Breast feeding is part of a continuum of nourishing the newborn from the womb to weaning. WHO recommend that mothers breast feed their babies for at least six months. Thereafter foods other than mother’s milk need to be introduced and complementary feeding may include cow’s milk or formula. Some babies born preterm or with specific diseases and surgical problems require special feeds from birth, particularly when expressed breast milk is not available. Some mothers choose not to feed their babies on the breast, and for them safe breast milk substitutes are available.

It would be nice to think that there was no need for artificial feeds, that all mothers would bear healthy babies who would be successfully breast fed and safely weaned on to complementary foods. But we do not live in an ideal world. We live in a complex and changing world, which includes choice, chance, and stark contrasts between rich and poor. Malnutrition and growth faltering affect many babies in developing countries during this dietary transition,¹ and exclusive breast feeding from birth is a central component of international strategies to reduce early infant mortality and morbidity.² However, there is debate about the optimum duration of breast feeding³ and time of first introduction of complementary foods, and whether these should be the same for all babies world wide. Recognising the importance of rational guidance during this critical period, UNICEF and WHO have published reviews⁴ and recommendations.⁵

HISTORY OF INFANT FEEDING

We take for granted the existence of safe infant formulas and have forgotten the dire fate of babies that were not breast fed in the past. In 1790, the Dublin lying-in hospital recorded a mortality of …