies to return more quickly to a prepregnancy state. These hormones also may inhibit ovulation, reducing (but not eliminating!) the chance of becoming pregnant, and thereby help space the birth of additional children. (Ma et al., 2006; Kim et al., 2007; Pearson, Lightman, & Evans, 2011; Kornides & Kitsantas, 2013).

Breastfeeding is not a cure-all for infant nutrition and health, and the millions of individuals who have been raised on formula should not be concerned that they have suffered irreparable harm. (Recent research suggests that infants fed enriched formula show better cognitive development than those using traditional formula.) But it does continue to be clear that the popular slogan used by groups advocating the use of breastfeeding is right on target: “Breast is best” (Birch et al., 2000; Auestad et al., 2003; Rabin, 2006; Ludlow et al., 2012).

Introducing Solid Foods: When and What? Although pediatricians agree that breast milk is the ideal initial food, at some point infants require more nutriments than breast milk alone can provide. The American Academy of Pediatrics suggests that babies can start taking one to two tablespoons of solids at around 6 months, and two to three healthy and nutritious snacks per day after 9 months (Clayton et al., 2013).

Solid foods are introduced into an infant’s diet gradually, one at a time, to allow awareness of the child’s preferences and allergies. Most often cereal comes first, followed by strained fruits. Vegetables and other foods typically are introduced next, although the order varies significantly from one infant to another.

The timing of weaning, the gradual cessation of breast or bottle-feeding, varies greatly. In developed countries such as the United States, weaning frequently occurs as early as 3 or 4 months. On the other hand, some mothers continue breastfeeding for two or three years. The American Academy of Pediatrics recommends that infants be fed breast milk for the first 12 months (American Academy of Pediatrics, 1997; Sloan et al., 2008).

Malnutrition. Malnutrition, the condition of having an improper amount and balance of nutrients, produces several results, none good. For instance, malnutrition is more common among children living in many developing countries than it is among children who live in more industrialized, affluent countries. Malnourished children in these countries begin to show a slower growth rate by the age of 6 months. By the time they reach the age of 2 years, their height and weight are only 95 percent the height and weight of children in more industrialized countries.

Children who have been chronically malnourished during infancy later score lower on IQ tests and tend to do less well in school. These effects may linger even after the children’s diet has improved substantially (Grantham-McGregor, Ani, & Fernald, 2001; Ratanachu-Ek, 2003).

The problem of malnutrition is greatest in underdeveloped countries, where overall 10 percent of infants are severely malnourished. In some countries the problem is especially severe. For example, 37 percent of North Korean children are chronically malnourished, suffering moderate to severe malnutrition (World Food Programme, 2008; Chaudhary, & Sharma, 2012; also see Figure 5-9).

Figure 5-9

Underweight Children

Problems of malnourishment are not restricted to developing countries, however. In the United States, some 16 million children—22 percent—live in poverty, which puts them at risk for malnutrition. In fact, the proportion of children living in low-income families has risen since 2000. Overall, some 26 percent of families who have children 3 years old and younger live in poverty, and 49 percent are classified as low income. And, as we can see in Figure 5-10, the poverty rates are even higher for Hispanic and African American families (Addy, Engelhardt, & Skinner , 2013).

Figure 5-10

Children Living in Poverty

A variety of social service programs, such as the federal Supplemental Nutrition Assistance Program (SNAP), have been created to combat this issue. These programs mean that children rarely become severely malnourished, but such children remain susceptible to undernutrition, in which there is some deficiency in diet. Some surveys find that as many as a quarter of 1- to 5-year-old children in the United States have diets that fall below the minimum caloric intake recommended by nutritional experts. Although the consequences are not as severe as those of malnutrition, undernutrition also has long-term costs. For instance, cognitive development later in childhood is affected by even mild to moderate undernutrition (Pollitt et al., 1996; Tanner & Finn-Stevenson, 2002; Lian et al., 2012).

Severe malnutrition during infancy may lead to several disorders. Malnutrition during the first year can produce marasmus, a disease in which infants stop growing. Marasmus, attributable to a severe deficiency in proteins and calories, causes the body to waste away and ultimately results in death. Older children are susceptible to kwashiorkor, a disease in which a child’s stomach, limbs, and face swell with water. To a casual observer, it appears that a child with kwashiorkor is actually chubby. However, this is an illusion: the child’s body is in fact struggling to make use of the few nutrients that are available (Douglass & McGadney-Douglass, 2008).

In some cases, infants who receive sufficient nutrition act as though they have been deprived of food. Looking as though they suffer from marasmus, they are underdeveloped, listless, and apathetic. The real cause, however, is emotional: they lack sufficient love and emotional support. In such cases, known as nonorganic failure to thrive, children stop growing not for biological reasons but due to a lack of stimulation and attention from their parents. Usually occurring by the age of 18 months, nonorganic failure to thrive can be reversed through intensive parent training or by placing children in a foster home where they can receive emotional support.

Obesity. It is clear that malnourishment during infancy has potentially disastrous consequences for an infant. Less clear, however, are the effects of obesity, defined as weight greater than 20 percent above the average for a given height. Although there is no clear association between obesity during infancy and obesity during adolescence, some research suggests that overfeeding during infancy may lead to the creation of an excess of fat cells, which remain in the body throughout life and may predispose a person to be overweight. Weight during infancy is associated with weight at age 6. Other research shows an association between obesity after the age of 6 and adult obesity, suggesting that obesity in babies ultimately may be found to be associated with adult weight problems. A clear link between overweight babies and overweight adults, however, has not yet been found (Stettler, 2007; Adair, 2008; Taveras et al., 2009; Carnell et al., 2013).

Although the evidence linking infant obesity to adult obesity is inconclusive, it is plain that the societal view that “a fat baby is a healthy baby” is not necessarily correct. Indeed, cultural myths about food clearly lead to overfeeding. But other factors are related to obesity in infants. For example, infants delivered via Cesarean section are twice as likely to become obese as infants than those born vaginally (Huh et al., 2012).

Given the lack of clarity regarding infant obesity, parents should concentrate less on their baby’s weight and more on providing appropriate nutrition.