Your Voice: Why not use formula? Plus, thoughts on teaching testicular self-examination


Letters about iron supplementation and testicular self-exam (TSE).

Why not use formula?

I believe a better solution is for infants older than one year of age to stay on breast milk (and if other liquids are part of their diet, complemented with an iron-fortified formula) or iron-fortified formula until at least age 2 years. There is no nutritional benefit of cow milk over either formula or breast milk. In addition, iron-fortified vitamins present risks such as toxicity if overdosed, teeth staining, and harder stools (especially when combined with cow milk). Also, the need for vitamin and/or mineral supplementation is avoided when formulas are used. Both breast milk and formula provide far better nutrition, a better calcium/phosphorus ratio, lower solute load, and the presence of multiple important vitamins and minerals. The use of formula also provides some nutritional insurance for children this age that are picky eaters. The only advantage of cow milk over formula is cost. Formula supplementation/complementation is a preferrable way to ensure nutrition and optimal iron status.


I wish to thank Dr. Alan Joffe for his thoughtful review of my 1985 article on teaching testicular self-examination (TSE).1 In addition to his points, I would like to make two more.

First, my work spawned some immediate efforts to improve teaching of TSE through media2 or more importantly in schools,3 since preventive medicine cannot be laid only in the lap of health care practitioners.

Second, single health education messages are not very effective. We must teach all possible moments and by all possible media - radio, television, magazines, newspapers, and on the Internet and in schools - as well as in our offices. Only repetition enhances and, over time, assures learning.

Thus, while there is still considerable interest in teaching of TSE by health care practitioners (in Europe and the South Pacific more than in the US), I believe we all have to coodinate our teaching about preventive health care with media and community organizations.

Our Academy, and academics like me, continue to pile on to practitioners more and more counseling messages from encouraging breastfeeding to preventing violence. All well and good - but not really practical, since our poor young patients and their parents can probably hear and process at most two or three of these counseling messages in a visit! So if we really want to do preventive medicine and anticipatory guidance, we need to keep hitching up our wagons and moving out into an ever smaller and more connected world, to see that our messages are "out there" where they can be seen again and again in different contexts. Only then do we have a real hope of changing health-related behaviors, and having those behaviors become the social norm.

San Diego, CA


1. Joffe A: Then and Now: Should we teach testicular self-exam? Contemp Pediatr 2009;26(8):33

2. Vaz RM, Best DL, Davis SW: Testicular cancer: Adolescent knowledge and attitudes. J Adolesc Health Care 1988;6:474

3. Klein JF, Berry CC, Felice ME. The development of a testicular self-examination instructional booklet for adolescents. J Adolesc Health Care 1990;3:235

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