Artificial marketing

Pregnant women and mothers of infants are the target audience for advertisements of artificial breastfeeding replacements, also known as infant formula. Although infant formula #1 marketing is outlawed in the Netherlands, following the International WHO Code, marketing for #2 and #3 flourishes and they are more or less identical to #1 in lay-out and claims. Infant formula manufacturers claim all kinds of health profits for children that are fed their product. This kind of claiming health benefit through food is prohibited and may cause parents to make infant feeding choices based upon wrongful information. Infant formula being a health hazard rather then it offering health benefits would be a better kind of information for parents, that should be shared with them by their health care providers. Health care providers themselves, however, are still not all completely convinced that this is the matter. This may very well be caused by the fact that infant feeding research  often go from the hypothesis that infant formula is the norm, rather than formulate report titles and research-questions around the hazards of not-breastfeeding.

Stang J, Hoss K, Story M: Health Statements Made in Infant Formula Advertisements in Pregnancy and Early Parenting Magazines: A Content Analysis. ICAN 2010, 2:16-25.

Smith J, Dunstone M, Elliott-Rudder M: Health Professional Knowledge of Breastfeeding: Are the Health Risks of Infant Formula Feeding Accurately Conveyed by the Titles and Abstracts of Journal Articles? J Hum Lact August 2009 25: 350-358

Breastfeeding and diabetes

Both the initiation and maintenance of breastfeeding have been reported to be negatively affected by maternal diabetes. Breastfeeding, however, is for both mother and baby important in the prevention and treatment of diabetes. Type 1 diabetes is a chronic disease with a subclinical prodrome during which β cell autoimmunity becomes overt. According to research this may start as early as during the first year of life. Infant feeding practices play a significant role, complex proteins being a risk-adding factor, human milk a risk-lowering one. Mothers with type 2 diabetes should be advised to exclusively breastfeed each child for at least one month. According to Schwarz et al this would increase their carbohydrate metabolism. Sorkio c.s. showed in their study that is not the diabetes per se that decreases incidence and duration of breastfeeding, but the accompanying complications like a higher incidence of preterm labour and caesarean sections and the statistically lower age and education of mothers with diabetes.

Sorkio S, Cuthbertson D, Bärlund S, Reunanen A, Nucci AM, Berseth CL, Koski K, Ormisson A, Savilahti E, Uusitalo U, Ludvigsson J, Becker DJ, Dupré J, Krischer JP, Knip M, Åkerblom HK, Virtanen SM (2010): Breastfeeding patterns of mothers with type 1 diabetes: results from an infant feeding trial. Diabetes/Metabolism Research and Reviews, 26:206–211.

Knip M, Virtanen SM, Åkerblom HK: Infant feeding and the risk of type 1 diabetes Am J Clin Nutr 2010 91:1506S-1513S.

Schwarz EB, Brown JS, Creasman JM, Stuebe A, McClure CK, Van Den Eeden SK, Thom D: Lactation and Maternal Risk of Type 2 Diabetes: A Population-based Study. The American journal of medicine 2010, 123(9):863.e1-863.e6.

Breastfeeding and Multiple Sclerosis

Breastfeeding is good for babies and mothers as well. Mothers do their selves a favour by breastfeeding, and that is true for women with chronic diseases like MS as well. Langer-Gould et al (2009;2010) studied the combinations of Multiple Sclerosis and breastfeeding and vitamin D and with exclusivity of breastfeeding. They found that probably exclusive breastfeeding and concomitant suppression of menses significantly reduces the risk of postpartum relapses in MS.  In another study they found that although during pregnancy and exclusive breastfeeding in women with MS 25(OH)D levels are low, this was not associated with an increased risk of postpartum MS relapses. Earlier Haas & Homme (2007) found that breastfeeding had a positive effect on postpartum MS patients with intravenous immunoglobulin (IVIG) treatment in the 6 months postpartum.

Haas J, Hommes OR: A dose comparison study of IVIG in postpartum relapsing-remitting multiple sclerosis.  Multiple Sclerosis 2007; 13: 900-908.

Langer-Gould A, Huang SM, Gupta R; Leimpeter AD, Greenwood E; Albers KB, Van Den Eeden SP, Nelson LM: Exclusive Breastfeeding and the Risk of Postpartum Relapses in Women With Multiple Sclerosis. Arch Neurol. 2009;66(8):958-963.

Langer-Gould A, Huang S, Van Den Eeden SK, Gupta R, Leimpeter AD, Albers KB, Horst R, Hollis B, Steinman L, Nelson LM: Vitamin D, Pregnancy, Breastfeeding, and Postpartum Multiple Sclerosis Relapses.  Arch Neurol. Published online November 8, 2010.

Milksisters

Milksharing can, as with the sharing of blood, go through a structured system (milk bank analogue to blood bank), but there are also more informal ways. In The Netherlands the Mothers’ Milk Network is active since about 6 years. Basically this is database with donor and asking mothers. Donor mothers will have to do blood testing like blood donors do. The simplest way to share milk is when two women who know each other (neighbours, sisters, friends, …) nurse each other’s children or share their expressed milk. In the village the world turned into since the internet the pool in which to find a milksister is enlarged. On Facebook a grassroots movement (‘’Eats on feets’’ like ‘’Meals on Wheels’’) started en grew wide where donating and asking women can easily find each other. Shell, the woman who started the movement, advises mothers using other milk to be sure to check the source in order to prevent disease transmission.

Moedermelk Netwerk http://www.moedermelknetwerk.nl/donormelk.php

Sophia Moedermelkbank http://www.erasmusmc.nl/neonatologie/sophiamoedermelkbank/2475949/

Eats on Feets (NL) http://www.facebook.com/pages/Eats-on-Feets-Nederland/102427463158613

Donor milk

Giving and receiving blood is a well-respected custom. The donor freely gives what he has in abundance and saves a life. Safety precautions will keep risks as low as possible. Organ donations may be a bit more of a problem to some, but few will refuse a donated organ when absolutely necessary. When speaking about donor human milk more noses will be wrinkled and brows lifted, for this obviously has a higher ‘’Yucky-factor’’. But human milk can save lives as well. As food for an infant that can’t receive enough or none at all from his own mother, but also as medicine for children and adults. For premature babies a exclusively human milk based diet is safer than infant formula or human milk fortified with non-human-milk based products. The strong immunologic properties of human milk make it a powerful factor in the treatment of all kinds cancer.

Sandra Sullivan S, Richard J. Schanler RJ, et al: An Exclusively Human Milk-Based Diet Is Associated with a Lower Rate of Necrotizing Enterocolitis than a Diet of Human Milk and Bovine Milk-Based Products. The Journal of pediatrics 2010, 156(4):562-567.

Megan Doyle: Use of Human Milk as Cancer Therapy; Breast Milk Helps Reduce Cancer-Related Symptoms. Apr 27, 2009 http://www.suite101.com/content/use-of-human-milk-as-cancer-therapy-a113100

Another mom’s milk

Breastfeeding has been the preferred feeding for infants and toddlers since the dawn of mankind. The WHO stresses that each and every child should be exclusively breastfed during his first six months of life and continue to breastfeed complemented with suitable other foods till or passed his second birthday. Many people find this a hard to follow advice, because what if a mother can’t or isn’t allowed to breastfeed? The answer is simple: another mom’s milk is defined as exclusive breastfeeding as well. Throughout human history women fed ach others’ children for convenience and emergencies. In many cultures and times this even was a profession: women hired themselves, or rather their breasts, out to nurse other women’s’ children as a wet-nurse. Another woman’s milk always is better suited for a child than any animal milk be it processed or not, even if the wet-nurse’s child is of a different age than it’s milk-sibling. Breastmilk that is saf for a mom’s own child will be safe for another child as well. Mothers who cross-nurse (breastfeed each othr’s children) will additionally provide for tailor-made antibodies for both nurslings.

Thorley V. Sharing breastmilk: wet nursing, cross feeding, and milk donations. Breastfeed Rev. 2008 Mar;16(1):25-9.

Binns CW, Fraser ML, Lee AH, Scott J: Defining exclusive breastfeeding in Australia. Journal of Paediatrics and Child Health 2009, 45(4):174-180

Thorley V: Breasts for hire and shared breastfeeding: wet nursing and cross feeding in Australia, 1900-2000. Health History. 2008;10(1):88-109.

Thorley V: Mothers' experiences of sharig breastfeeding or breastmilk co-feeding in Australia 1978-2008. Breastfeed Rev. 2009 Mar;17(1):9-18.

Species specific milk

Each mammal receives milk form its own mother and that milk is species specific, tailor-made for the specific needs for growth and development for that species. In natural surroundings there is little chance to see a baby-animal consuming milk from the mother of another species. Humans don’t think something to be weird fast, so there are quite some orphaned animal babies who are happily drinking at another species mother’s teats. We even harvest tons of milk from cows to feed our own young. Milking human females to feed calves is a not so often viewed picture, although singer Pink doesn’t see that as an impossibility. Why is it then that so many people think it gross to feed a human child human milk from another mother?

http://www.youtube.com/watch?v=HcmfHZuJe0E&feature=fvst

http://www.growingyourbaby.com/2008/08/27/kate-garraway-raises-the-cross-breast-feeding-issue-again/

http://www.metro.co.uk/news/40405-pig-suckles-milk-from-cows-udders

http://eco-health.blogspot.com/2008/09/got-breast-milk-interspecies-suckling.html

http://www.stuff.co.nz/life-style/blogs/four-legs-good/3083733/When-mum-is-a-different-species

Milk production

Researchers have a growing understanding about how milk synthesis and output works and what the determinants or an adequate milk production are. Right after birth milk production is solely hormone driven. Whether or not a baby is drinking. After a day or 3 production will to convert into a demand-and-supply system where supply follows demand and frequent and functional breast stimulation is essential. This is a highly individual process, where rhythms and patterns need to be adapted to fit the possibilities and needs of mother and child as a pair. In breastfeeding counselling often a ‘’cooking book’’ technique is used, thinking breastfeeding is a one size fits all. On the one hand this may lead to an overload of milk produced, on the other hand to a significant deficit in milk volume, or, even more often, to a perceived low milk supply due to a misinterpretation to normal patterns and behaviour.

van Veldhuizen-Staas CGA: Overabundant milk supply: an alternative way to intervene by full drainage and block feeding. International Breastfeeding Journal 2007, 2:11

Christina M. Smillie CM, Suzanne Hetzel Campbel Sl, Susan Iwinski S: Hyperlactation: How Left-brained ‘Rules’ for Breastfeeding Can Wreak Havoc With a Natural Process.

Newborn and Infant Nursing Reviews 2005, 5(1):49-58

Dykes F: Western medicine and marketing: construction of an inadequate milk syndrome in lactating women. Health Care Women Int 2002; 23(5):492-502

Child’s teeth

Kay at al (2010) compared the incidence of caries in children with average or higher birth weights and lengths. They found that children who weight more and are longer at birth, but not at present, tended to show more caries at age 5. They do not explain this phenomena, but encourage further research. Breastfeeding is a well-researched factor in caries development in children. Kotlow c.s. studied breastfeed children with a tight maxillary frenum and found them to have more caries in the upper front teeth. In these children this kind of caries is thus probably not due to extended and/or night-time breastfeeding (as often suggested) but to the inability of these children to remove milk residues from between the upper lip and the mandible. Early detection and treatment of this anatomic variation is urged by the authors. Kobayashi et al assessed the incidence of cross-bite in children who did not breastfeed with those who breastfed short time (<6 months), medium long (6-12 months or extended (> 12 months). Children who never breastfed had a 15 fold chance of crossbite, as compared to children who breastfed past their first birthday. Short and medium term breastfeeders showed a 4 to 10 fold increase. In long time breastfeeders only 2 out of 100 showed crossbite, but never breastfed children had a 1 in 3 incidence.

Kay EJ, Northstone K, Ness A, Duncan K, Crean SJ. Is there a relationship between Birthweight and subsequent growth on the development of Dental Caries at 5 years of age? A cohort study. Community Dent Oral Epidemiol 2010; 38: 408–414

Kotlow LA: The Influence of the Maxillary Frenum on the Development and Pattern of Dental Caries on Anterior Teeth in Breastfeeding Infants: Prevention, Diagnosis, and Treatment. J Hum Lact August 2010 26: 304-308

Kobayashi H, Scavone H, Ferreira RI, Garib DG: Relationship between breastfeeding duration and prevalence of posterior crossbite in the deciduous dentition.

American journal of orthodontics and dentofacial 2010, 137(1):54-58

Fat in human milk

The energy value of human milk is determined by the levels of protein, sugars and fats. One gram of fat supplies just a bit more energy than one gam of lactose plus one gram of protein. The fat content in human milk is also the most changeable component. The Hartmann group in Australia (Mitoulas et al 2002)  did an intensive research on the levels of lactose, proteins and fat in human milk and they found a big differentiation in fat levels throughout the day and the total breastfeeding period (12 months) they monitored. Total energy delivered to the child per day did not differ between the breasts of individual women. Powe at al found in a rc4nt study, howeve, that mothers produce milk with a higher energy density for boys than for girls, boys rciving up to 25% more energy than girls. This might explain the faster growth of boys when compared with girls.

Van Veldhuizen-Staas CGA: Samenstelling van moedermelk: Suiker en vet. http://eurolac.net/index.php?p=122

Van Veldhuizen-Staas CGA: Vet in moedermelk: functie, waarde en bepaling. http://eurolac.net/index.php?p=126

Mitoulas LR, Kent JC, Cox DB, Owens RA,  Sherriff JL, Hartmann PE: Variation in fat, lactose and protein in human milk over 24h and throughout the first year of lactation. British Journal of Nutrition 2002, 88(01):29-37

Powe CE., Knott CD, Conklin-Brittain N: Infant sex predicts breast milk energy content. Am. J. Hum. Biol. 2010, 22(1):50-54

Nipple shields

‘’Friend or foe’’?  (Mohrbacher 2010) Nipple shields are a tools like any other tool: ‘’good’’ or ‘’bad’’ depends largely on indication and techniques than on the thing itself. Despite the overgrowth of protocols for about any medical piece of equipment, no protocols exist for the use of nipple shields in the professional literature. This lack of protocols does not prevent any of the recommendations to use nipple shields by health care professionals, including lactation consultants. (Eglash et al 2010; in a self-reporting study, so only already interested subjects answered the questionnaires, this may influence outcomes.) The majority advice nipple shields for the use in premature infants who have difficulty staying at the bare breast and transferring adequate milk. Most concerns consider the use of nipple shields by other health care providers without sufficient follow-up care. When used for good reasons and with professional instruction and follow up the newest generation of ultra-thin silicon nipple shield s are no hazard to milk production.

Eglash A, Ziemer AL, ChevalierA: Health Professionals' Attitudes and Use of Nipple Shields for Breastfeeding Women. Breastfeeding Medicine. August 2010, 5(4):147-151.

Mohrbacher N: Nipple Shield: Friend or Foe? http://www.nancymohrbacher.com/blog/2010/9/19/nipple-shield-friend-or-foe.html

Breast milk expression

Ideally every baby is fed at mom’s breast, but there are occasions that all or part of feedings need to be expressed and alternatively fed. Milk expression can be done by hand or with a hand or electric pump. What the best way is to obtain milk from the breast depends on technicalities, but also feelings as they have impact on hormone responses. The Medela sponsored Hartmann research group in Australia stresses above all the importance of suction, where others see more effect in manual expression. Ohyama et al found that especially in the early postpartum period gentle hand expression worked best. For mothers who experience this as painful they found that the use of a 2-phase electrical pump might help get a let-down reflex. Morton compared hands and machines and found that the combination of the both got the best results. The suction of the pump was supported by the pressure of the hand, which acknowledges the notion that breast emptying is a combination of positive and negative pressure. Hopkinson & Heird compared two different electric pumps and did found differences in day to day outcomes, but in the end their effect on the maintenance of lactation was comparable.

van Veldhuizen-Staas CGA (2006): Afkolven van moedermelk. http://eurolac.net/index.php?p=15

Ohyama M,  Watabe H, Hayasaka Y: Manual expression and electric breast pumping in the first 48 h after delivery. Pediatrics International (2010) 52, 39–43

Morton JA: Is use of breast pumps out of hand? • Mothers who use ‘hands-on’ technique see increase in milk production. AAP News 2009, 30(6):14

Hopkinson J, Heird W: Maternal Response to Two Electric Breast Pumps. Breastfeeding Medicine 2009, 4(1):17-23.