Bottle-feeding rather than breast-feeding is associated with a doubling of the risk of pyloric stenosis, a bowel malformation common in young boys.
Parents report very impressive jet vomiting in infants of a few months, most often boys and firstborns. The cause ? Hypertrophic pyloric stenosis. In other words, the pylorus, the muscular ring that makes the junction between the stomach and the intestine is too large and no longer allows the passage of food even when it is not contracted. On average, 2 in 1000 children are affected and a small surgical operation must be performed to allow them to eat normally. Despite the frequency of this malformation, its cause is still unknown to the medical profession.
The first born is more at risk
A Seattle team has just shown that breastfeeding could play a protective role, according to a study published in the specialist journal Jama Pediatrics. By studying the medical records of more than 700 children with pyloric stenosis and more than 7,000 unaffected children born at the same time in Washington state, the authors found that 19.5% of children with this defect had left maternity bottle-fed and 9.1% breast-fed. Bottle-feeding is therefore associated with a risk of pyloric stenosis multiplied by 2.3 on average, by 3.4 if the mother is multiparous and by 6 if she is over 35 years old.
“It is a strong and indisputable statistical association, but it is in no way the demonstration of a cause and effect relationship”, nuances Professor Frédéric Gottrand, pediatrician and head of the Child center at the Lille CHRU. It is indeed impossible to demonstrate epidemiologically an effect of breastfeeding since it would be necessary to draw lots from among the newborns those to breastfeed and those to be bottle-fed. “It would not be ethical, so we must be satisfied with comparisons, continues Frédéric Gottrand. However, we know that among what pushes women to choose to breastfeed, there are very probably important confounding factors such as socio-economic level for example ”.
His colleague Patrick Tounian from the Armand Trousseau hospital in Paris is also extremely cautious about the results of this study: “We cannot exclude that there is a factor in breast milk which has a protective effect against pyloric stenosis. but this study does not allow us to identify it ”.
Listen to Prof. Patrick Tounian, head of the pediatric nutrition department at Armand Trousseau hospital in Paris: “I don’t think this is the explanation for pyloric stenosis, but a new argument in favor of breastfeeding, yes. “
“This is one more element to think that there is a benefit to breastfeeding, but that does not make the bottle responsible for pyloric stenosis”, insists Frédéric Gottrand. “We still do not know if the risk of pyloric stenosis is due to bottle feeding or not breastfeeding,” said the editorial published in JAMA Pediatrics with the study of American pediatricians. “We should not use this type of statistical study to exert guilt-inducing pressure on mothers who do not wish to breastfeed,” also worries Patrick Tounian.
Listen to Prof. Patrick Tounian, head of the pediatric nutrition department at Armand Trousseau hospital in Paris: “Yes, encourage breastfeeding, impose it by saying if your son has pyloric stenosis, it will be your fault, it’s scandalous!” “
A risk factor for pyloric stenosis, on the other hand, is clearly identified and preventable: maternal smoking during pregnancy, which doubles the risk. “Be careful, breastfeeding is not an antidote to smoking during pregnancy, warns Patrick Tounian. While there are doubts about this beneficial effect of breastfeeding on pyloric stenosis, there are only certainties about the deleterious effects of smoking during pregnancy! “
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