Amid an ongoing baby formula shortage, Gastropod looks back at how the “fathers of pediatrics” turned infant formula into a replacement for breastfeeding
If you’re under six months old, there’s usually only one thing on the menu: milk, either human or formula. These days, by the time they reach that six-month mark, three-quarters of all American babies receive at least some formula as part of their diet. But, as you’ve probably noticed, recently that’s become harder to score than a table at the hottest restaurants. For the young, helpless segment of the population that relies on formula, this is a genuine food crisis. So, how did we get here? In this week’s episode of Gastropod, hosts Cynthia Graber and Nicola Twilley tell the story of how formula milk was invented, how it came to compete with breast milk as a first food, and what we can and should do to make it easier and safer for parents to feed their babies.
If you were an American parent in the early 1900s, odds were pretty good that you had a book called The Care and Feeding of Children on your shelves. Written by eminent physician Luther Emmett Holt, the book was a bestseller, reprinted 75 times in the quarter-century following its publication in 1894. In it, Holt gave parents some advice that would be familiar to any parent today: how to bathe and clothe your child, to keep them warm and happy and growing. Where Holt’s book might seem strange today is his advice about feeding those newborns.
Holt was a small, unsmiling man, with what the British Medical Journal described as “a stern sense of duty,” and, as one of the founders of the fledgling field of pediatrics, he was determined to make infant feeding scientific. He had firm opinions about breastfeeding, and, in particular, about its timing. Not only should mothers not feed on demand, and certainly not at night, they should also avoid feeding whenever they felt under the influence of “uncontrolled emotions” — worry, anxiety, fatigue, household cares, and “social dissipation” were all contributors to “the failure of the modern mothers as a nurse.” “Grief, excitement, fright, [and] passion” would likely “cause milk to disagree with the child,” and even make them sick.
To Holt, and to many of his colleagues at the time, the best way to avoid this risk was to rely on a newly created invention: formula milk. (Mothers who followed his advice to skip feedings would probably struggle to produce sufficient breast milk in any case, because as they fed their child less frequently, their bodies responded by reducing the amount of milk generated.)
When formula milk was invented, it was truly a scientific miracle. For all of human history up to that point, breast milk had really been the only good choice for feeding a baby. If a baby couldn’t breastfeed for whatever reason, it typically died. Medical statistics from the past are patchy and not necessarily reliable, but, according to Laurence Weaver, author of White Blood: A History of Human Milk, the doctor in charge of one Dublin maternity hospital in the late 1700s and early 1800s recorded that a shocking 99 percent of babies born there and not nursed by their mothers died. “Want of mother’s milk” was listed as the principal cause.
There were some potential solutions. A newborn whose mother couldn’t breastfeed — or whose mother was wealthy enough that she chose not to breastfeed — was frequently handed to a wet nurse, an already lactating woman (there were plenty around at the time, as women had babies frequently); if that woman took in an additional baby, their body naturally produced additional milk. Or a child might be “dry nursed” — fed a gruel-like mix of flour or breadcrumbs mixed with animal milk or water. But, for the first few months of a baby’s life, its gut isn’t actually able to digest the proteins in cow’s milk, so it’s not surprising that most of these children failed to thrive.
That all began to change in the 1800s. In the 1860s, German chemist Justus von Liebig patented the first artificial milk, made of cow’s milk, baking soda, and a mix of wheat and malt flour. Around the same time, a pharmacist named Henri Nestlé (yes, that one) started selling a formula of his own, made up of crumbled wheat rusks that had been soaked in sweetened condensed milk and dried. Although these first formulas were designed as an emergency measure for orphaned and starving babies, they were made by commercial companies who were, unsurprisingly, interested in making more money. Before long, infant formulas were being advertised as endowing the babies that consumed them with “muscular strength, firmness of flesh, and a lively intelligent appearance,” to quote Wagner’s Infant Food’s marketing copy.
Hand-in-hand with the rise of formula milk was a rapid decline in infant mortality rates. Most of that, Weaver says, can be credited to the sanitation revolution that occurred at the same time — the development of germ theory, the invention of pasteurization, and the beginnings of systematic water treatment. Formula milk was part of that scientific revolution, and, for some babies, it was a life-saver. But this shift had other impacts. Birth and childrearing became increasingly medicalized. To the new “men of science” (they were mostly, though not exclusively, male), it seemed as though everything in life could and should be measured, quantified, and regulated. And infant formulas, with their precisely measured proportions and their ability to be given to the baby in set amounts, on a set schedule, seemed like just the sort of rational, optimized system that should benefit every baby, regardless of their situation. If it was scientifically made, they reasoned, shouldn’t it be better?
These attitudes led to advice like that of Luther Emmett Holt’s, which treated formula not as an alternative to breastfeeding, but a replacement altogether. Over the next 50 years, thanks to this kind of medical endorsement, human milk became the norm. By the 1950s, only a quarter of American babies were breastfed at all, for any length of time.
Breastfeeding has risen again over the past few decades, but millions of families around the U.S. still rely on formula — which brings us to today’s crisis, with empty shelves forcing desperate parents to drive miles, scouring supermarkets for precious tins of formula, while the government airlifts emergency supplies in from Europe. Is the solution to the formula milk crisis more formula, or are there other things that we could and should be doing to help parents feed their babies? Why does one factory produce a quarter of the U.S. supply of formula? And how have science, culture, and capitalism shaped the way we all eat in our first years of life? Follow, subscribe, and listen to the new Gastropod episode for the story behind the news.