Breastfeeding Is a Dynamic Biological Process—Not Simply a Meal at the Breast

S ometimes, even the most obvious facts need to be reiterated.An infant suckling at his or her mother's breast is not simply receiving a meal, but is intensely engaged in a dynamic, bidirectional, biological dialogue.It is a process in which physical, biochemical, hormonal, and psychosocial exchange takes place, designed for the transfer of much needed nutrients, as well as for building a lasting psychosocial bond between the mother and her infant.Among mammals, breastfeeding has evolved over millions of years as a multitiered interaction to meet the biological and psychosocial needs of the progeny, enhancing its well-being and survival chances, as well as complementing the nurturing role of the mother.Thus, this unique, dynamic process benefits both the mother and her infant. 1Breastfeeding needs to be considered quintessentially as a continuation of the more intense, intrauterine dialogue, mediated through the placenta and the umbilical cord between the mother and her fetus.Whether feeding at the breast is complementary to the nutritional value of human milk, which might explain the diverse range of benefits to the mother and her infant, 1 remains to be studied.Perhaps, innovative methods from different scientific disciplines, such as behavioral, cognitive, and developmental neurosciences, and social anthropology may be useful to study this unexplored territory.In this commentary, a brief overview is presented concerning the possible link between the process of breastfeeding and neurocognitive outcomes.3][4][5][6][7] The reasons for the controversy include methodological limitations in breastfeeding research, inability to adjust for unmeasured confounders (residual confounding), and the possibility that women who can, and choose to, breastfeed may be inherently different from those who cannot, or choose not to, breastfeed their infants. 4On the other hand, some scientists contend that breastfeeding should be considered the social norm, and lower cognitive scores in infants fed formula should be considered abnormal. 7Sullivan 7 asked, ''Is it possible that some property in the infant formula may not be conducive to full cognitive development?''It is an interesting question that needs to be elucidated in future studies.