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Jerome L. Sullivan, MD, PhD

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Kramer et al¹ present evidence that breastfeeding improves children's cognitive development. They discuss 2 classes of explanation for their findings, noting that the superior cognitive development of breastfed children may be due either "to some constituent of breast milk" that promotes improved development or "to the physical and social interactions inherent in breastfeeding."^1(p582)

There is a third class of possible explanations not addressed in the discussion. Some property of infant formula may diminish developmental potential. This alternative explanation raises the possibility that breastfed children represent a normal reference population and that formula-fed children are harmed in some way in comparison with the breastfed group. The findings appear equally compatible with either an improved outcome from breastfeeding or, alternatively, a deficit conferred by some property of infant formula.

One candidate mechanism of harm in formula-fed infants is iron-mediated subclinical brain injury. Formula may increase infant exposure . . . [Full Text of this Article]

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