Microplastics, Bottle Feeding and the Environment.
I've been asked my view point about the following article posted in the Guardian, and I've decided to post these thoughts to a wider audience to open up discussions.
I think it's pertinent to note that the article is not trying to add to the burden of new parents, nor is there any blame. It is simply an observation that they came across and, when they did, they decided to measure the impact.
However, I acknowledge that there are many parents who will experience huge amounts of discomfort with this information, so it's worth exploring these issues in more detail. With any dilemma like this, I tend to go for an approach of informed decision making, utilising a tool like BRAIN.
Historically there’s been an acknowledgement of the environmental impact of the use of bottles, with the number needed, how often they have to be replaced, and the impacts of single use bottles in hospital settings (noted in the BMJ here) all being contributing factors. Any exclusively bottle feeding parents may need at least 4 bottles per 24 hours in the early days when babies are exclusively milk fed, and most manufacturers recommend that teats should be replaced every 2-3 months. Add in sterilising equipment and bottle brushes, and that's potentially a lot of waste being produced from the final product themselves, as well as the manufacturing and marketing process. Most bottles, if they are made from polypropylene (PP), can be recycled, however, so this does potentially reduce the end impact of waste.
When it comes to formula feeding, there’s more plastic in the way the formula is produced, and both water and fuel is used throughout the manufacturing process. The effect of formula on the environment has already been commented on by Dr Natalie Shenker and colleagues (see editorial in the BMJ here).
Going back to the microplastics, it's whether we consider this an environmental issue, or whether there is genuine concern about how this consumption might interact with an infant's gut.
What we don't know from the article is whether swallowing the microplastics causes harm. It’s suggested that they just pass through, although nobody has measured any baby poop yet to test this!
Evidence suggests that newborn babies have higher levels of gut permeability, which means that larger molecules are able to pass through the gut wall to the rest of the body. This is particularly pertinent to preterm babies (see relevant study here). There is also is a small body of evidence that suggests this effect lasts longer if babies are formula fed. The concern, with this in mind, is whether microplastics interact with the body in this way.
Although, I wouldn't like to extrapolate any bold assertions from this theory: Just because something sounds like it could be true doesn't necessarily mean that it is. It does mean, however, that we need to get some more robust answers around this given the proportion of people that bottle feed, at least partially, in the UK alone. We need to understand whether the age of the bottles makes any difference, whether wear and tear on equipment impacts on the microplastics in the milk, and also how much passes through the infant gut, and whether any is taken into the body, and what, if any, effect this may have.
Whether they may be interacting with the human body or passing through and building up in the environment around us, there have been concerns raised (see articles here & here), so parents need to be offered ways to reduce this impact one way or another if it concerns them.
It seems unlikely that we’ll be able to completely eradicate the consumption of microplastics in many cases (unless exclusively breastfeeding), but it’s worth having a look at each contact point with plastic and work out how it’s reasonable for you to reduce it if you have concerns - bearing in mind that it’s often heat that creates a higher transfer of microplastics into the milk, as discussed by the article.
Glass or stainless steel bottles would minimise the impact, and I would be conscious about how milk is stored, and reheated, in particular. Are parents using plastic storage bags for breastmilk, and what alternatives are available? Are they heating milk up in a plastic container, and is there another option? Is the milk in the bottle warm enough to transfer plastics into it, and can it be cooled further before being in contact with plastic? How are we sterilising the equipment, and are there other viable options? These are all questions that we need to ask ourselves and potentially find a solution around, and it's not about making the solution unattainable, but understanding if there's possibly even one small change that we can make as individuals.
The study mentions that formula made from water boiled in a plastic kettle produces much higher levels of microplastics, so considering how infant formula is prepared (can water be boiled in a pan instead?) may also be a factor that parents want to consider if they are not breastfeeding or using breastmilk.
If mothers are expressing, hand expressing could be considered to minimise the contact with equipment, and rather than using bottles, cups could be a plausible alternative and remove the need for bottles altogether.
Given the wide range of areas that plastics can potentially interact, it then needs to be considered how much is reasonable for parents to adapt their current set up, and what is available to them on the market. Undoubtedly, any changes will have a positive environmental impact, but the question remains for parents, rightly or wrongly, whether the plastics will affect their baby, and this will be the biggest driver in decision making.
Given that we don't bat an eyelid about how much plastic is in our cup of tea (arguably these are the "extra" plastics found when making formula from water from a plastic kettle), it puts into perspective how long these unknowns have been in all of our lives. But maybe we should be concerned, at least for the environment, and it poses a question for all the microwave meals and food that is bulk cooked and stored in Tupperware in my home!
I don't have a solution to the problem, but I do think the study has raised some important questions that parents will want answers to.