Eats on Feets facilitates a worldwide network of parents, caretakers, and professionals who have made the informed choice to share or support the sharing of human milk.

Parents and caretakers accept full personal responsibility for their milksharing experience(s) and outcome(s).

Where did the name Eats on Feets come from and how did it all start?

Hey, why don’t we just become wet nurses; instead of Meals on Wheels, we can call ourselves Eats on Feets.
Shell Walker Luttrell, 1991

These words are at the foundation of the Eats on Feets network.

Meals on Wheels is a network comprised of 5,000 community-based programs across the United States dedicated to addressing senior hunger and isolation.

In July of 2010, Shell, retired LM, CPM, started the original Eats on Feets Facebook Chapter for her community in Arizona. Remembering her words from 1991, she thought that Eats on Feets would be a fun and lighthearted name for a page dedicated to bringing human milk to babies in need. In October of 2010, the idea caught on, and a network of multiple chapters was created.

From Shell’s original Eats on Feets page:

“I started this page after receiving a phone call from a mom who was desperate to find breastmilk for her newborn. I posted her needs on Facebook and the response was immediate and fantastic. I thought it would be awesome if there were a page dedicated to milksharing and tribe nursing.

So, this is a networking page for families to share and receive milk when needed. I am not responsible for milksharing results or content shared by other posters.

And a note of caution; KNOW THY SOURCE. While it is true that tribe feeding offers MANY benefits, there is ALWAYS the risk of disease/contamination.

I support many causes and movements but in the spirit of keeping the site as focused as possible status updates are specific to milksharing.”

What does Eats on Feets believe?

Eats on Feets believes that:

Breastfeeding is essential for both infant and global health.¹
Breastmilk can be shared in a safe, ethical manner and families are capable of making informed choices.
Sharing healthy breastmilk is a vital option, when necessary, to maintain exclusive breastfeeding.
There is enough breastmilk for all the babies who need it.
Informed use of healthy donor milk is superior to artificial substitutes.
Wet nursing is an important part of milksharing.
Hand expressing (while maintaining a clean technique) of milk does not involve the cleaning of parts and may thus be cleaner and safer than using a mechanical pumping system.
Breastmilk from a healthy donor that is raw and fresh (not frozen) is closest to its natural state and therefore most beneficial.²
Detailed health history and blood work can be discussed between donors and recipients to come to a mutual agreement for both long- and short-term sharing.
Proper health screening can be done to reduce the risk of exposure to pathogens (gems).
When full screening is not available, donor health status is unknown, or to reduce the potential risks of exposure to HIV and other pathogens, breastmilk can be pasteurized.³
Individual rights should be respected in all decision-making and milksharing interactions. Those who participate in the sharing of breastmilk should be aware of their options so that they can make informed choices that are best suited to their unique situation.
Individuals and communities are in a key position to help meet the breastmilk needs of babies.

What does Eats on Feets not do?

Eats on Feets does not:

Support or approve of the selling of breastmilk on our network.
Accept any bartering for breastmilk other than bag-for-bag replacement if needed.
Match donors and recipients.
Accept third-party offers or requests (Email us for accommodations)
Suggest our users rely on the results of milk bank screening processes or milk bank donor approval letters for the assurance of safe milksharing.
Allow re-donating donated milk (Email us for accommodations)
Keep track of matches being made on our page.
Screen donors or recipients.
Provide clinical advice/care for breastfeeding difficulties.
Provide contracts or questionnaires.
Dictate who should receive breastmilk.
Collect, store, or distribute breastmilk.
Endorse any product for sale.
Purchase advertising or accept advertising on the chapter pages.
Reimburse volunteers/supporters.
Act as mediators or advisors if difficulties or misunderstandings occur between parties.
Accept liability for the outcomes associated with sharing breastmilk.
Expect donors to try to increase their supply to donate milk.
Refer to outside networks, groups, organizations, professionals, etc.

Community Milksharing

The 4 Pillars of Safe Milksharing

The use of healthy, commerce-free donor milk is a natural option when a baby cannot receive milk from their own lactating parent. However, there are risks associated with feeding a baby anything outside of the closed bio-system of mouth-to-nipple. This includes storing and feeding expressed milk to one’s own child, donating expressed milk that will not be used, and storing and feeding donor milk. From expression to feeding, and especially in the context of donating since the intended recipient baby may not have the same antibodies as the donor, steps can be taken to reduce the exposure to pathogens. Both donors and recipients can screen each other using this document and The Four Pillars of Safe Breastmilk Sharing.

The Four Pillars of Safe Breastmilk Sharing came out of the extensive research that is compiled in this document and they form the foundation from which families can learn how to safely share human milk. These four pillars provide evidence-based information for the support of safe community-based and private arrangement milksharing. The Four Pillars of Safe Breastmilk Sharing are not only useful to parents and caretakers, but also to pediatricians, midwives, and those active in birth and parenting communities.⁴ By understanding the easy-to-implement principles of the Four Pillars of Safe Breastmilk Sharing, they too can help babies in their communities by supporting safe community-based and private arrangement milksharing.

The Four Pillars of Breastmilk Sharing

Informed Choice

Understanding the options, including the risks and benefits, of all infant and child feeding methods
Know thy source

Donor Screening

Donor self-exclusion for, or declaration of, medical and social concerns
Communication about lifestyle and habits
Screening for HIV I and II, HTLV I and II, HBV, HCV, Syphilis, and Rubella

Safe handling

Inspecting and keeping skin, hands, and equipment clean
Properly handling, storing, transporting, and shipping breastmilk

Home pasteurization

Heat treating milk to address infectious pathogens
Informed choice of raw milk when donor criteria are met

Are there risks to using privately arranged donor milk?
Some argue that even after donors are screened, a small number of pathogens can still remain in the milk⁵ and that therefore raw donor milk is never safe.⁶ However, when considering pasteurized milk, there are also risks that need to be evaluated, and in situations where donor milk has been pasteurized, pathogens can (re-) contaminate milk.

Informed milksharing⁷
To our knowledge, there are no documented cases of disease transmission or bacterial infection associated with informed milksharing at this point.

The article The Four Pillars of Safe Breastmilk Sharing was published in Midwifery Today. Spring 2012. The photo was taken at our very first Eats on Feets gathering in Arizona where donors and recipients could meet and share milk!

Who needs donor milk?

Eats on Feets focuses on the breastmilk needs of babies and young children.⁸

All children have the right to breastmilk. There are many situations wherein a child or baby would need donor milk, including but not limited to the death of a lactating parent, adoption, foster care, guardian care, low milk production, no milk production, or the health of the lactating parent. Eats on Feets does not endorse any order of priority for the sharing of human milk with babies and young children.⁹

A strong case can be made for the medical use of breastmilk by adults. Eats on Feets supports informed choice and a person’s right to share breastmilk with whomever they choose. Medical adult needs are welcome on our network as long as they are transparent and not posted anonymously.

Regarding adults requesting milk for non-medical reasons (weightlifting, fetishism), we do not allow these.¹⁰ Eats on Feets administrators will delete these types of requests. Eats on Feets encourages families to practice safe social networking.

What are the benefits of community-based milksharing?

Some benefits are:

Normalizes breastmilk as the primary food source for babies, wet-nursing, and the sharing of breastmilk.
Rapid response in acute situations,
Affordable,¹¹
Control of the pasteurization process,
Likelihood of obtaining age-specific milk if desired,¹²
Opportunity to meet donor(s) and verify lifestyle and health habits,
Provides parental autonomy,
Builds community with other parents,
In some cultures: extends family to include ‘milk-brothers and -sisters,’¹³
Key placement of those whose knowledge, assistance, and networks could be imperative during a state of emergency,¹⁴

Are there risks to using donor milk?

There are always risks associated with feeding a baby anything other than its own parent’s healthy milk via direct nursing.¹⁵ When considering (private) donor milk, parents are balancing the benefits of optimal nutrition and immunity against the risk of disease transmission. Some argue that even after donors are screened, a small number of pathogens can still remain in the milk¹⁶ and that therefore raw donor milk is never safe.¹⁷ However, when considering pasteurized milk, there are also risks that need to be evaluated, and in situations where donor milk has been pasteurized, pathogens can (re-) contaminate milk (see below).

Informed milksharing¹⁸
To our knowledge, there are no documented cases of disease transmission or bacterial infection associated with informed milksharing at this point.

Milksharing is also not considered to be a pressing public health risk according to Dr. Chessa Lutter, Regional Advisor on Food and Nutrition for the Pan American Health Association (Regional Office of the WHO) on ‘The Current.’¹⁹

From the interview:

Q: “Is Eats on Feets safe in the opinion of the World Health Organization? Are they a credible alternative?”
A: “We don’t have a position on this. We focus our efforts on what we consider are the most pressing public health concerns. This has not made it to the top of the list. What I would like to share…”

Dr. Chessa Lutter goes on to describe a pediatrician’s positive and privately arranged donor breastmilk experience.

There may be concern regarding the spread of infectious diseases through breastmilk, in particular HIV. The CDC states that HIV and other serious infectious diseases can be transmitted through breastmilk. They also state that the risk of infection from a single bottle of breastmilk, even if someone is HIV positive, is extremely small. For those who do not have HIV or other serious infectious diseases, there is little risk to the child who receives their breastmilk.²⁰ Please see How can breastmilk be pasteurized at home? for more information on mitigating the risk of exposure to HIV and other pathogens.

Risk from handling
Some of the risks associated with donor milk are caused by the method used to feed the milk to the baby.²¹ There have been documented cases in hospitals where newborns developed bacterial infections after receiving milk obtained from milk banks and delivered via feeding tubes or artificial nipples. For instance, one outbreak of F. meningosepticum was not from milk but was located on milk bottle stoppers and ‘cleaned’ teats, as well as the ward environment. Dr. John May²² identifies four related deaths as a result of contaminated breastmilk in hospitals. Some of these infections appear to have been associated with a single donor, which indicates that there was some cross-contamination that occurred with that particular batch of donor milk. The infections linked to contaminated breastmilk were generally caused by normal bacteria that live on human skin and are by definition not isolated to babies in hospitals. Sick and premature infants are more at risk for these infections. Please see Handling of breastmilk for more information on proper handling techniques.

Theoretical risks
While there is a risk of disease transmission, there are other, theoretical, risks of informed milksharing:

Unwanted contact from adults who seek milk for non-medical needs²³
Harassment by donor/recipient
Possible sabotage by recipient or donor
Transmission of pathogens that could cause a baby to become sick or die
Legal action, founded or unfounded, in case of a bad outcome²⁴

Risk of pasteurized versus raw breastmilk
Sick and premature babies are at risk for neonatal hospital-acquired infections.²⁵ In a previous but valuable study on the effect of routine screening of raw human milk and donor milk for premature babies, the authors discuss that while the data clearly document that premature infants fed raw expressed human milk are frequently exposed to large numbers of bacteria, no adverse events directly related to consuming this milk were documented.²⁶

The lack of anti-infective properties in pasteurized milk can put a baby at risk, especially when a baby is sick or premature. Please see What about premature babies? for more information about the effect of heat-treating on breastmilk.

What should I know about appropriate (online) social networking? Is it safe?

Eats on Feets is not responsible for the outcome of donor/recipient arrangements.

Potential risks of social networking can be avoided by following safe social networking guidelines.²⁷ Part of safe networking includes keeping your exact location and information that could disclose your location (such as digitally uploaded photos), private.

Successful milksharing relationships between donors and recipients are based on mutual understanding, transparency, informed choice, and respect. This process is best done by starting with corresponding via private messages or private email before meeting in person.

Please beware of scams. The two main scams are shipping scams (people asking someone to pay to ship milk that does not exist) and flipping milk (requesting in one group and selling in another).

If for any reason, someone does not feel comfortable pursuing or continuing a donor/recipient relationship, they are always free to withdraw from it, regardless of the situation. Trust your intuition!

Please notify the local chapter page or email us about any wrongdoing in your community. If undesired contact keeps occurring, please know that FB has a blocking feature.²⁸

❆✼❆

Some adults might request milk for non-medical reasons (weightlifting, fetishism).²⁹ Eats on Feets administrators will delete these types of requests.

For the full informed choice process and self-determination of all families practicing private arrangement milksharing, for the safety of babies, and for network transparency, we only accept offers and requests from legally or medically responsible parties.³⁰

If you are not a legal or medical representative, please email us with proper contact information so we can create a post for the original donor or intended recipient.

Human milk in a state of emergency

In an emergency situation, whether a natural or human-made disaster, breastfeeding and human milk feeding are important strategies for increasing infant and child survival. Appropriate and timely support of infant and young child feeding in emergencies saves lives.

It is rarely in the best interest of the lactating parent or the child to cease breastfeeding in case of disease outbreaks or illnesses affecting lactating parents or children.³¹

Following a disaster, one of the first things that are donated is breastmilk substitutes –often with the best of intentions, but this can have a negative impact on the health of mothers and children, even when clean water and sanitary conditions exist. Infants who are not breastfed are vulnerable to infection and to developing diarrhea. These substitutes may put infants’ lives at risk.³²

Wet nursing or human donor milksharing are recognized options for feeding infants and young children in emergencies and disasters. Unfortunately, despite the uniquely complex qualities and functions of human milk, as a food, tissue, and/or therapeutic product, the relevant regulatory frameworks for donor human milksharing and wet nursing are practically non-existent³³ and myths prevail.³⁴

Identifying key decision-makers at the household, community, and local health-facility level who influence infant and young child feeding practices is crucial information when determining the priorities for action and response in emergencies. A parent-to-parent milksharing network can be vital for the fast mobilization of aid when and where needed.³⁵

Heat-treating breastmilk remains an option in any affected area if necessary.
How do I protect my breastmilk during a power outage?

Resources for support

Local resources for obtaining referrals, lactation support, donor/recipient support, blood testing, and more. If the professionals on this list cannot directly help you, they will most likely be able to refer you to someone who can.

These are general suggestions for types of providers only. Eats on Feets cannot recommend any particular local resources, organization, or person.

Midwives
Lactation Consultants³⁶
Health Care Providers
Nurse Practitioners
Community Nurses
Doulas
Breastfeeding Counselors
Naturopathic Physicians
Chiropractors
Acupuncturists
Craniosacral Therapists
Peer-to-Peer Breastfeeding Support Groups
Parent groups
Others with breastfeeding and milksharing experience

Human Milk and Substitutes

Why human milk?

Human milk is for human babies.

In this document, Eats on Feets utilizes the WHO definition of exclusive breastfeeding which includes wet nursing and donor milk.³⁷ In support of exclusive breastfeeding, informed milksharing is a safe and viable infant feeding option for families.

Eats on Feets recognizes both the benefits that direct feeding from the breast bestows as well as the value of the milk itself. We may, therefore, use the words breastfeeding and breastmilk interchangeably. We also recognize and affirm chest feeding as part of the infant feeding spectrum.

Benefits of breast(milk)feeding
In a previous WHO document called ‘The 10 Facts on Breastfeeding,’ the WHO stated that a lack of exclusive breastfeeding during the first six months of life contributes to over a million avoidable child deaths each year. In 2013, it stated that if every child was breastfed within an hour of birth, given only breastmilk for their first six months of life, and continued breastfeeding up to the age of two years, about 220,000 child lives would be saved every year.³⁸ ³⁹

Breastfeeding is widely recognized as vital in low and middle-income countries, but health authorities in high-income countries seem to ignore the low breastfeeding rates and the resulting significant short and long-term health issues for mothers and children. With few exceptions, breastfeeding duration is shorter in high-income countries than in resource-poor countries. It is estimated that breastfeeding at a near-universal level could prevent 823,000 annual deaths in children under 5 and 20,000 annual deaths from breast cancer.⁴⁰ Promoting breastfeeding in the United States has the potential to save or delay 720 postneonatal (28 days-1 year) deaths each year.⁴¹

Private and government insurers spend a minimum of $3.6 billion dollars a year to treat medical conditions and diseases that are preventable by breastfeeding. Since children who are not breastfed have more illnesses, employers incur additional costs for increased health claims, and parents lose more time from work to care for sick children. ⁴²

Everyone has the right to information about the benefits of breastfeeding and the risks of infant formula. Breastfeeding is the natural and recommended way of feeding all infants, even when infant formula feeding is affordable, clean water is available, and good hygienic conditions for preparing and feeding infant formula exist. Given the compelling evidence for differences in health outcomes, breastfeeding should be acknowledged as the biological norm for infant feeding.⁴³

Governments and authorities have a responsibility to provide proper breastfeeding information and make available the resources needed to achieve exclusive breastfeeding for the first 6 months of a baby’s life and partial breastfeeding from 6 to 24 months, especially where inequities prevail. Communities, media, and other channels of communication can play a key role in promoting breastfeeding. The use of donor milk from a milk bank and supporting private-arrangement milksharing as a safe and vital way of achieving this goal is another.⁴⁴

Protective factors of breastmilk
Because of its inherent anti-microbial properties, breastmilk can be stored for 8 hours at room temperature (25ºC/77ºF) and for three days in the fridge (4ºC/39ºF) without any significant increase in the levels of pathogens it contains.⁴⁵ ⁴⁶

Unlike infant formula, fresh human milk contains thousands of distinct bioactive molecules that protect against infection and inflammation and contribute to immune maturation, organ development, and healthy microbial colonization.⁴⁷

Human milk provides protection against many infectious agents through repeated exposure and the total antimicrobial protection provided by human milk appears to be far more than can be explained by examining protective factors individually. The antimicrobial potential of human milk is most likely underestimated and components are still being identified.⁴⁸ ⁴⁹ ⁵⁰

For premature infants, donor milk feedings are associated with a decrease in Necrotizing Enterocolitis (NEC) and this can only be attributed to the unique immunologic properties of breastmilk.⁵¹

While pasteurized human milk is more beneficial than artificial infant formula, a strong case can be made for feeding premature infants fresh, unpasteurized human milk.⁵² An older but valuable study on human milk and bacteria documented routine screening of raw breastmilk and donor milk for premature babies and showed that while premature infants fed raw expressed human milk are frequently exposed to large numbers of inherent bacteria, no adverse events directly related to consuming this milk were documented.⁵³ When comparing babies fed with donor milk, preterm formula, or someone’s own milk, the advantages of an exclusive diet of someone’s own milk for their premature infant include fewer infection-related events and shorter hospital.⁵⁴

It can be said that in any part of the world, no single pediatric measure has such widespread and dramatic potential for child health as breastfeeding.⁵⁵

Physical benefits of breastfeeding⁵⁶
The act of breastfeeding promotes adequate growth and bone and muscle development, ie. proper jaw and facial development which reduces both ear infections and bite issues. It also reinforces the physiological nasal breathing of the newborn during and after sucking breastmilk, avoiding oral breathing. All of this has a preventative effect on the development of malocclusions. The act of breastfeeding is also positively associated with the development of proper dental arches.⁵⁷ ⁵⁸ ⁵⁹

Another important aspect of feeding at the breast is that the baby’s saliva, reacting with the breastmilk, generates hydrogen peroxide and provides growth-promoting nucleotide precursors. In other words, breastmilk produces a combination of stimulatory and inhibitory metabolites that regulate early oral and gut microbiota when mixed with saliva.⁶⁰

The skin-to-skin transference of bacteria that breastfeeding provides also helps babies acquire the beneficial bacteria to protect them from diseases and builds their immune system. Approximately ten percent of the bacteria introduced to an infant is from the skin around the areola.⁶¹

The specificity of bacteria in the infant’s gut is associated with feeding practices. Some bacteria may be reduced when a baby is not able to feed at the breast. However, there are ways to optimize feeding one’s own milk and/or using donor milk at the breast. With motivation, support, and guidance, combinations of feeding methods are possible to optimize beneficial aspects of both human milk feeding and feeding at the breast. That said, any amount of breastmilk is beneficial – even if only for a short period of time, even if there is no sucking at the breast.⁶² ⁶³ Physical skin-to-skin contact and bodily proximity with any feeding also provide relaxation for both parent/caretaker and child due to the effects of oxytocin.⁶⁴

Long-term health benefits
Some long-term benefits that have been studied are lower rates of obesity (10% reduction in the prevalence of overweight or obesity in children exposed to longer durations of breastfeeding), type 1 and type 2 diabetes, hypertension (a small protective effect of breastfeeding against systolic blood pressure), cardiovascular disease, hyperlipidemia (results do not support a long-term programming effect of breastfeeding on blood lipids), and some types of cancer (For every 12 months someone breastfeeds, the risk of breast cancer dropped 4.3 percent.).⁶⁵ ⁶⁶

These studies are typically confounded by many factors, including socio-economics and inequities, but the benefits of breastfeeding always need to be evaluated against the risks of not breastfeeding. To say that breastfeeding and/or human milk improve something is a distortion of sorts. Breast(milk)feeding is normative. It is better to acknowledge that not breastfeeding causes harm and that no matter how someone needs to feed their baby for various reasons, human milk can and should be a part of this.

Meta-analysis of studies on cognitive performance suggests that breastfeeding is associated with increased performance in intelligence tests in childhood and adolescence. Breastfeeding promotes brain development, particularly white matter growth.⁶⁷ Some pathways for the beneficial effect of breastfeeding on cognitive development results from the presence of certain essential long-chain fatty acids in breastmilk, particularly arachidonic acid (AA) and docosahexaenoic acid (DHA). These favor the cerebral cortex and retina and accumulate during the last trimester from the placenta and during the first year of life. Infants can synthesize neither AA nor DHA.⁶⁸

Economic benefits
The absence of breastfeeding not only affects short and long-term health outcomes. It also has a financial toll on the economy. When evaluating the cost of not breastfeeding, Melissa Bartick, et al, conclude that all costs were significantly lower under optimal breastfeeding conditions, with the exception of pre-menopausal ovarian cancer and acute lymphatic leukemia. These costs were qualified into 4 mutually exclusive categories: direct medical costs, indirect medical costs, indirect non-medical costs, and premature maternal death costs. In the US, the cost of a lack of breastfeeding in 2014 was 3.0 billion dollars for total medical costs, 1.3 billion for non-medical costs, and 14.2 billion for premature maternal deaths.⁶⁹ ⁷⁰

Environmental benefits

Coming soon

Medicinal uses of human milk
In addition to its long and short-term biological, physiological, and economic benefits, a growing body of research is showing the amazing disease-killing and healing properties of human milk. Human milk contains multipotent stem cells, stem cells that can be reprogrammed to form many types of human tissues. This is especially important for further regenerative therapies, tissue culture techniques, and gene therapy. The presence of these cells in human milk suggests that milk could be an alternative source of stem cells for a patient’s own stem cell therapy. Isolating stem cells from human milk is a simpler and less invasive technique than extracting them from organs. Colostrum is especially rich in stem cells.⁷¹ ⁷² ⁷³ ⁷⁴

Human milk is also being researched in the context of skin warts and cancer. A protein in human milk called alpha-lactalbumin, when processed with oleic acid (simply put) forms a compound called alpha-lactalbumin-oleic acid. When this compound was applied topically to skin warts of people who were not responding to conventional treatment, there was an 82% in wart reduction. With time, all lesions resolved completely in most of the patients who received alpha-lactalbumin–oleic acid (83 percent), and these patients were still free of lesions at the two-year follow-up. This raises hope it might also prove effective against cervical cancer and other lethal diseases caused by the same virus.⁷⁵

The effect of α-lactalbumin–oleic acid on tumor cells was discovered by chance when researchers were studying the antibacterial properties of human milk. HAMLET, which is the same human protein-derived alpha-lactalbumin but with the addition of ‘made-lethal-to-tumor-cells’ induces apoptosis-like death in tumor cells while leaving healthy cells unaffected. Patients with cancer of the bladder who were treated with the substance excreted dead cancer cells in their urine after each treatment.⁷⁶ ⁷⁷ ⁷⁸

Lastly, studies showed that HAMLET also has direct bactericidal activity against some bacteria. The findings suggest that maybe HAMLET can be used where antibiotics fail due to antibiotic resistance. Antibiotic resistance is a growing global health concern and hopefully, further research in this area will contribute to novel treatment options.⁷⁹

It has to be noted that HAMLET does not occur in human milk. HAMLET is a lab-altered human milk protein. Drinking human milk may or may not have beneficial properties for adults, but it may also have risks for the immuno-compromised, like CMV.⁸⁰ While breastfeeding a child for six months or longer has been associated with a lower risk for childhood cancer compared to children who had been breastfed for less time or not at all, this is most likely due to the age-appropriate immuno-developing properties of human milk and the metabolic processes in the infant. The adult gut has a higher pH than that of babies. Adults need a much bigger variety of food in order to obtain all the essential nutrients.

The importance of the act of breastfeeding
Finally, the benefits of breastfeeding are beyond its product, the milk. They are beyond providing nutrition to one’s child for optimal health, growth, and development. The time spent between lactating parent and child when breastfeeding is also vital to the development of a bonded relationship. It provides an opportunity to interact and connect – or more accurately, it demands it, in a way that is not a given when bottle feeding. Although breastfeeding duration is only one of many factors associated with maternal abuse and neglect, it does offer a protective effect that is higher than in situations where an infant is not breastfed.⁸¹

Newborn humans are born in a helpless state and continue their development after birth. The nurturing embraces of breastfeeding mimic the embrace of the womb that the baby experienced in utero. In light of this, the method a parent or caregiver uses to provide donor milk to a baby is thus also very important.⁸²

As Dr. Brian Palmer, DDS said: Breathing well, sleeping well, and breastfeeding infants are three key ingredients to good health, feeling better, and reducing healthcare costs for everyone – including insurance companies and governments.

WHO guidelines for exercising feeding options

The WHO recommendations for feeding infants and young children are:⁸³

Milk from own parent by breastfeeding,
Milk from own parent, expressed,
Milk from a wet nurse, or
Milk from a milk bank, or
Breastmilk substitute fed by cup,
depending on individual circumstances and as discussed with a healthcare provider.

To enable parents to establish and sustain exclusive breastfeeding for six months, WHO and UNICEF recommend:

Initiation of breastfeeding within the first hour of life;
Exclusive breastfeeding –that is, the infant only receives breastmilk (including milk expressed or from a wet nurse) without any additional food or drink or water;
Breastfeeding on demand –that is, as often as the child wants, day and night;
No use of bottles, teats, or pacifiers.

In this document, Eats on Feets uses the WHO definition of exclusive breastfeeding, which includes wet nursing and donor milk. In support of exclusive breastfeeding, in circumstances where breastfeeding from a wet nurse is not feasible, informed milksharing can be a safe and viable infant feeding option for families. Milk sharing can be interpreted as an extension of wet nursing, and as a safe alternative for infant feeding and successful exclusive breastfeeding.

Why human milk substitutes

For certain rare genetic diseases, such as galactosemia,⁸⁴ (identified through the early newborn metabolic screening)⁸⁵ the use of non-milk-based breastmilk substitutes is the suggested feeding option.

Reasons for infants to require specialized formula instead of human milk:⁸⁶

Infants with classic galactosemia: a special galactose-free formula is needed.
Infants with maple syrup urine disease: a special formula free of leucine, isoleucine, and valine is needed.
Infants with phenylketonuria: a special phenylalanine-free formula is needed (some breastfeeding is possible, under careful monitoring).

There are medical reasons pertaining to the health of the lactating parent to not breastfeed as well.⁸⁷

Risks and ethics of human milk substitutes

Infants who are not fed with human milk, for whatever reason, should receive special attention from the health and social welfare system since they constitute a risk group. ⁸⁸ ⁸⁹ Formula feeding is associated with adverse health outcomes for both lactating parents and infants, ranging from infectious morbidity to chronic disease.⁹⁰ ⁹¹

The protective properties of human milk are unique, multifunctional, and interactive, and complement the developing immune system in the newborn infant. They simply cannot be duplicated in the laboratory.⁹² ⁹³ Since human milk feeding is the biological norm for infants, this means that there are risks to using any and all artificial human milk substitutes for infant feeding purposes as they affect bacterial colonization in the gastrointestinal (GI) tract.⁹⁴

Parents and caretakers who cannot (exclusively) breastfeed and who cannot use a wet nurse or donor milk generally turn to infant human milk substitutes. The World Health Organization (WHO) and UNICEF recommend that healthcare providers inform parents and caretakers about the health risks of artificial feeding and the benefits associated with human milk.⁹⁵ The risks are numerous, and many families are not informed about proper handling and preparation. Formula companies have indeed misinformed consumers by making false statements about their products and by neglecting to provide key information.⁹⁶ ⁹⁷ This has widespread health and economic implications in many countries but is devastating to developing nations in particular.⁹⁸

Preparing formula
Powdered infant formula needs to be handled and prepared safely, especially for infants under two months, infants born prematurely, or infants with a weakened immune system. Parents and caretakers are often not informed to use boiled water and let it cool for about 5 minutes. This is however especially important in order to avoid potentially deadly Cronobacter infection.⁹⁹ Besides Cronobacter, Enterobacter sakasakii is another common contaminant in infant formula (as opposed to possible exposure to). If needed, liquid formula is the most effective control measure to minimize the risks of Cronobacter, Salmonella, and E. sakazakii because it is sterile.¹⁰⁰ ¹⁰¹

Prepared infant formula needs to be used quickly, refrigerated within two hours if not used, and discarded after the first feeding attempt because it contains no antibodies or anti-infective properties.¹⁰² ¹⁰³

Unlike human milk, human milk substitutes also need to be carefully measured based on their caloric content to ensure that a baby is getting the suggested portion. Caregivers need to be warned against diluting or over-mixing, as doing so may put a child on a path of battling obesity or malnourishment.

When using infant formula, risk monitoring by following official safety alerts and education associated with artificial infant feeding are important.¹⁰⁴ ¹⁰⁵

Necrotizing Enterocolitis
When it comes to premature babies, Necrotizing Enterocolitis (NEC) is a very dangerous complication of feeding with human milk substitutes. Human milk has been associated with a decrease in NEC in premature babies and should be widely available to all infants in hospitals.¹⁰⁶ ¹⁰⁷ ¹⁰⁸

Environmental concerns
We are all exposed to environmental contaminants that we have no control over, but there are separate concerns with regard to infant formula, especially in storage and feeding containers. Environmental contaminants include phthalates,¹⁰⁹ bisphenol A (BPA),¹¹⁰ and melamine.¹¹¹ Genetic engineering is also of concern.¹¹²

When it comes to the lack of official recommendations and support for milksharing, Karleen Gribble writes that it is the cultural distaste for sharing human milk, as opposed to evidence-based research, that supports official warnings. Regulating bodies should conduct research and disseminate information about how to mitigate possible risks of sharing human milk, rather than proscribe the practice outright.¹¹³

There is an overall lack of support for people who struggle with breastfeeding and human milk feeding. Parents and caretakers are exposed to media, and clinical or hospital environments filled with formula advertisements that give a strong message that undermines any form of lip service paid to breastfeeding and human milk feeding. This type of marketing and distribution goes directly against the International Code of Marketing Breast Milk Substitutes, a code that aims to protect breastfeeding, protect all lactating parents and babies (whether breastfeeding, formula-feeding, or combination feeding), and prevent aggressive marketing practices that often prevent lactating parents from meeting their own breastfeeding goals.¹¹⁴

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In this document, Eats on Feets utilizes the WHO definition of exclusive breastfeeding which includes wet nursing and donor milk. In support of exclusive breastfeeding, informed milksharing is a safe and viable infant feeding option for families. WHO Guidelines for exercising feeding options. Eats on Feets recognizes both the benefits that direct feeding from the breast bestows as well as the value of the milk itself. We may, therefore, use the words breastfeeding, breastmilk, human milk, milk, and donor milk interchangeably. We also recognize and affirm chest feeding as part of the infant feeding spectrum. ↩︎
Please see Why breastmilk for more information on the properties of breastmilk. ↩︎
See How can breastmilk be pasteurized at home? for more information. ↩︎
Eats on Feets – Safe Milksharing ↩︎
Ronald S. Cohen, et al. 2009. Retrospective review of serological testing of potential human milk donors . Screening tests are designed to have a relatively high incidence of false positives in order to prevent any false negatives. While false positives happen to many people, they tend to be higher in those who are pregnant or were recently pregnant. From the perspective of a milk bank that will be testing the donors on a regular basis, it makes sense to exclude anyone with a history of false positives since the cost of pursuing confirmations at every testing opportunity is not only prohibitive for a non-profit org, it also can lead to logistical issues with the milk received from the donor. This study does not follow up on the actual serological status of those screened but, even per the most optimistic values, it is quite likely that many did not in fact have any current infections. ↩︎
Screening tests are designed to have a relatively high incidence of false positives in order to prevent any false negatives. While false positives happen to many people, they can occur more often during pregnancy. From the perspective of a milk bank that will be testing the donors on a regular basis, it makes sense to exclude anyone with a history of false positives since the cost of pursuing confirmations at every testing opportunity is not only prohibitive for a non-profit org, it also can lead to logistical issues with the milk received from the donor. This study does not follow up on the actual serological status of the subjects but, even per the most optimistic values, it is quite likely that many did not in fact have any current infections. ↩︎
Donated breastmilk is, in most situations, milk expressed and/or stored for her own child. After blood screening of donors and education on safe expressing/handling/storing techniques, the risks to milksharing are minimized. To suggest that this milk is not safe for sharing is to suggest that it is not safe for parents to feed their own babies with their expressed milk. We question this line of logic. ↩︎
World Health Organization. Unicef. 2003. Global Strategy for Infant and Young Child Feeding, bullet 10, p. 14, the WHO states: “Breastfeeding is an unequaled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development, and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.” ↩︎
Pediatric Populations: Food and Drug Administration. 2003. Pediatric Expertise for Advisory Panels. Nonbinding guidance for the use of medical devices. Although the upper age limit used to define the pediatric population varies among experts, including adolescents up to the age of 21 is consistent with the definition found in several well-known sources. The Center for Devices and Radiological Health (CDRH) believes this age range is generally appropriate for the use of medical devices in pediatric subpopulations but recognizes that there may be cases in which the pediatric population should be defined differently, depending upon the type of device.Pediatric Subpopulation Approximate Age Range Newborn Birth to 1 month of age Infant 1 month to 2 years of age Child 2 to 12 years of age Adolescent 12-21 years of age ↩︎
Claire Levenson. Archived. Mothers selling breastmilk … to men ↩︎
Eats on Feets does not support or approve of the selling of breastmilk on its network. ↩︎
See Can I receive milk from a donor whose baby is not the same age as mine? ↩︎
According to Islamic law, two babies breastfed by the same milk-providing parent automatically become Mahram (unmarriageable kin). This prevents the use of mixed donor milk from milk banks as it would be impossible to know the family status. ↩︎
See Breastmilk in a state of emergency for more information. ↩︎
Also see Risks and ethics of breastmilk substitutes. ↩︎
Ronald S. Cohen, et al. 2009. Retrospective review of serological testing of potential human milk donors . Screening tests are designed to have a relatively high incidence of false positives in order to prevent any false negatives. While false positives happen to many people, they tend to be higher in those who are pregnant or were recently pregnant. From the perspective of a milk bank that will be testing the donors on a regular basis, it makes sense to exclude anyone with a history of false positives since the cost of pursuing confirmations at every testing opportunity is not only prohibitive for a non-profit org, it also can lead to logistical issues with the milk received from the donor. This study does not follow up on the actual serological status of those screened but, even per the most optimistic values, it is quite likely that many did not in fact have any current infections. ↩︎
Screening tests are designed to have a relatively high incidence of false positives in order to prevent any false negatives. While false positives happen to many people, they can occur more often during pregnancy. From the perspective of a milk bank that will be testing the donors on a regular basis, it makes sense to exclude anyone with a history of false positives since the cost of pursuing confirmations at every testing opportunity is not only prohibitive for a non-profit org, it also can lead to logistical issues with the milk received from the donor. This study does not follow up on the actual serological status of the subjects but, even per the most optimistic values, it is quite likely that many did not in fact have any current infections. ↩︎
Donated breastmilk is, in most situations, milk expressed and/or stored for her own child. After blood screening of donors and education on safe expressing/handling/storing techniques, the risks to milksharing are minimized. To suggest that this milk is not safe for sharing is to suggest that it is not safe for parents to feed their own babies with their expressed milk. We question this line of logic. ↩︎
The Current. Archived. December 23rd, 2010. Sharing Breast Milk. [Unfortunately, the podcast itself has been lost.] ↩︎
CDC – What to Do if an Infant or Child Is Mistakenly Fed Another Woman’s Expressed Breast Milk ↩︎
The same potential infections can occur when breastmilk substitutes are used in the same setting. Please also see Risks and ethics of breastmilk substitutes. ↩︎
Dr. John May, et al. 2005. La Trobe Tables ↩︎
Claire Levenson. Archived. Mothers selling breastmilk … to men ↩︎
Donors may request recipients to provide blood and health screening(s). ↩︎
Brenda L. Tesini, MD. 2020. Neonatal Hospital-Acquired Infection. ↩︎
Barbara J. Law, et al. 1988. Is Ingestion of Milk-Associated Bacteria by Premature Infants Fed Raw Human Milk Controlled by Routine Bacteriologic Screening? ↩︎
Get Safe Online ↩︎
Help Center – Unfriending or Blocking Someone ↩︎
Claire Levenson. Archived. Mothers selling breastmilk … to men ↩︎
Legal and medical representatives are a parent(s) of the child, someone with custody, legal guardianship, or power of attorney, a foster parent, donors donating their own milk, midwives, and anyone legally allowed to prescribe medication, including the nurse practitioner. Siblings, children, grandparents, friends, aunts, sister-/brother-in-law, etcetera, are not legally nor clinically responsible parties. IBCLCs, nurses, and doulas are also not clinically responsible parties and they cannot request milk for their clients. ↩︎
World Health Organization (WHO). 2004. Guiding principles for feeding infants and young children during emergencies ↩︎
Veronica Riemer. World Health Organization. 2009. The importance of breastfeeding during emergencies. Podcast ↩︎
Julie P Smith, Alessandro Iellamo. 2020. Wet nursing and donor human milksharing in emergencies and disasters: A review ↩︎
Infact Canada – Infant Feeding in Emergencies ↩︎
American Academy of Pediatrics. 2020. Infant Feeding in Disasters and Emergencies) ↩︎
There can be vast differences in training and expertise. Not every lactation consultant is an IBCLC. IBCLCs are International Board Certified Lactation Consultants working in lactation clinics attached to hospitals and/or private practice. They are healthcare professionals who specialize in the clinical management of breastfeeding. IBCLCs are certified and regulated by the International Board of Lactation Consultants Examiners. Find/verify an IBCLC. ↩︎
WHO Guidelines for exercising feeding options ↩︎
World Health Organization. 2009. 10 Facts on Breastfeeding ↩︎
World Health Organization. 2013. 10 Facts of Breastfeeding ↩︎
Victora CG, et al. 2016. Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet ↩︎
Aimin Chen and Walter J. Rogan. 2004. Breastfeeding and the Risk of Postneonatal Death in the United States ↩︎
Coalition for Improving Maternity Care. 2009. Breastfeeding is priceless: No Substitute for Human Milk ↩︎
Alison Stuebe. 2009. The Risks of Not Breastfeeding for Mothers and Infants ↩︎
UNICEF. 2002. Facts for Life ↩︎
R.A. Lawrence. 1999. Storage of human milk and the influence of procedures on immunological components of Human milk ↩︎
Anne Eglash, et al. BREASTFEEDING MEDICINE Volume 12, Number 7, 2017. ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants The basic principles of freezing dictate that frozen foods at -18ºC (0ºF) are indefinitely safe from bacterial contamination, although enzymatic processes inherent in food could persist, with possible changes in milk quality. ↩︎
Olivia Ballard, JD, Ph.D. 2015. Human Milk Composition: Nutrients and Bioactive Factors ↩︎
Charles E. Isaacs. 2002. Human Milk Inactivates Pathogens Individually, Additively, and Synergistically ↩︎
Dr. John May, et al. 2005. La Trobe Tables ↩︎
Esperanza F. Rivera, M.D. Ricarchito B. Manera, M.D. 1989. Antimicrobial Activity of Breastmilk Against Common Pediatric Pathogens ↩︎
Barbara Noerr, RNC, MSN, CRNP. 2003. Current Controversies in the understanding of Necrotizing Enterocolitis ↩︎
What about premature babies? ↩︎
Barbara J. Law, et al. 1989. Is Ingestion of Milk-Associated Bacteria by Premature Infants Fed Raw Human Milk Controlled by Routine Bacteriologic Screening? ↩︎
Richard J. Chandler, et al. 2005. Randomized trial of donor human milk versus preterm formula as substitutes for mothers’ own milk in the feeding of extremely premature infants ↩︎
Esperanza F. Rivera, M.D. Ricarchito B. Manera, M.D. 1989. Antimicrobial Activity of Breastmilk Against Common Pediatric Pathogens ↩︎
When nursing directly from the breast is not possible, feeding with an at-the-breast system mimics the natural mechanisms of nursing and provides the same skin-to-skin contact. How do I feed the milk to my baby? ↩︎
Page, David C., DDS Your Jaws Your Life. 2003. Print p. 47 ↩︎
Andrea Abate, et al. 2020. Relationship of Breastfeeding and Malocclusion: A review of the literature ↩︎
Brian Palmer, DDS. The Importance of Breastfeeding as it Relates to Total Health ↩︎
Al-Shehri, et al. 2015. Breastmilk-Saliva Interactions Boost Innate Immunity by Regulating the Oral Microbiome in Early Infancy ↩︎
Kelsey Fehr, et al. 2020. Breastmilk Feeding Practices Are Associated with the Co-Occurrence of Bacteria in Mothers’ Milk and the Infant Gut: The Child Cohort Study ↩︎
How can I feed the milk to my baby? ↩︎
Resources for support ↩︎
Jeannette T. Crenshaw, DNP, RN, NEA-BC, IBCLC, FAAN, LCCE, FACCE 2014. Healthy Birth Practice #6: Keep Mother and Baby Together—It’s Best for Mother, Baby, and Breastfeeding ↩︎
Bernardo L. Horta, MD, Ph.D., Cesar G. Victora, MD, PhD. WHO 2017. Long-term effects of breastfeeding ↩︎
A. M. Stuebe, E. B. Schwarz. 2009. The risks and benefits of infant feeding practices for women and their children ↩︎
Elizabeth Isaacs, et al. 2010. Impact of breastmilk on IQ, brain size and white matter development ↩︎
Marcus Richards, et al. 2002. Long-term effects of breast-feeding in a national birth cohort: educational attainment and midlife cognitive function ↩︎
Bartick, M. C., Schwarz, et al. 2017. Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs ↩︎
For the US to achieve its national goals for increasing the incidence and duration of breastfeeding, the USBC identifies the below requirements:
– Continued full authorization of the WIC program with improved breastfeeding support services
– Inclusion of breastfeeding care and services in government health strategic plans
– Coordination of breastfeeding programs among government agencies
– Worksite breastfeeding protection and support incentives for employers
– Insurance coverage for lactation care and services
– Development of legislation that supports exclusive breastfeeding for the first 6 months of life, with gradual introduction of solids foods after 6 months
– Inclusion of breastfeeding language in child health acts
– Implementation of the provisions of the International Code of Marketing of Breast Milk Substitutes
– Education and support for families
– Education for health professionals
United States Breastfeeding Committee. 2002. Economic Benefits of Breastfeeding
These requirements are unfortunately still relevant after 20 years. ↩︎
Patki S, et al. 2010. Human breastmilk is a rich source of multipotent mesenchymal stem cells ↩︎
Shailaja Mane, et al. 2022. Studies of Stem Cells in Human Milk ↩︎
Seema Tripathy, et al. 2019. Potential of breastmilk in stem cell research ↩︎
Foteini Hassiotou and Peter E. Hartmann. 2014. At the Dawn of a New Discovery: The Potential of Breast Milk Stem Cells ↩︎
Lotta Gustafsson, M.Sc., et al. 2004. Treatment of Skin Papillomas with Topical a -Lactalbumin–Oleic Acid ↩︎
Catharina Svanborg, et al. 2003. HAMLET kills tumor cells by an apoptosis-like mechanism—cellular, molecular, and therapeutic aspects ↩︎
Ann-Kristin Mossberg, et al. 2007. Bladder cancers respond to intravesical instillation of HAMLET (humana-lactalbumin made lethal to tumor cells) ↩︎
HamletPharma – The History of HAMLET ↩︎
Feiruz Alamiri, et al. 2019. HAMLET, a Protein Complex from Human Milk, Has Bactericidal Activity and Enhances the Activity of Antibiotics against Pathogenic Streptococci ↩︎
See Cytomegalovirus (CMV) ↩︎
Lane Strathearn, et al. 2019. Does Breastfeeding Protect Against Substantiated Child Abuse and Neglect? A 15-Year Cohort Study ↩︎
Please also see How do I feed the milk to my baby? ↩︎
WHO/UNICEF. 2003. The Global Strategy for Infant and Young Child Feeding, bullet 18: The vast majority can and should breastfeed, just as the vast majority of infants can and should be breastfed. Only under exceptional circumstances can a baby’s own mother’s milk be considered unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative –expressed breastmilk from an infant’s own parent, breastmilk from a healthy wet nurse or a human-milk bank, or a breast-milk substitute fed with a cup, which is a safer method than a feeding bottle and teat –depends on individual circumstances. ↩︎
CDC – The Galactosemias ↩︎
Commonly referred to as the heel prick or PKU test but it is an extensive panel. Health Resources & Services Administration – Recommended Uniform Screening Panel ↩︎
The Codex Alimentarius sets guidelines on formulated complementary foods for infants 6-12 months and young children 12-36 months. Codex Alimentarius. 2017. Guidelines on Formulated Complementary Foods for Older Infants and Young Children ↩︎
WHO – Acceptable medical reasons for use of breast-milk substitutes ↩︎
WHO. 2003. Global Strategy for Infant and Young Child Feeding, bullet 19 ↩︎
Also see HIV and the global context of infant feeding ↩︎
Allison Stuebe. 2009. The Risks of Not Breastfeeding for Mothers and Infants ↩︎
Infact Canada – Risks of Formula Feeding ↩︎
Susan Orlando, RNC, MS. 1995. The Immunologic Significance of Breast Milk ↩︎
Cecily Heslett, Sherri Hedberg, Haley Rumble. 2007. Did you ever wonder what’s in… ↩︎
Marsha Walker, RN, IBCLC. 2014 Just One Bottle Won’t Hurt” –or Will it? ↩︎
WHO – The International Code of Marketing of Breast-Milk Substitutes, bullet 4.2 ↩︎
Infact Canada – Genetically Modified Organisms ↩︎
Infact Canada – Misinformation: Redefining baby feeding ↩︎
UNICEF – Formula for Disaster
This eye-opening documentary reveals how the marketing of powdered milk has caused fewer mothers to breastfeed in the Philippines – including those who can ill afford artificial milk and suffer its harmful consequences. The milk companies’ formula for profits is a formula for disaster. ↩︎
(WHO – Safe preparation, storage and handling of powdered infant formula: guidelines ↩︎
European Food Safety Authority. 2004. Microbiological risks in infant formulae and follow-on formulae ↩︎
Dr. John May, et al. 2005. La Trobe Tables ↩︎
Lawrence, Ruth. Breastfeeding, A Guide for the Medical Profession. P. 438. 2005. Print. ↩︎
CDC – Infant Formula Preparation and Storage ↩︎
Follow the FDA’s Alerts & Safety Information and Reporting Illnesses, Injuries and Problems for the latest recalls of formula. ↩︎
For more information on safe practices, sterilization, and the micro bacterial content in powdered formula see the Codex Alimentarius – CODE OF HYGIENIC PRACTICE FOR POWDERED FORMULAE FOR INFANTS AND YOUNG CHILDREN and Codex Alimentarius – STANDARD FOR INFANT FORMULA AND FORMULAS FOR SPECIAL MEDICAL PURPOSES INTENDED FOR INFANTS ↩︎
Standford Children’s Health – Necrotizing Enterocolitis in the Newborn ↩︎
Barbara Noerr. 2003. Current Controversies in the Understanding of Necrotizing Enterocolitis ↩︎
What about premature babies? ↩︎
Government of Canada – Phthalate Substance Grouping ↩︎
MA Department of Public Health – How to Protect Your Baby From BPA (Bisphenol A) ↩︎
WHO/FAO/Health Canada. 2008. Toxicological and Health Aspects of Melamine and Cyanuric Acid ↩︎
Government of Canada – Novel foods: Safety of genetically modified foods ↩︎
Karleen D. Gribble, Bernice L. Hausman. 2012. Milk sharing and formula feeding: Infant feeding risks in comparative perspective? ↩︎
World Health Organization. 2003. International Code of Marketing Breast Milk Substitutes. ↩︎

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