Bottle-feeding is a dangerous and often lethal practice in countries with low levels of income, poor environmental sanitation, and limited parental education. This encompasses the majority of populations in developing countries and includes some disadvantaged communities in more affluent countries, such as the United States, eg, Indian reservations and inner-city ghettos.
In addition to marasmus from over-dilution of prohibitively expensive formulas, diarrheal disease principally due to enteral infection is the main killer of bottle-fed babies. This is partly the result of the absence of the active protective effects of breast milk. It also stems from the difficulty, or indeed impossibility, of keeping liquid feeds, eg, formula or animal milk, from becoming a contaminated culture medium, and from the high probability of feeding utensils acquiring bacterial contaminants.
Bacteriologic studies of feeding utensils, such as the study by Elegbe et al in this issue of the Journal (see page 672) clearly