Editing Infant formula (section)

==Uses, risks and controversies==
{{See|Infant food safety}}
The use and marketing of infant formula has come under scrutiny. [[Breastfeeding]], including exclusive breastfeeding for the first 6 months of life, is widely advocated as "ideal" for babies and infants, both by health authorities<ref name="WHO"/><ref name="CDC Breastfeeding FAQ"/>—and accordingly in ethical advertising of infant formula manufacturers.<ref>{{Cite web |url=http://www.babymilk.nestle.com/FAQ/HomeFAQ.htm#question0 |title=Nestlé FAQ – Should all mothers be encouraged to breastfeed exclusively for the first 6 months? |access-date=June 1, 2009 |archive-date=May 3, 2009 |archive-url=https://web.archive.org/web/20090503161833/http://www.babymilk.nestle.com/FAQ/HomeFAQ.htm#question0 |url-status=dead }}</ref>

Despite the recommendation that babies be exclusively breastfed for the first 6 months, less than 40% of infants below this age are exclusively breastfed worldwide.<ref>World Health Organization. [https://www.who.int/child_adolescent_health/news/archive/2011/29_07_2011/en/index.html World Breastfeeding Week August 1–7, 2011.] Retrieved August 8, 2011.</ref> The overwhelming majority of American babies are not exclusively breastfed for this period—in 2005 under 12% of babies were breastfed exclusively for the first 6 months,<ref name="CDC Breastfeeding FAQ"/> with over 60% of babies of 2 months of age being fed formula,<ref>{{cite web|url=https://www.cdc.gov/ifps/results/ch3/table3-1.htm|title=Results: Breastfeeding and Infant Feeding Practices - Breastfeeding - CDC|date=December 5, 2017|website=www.cdc.gov|access-date=April 3, 2018}}</ref> and approximately one in four breastfed infants having infant formula feeding within two days of birth.<ref>{{cite web|url=https://www.cdc.gov/breastfeeding/data/NIS_data/index.htm|title=National Immunization Survey (NIS)|date=December 1, 2017|website=cdc.gov|access-date=April 3, 2018}}</ref>

Some studies have shown that use of formula can vary according to the parents' [[socio-economic status]], ethnicity or other characteristics. For example, according to a research conducted in Vancouver, Canada, 82.9% of mothers breastfeed their babies at birth, but the number differed between Caucasians (91.6%) and non-Caucasians (56.8%), with the difference essentially attributed to marital status, education and family income.<ref>{{cite journal | vauthors = Williams PL, Innis SM, Vogel AM | title = Breastfeeding and weaning practices in Vancouver | journal = Canadian Journal of Public Health | volume = 87 | issue = 4 | pages = 231–236 | year = 1996 | pmid = 8870300 }}</ref> In the United States, mothers of lower socio-economic status have been found less likely to breastfeed, although this may be partly related to adverse effects of government nutrition supplementation programs that provide subsidies for infant formula.<ref name="whopays"/>

The use of hydrolysed cow milk baby formula versus standard milk baby formula does not appear to change the risk of [[allergies]] or [[autoimmune disease]]s.<ref>{{cite journal | vauthors = Boyle RJ, Ierodiakonou D, Khan T, Chivinge J, Robinson Z, Geoghegan N, Jarrold K, Afxentiou T, Reeves T, Cunha S, Trivella M, Garcia-Larsen V, Leonardi-Bee J | display-authors = 6 | title = Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis | journal = BMJ | volume = 352 | pages = i974 | date = March 2016 | pmid = 26956579 | pmc = 4783517 | doi = 10.1136/bmj.i974 }}</ref>

===Use of infant formula===
{{Main|Breastfeeding contraindications}}
In some cases, breastfeeding is medically [[contraindicated]]; these include:
* '''Mother's health:''' The mother is infected with HIV or has active [[tuberculosis]].<ref name="CDCwhen">{{cite web | title = When should a mother avoid breastfeeding? | publisher = Centers for Disease Control and Prevention | date = August 26, 2006 | url = https://www.cdc.gov/breastfeeding/disease/contraindicators.htm | access-date =February 25, 2007 }}</ref> She is extremely ill or has had certain kinds of [[breast surgery]], which may have removed or disconnected all milk-producing parts of the breast. She is taking any kind of drug that could harm the baby, including both prescription drugs such as [[Chemotherapy|cytotoxic chemotherapy]] for cancer treatments as well as illicit drugs.<ref name="CDCwhen"/>
** One of the main global risks posed by breast milk specifically is the transmission of HIV and other infectious diseases. Breastfeeding by an HIV-infected mother poses a 5–20% chance of transmitting HIV to the baby.<ref>WHO, UNICEF, UNFPA, UNAIDS. ''HIV transmission through breastfeeding: A review of available evidence''. Geneva: World Health Organization, 2004.</ref><ref name="pmid15325535">{{cite journal | vauthors = Lawrence RM, Lawrence RA | title = Breast milk and infection | journal = Clinics in Perinatology | volume = 31 | issue = 3 | pages = 501–528 | date = September 2004 | pmid = 15325535 | pmc = 7133241 | doi = 10.1016/j.clp.2004.03.019 }}</ref><ref name="pmid15583769">{{cite journal | vauthors = Lamounier JA, Moulin ZS, Xavier CC | title = [Recommendations for breastfeeding during maternal infections] | language = pt | journal = Jornal de Pediatria | volume = 80 | issue = 5 Suppl | pages = S181–S188 | date = November 2004 | pmid = 15583769 | doi = 10.2223/jped.1252 | doi-broken-date = January 9, 2025 | doi-access = free }}</ref> However, if a mother has HIV, she is more likely to transmit it to her child during the pregnancy or birth than during breastfeeding. A 2012 study conducted by researchers from the [[University of North Carolina School of Medicine]] showed reduced HIV-1 transmission in humanized mice, due to components in the breast milk.<ref>{{cite journal | vauthors = Wahl A, Swanson MD, Nochi T, Olesen R, Denton PW, Chateau M, Garcia JV | title = Human breast milk and antiretrovirals dramatically reduce oral HIV-1 transmission in BLT humanized mice | journal = PLOS Pathogens | volume = 8 | issue = 6 | pages = e1002732 | year = 2012 | pmid = 22737068 | pmc = 3380612 | doi = 10.1371/journal.ppat.1002732 | doi-access = free }}</ref> [[Cytomegalovirus]] infection poses potentially dangerous consequences for pre-term babies.<ref name="pmid15325535"/><ref name="pmid16287195">{{cite journal | vauthors = Schleiss MR | title = Acquisition of human cytomegalovirus infection in infants via breast milk: natural immunization or cause for concern? | journal = Reviews in Medical Virology | volume = 16 | issue = 2 | pages = 73–82 | year = 2006 | pmid = 16287195 | doi = 10.1002/rmv.484 | s2cid = 31680652 }}</ref> Other risks include mother's infection with [[HTLV-1]] or [[HTLV-2]] (viruses that could cause [[T-cell leukemia]] in the baby),<ref name="pmid15325535"/><ref name="pmid15583769"/> [[herpes simplex]] when lesions are present on the breasts,<ref name="pmid15583769"/> and [[chickenpox]] in the newborn when the disease manifested in the mother within a few days of birth.<ref name="pmid15583769"/> In some cases these risks can be mitigated by using heat-treated milk and nursing for a briefer time (e.g. 6 months, rather than 18–24 months), and can be avoided by using an uninfected woman's milk, as via a wet-nurse or milk bank, or by using infant formula and/or treated milk.<ref name="contextHIV">{{cite web|url=http://www.aed.org/Publications/loader.cfm?url=/commonspot/security/getfile.cfm&pageid=1040|title=Infant Feeding Options in the Context of HIV|website=aed.org|access-date=April 3, 2018}}</ref>
** In balancing the risks, such as cases where the mother is infected with HIV, a decision to use infant formula versus exclusive breastfeeding may be made based on alternatives that satisfy the “AFASS” (Acceptable, Feasible, Affordable, Sustainable and Safe) principles.<ref name="contextHIV"/><ref>de Paoli MD, Manongi RM, Klepp KI. [http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102284289.html Infant Feeding Options Recommended for Mothers with HIV: Are they acceptable, feasible, affordable, sustainable and safe?] ''Int Conf AIDS''. 2004 Jul 11–16; 15.</ref>
* '''Baby is unable to breastfeed:''' The child has a [[birth defect]] or [[inborn error of metabolism]] such as [[galactosemia]] that makes breastfeeding difficult or impossible.<ref>{{cite web |title=Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infants {{!}} Breastfeeding {{!}} CDC |url=https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/contraindications-to-breastfeeding.html |website=www.cdc.gov |access-date=23 February 2019 |language=en-us |date=24 January 2019}}</ref>
*'''Baby is considered at risk for malnutrition:''' In certain circumstances infants may be at risk for malnutrition, such as due to [[iron deficiency]], vitamin deficiencies (e.g. [[Hypovitaminosis D|vitamin D]] which may be less present in breast milk than needed at high latitudes where there is less sun exposure), or inadequate nutrition during transition to solid foods.<ref name="pmid16262018">{{cite journal | vauthors = Mamiro PS, Kolsteren P, Roberfroid D, Tatala S, Opsomer AS, Van Camp JH | title = Feeding practices and factors contributing to wasting, stunting, and iron-deficiency anaemia among 3-23-month old children in Kilosa district, rural Tanzania | journal = Journal of Health, Population, and Nutrition | volume = 23 | issue = 3 | pages = 222–230 | date = September 2005 | pmid = 16262018 }}</ref> Risks can often be mitigated with improved diet and education of mothers and caregivers, including availability of macro and micronutrients. For example, in Canada, marketed infant formulas are fortified with vitamin D, but [[Health Canada]] also recommends breastfed infants receive extra vitamin D in the form of a supplement.<ref name="hc-sc.gc.ca">{{cite web |url=http://www.hc-sc.gc.ca/fn-an/pubs/infant-nourrisson/nut_infant_nourrisson_term_3-eng.php |title=Breastfeeding is the optimal method of feeding infants.|access-date=2009-12-03 |url-status=dead |archive-url=https://web.archive.org/web/20100213003706/http://www.hc-sc.gc.ca/fn-an/pubs/infant-nourrisson/nut_infant_nourrisson_term_3-eng.php |archive-date=February 13, 2010 |df=mdy-all }}</ref>

Other reasons for not breastfeeding include:
* '''Personal preferences, beliefs, and experiences:''' The mother may dislike breast-feeding or find it inconvenient.<ref>{{cite news|url=https://www.bbc.co.uk/news/health-12008913|title=Mums who choose bottle over breastfeeding 'demonised'|author=Lee, Ellie|author-link=Ellie Lee|date=December 17, 2010|newspaper=BBC News|access-date=December 26, 2010 }}</ref> In addition, breastfeeding can be difficult for victims of rape or sexual abuse; for example, it may be a trigger for [[posttraumatic stress disorder]].<ref>{{cite web|url=http://www.pandys.org/articles/breastfeeding.html|title=Breastfeeding as a Rape or Sexual Abuse Survivor|publisher=Pandora's Project|author=Katy|year=2009|access-date=March 20, 2012|archive-date=December 29, 2011|archive-url=https://web.archive.org/web/20111229230136/http://www.pandys.org/articles/breastfeeding.html|url-status=dead}}</ref><ref>{{cite journal | vauthors = Kendall-Tackett K | title = Breastfeeding and the sexual abuse survivor | journal = Journal of Human Lactation | volume = 14 | issue = 2 | pages = 125–30; quiz 131–3 | date = June 1998 | pmid = 9775845 | doi = 10.1177/089033449801400212 | s2cid = 37288715 }}</ref> Many families bottle feed to increase the father's role in parenting his child.<ref>{{cite journal | vauthors = Earle S | title = Why some women do not breast feed: bottle feeding and fathers' role | journal = Midwifery | volume = 16 | issue = 4 | pages = 323–330 | date = December 2000 | pmid = 11080468 | doi = 10.1054/midw.2000.0222 }}<!--|access-date=March 20, 2012--></ref>
*'''Mental health:''' The pressure to breastfeed in many cultures can be so much that the mother's mental health may take a sharp decline. This can have physical effects such as poor latching as well as milk depletion and a lack of connection to the child. In some cases it is better for the child to be formula fed so that a better bond can be made between mother and child rather than the ‘special bond’ that comes from breastfeeding being tainted by negative breastfeeding experiences. The pressure to breastfeed in many cultures can increase the likelihood of [[postpartum depression]].<ref name="Breastfeeding and Postpartum Depres">{{cite journal | vauthors = Pope CJ, Mazmanian D | title = Breastfeeding and Postpartum Depression: An Overview and Methodological Recommendations for Future Research | journal = Depression Research and Treatment | volume = 2016 | pages = 4765310 | date = 2016 | pmid = 27148457 | pmc = 4842365 | doi = 10.1155/2016/4765310 | doi-access = free }}</ref>
* '''Absence of the mother:''' The child is [[adopted]], [[orphan]]ed, abandoned, or in the sole [[child custody|custody]] of a man or male [[LGBT adoption|same-sex couple]]. The mother is separated from her child by being in prison or a [[mental hospital]]. The mother has left the child in the care of another person for an extended period of time, such as while traveling or working abroad.
* '''Food allergies''': The mother eats foods that may provoke an allergic reaction in the infant.{{citation needed|date=August 2011}}
* '''Financial pressures:''' [[Maternity leave]] is unpaid, insufficient, or lacking. The mother's employment interferes with breastfeeding.<ref name="chen effects">{{cite journal | vauthors = Chen YC, Wu YC, Chie WC | title = Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey | journal = BMC Public Health | volume = 6 | pages = 160 | date = June 2006 | pmid = 16787546 | pmc = 1538587 | doi = 10.1186/1471-2458-6-160 | doi-access = free }}</ref> Mothers who breastfeed may experience a loss of earning power.<ref>{{cite news| vauthors = Dell'Antonai KJ |title=The True Cost of Breast-feeding — This Milk Isn't Free|url=https://parenting.blogs.nytimes.com/2012/04/03/the-true-cost-of-breast-feeding-this-milk-isnt-free/|access-date=15 September 2017|newspaper=The New York Times|date=3 April 2012}}</ref>
* '''Societal structure:''' Breastfeeding may be forbidden, discouraged or difficult at the mother's job, school, place of worship or in other public places, or the mother may feel that breastfeeding in these places or around other people is immodest, unsanitary, or inappropriate.<ref name="chen effects"/>
* '''Social pressures:''' Family members, such as mother's husband or boyfriend, or friends or other members of society may encourage the use of infant formula. For example, they may believe that breastfeeding will decrease the mother's energy, health, or attractiveness. {{citation needed|date=September 2015}} <ref>{{cite web|title=The Surgeon General's Call to Action to Support Breastfeeding|url=https://www.ncbi.nlm.nih.gov/books/NBK52688/|website=NCBI|access-date=15 September 2017}}</ref> Conversely, societal pressures to breastfeed can also lead to mental health issues. A sense of shame from not being able to or struggling to do so equalling being a failure has a connection to Postpartum Depression<ref name="Breastfeeding and Postpartum Depres"/> 
* '''Lack of training and education:''' The mother lacks education and training from medical providers or community members. {{citation needed|date=September 2015}} <ref name="BMJ 2007;335:596">{{cite journal | vauthors = Su LL, Chong YS, Chan YH, Chan YS, Fok D, Tun KT, Ng FS, Rauff M | display-authors = 6 | title = Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: randomised controlled trial | journal = BMJ | volume = 335 | issue = 7620 | pages = 596 | date = September 2007 | pmid = 17670909 | pmc = 1989016 | doi = 10.1136/bmj.39279.656343.55 }}</ref>
* '''Lactation insufficiency:''' The mother is unable to produce sufficient milk. In studies that do not account for lactation failure with obvious causes (such as use of formula and/or breast pumps), chronic lactation insufficiency affects around 10–15% of women.<ref>{{Cite journal |last1=Lee |first1=Sooyeon |last2=Kelleher |first2=Shannon L. |date=2016-08-01 |title=Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology |journal=American Journal of Physiology. Endocrinology and Metabolism |volume=311 |issue=2 |pages=E405–E422 |doi=10.1152/ajpendo.00495.2015 |issn=0193-1849 |pmc=5005964 |pmid=27354238}}</ref> For about 5–8% of women, milk coming in (i.e., lactogenesis II) may not occur at all, and only drops are produced.<ref>{{Cite journal |last1=Feldman-Winter |first1=Lori |last2=Kellams |first2=Ann |last3=Peter-Wohl |first3=Sigal |last4=Taylor |first4=Julie Scott |last5=Lee |first5=Kimberly G. |last6=Terrell |first6=Mary J. |last7=Noble |first7=Lawrence |last8=Maynor |first8=Angela R. |last9=Meek |first9=Joan Younger |last10=Stuebe |first10=Alison M. |date=2020-04-01 |title=Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥35 Weeks |journal=Pediatrics |volume=145 |issue=4 |pages=e20183696 |doi=10.1542/peds.2018-3696 |pmid=32161111 |s2cid=212679436 |issn=0031-4005|doi-access=free }}</ref> Alternatively, despite a healthy supply, the woman or her family may incorrectly believe that her breast milk is of low quality or in low supply. These women may choose infant formula either exclusively or as a supplement to breastfeeding. {{citation needed|date=September 2015}} New research is showing that mothers who report problems with milk production have physical markers indicating low milk production, calling into question the assumption (called “perceived insufficient milk supply” or PIMS) that mothers are incorrect about the quantity of milk they are producing.<ref>{{Cite journal |last1=Murase |first1=Masahiko |last2=Wagner |first2=Erin A. |last3=Chantry |first3=Caroline J. |last4=Dewey |first4=Kathryn G. |last5=Nommsen-Rivers |first5=Laurie A. |date=2017-02-01 |title=The Relation between Breast Milk Sodium to Potassium Ratio and Maternal Report of a Milk Supply Concern |url=https://www.jpeds.com/article/S0022-3476(16)31177-5/abstract |journal=The Journal of Pediatrics |language=English |volume=181 |pages=294–297.e3 |doi=10.1016/j.jpeds.2016.10.044 |issn=0022-3476 |pmc=5274566 |pmid=27871690}}</ref><ref>{{Cite journal |last1=Rivera |first1=Olivia C. |last2=Geddes |first2=Donna T. |last3=Barber-Zucker |first3=Shiran |last4=Zarivach |first4=Raz |last5=Gagnon |first5=Annie |last6=Soybel |first6=David I. |last7=Kelleher |first7=Shannon L. |date=2020-06-01 |title=A common genetic variant in zinc transporter ZnT2 (Thr288Ser) is present in women with low milk volume and alters lysosome function and cell energetics |journal=American Journal of Physiology. Cell Physiology |volume=318 |issue=6 |pages=C1166–C1177 |doi=10.1152/ajpcell.00383.2019 |pmid=32320289 |s2cid=216082748 |issn=0363-6143|doi-access=free }}</ref>
*'''Fear of exposure to environmental contaminants:''' Certain environmental pollutants, such as [[polychlorinated biphenyls]], can bioaccumulate in the food chain and may be found in humans including mothers' breast milk.<ref name="pmid11065082">{{Cite book|vauthors=Przyrembel H, Heinrich-Hirsch B, Vieth B |title=Short and Long Term Effects of Breast Feeding on Child Health |chapter=Exposition to and Heal Theffects of Residues in Human Milk|volume=478|pages=307–25|pmid=11065082|doi=10.1007/0-306-46830-1_27|series=Advances in Experimental Medicine and Biology|date=2002 |isbn=978-0-306-46405-8}}</ref>
** However studies have shown that the greatest risk period for adverse effects from environmental exposures is prenatally.<ref name="pmid11065082"/> Other studies have further found that the levels of most persistent [[organohalogen]] compounds in human milk decreased significantly over the past three decades and equally did their exposure through breastfeeding.<ref>Fürst P. [http://onlinelibrary.wiley.com/doi/10.1002/mnfr.200600008/abstract Dioxins, polychlorinated biphenyls and other organohalogen compounds in human milk. Levels, correlations, trends and exposure through breastfeeding.] ''Molecular Nutrition & Food Research'', 50(10): 922–933, October 2006.</ref>
**Research on risks from chemical pollution is generally inconclusive in terms of outweighing the benefits of breastfeeding.<ref name="NRDC">{{cite web|url=http://www.nrdc.org/breastmilk/chem9.asp|title=Healthy Milk, Healthy Baby&nbsp;– Chemical Pollution and Mother's Milk&nbsp;– Chemicals: Dioxins and Furans|website=nrdc.org|access-date=April 3, 2018}}</ref><ref name="rogan" /> Studies supported by the WHO and others have found that neurological benefits of breast milk remain, regardless of dioxin exposure.<ref name="rogan">{{cite journal | vauthors = Rogan WJ, Blanton PJ, Portier CJ, Stallard E | title = Should the presence of carcinogens in breast milk discourage breast feeding? | journal = Regulatory Toxicology and Pharmacology | volume = 13 | issue = 3 | pages = 228–240 | date = June 1991 | pmid = 1947235 | doi = 10.1016/0273-2300(91)90065-4 }}– cited in NRDC</ref><ref>Brouwer, A., et al. Report of the WHO Working Group on the Assessment of Health Risks for Human Infants from Exposure to PCDDs, PCDFs and PCBs, ''Chemosphere'' 1998; 37(9–12): pp.&nbsp;1627–1643. – cited in NDRC</ref> 
**In developing countries, environmental contaminants associated with increased health risks from use of infant formula, particularly diarrhea due to unclean water and lack of sterile conditions – both prerequisites to the safe use of formula – often outweigh any risks from breastfeeding.
* '''Lack of other sources of breast milk:'''
** ''Lack of wet nurses:'' [[Wet nursing]] is illegal and stigmatized in some countries, and may not be available.<ref>{{cite web|url=https://www.theguardian.com/society/2007/jan/05/health.medicineandhealth|title=Viv Groskop on women who breastfeed other people's babies| vauthors = Groskop V |date=January 5, 2007|website=The Guardian|access-date=April 3, 2018}}</ref> It may also be socially unsupported, expensive, or health screening of wet nurses may not be available. The mother, her doctor,<ref>[http://www.mayoclinic.com/health/breast-feeding/FL00133 "Breast-feeding and Guilt: Interview with a Mayo Clinic Specialist"]<!-- To clarify a perhaps unclear reference, this is to illustrate that American doctors at respected clinics may not mention the WHO recommendations of expressed breast milk, wet nursing, or milk banking. --></ref> or family may not know that wet nursing is possible, or may believe that nursing by a relative or paid wet-nurse is unhygienic.
** ''Lack of milk banks:'' [[Human-milk bank]]s may not be available, as few exist, and many countries cannot provide the necessary screening for diseases and refrigeration.

===Health risks===
Use of infant formula has been cited for association with numerous increased health risks. Studies have found infants in developed countries who consume formula are at increased risk for acute [[otitis media]], [[gastroenteritis]], severe lower respiratory tract infections, atopic [[dermatitis]], [[asthma]], [[obesity]],<ref>{{cite journal | vauthors = Melnik BC | title = Excessive Leucine-mTORC1-Signalling of Cow Milk-Based Infant Formula: The Missing Link to Understand Early Childhood Obesity | journal = Journal of Obesity | volume = 2012 | pages = 197653 | date = 2012-01-01 | pmid = 22523661 | pmc = 3317169 | doi = 10.1155/2012/197653 | doi-access = free }}</ref> type 1 and 2 [[diabetes]], [[sudden infant death syndrome]] (SIDS), [[eczema]] and [[necrotizing enterocolitis]] when compared to infants who are breastfed.<ref name="AHRQ-Tufts">{{cite journal | vauthors = Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J | display-authors = 6 | title = Breastfeeding and maternal and infant health outcomes in developed countries | journal = Evidence Report/Technology Assessment | issue = 153 | pages = 1–186 | date = April 2007 | pmid = 17764214 | pmc = 4781366 | isbn = 9781587632426 | url = https://archive.org/details/breastfeedingmat00ipst | url-access = registration }}</ref><ref name="pmid9233193">{{cite journal | vauthors = Riordan JM | title = The cost of not breastfeeding: a commentary | journal = Journal of Human Lactation | volume = 13 | issue = 2 | pages = 93–97 | date = June 1997 | pmid = 9233193 | doi = 10.1177/089033449701300202 | s2cid = 27447579 }}</ref><ref name="pmid15037991">{{cite journal | vauthors = Sadauskaite-Kuehne V, Ludvigsson J, Padaiga Z, Jasinskiene E, Samuelsson U | title = Longer breastfeeding is an independent protective factor against development of type 1 diabetes mellitus in childhood | journal = Diabetes/Metabolism Research and Reviews | volume = 20 | issue = 2 | pages = 150–157 | year = 2004 | pmid = 15037991 | doi = 10.1002/dmrr.425 | s2cid = 41423626 }}</ref><ref name="pmid6734490">{{cite journal | vauthors = Pratt HF | title = Breastfeeding and eczema | journal = Early Human Development | volume = 9 | issue = 3 | pages = 283–290 | date = April 1984 | pmid = 6734490 | doi = 10.1016/0378-3782(84)90039-2 }}</ref> Some studies have found an association between infant formula and lower [[cognitive development]], including iron supplementation in baby formula being linked to lowered [[I.Q.]] and other neurodevelopmental delays;<ref name="pmid16087970">{{cite journal | vauthors = McCann JC, Ames BN | title = Is docosahexaenoic acid, an n-3 long-chain polyunsaturated fatty acid, required for development of normal brain function? An overview of evidence from cognitive and behavioral tests in humans and animals | journal = The American Journal of Clinical Nutrition | volume = 82 | issue = 2 | pages = 281–295 | date = August 2005 | pmid = 16087970 | doi = 10.1093/ajcn.82.2.281 | doi-access = free }}</ref><ref name="Kerr1">{{cite news| vauthors = Kerr M, Lie D | title = Neurodevelopmental Delays Associated With Iron-Fortified Formula for Healthy Infants | work = Medscape Psychiatry and Mental Health| year = 2008| url = https://www.medscape.com/viewarticle/574363| access-date =August 4, 2008 }}</ref> however other studies have found no correlation.<ref name="AHRQ-Tufts"/> Causation, however, has not been established for negative long-term health effects of infant formula; studies analyzing health outcomes for breastfed vs. formula fed babies are primarily observational in nature and are plagued with confounding factors such as socioeconomic status, education level, and maternal preexisting conditions (such as obesity, which is associated with both low milk production and childhood obesity). When confounding factors are controlled for, differences between long-term health of breastfed and formula fed infants decrease.<ref>{{Cite web |title=Is the "breast is best" mantra an oversimplification? |url=https://www.mdedge.com/clinicianreviews/article/166932/pediatrics/breast-best-mantra-oversimplification |access-date=2022-03-12 |website=www.mdedge.com |language=en}}</ref>

====Melamine contamination====
{{Main|2008 Chinese milk scandal}}
In 2008, a case of melamine poisoning of infant formula was discovered in [[China]], where milk was deliberately adulterated with the chemical, leading to the death of six babies, and illnesses in more than 300,000 infants, including cases of [[acute kidney failure]]. Large quantities of melamine were added to watered-down milk to give it the appearance of having adequate protein levels. Some of those responsible for the poisoning were sentenced to death.<ref name="theglobeandmail.com"/>

In November 2008, traces of [[melamine]] were reported to have been found by the U.S. [[Food and Drug Administration]] in infant formula sold in the United States made by the three main American firms<ref name="AP">{{cite web | url = http://www.ap.org/FOI/foi_112608b.htm | title= FDA Finds Traces Of Melamine In US Infant Formula | website= [[Associated Press]] | archive-url = https://web.archive.org/web/20110711215534/http://ap.org/FOI/foi_112608b.htm | archive-date = July 11, 2011 }}, posted by [[Associated Press]], November 26, 2008.</ref><ref>[http://www.nbcnews.com/id/27914218 Calls for national infant formula recall spread: Worried parents look for guidance after traces of melamine found], posted by NBC News, November 26, 2008.</ref> — [[Abbott Laboratories]], [[Nestlé]] and [[Mead Johnson]] — responsible for 90–99% of the infant formula market in that country.<ref name="whopays"/><ref name="AP"/> The levels were much less than those reported in China, where levels of melamine contamination had reached as much as 2,500 parts per million, about 10,000 times higher than the recorded US levels. The [[safety data sheet]] for melamine ([[CAS registry number]] 108-78-1; C3-H6-N6) recorded the acute oral toxicity ([[median lethal dose]]) at 3161&nbsp;mg/kg for a rat.

[[Health Canada]] conducted a separate test and also detected traces of melamine in infant formula available in Canada. The melamine levels were well below Health Canada's safety limits,<ref>Health Canada. [http://hc-sc.gc.ca/fn-an/securit/chem-chim/melamine/qa-melamine-qr-eng.php Questions and Answers – Melamine.] Retrieved August 9, 2011.</ref> although concerns remain about the safety of manufactured food for infants and monitoring of potentially dangerous substances.<ref name="theglobeandmail.com">[https://www.theglobeandmail.com/report-on-business/international-news/global-exchange/chinese-news-media-step-up-efforts-in-fight-for-food-safety/article2026156/ Chinese news media step up efforts in fight for food safety] {{Webarchive|url=https://web.archive.org/web/20161013145209/http://www.theglobeandmail.com/report-on-business/international-news/global-exchange/chinese-news-media-step-up-efforts-in-fight-for-food-safety/article2026156/ |date=October 13, 2016 }}, ''The Globe and Mail'', posted May 18, 2011.</ref>

====Other health controversies====
* In 1985, [[Syntex Corporation]] was ordered to pay $27 million in compensation for the deaths of two American infants who suffered brain damage after drinking the company's baby formula, called ''Neo-mull-soy''.<ref>{{cite news |vauthors=Mount C |title=$27 Million for 2 Victims |url=https://pqasb.pqarchiver.com/chicagotribune/access/25099431.html?dids=25099431:25099431&FMT=ABS&FMTS=ABS:FT&date=Mar+01%2C+1985&author=Charles+Mount&pub=Chicago+Tribune+(pre-1997+Fulltext)&desc=%2427+MILLION+FOR+2+VICTIMS+OF+BABY+FORMULA&pqatl=google |quote=were given the baby formula, called Neo-mull-soy, when they were infants ... In 1978, Syntex eliminated salt from the formula, a move that Hayes said caused ... |work=Chicago Tribune |date=March 1, 1985 |access-date=April 23, 2009 |archive-date=October 20, 2012 |archive-url=https://web.archive.org/web/20121020081548/http://pqasb.pqarchiver.com/chicagotribune/access/25099431.html?dids=25099431:25099431&FMT=ABS&FMTS=ABS:FT&date=Mar+01,+1985&author=Charles+Mount&pub=Chicago+Tribune+(pre-1997+Fulltext)&desc=$27+MILLION+FOR+2+VICTIMS+OF+BABY+FORMULA&pqatl=google |url-status=dead }}</ref> Formulas produced by Syntex had previously been subject to a major recall as they were found to have insufficient chloride to support normal infant growth and development.<ref>[http://leda.law.harvard.edu/leda/data/823/Goedert_07.html The Syntex Problem] {{webarchive|url=https://web.archive.org/web/20110927172129/http://leda.law.harvard.edu/leda/data/823/Goedert_07.html |date=September 27, 2011 }}, by Robert Goedert, Harvard Law School, May 2007.</ref>
* In 2003, baby plant-based formula manufactured by the German company ''Humana'' and sold in Israel under the brand ''Remedia'' caused severe vitamin deficiencies in babies. Babies who consumed the formula were hospitalized with cardiac and neurological symptoms. Three of them died, and at least twenty others were left with severe disabilities. An investigation revealed that the formula contained a much lower quantity of [[Thiamine]] than is needed for healthy infant development because of a manufacturing error. Humana's chief food technologist received a 30-month prison sentence for negligent manslaughter in February 2013 over the case.<ref>{{cite web|url=http://www.timesofisrael.com/study-of-israeli-baby-formula-tragedy-highlights-vital-vitamin-b1-role/|title=Study of Israeli baby formula tragedy highlights vital vitamin B1 role|website=The Times of Israel|access-date=April 3, 2018}}</ref>
* In 2010, [[Abbott Laboratories]] issued a voluntary recall of about five million ''Similac'' brand powder infant formulas that were sold in the United States, Guam, Puerto Rico and some Caribbean countries. The recall was issued after the presence of a 'small common [[beetle]]' was detected in the product.<ref>[http://www.abbott.com/global/url/pressRelease/en_US/60.5:5/Press_Release_0900.htm Abbott Voluntarily Recalls Certain Similac® Brand Powder Infant Formulas] {{Webarchive|url=https://web.archive.org/web/20111021063012/http://www.abbott.com/global/url/pressRelease/en_US/60.5:5/Press_Release_0900.htm |date=October 21, 2011 }}, Abbott Press Release, issued September 22, 2010.</ref>
*In Canada, New Zealand and elsewhere, public concerns have been raised over the continued sale and marketing of soy-based formulae potentially containing high levels of [[phytoestrogens]],<ref>INFACT Canada. [http://www.infactcanada.ca/genetic.htm Genetic engineering and infant foods.]</ref><ref>World Alliance for Breastfeeding Action. [https://www.waba.org.my/whatwedo/environment/penny_infants.htm Infant Feeding Products.]</ref> linked to abnormal child development<ref>Aksglaede L. [http://www.healthcoalition.ca/archive/hormones2006.pdf The sensitivity of the child to sex steroids: possible impact of exogenous estrogens.] {{webarchive|url=https://web.archive.org/web/20110927084213/http://www.healthcoalition.ca/archive/hormones2006.pdf |date=September 27, 2011 }} ''Human Reproduction Update'', Advance Access published May 2, 2006.</ref> including damage to babies' thyroid glands.
*In December 2011 Wal-Mart recalled a quantity of infant formula after a baby died in Missouri. "We extend our deepest condolences to this baby boy's family as they try to come to grips with their loss," said Dianna Gee, a Wal-Mart spokeswoman. "As soon as we heard what happened, we immediately reached out to the manufacturer of the formula and to the Department of Health and Senior Services to provide any information we may have to help with the investigation." Wal-Mart said it pulled a batch of Enfamil from its stores nationwide that matched the size and lot number ZP1k7G of the formula that may have sickened the baby in Missouri, Gee said. The baby formula was purchased from a Wal-Mart in Lebanon, Missouri. After the purchase, a 10-day-old infant died from a rare bacterial infection, CNN affiliate KYTV reported. Authorities ran tests to determine if the death came from the formula, the water to make the formula or any other factor, said Mead Johnson Nutrition, the company that makes Enfamil. "We are highly confident in the safety and quality of our products – and the rigorous testing we put them through," said Chris Perille, a Mead Johnson Nutrition spokesman.[Source CNN]