Why Breast Is Best

Currently, only 37% of infants under the age of six months in low- and middle-income countries are exclusively breastfed.

This figure is even lower in high-income countries.

Breastfeeding has been shown to be a protective factor for several infectious, atopic, and cardiovascular diseases as well as for leukemia, necrotizing enterocolitis, celiac disease, and inflammatory bowel disease. It has a positive impact on neurodevelopment, improving IQ, reducing the risk of attention deficit disorder (ADD), and generalized developmental and behavioral disorders like autism spectrum disorders.

Breastfeeding can decrease risk of sudden infant death syndrome (SIDS) and prevent infant mortality. It can result in direct savings on the use of infant formulas and bottle as well as indirectly on associated health care costs, premature deaths, and quality-adjusted life years, among others and is environmentally friendly.

The use of baby formulas and bottles come with inherent risks, such as increased risk of oral diseases such as tooth decay. Also potentially problematic long-term is that discovery that formula use negatively affects intestinal microbiota, oxygenation, and thermoregulation.



Exclusive breastfeeding (EBF) – feeding the infant only breastmilk without inclusion of solids or other liquids – has been shown to decrease the risk of gastrointestinal infections, whereas exclusively formula-fed infants have an 80% increase in risk for diarrhea. There is also a residual protective effect for up to two months after discontinuation.

There has been found to be an inverse correlation between breastfeeding (BF) and acute febrile illness during the first months of life, resulting in fewer hospitalizations. In relation to respiratory infections, compared to children with EBF in the first six months of life, non-BF children have almost 15x greater mortality from pneumonia. Even once the children are older (up to 2 years old) – those who were receiving complementary foods in addition to breastmilk were half as likely to die from pneumonia as those fed formula. Risk of hospitalization for lower respiratory infection during the first year of life is decreased by 72% in children with EBF for at least 4 months compared to partial BF or exclusively formula fed infants.

Infants breastfed for a shorter time showed a higher frequency of eczema, atopy, food allergy, and respiratory allergy than those fed for longer. Breastfed infants were also shown to have reduced risk of asthma especially in those with a family history.


Although controversial, BF may play a protective role against obesity, high blood pressure, dyslipidemia, and type 2 diabetes during adulthood.

There is a 15-30% risk reduction for obesity during adolescence and adulthood among those who were BF during childhood – with each extra month of BF being associated with a 4% decrease in risk.

Up to a 30% reduction in the incidence of type 1 diabetes in those with EBF for at least 3 months has been reported, as well as a reduction of up to 40% in the incidence of type 2 diabetes. This is possible in relation to the positive effect of long-term weight control and self-control of food intake seen in BF infants.

With respect to SIDS, BF is associated with a 36% risk reduction and is dose dependent. It has been estimated that over 900 children would be saved each year in the United States if 90% of mothers exclusively breastfed their children during the first six months of life.


If 75% of newborns were BF were at the time of hospital discharge and 50% at 6 months of age, this could save the United States $3.6 billion or more. This is actually a conservative estimate as it does not account for the costs associated with cognitive effects, various childhood diseases, and maternal or chronic illnesses.

Another study showed that suboptimal BF implies a total cost to society of $17.4 billion for premature deaths, $733.7 million for direct costs, and $126.1 million for indirect morbidity.

The American Academy of Pediatrics concluded that if 90% of American mothers EBF their children for at least 6 months they would save the US $13 billion every year – not including expenditures related to work absenteeism by parents or deaths in adults due to illnesses acquired in childhood (asthma, type 1 diabetes, obesity).

BF is a “natural and renewable” food, environmentally friendly and safe, and produced and delivered directly to the consumer (baby) without contamination, packaging, or associated waste. Formulas, however, have an inherent carbon footprint – requiring energy to manufacture, package, transport, and prepare at home.


RISKS of NOT Breastfeeding

It has been shown that the use of a bottle interferes with the maturation of oral functions as the child grows – increased risk of atypical swallowing, mouth breathing, chewing dysfunction, difficulties in speech and an alteration of body posture among others.

The microbiota plays a nutritional, metabolic, immunological, and protective role. It is established from childbirth during breastfeeding and later by external factors. The type of feeding has been shown to directly influence the composition of the intestinal microbiota – BF infants have a more stable and uniform microbial population compared to those who were formula fed, even if only in small amounts to supplement BF. This is important because the microbiota acquired in early childhood are critical for determining immune response and tolerance.

**While not discussed in this paper, but I would be happy to address in another post, is the NUMEROUS benefits to the MOTHER when she chooses to breastfeed her child.**

Both mother’s and donated breast milk can reduce the risk of various pathologies.

Breastfeeding is environmentally friendly and also promote an economic benefit not only from direct savings by not consuming formula, but from a decrease in health expenses and an increase in years and quality of life gained.

Finally, there are inherent risks in the use of formulas and bottles.

Brahm P & Valdes V. “Benefits of breastfeeding and risks associated with not breastfeeding.” Rev Chil Pediatr. 2017;88(1):15-21.

2 thoughts on “Why Breast Is Best

  1. Kristen says:

    I know this is a post based on a particular paper – but respectfully- breast is not always best. There are many reasons why breastfeeding is not the right or a possible choice and formula can be and has been a literal life saver for countless babies. You mentioned being happy to address benefits to mothers in another post. I’d love to also see a post about the benefits of formula feeding too.

    • Ellen Ratliff, MS, RD says:

      You’re correct – this post was not based on my personal opinion, simply summarizing an article. Breastfeeding is, of course, the choice of the mother and is not always an option for a multitude of reasons. However, IF IT IS an option, I still believe that it is best both for the health of the baby and that of the mother.

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