Is the "breast is best" mantra an oversimplification?

Shared decision-making is best—for mother and baby

Breastfeeding might prevent certain infections in as many as 50% of infants, but a mother unable to breastfeed can take solace in the fact that >95% of breastfed infants will not realize any benefit from the preventive potential of breastfeeding in regard to hospitalization or allergic disease, and >99% will not realize benefit from either the prevention of SIDS or ALL, or from improvement in long-term health measures (except for, perhaps, a slightly higher IQ). The “breast is best” mantra is likely true at a public-health level; for the individual mother–infant dyad, however, where there is a need to balance personal, social, family, and financial factors, that mantra is an oversimplification.

The "breast is best" mantra is likely true at a public- health level; for the individual mother-infant dyad, however, that mantra is oversimplified.

Regrettably, there is a paucity of data on the risks of breastfeeding promotion—an area that deserves more study. Balancing the abundant, but often limited-quality, data on the benefits of breastfeeding and the sheer lack of data regarding the risks of advocacy represents a clinical and an ethical challenge for physicians. It is a challenge that can only be resolved through individualization of care and shared decision-making, in which the physician is expert on the benefits of breastfeeding, and the mother is expert on the personal circumstances to be weighed against those benefits.

CORRESPONDENCE
Joseph Lane Wilson, MD, ECU Brody School of Medicine, Department of Family Medicine, 101 Heart Drive, Greenville, NC 27834; wilsonjo@ecu.edu.