Contagious

Photo: Miranda Kerr breastfeeding baby Flynn during a break at Victoria’s Secret photo-shoot.
Behaviour is contagious. Good behaviour and bad behaviour alike. Most people probably feel better when imitating behaviour of people they like to identify with or of people in groups they would want to belong to. That is a reason why breastfeeding promoters (also known as lactivists) like to show celebreties breastfeeding their offspring. Which woman would not like to be as beautifull as Miranda Kerr or as heroic as Lucy Lawless or have such a cuty as husband as Mrs Depp<>. Less desirable behavior is contagious as well and marketers happily use that fact. Junkfood, fastfood, sweets, infant formula, and the like are all savored by cheerful, healthy and happy looking people from the producers of the products. But most contagious of course are diseases caused by all kinds of bugs. Depending on the route of infection the risk to get it is more or less high. One of the most difficult routes of infection is breastfeeding. Because, although some bugs may enter mom’s milk, the protection comes right with it. In the majority of cases that protection suffices. A recent studie by Zhongjie Shi et al (2011) on the internet information about LYme’s disease and breastfeeding showed a stunning high rate of wrong advise to quit breastfeeding. In fact a well-treated mother with diagnosed Lyme’s disease can happily continue breastfeeding. According to a somewhat less recent study by Cooper c.s. (2004) the same is true for hepatitis B.
To finish with a lighter tone: Victoria’s Secret, where the beautiful Miranda Kerr nursed her son in between photo shooting, and where the female body is cherished,  has gotten some bad press as well, when employees directed breastfeeding moms to the staff toilets. Apparently, the home-brand nursing bras can be fitted, but not tested in the fitting rooms.
Zhongjie Shi; Yuebo Yang; Hao Wang; Lin Ma; Ann Schreiber; Xiaomao Li; Wenjing Sun; Xuan Zhao; Xu Yang; Liran Zhang; Wenli Lu; Jin Teng; Yufang An: Breastfeeding of Newborns by Mothers Carrying Hepatitis B Virus: A Meta-analysis and Systematic Review
Arch Pediatr Adolesc Med. 2011;0(2011):archpediatrics.2011.72.
Cooper JD, MD, Henry M. Feder HM Jr.: Inaccurate Information About Lyme Disease on the Internet. Pediatr Infect Dis J 2004;23: 1105–1108)
Nicole Weaver: Breastfeeding Moms Blast Victoria's Secret in Nationwide Protests.  Daily News Central 03 July, 2006  http://health.dailynewscentral.com/content/view/0002331/52/

For crying out loud

Photo: Meat Loaf, performer of For crying out loud"
Babies cry. Inevitably. Universally. But how and how long is certainly not universal and the notion of non-baby people about baby crying most absolutely is not universal . In industrialized societies we want to know why? for everything, and preferably a scientific why (La Haye et al, 2011, in process). And which factors contribute and if those factors are scientifically significant and clinically relevant. And if all crying is alike and if every cry needs the same reaction, and then how, and when, and by whom and for how long. And from which duration on and for which age-span it is or is not a problem. And for who is it a problem. And what can be the consequences and are those consequences scientifically significant and clinically relevant. In other societies, say the Mongolian nomads (Kamnitzer, 2011), babies cry as well. If so, mom picks him up, or someone else picks him up and brings him to mom, baby latches on to the breast. Silence. No questions. No research. No science, significance nor relevance. We could learn a lesson from that. We should do some research on it.
Kamnitzer R: Breastfeeding in the Land of Genghis Khan. InCulturalParent, 2011. http://www.incultureparent.com/2011/02/breastfeeding-land-genghis-khan
La Haye W, Engelberts AC, Tiemens IKF et al (redactie): Concept Multidisciplinaire Richtlijn juni 2011: Preventie, signalering, diagnostiek en behandeling van excessief huilen bij baby’s. http://ajn.artsennet.nl/Artikel/Concept-richtlijn-excessief-huilen.htm

Soul to the devil

Photo: Meryl Streep as Miranda Priestley in The devil wears Prada 

The city council of Amsterdam sold its soul to the devil, a devil dressed up as a wolf in sheepskin. But even if the sheepskin is designed by Prada, the devil stays his evil old self. In their attempts to make healthier citizens, Amsterdam allied with Nestlé in healthy eating habits keeps slim campaign. They might as well hire Philip Morris for an clean lungs campaign.  The principle of the Amsterdam campaign of course is great, and yes, of course it will cost more money than the city can provide for. But to choose a sponsor whose most important products are (potential) fatteners? Nestlé’s bosses are laughing their butts of in their fancy offices. Healthy eating habits start right after birth: WHO, based on stacks and stacks of scientific literature, advises to breastfeed every child exclusively from birth up to six months of age and to breastfeed alongside suitable other foods up to or past the second birthday. In the illustration of these ‘’suitable’’ other foods, no broadly and fervently advertised Nestlé products are listed. Even more, based on the International Code for the marketing of breastfeeding substitutes a company like Nestlé isn’t even allowed to be involved at advising parents of young children on child feeding. Nestlé is one of the major players in the breastfeeding-substitutes market. No-breastfeeding is the first factor adding to overweight in children and adults. That doesn’t bother Nestlé, of course, because they’ll have slimming food products ready for then, and food products for lowering high cholesterols and diabetes specialty foods ready. Thus, Nestlé, as all infant formula producers, creates and entertains its own market from cradle to grave. It kind of reminds me to my childhood dentist who’d give out those delicious, sweet (no no-sugar back then), pink, huge Bazooka bubblegums when his child-customers had been good. Customer relations, even back then. And Amsterdam is happily going with it.
http://www.amsterdamcentraal.nl/archief/2011/7/5/borstvoeding-beter-dan-nestl
World Health Organization & UNICEF: Global strategy for infant and young child feeding. 2008. download: http://www.who.int/child_adolescent_health/documents/9241562218/en/index.html
The international code of marketing of breast-milk substitutes; Frequently asked questions; Uodated version 2008

Changeling

Photo Angelina Jolie as mother of a changeling in Changeling
In folk literature the changeling is a common figure. In most tales it concerns a newborn baby robbed from his crib, with dark intentions, by an elf or goblin and replaced by a child of the robber’s race. In more recent literature and movies changelings can be older and are mostly human (like in the movie Changeling with Angelina Jolie) or near-human (like in the novel Changeling by Morgan Gallagher) In all cases no good is intended. In modern real life cases of changelings it is presumed there was no harm intended, but people made mistakes, were clueless or just plain inattentive. It’s all about hospital-born infants who were taken away from their mothers for medical exams and nursing care and returned to another mother afterwards. The fuss the last changelings case in an Australian hospital created in the media, is a good example of how many people share this kind of happenings among the worst they can imagine. (As an aside: for many people the fact that the babies were breastfed by the wrong mothers was even worse than the fact of changing itself!)
The shock for parents is, of course, immense. Personally I think that for a mother the pure fact that she doesn’t recognize a strangers child as not being her own is the most shocking. Isn’t a mother supposed to be able to blindly recognize her own child? yes, she is, in fact quite literary so. Mothers and their newborn children recognizes each other by smell and discriminate between similar but alien smells. Prerequisite is that mother and child are kept together, undisturbed for quite a while after birth, in order to get to know each other; to imprint on each other’s smells, tastes and features. To keep mother and child undisturbed together after birth has a lot of other positive consequences. Infant skin-to-skin on mom’s chest have more stable temperatures, don’t lose energy on stressing out and have better glucose levels as a result, they search and find and latch onto the breast well and lose less weight. Both mother and child have higher levels of prolactin and oxytocin, which do not only aid breastfeeding, but will help knitting a close mother-child attachment, an overall better well-being and the recovery from respectively giving birth and being born. Mothers and infants who stay together don’t get mixed up by inattentive caretakers, for what isn’t gone doesn’t need bringing back.

Divide et impera

Photo: Philoppos II of Macedonia, father to Alexander the Great

Divide and conquer is a motto presumed to originate from the warlord Phillip II of Macedonia. It is a warfare technique that can be used politically in order to set 2 concurring entities against each other in order to prevent them from attacking a third party together. In the infant food world it is used to set mothers up against each other, those who choose mothers milk or powdered milk. All in all a rather negative notion, that divide and conquer thing. But, on the other hand, dividing and, because of it, conquer problems can be positive as well. Some kids can seeming to attach well to the breast and seem to suckle well, but still hurt mom’s nipples and get insufficient milk. At closer look it may be that their tongues do not function as planned because it is too tightly tied to the bottom of the mouth, or the tie is too thick or connected too far to the tip of the tongue. In other words: the bond between tongue and mouth bottom is a too tightly knitted one. Dividing tongue and mouth-bottom into two separate entities can make the child being lord and master of his own drinking technique: mom’s pain disappears and baby gets all the milk he needs. Even in the longer run dividing tongue and mouth-bottom will turn out profitable. Children with tongue ties can have problems learning certain language-sounds, can have breathing difficulties (especially during sleep) and develop very rummaged-looking sets of teeth. And later on licking ice cream cones can be hard or impossible and the same for kissing the lover. A bit of divide and conquer could come in handy in the medical world considering the clipping of tied tongues. In medical circles is seems to be a trend close ranks on the statement  to not do frenulotomies; a trend which may seem to go alongside the trend to not bother to look for the most adequate measures in treating breastfeeding problems, but to hang out with the old wife’s telltales, or the trend to view breastfeeding as not quite interesting nor important. Just imagine that it would be a necessity to have an internet source for hcp’s willing to treat warts as there is for those who will clip tongue ties. (Dutch main breastfeeding site offers a list with Dutch and one with Flemish hcp’s to do frenulotomy.) http://www.borstvoeding.com/zoekdskndgn/tongriempje-nl/nederland.html
http://www.borstvoeding.com/zoekdskndgn/tongriempje-b/belgie.html There are, however researchers who do dive into the pool of what is to know about ankyloglossia and breastfeeding and come up with fine studies. Geddes et al (2008) publishes about a study in which they made visible what is going on inside the mouth of a nursing infant with a untreated or treated tongue tie. Clipping significantly increased adequacy of suckling and milk transfer. Buryk c.s. (2011)carried out a single-blinded randomized trial and found that frenulotomy significantly increased the quality of breastfeeding performance.
Geddes DT, Langton DB, Gollow I, Jacobs LA, Hartmann PE, Simmer K: Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics. 2008 Jul;122(1):e188-94. Epub 2008 Jun 23.
Buryk M, Bloom D, Shope T: Efficacy of Neonatal Release of Ankyloglossia: A Randomized Trial. Pediatrics 2011; peds.2011-0077

Minding my own business

Photo: Shirley Henderson as Moaning Myrtle: "Don't ask me, here I am minding my own business and someone decides to throw something at me." Moaning Myrtle in: Harry Potter and the Chamber of Secrets.
Are you being happily minding your own business, someone sure will find it a necessity to break in to your personal space and throw in a request for attention for his business. especially mothers are quite used to this phenomenon, because the idea seems to exist that everyone has to mind to the business of raising other people’s children. Sometimes to ‘’help them raise the kids’’, sometimes because it is financial profitable to have moms listen to them. Unsolicited advice from family, friends and the neighbor can easily been put aside with a ‘’Please, mind your own business’’. Advice from health care providers should, but not always is, accurate, and they can be advised to better mind their own business until that is up-to-date. The combination of conflicting advices from relatives and professionals results in internal conflicts in mothers about when to start weaning (Arden, 2010). Unsolicited and undermining advice by those who earn money from it is tricky. Advising them to not bother you when you mind your own business  and to go mind their own business isn’t going to work: manufacturers of infant formula and baby and toddler foods actually make it their business to provide mothers with ‘’information’’ on their ‘’fabulous and indispensable’’ stuff, aiming at selling more and more and then some of it. Manufacturers who mind their own business do exactly that: their business, their wallets and those of the shareholders have their primal, most important and all overlooking attention. All else, like mother who mind their own business and the health and wellbeing of the children whose stomachs they’d like to fill, are totally secondary and inferior to that. And so the public is bombarded with marketing, sly information via HCP’s (who should really know better if they their own business minded to better) and indoctrination through all available media. The bombarding sometimes may resemble real bombing in the outcomes with casualties in the sense of injuries and even, in some cases, death. In formula and packaged baby and toddler foods often ‘’product-strange objects’’ (VWA, 2009) can be found (animal-originated yucky stuff, metal or plastic particles, glass splinters, wood, …). The safe chice for mothers thus is to rely on home-made to feed their children starting with breastfeeding an up to cooked from scratch meals. Pure, food, good food: that’s a lot of own business to mind for a mom.
Some examples of infant and toddler food recalls:
Similac Banana meal with glass (2011)
Similac formula with bugs (2010)
Presidents Choice Organics Pear Juice with arsenic (2008)
Similac Advance with pieces of black plastic (2005)
Melamine in Chinese formula (2008)
Olvarit baby food jars with glass (2002)
Voedsel en Warenautoriteit: Productvreemde delen in voedsel. Kennisbank Voedselveiligheid VWA, 2009.
Arden MA: Conflicting influences on UK mothers' decisions to introduce solid foods to their infants. Maternal & Child Nutrition, 2010, 6(2):159-173.

Double diagnosis

(Photo: Hugh Laurie as Dr. House, the maniac-genius doctor specialized in diagnostic medicine in the TV series with the same name)
To diagnose is being a detective. It’s a search for evidence, means and possibilities. As a true Sherlock the diagnostician (is that even an English word?) has to combine and deduce in order to find answers. Lactation Consultants get their share, too. Some lactational diagnoses are easily made, other are more tricky. It can make a lactation consultant feel like being  Dr. House in the art of shoving, puzzling and combining all important, lesser, coinciding, forgotten and later added factors and symptoms. Take, for example, the mother reporting painful feeding, a white nipple and pain after feeding as well. The combining an deducing lactation consultant will want to know what pain, where, exactly when, how long? And white: what kind of white, where: in or on, always or receding or changing? Often ‘’pain and white nipple’’ is promptly diagnosed as thrush; followed by a fungus-treatment, which often gives no to little result. The next diagnosis often is not ‘’probably it wasn’t thrush at all’’, but ‘’we probably didn’t get the treatment well’’ and a new treatment is started or the current one intensified and prolonged. But it might as well not have been thrush in the first place, but Raynaud’s phenomenon. That, too, is extremely painful during and for some time after feeding. The nipple turns white as well, but this is not a plague, but a discoloration, due to interruption in the blood flow. Still, it is not that strange that thrush is more thought of than Raynaud’s. After all, Candida Albicans is found in the oral cavity of one third of all breastfed babies (and in two thirds of all formula fed babies!) and on the nipple and areolae of one third of all lactating and a bit over one sixth of all non-lactating mothers (Zolner 2003). despite the common occurrence of thrush in the nursing couple little recent literature is to be found on its treatment. Many physicians ridicule thrush in mothers and children: ‘’it’s not serious and will get by on itself, anyway’’. BY doing so they totally ignore the pain it can cause both mother and child and the increased risk of premature weaning as a result. Hanna and Cruz (2011) strongly advice HCPs to be more alert on thrush symptoms and to treat adequately, however difficult this may prove to be. Raynaud’s is well-known as phenomenon in hand and feet, lesser so in the breasts of nursing mothers. Treatment is complicated, probably because the causes are relatively unknown, but probably divers (Anderson et al, 2004). Sometimes antihypertensives are used, with very little effect. Other options used are nutritional supplements of vitamin B6, magnesium and calcium, and, recently heard, omega 3 and 6. Pinching of the nipples (by bad sucking habits or anomalies in the mouth), temperature changes and cold are some of the triggers for Raynaud’s and should therefore be prohibited.  It is an ongoing trial and error mission, so: lactation consultants try and be a Sherlock Holmes meets Dr. House.
Zöllner MS, Jorge AO. Candida spp occurrence in oral cavities of breast-feeding infants and in their mothers' mouths and breasts. Pesqui Odontol Bras. 2003 Apr–Jun;17(2):151–5.
Louisa Hanna, MD and Stacie A Cruz, MD: Candida Mastitis: A Case Report. Perm J. 2011; 15(1):62–64.
Anderson JE, Held N, Wright K.: Raynaud's phenomenon of the nipple: a treatable cause of painful breastfeeding. Pediatrics. 2004;113(4):e360-4.

The Voldemort effect

(Photo: Ralph Fiennes as Lord Voldemort, aka ‘He Who Shall Not Be Named)

‘’The scientific world is that part of human society that has as sharply defined goal to systematically gather knowledge. Science has an own character, which are shown in her methods and convetions. The thus developed scientific knowledge forms a specific reconstruction of a part of reality and is built with the aid of certain scientific methods. […] Science is the organized knowledge of reality. Her ideal is objectivity and universal validity. An ongoing intention to test opinions and hypotheses onto science.’’ (Wikipedia, Dutch) In the scientific world the use of Wikipedia as source is deemed a unscientific way of working. The scientific world, of course, is a real different world, with own laws and rules and, contradiction in terminis, only those who embrace the principle may ignore them. Especially two principles apply to this: objectivity and starting from the norm. A scientist who is going to study anything will start from the norm and from there does some experimenting, adds interventions or influences. the study outcomes are qualitative or quantitative positives or negatives compared to the norm, the normative basis, the null-value. In some scientific niches, for reasons not scientifically researched yet, but may very well have working hypotheses in the ‘’follow the money’’-range, it seems to be rather systematical to not be based on the norm. One of those niches is infant feeding. Based upon medical-scientific, anthropological-scientific and biological-scientific the norm in infant feeding ought to be breastfeeding. Study questions to be answered could have forms like ‘’What is the influence of {breastfeeding substitute} on the normal development of children?’’. Smith & Elliott-Rudde describe a phenomenon that they named the Voldemort Effect. The ‘’F-word’’ (not the one-syllable one) is as ‘He Who Shall Not Be Named’ as the devilish wizard in the popular book and film series Harry Potter. The majority of infant feeding research does not start with breastfeeding as norm and they rarely name the substitute, which they do take as the norm, as an exposure increasing health risk in publication titles or abstracts.
http://nl.wikipedia.org/wiki/Wetenschap
Smith JP, Dunstone MD, Elliott-Rudder ME:  ‘Voldemort’ and health professional knowledge of breastfeeding – do journal titles and abstracts accurately convey findings on differential health outcomes for formula fed infants? ACERH Working Paper Number 4, 2008

With a little help from some friends

There you are: made all the right choices and stated off breastfeeding, cheered for it and encouraged by every-one, especially your HCP’s, and here you find yourself: crying baby, crying mother, cracked nipples and hurting breasts. Now where is that rosy picture of a happy mother with an all cream ‘n roses (cream ‘n chocolate if that's your variety) baby sitting on a pink cloud? And where are those cheering HCP’s? Is help underway? Many moms experience a tremendous pressure to breastfeed (you do want the best for your little one, now, don’t you!) , but feel abandoned, even betrayed, when it gets to putting advise into practice. They feel that they’d better not expect much from their HCP’s in terms of breastfeeding counseling: hardly correct to bad advices, not working tips and prescriptions and often the advice to top up with a bottle or completely wean to formula feeding. Moms would probably be better of wit help from other moms. Chapman et al studied and analyzed a bunch of studies on peer counseling and found that peer counselor help leads to more breastfeeding moms, more babies breastfeeding, and for longer and more exclusively, and even babies having less gut-infections. So count on your friends, especially friends who’ve ‘’been there, done that’’.  Friends help to reach your personal goals. And when breastfeeding is going well and you enjoy nursing your little one outdoors, don’t let anyone dare sending you to the bathroom: gather your friends and support each other.
Chapman DJ, Morel K, Anderson AK, Damio G, Pérez-Escamilla R: Review: Breastfeeding Peer Counseling: From Efficacy Through Scale-Up. J Hum Lact August 2010 26: 314-326, doi:10.1177/0890334410369481
The Milk Truck http://www.kickstarter.com/projects/jillmiller/the-milk-truck
The Beatles: with a little help from my friends; http://youtu.be/i24mkN0ybZ8

Smoke signals

(Picture: Terrence Hill as Lucky Luke, the cowboy ‘’who shoots faster than his shadow’’ and who, pressured by the WHO, weaned himself from his ‘’glued to the lips’’ cigarette to a straw.)
Despite the fact that ‘’every one’’ knows by now that smoking is a bad habit, and much more so for the growing children of pregnant women and for babies, many women keep on smoking while pregnant or they return to the old habit after the birth of their child. Smoking during pregnancy exposes a child to more serious dangers then smoking after birth. Co-smoking is more dangerous for a child, as it appears up till now, then to breastfeed when mom is a smoker. Especially for children who grow up in a less fortunate socio-economic situation (SES) experience the negative effects of smoking parents. Mothers in lower SESs are less likely to choose to breastfeed and smoking as an added factor in the choice to breastfeed. Smoking moms better choose to breastfeed for as long as they can, in order to compensate for the smoking risks and for the risk attached to not breastfeeding. Campaigns to quit smoking, especially during pregnancy and when living with young children, are worth continuing. But to have a safety net for those who cannot make that step (yet) strong encouragement to breastfeed is a necessity, too.

Mother Power or Powdered Formula?

In several previous blogs I mentioned the normalcy of breastfeeding. Breastfeeding is not the best, is has no benefits, is not special nor magical. Breastfeeding just is, is the norm. The substitutes – heavily marketed by their producers who need to keep their wallets and those of their shareholders healthy – are getting better and better, but come no way near the norm. Not being breastfed exposes babies to a diversity of risks. Those risk can be divided into several categories. The categories include bacterial contamination in the container (e.g. powder), during preparation, from inadequate cleaning of the feeding device, and during storage after opening the container; chemical leaching from containers and feeding devices; mechanical challenges like aspiration from feeding device, inadequate skin to skin contact, overeating due to inappropriate flow; immunological suppression by changes in gut lining and insufficient dosages of antibodies; nutritional inadequacies including missing nutrients (the many known and yet unknown components of human milk), imbalances in nutrients (fatty acids, types of sugards, etc), and malabsorption of nutrients (necessitating higher amount of iron and vitamin D to compensate).

Newsflash becomes *flash

More than half a year I wrote a Newsflash nearly every office day.  Scientific news en combinations of studies as basis for a daily serving of breastfeeding science. But I’ve noticed that I’ve kind of had it with science: bit by bit instead of scientific news my writings conversed into little articles with an opinion. What is my problem with science? Don’t I want to practice evidence based? To have evidence based breastfeeding support and advice? Well, yes, I guess, but above all I want breastfeeding support to be given by engaged and compassionate health care persons who use their own logical thinking skills and who care for the well-being of their clients. And even more I do not want to keep on defending and proving breastfeeding. Breastfeeding is. Period. Just let the alternatives and interventions prove themselves; just prove to me that the alternatives and interventions are safe, effective and necessary. To introduce and illustrate the new course of the Flashes two short entries from my blog Lactavision.
‘’Breastfeeding - an inborn ability for nearly every woman, but a skill to be learned. Our modern society is very skilled in blocking natural abilities and preventing them from becoming skills. Instinct, reflexes, trust in the own body - all disposed of or put away in a little corner called ''alternative-strange-possibly dangerous''. Breastfeeding: an inborn ability – a cultuarally disgarded skill.’’
‘’ OK, I admit: I’m a huge Twilight fan. Twilight could be described as a romantic-horror genre. Horror, because it is all about vampires, werewolves, but above that, it is about love, unconditional love. The lover that makes you go through fire, makes you sacrifice yourself for the other’s well-being. And about compassion, love for your fellow-humans. In these books and the movies this compassion is personified by a vampire (Dr Carlisle Cullen), who trained himself to be able to stand the smell of blood in order to be able to help people as a physician. He puts himself above his intrinsic impulses and instinct to be good and do good. This is the kind of compassion I would so love to see in more health care providers: the care for your patients/clients without the prevalence of your own agenda. The bloodlust some HCP’s may have to overcome could be own previous experiences, learned concepts or whispered-in concepts from third parties with even more pushing agenda’s.’’

Many health care people are around who, in my not very humble opinion, could use some of the actor Peter Facinelli’s skills to switch from the egotripping, brawling prat dr. Fitch Cooper (Nurse Jackie) into the empathic, compassionate dr Carlisle Cullen (Twilight Saga).

Setting priorities

Life is risky. A riskless life is impossible, but we can try to decrease risks as far as possible. Especially when the lives and health of children are at stake. That’s why international organizations like WHO and Unicef and governments perform broad and sometimes harsh campaigns to persuade parents to make healthy and safe choices for their children. Worldwide campaigns for all kinds of vaccinations are widespread. National governments in many countries have quite fervent campaigns against child obesity and SIDS. In The Netherlands gynecologists and midwifes have a more or less civilized, but hard war on the question whose fault it is that in the Netherlands the numbers for perinatal child mortality are relatively high. The anti SIDS campaigns targeting supposedly SIDS inducing behavior is at the verge of being unethical in the pressure on parents to take unpractical measures. These campaigns all but say that co-bedding parents are child murderers. It is strange that other risks and risky behavior gets way less attention. Stacey et al reported in BMJ their study that showed that women who sleep on their backs or right side during the last pregnancy trimester have a strongly heightened chance of delivering a lifeless child. Commentaries point out that where more children die in utero in the last trimester than die of SIDS, hardly any efforts are made to decrease those numbers. Durmuş et al published recently as part of the generation R studies about the risks of smoking during pregnancy: not only risky behavior for mom’s own health, but also increasing baby’s chances of being born underweight, but increasing the chance of ending up obese later on in childhood. Parents who smoke during and after pregnancy increase the SIDS risks for their offspring, as does not breastfeeding as shown clearly in Hauck et al’s meta-analysis earlier this week. Risk management is a great good, but should be done well and efficiently. To scare parents out of co-bedding (which is safe to do as can be read in previous Newsflashes) and not paying attention to the risks of smoking and not breastfeeding is far from effective in decreasing perinatal infant mortality.
Stacey T, Thompson JMD, Mitchell EA, Ekeroma AJ, Zuccollo JM, McCowan LME: Association between maternal sleep practices and risk of late stillbirth: a case-control study. BMJ
Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics 2011; peds.2010-3000; published ahead of print June 13, 2011, doi:10.1542/peds.2010-3000
Durmuş B, Kruithof CJ, Gillman MH, Willemsen SP, Hofman A, Raat H, Eilers PHC, Steegers EAP, Jaddoe VWV: Parental smoking during pregnancy, early growth, and risk of obesity in preschool children: the Generation R Study. Am J Clin Nutr 2011 ajcn.009225; First published online May 18, 2011. doi:10.3945/ajcn.110.009225

No-one ever died of it so far …

People who make an effort to support breastfeeding often get strange looks, are named fanatics (even with the use of words indicating involvement in militant fascism or organized crime). A frequently heard remark is: ‘’Formula isn’t that bad at all in our part of the world, no one ever died of it’’. Studies were out there that showed this statement to not be true: children have increased mortality risks when not breastfed. Life is risky, it is impossible to lower risks to zero, not even by breastfeeding vaccination, adding vitamins and have them wear helmets 24/7. But risks can be minimized. Breastfeeding is the first, most prominent, most effective way to protect an infant from birth on against several risks. Hauck et al (2011) recently did a meta-analysis. They found 288 studies from 1966-2009 and kept 24 that met their high standards of research.  These 24 studies were then analyzed by 2 independently operating research teams, and 6 more were dismissed. The remaining 18 showed a clear, dose-related correlation between a higher mortality due to SIDS and a decreasing duration and exclusivity of breastfeeding. In plain language: How shorter the breastfeeding period and how less exclusively breastfed how more chance a child has to die of SIDS. The researchers strongly advice to add breastfeeding to the lists of SIDS preventative measures.
Hauck FR, Thompson JMD, Tanabe KO, Moon RY, Vennemann MM: Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics 2011; peds.2010-3000; published ahead of print June 13, 2011, doi:10.1542/peds.2010-3000

The sky is the limit.

(Picture: Peter Paul Rubens: The Fall of Icarus)

During many millennia man thrived on breastfeeding. this built-in nutrition for the young human proved t be so successful that humans could become the dominant species of the earth. A powerful position for this species with little superpowers: not exceptionally strong or fast, not equipped with outstanding senses for smell, eyesight or hearing, no natural defense against any attacker above the size of bacteria. But we’ve got the brains. But power corrupts and makes arrogant. The combination of corrupting power and the high intellect made man to thinking he could improve nature (or Creation for who prefers that). What man can reach … the sky is the limit as Ikaros found out when the sun melted the wax in his bird-feather wings. The urge to improve human possibilities did not die with Ikaros’ fall, till today (and probably long after) scientists keep up the good work. Human milk is one of the items to be challenged: it can’t be so good it has no flaws. Take vitamin D. If the studies are to be taken serious, all children who are not supplemented, fully breastfed will continue their lives crouched and crippled and suffering from all kinds of insufficiency ailments. How for all that’s good did we managed all those ages before some smart manufacturers provided us with bottled D to buy? Of course a mother’s milk has everything in it a child needs for healthy grow and to develop well. No one ever doubts that in any other mammal. But there are some prerequisites: mom must provide sufficient vitamin D (through food and sunlight or supplements if those are not possible) during and preferably before pregnancy, to ensure sufficient D in the growing fetus and to make sure her milk will contain enough of it, the healthy term infant must breastfeed well in order to receive all vitamin D available end his/her skin must have daily sun exposure. But then, of course, it is much easier and sounds very much more scientific to just advise every breastfed infant to be supplemented with a daily dosis bottled D.
F Savino, S Viola, V Tarasco, M M Lupica, E Castagno, R Oggero and R Miniero: Bone mineral status in breast-fed infants: influence of vitamin D supplementation. European Journal of Clinical Nutrition 65, 335-339 (March 2011) (+ Comment: Nirmal S Panesar: Is it a case of too much vitamin D3?)

To the teeth

Watching the MTV Movie Awards being awarded, where vampires and werewolves sank their teeth in a fair lot of the awards, I thought of a nice blog entry: breastfeeding a teething child. Some mothers do refer to this episode like nursing a little vampire. (Which I personally like more as a metaphor than Dutch comedian Claudia’s garlic press, but then again, I don’t like garlic presses, but I do like vampire stories.) That feeling is said to really suck (pun, well, intended actually). A search for scientific references about this phenomenon left me with hardly anything. A Google Scholar search for breastfeeding and teeth gives thousands of hits in the realm of oral development and tooth health in relation to infant feeding (see previous newsflashes), but none about the problems and solutions for breastfeeding a teething child. Multiple mentions are to be found about teething problem symptoms and cures and ways to handle it. For the most nursing a teething is child is like hedgehog’s lovemaking: do it very carefully, because is pricks!

Research Mysteries

Normal, physiological processes can’t be true and good until scientifically proven. For example responsive parenting: keeping yous child close and giving him what he needs when he needs it provides him with the opportunities to develop his body, spirit and mind to the fullest. Responsive parenting includes feeding on demand (rather feeding on clue). A child is born with a perfect system of hunger and satiety cues, which prevents him from eating more than is healthy. Feeding a child on schedule and persuading him to finish the amount of food prepared will lead the child ignoring and distrusting his own cues, overeating, and ultimately an increased risk of obesity later. Thankfully all mothers who kenw and practiced this for ages are now acknowledged by modern scientific evidence brought by Hurley et al. many older studies already showed the relation between formula feeding and later obesity, but Crume c.s now made it clear that this is true, too, for infants of mothers who were diabetic during pregnancy. The most mysterious studies are those on the use of pacifiers (dummies, soothers). Logical thinkers already knew of course that pacifiers (dummies, soothers) are just substitutes for a mother’s breasts. A mother’s breasts provide for breastfeeding (protection from obesity and all kinds of other unhealthy conditions) and for cue-feeding (if hunger cues are not mistaken for ‘’sucking cues that can easily be met with a pacifier/dummy/soother’’). Nevertheless big research analysis studies about the safety of pacifier use the influence on duration of (exclusive or not) breastfeeding as sole indicator. Not signals that easiness of breastfeeding may be damaged or if there might be an increase in breastfeeding problems or if cue-feeding is endangered, which then may lead to more obesity in later life. The great mystery of scientific research: scientists that are so focused on researching that they don’t see their own blinders anymore.
Crume TL, Ogden L, Maligie M, Sheffield S, Bischoff KJ, Daniels S, Hamman RF, Norris JM, Dabelea D: Long-Term Impact of Neonatal Breastfeeding on Childhood Adiposity and Fat Distribution Among Children Exposed to Diabetes In Utero Diabetes Care March 2011 34:641-645; doi:10.2337/dc10-1716
Jaafar SH, Jahanfar S, Angolkar M, Ho JJ: Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database Syst Rev. 2011 Mar 16;3:CD007202.

Mother Milk Mysteries

The piles of research reports, that show that differences in infant feeding can cause differences in outcomes of physical, brain and emotional health, keep growing. Kuhn, for instance, discusses the Lunney et al study that shows that mothers who breastfeed exclusively are less likely to transfer HIV to their infant than do mothers who partially breastfeed. Het discussion is more focused on why this can be than the fact that is does per se. How can it be that to breastfeed exclusively is better protection than to breastfeed part-time? Kuhn thinks it is because part-time breastfeeding means skipping feeding sessions, what may lead to milk stasis and mastitis, leading to a change in Na/K ratio what would clear the way for the HIV to start acting. Personally, I think it to be more likely due to the fact that feeding a child a non-human-milk substance to an infant may lead to (micro) damages in the gut which may offer the HIV a way into the infant’s bloodstream. In other research projects, too, especially those investigating the influence of infant feeding on IQ and socio-emotional development, one could ask if the differences in outcomes in children with or without (exclusive) breastfeeding are due to the milk, the feeding method or just because intelligent moms interact more with their children. Because higher educated moms are more likely to breastfeed, so probably their children’s higher IQ’s is just a matter of inheritance and not an added benefit of breastfeeding, as the mainstream reasoning goes. But just a few generations back, higher educated women actually choose the ‘’more scientific’’ infant feeding method of formula feeding; IQ studies that started in that era also showed lower IQ development in children that were not breastfed or received human milk. But does it in fact matter what exactly the reason is that children who are not breastfed or fed human milk have increased risks of performing less at many health and life issues? Couldn’t we just accept the fact that that, what was during millions of years of evolution developed, probed, enhanced and probed again, just is what it is: the way creation and nature meant to nourish and nurture our children. Just accepting the mother-milk mystery, accept that breastfeeding just ís. Not better, great, hip, superior, but just ís. Let the intervention prove it is healthy, safe and effective.
Milk Mysteries: Why Are Women Who Exclusively Breast-Feed Less Likely to Transmit HIV during Breast-Feeding? Clin Infect Dis. (2010) 50(5): 770-772 doi:10.1086/650536
@Tearsong: Borstvoeding: Hot or Not? (blog) http://www.tearsong.com/?p=47

Guardian angel

Every child has her own guardian Angel even before she is born: her own mother. The mother’s body protects the growing child during this vulnerable period of development of the body. Amniotic fluid and vernix contain lysozyme, lactoferrin, human neutrophil peptides 1–3, and secretory leukocyte protease inhibitor. These immune substances are found to be effective in inhibiting the growth of common perinatal pathogens, including group B. Streptococcus, K. pneumoniae, L. monocytogenes, C. albicans, and E. coli. Initially these factors are found in vernix. As the baby prepares for extrauterine life, pulmonary surfactant (a substance produced by the maturing fetal lungs) increases in the amniotic fluid, resulting in the detachment of vernix from the skin. The vernix mixes with the amniotic fluid. The unborn child continually swallows little sips of the amniotic fluid which results in these substances reaching into his GI system, tus starting the preliminary protection is started. After birth the protective properties in colostrum and breastmilk, resembling those in vernix and amniotic fluid, will take over the protective duties. Combined with the pathogens he receives while travelling through the birth canal and entering into the world and the protection in the first sips of colostrum, these protective substances form the basis of the healthy gut flora. It is a good habit to not wash or bath a newborn baby, in order to have him benefit from the protection taken with him from the womb, to take care of his outside safety, while colostrum takes care of the inside protection. Mother Gardian Angel has the most amazing superpowers anyone could imagine. Let’s not unthinkingly whipe them off and reject them.
Akinbi, H. T., Narendran, V., Pass, A. K., Markart, P., & Hoath, S. B. (2004). Host defense proteins in vernix caseosa and amniotic fluid. American Journal of Obstetrics and Gynecology, 191(6), 2090–2096.

George

Remember my George Clooney blog? Coffee-substitutes just are fake, even with George as a bonus. Infants can have their own George now: a fake-milk-machine á la Nespresso. Nestle proofs to keep his tricky ways while growing older and to not have lost his precious art of deception. The machine costs more than the most fancy Senseo and the price-a-piece of the capsules buys you liters of cow’s milk. A thing that expensive must be very good, right? Right? Wrong. This machine mixes a certain amount of powdered infant food substitute with water at body temperature. Powdered milk is (inherently to the production process) not sterile and always contains more or less amounts of dangerous and very dangerous pathogens. Only preparing it with water at at least 70 degrees Celcius will prevent children from infection with these bugs. And then: those little tubes for milk and diluted powder to be transported out of the machine. Ever tried to cleanse the milk reservoirs and tubes of a coffee machine with built-in cappuccino device? Hardly possible. I imagine baby’s George to have the same problem. More ways for bacterial infection, not to even start thinking of the mold. Nah, there really is only 1 avanced milk making and delivery system for babies: mom’s own bossom.

Fear gives bad advice

In oktober 2011 dr. Raymond de Vries starts as special professor  ‘Fysiologische Verloskunde/Midwifery Science’ at the Faculty of Health, Medicine and Life Sciences, Maastricht University. I his inaugural speech he addresses the fear for normalness in normal conditions: the hyped idea that a healthy woman with a healthy pregnancy might be at great risk if she has her baby at home. In the USA, where practically every woman births in a hospital and where in some states C-sections compose more than half of all deliveries, more mothers and babies die around delivery and early postpartum than in The Netherlands. The normalness of breastfeeding is as much a victim to fear and dread. Throughout human history mothers have without doubts shared their breasts and their milk to feed each other’s children; still in the last decennia this is viewed as scary, yucky and possibly dangerous. And here as well, fear gives bad advice, because the alternative for a child whose mother for any reason can’t breastfeed (or has too little or no milk for the short or long term), is something that in fact is even more scary. The risks of sharing mother’s milk can almost completely be prevented by good methods for harvesting, storing and handling, where most of the risks of formula are inherently bound to the product itself and cannot be prevented nor erased even with the most secure ways of handling. Governments and (breastfeeding) organizations who are strongly opposing against informal milk sharing, had better put their energy in promoting safe ways to do so and in educating about the real and not preventable hazards of formula feeding.
Prof.dr.  G. de Vries : Midwives, obstetrics, fear and trust. A four-part invention. Inauguratie rede ter gelegenheid van de benoeming tot bijzonder hoogleraar ‘Fysiologische Verloskunde/Midwifery Science’ aan de Faculty of Health, Medicine and Life Sciences van de Universiteit Maastricht. 26 mei 2011.
Thorley V: Mothers' experiences of sharig breastfeeding or breastmilk co-feeding in Australia 1978-2008. Breastfeed Rev. 2009 Mar;17(1):9-18.
phdinparenting: Risks of Informal Breastmilk Sharing versus Formula Feeding. http://www.phdinparenting.com/2010/11/28/risks-of-informal...-breastmilk-sharing-versus-formula-feeding/

Popeye

In order to grow well en become as strong as Popeye spinach is a must-eat, as every child knows. In fact, spinach does contains lots of iron, 2-4 times as much as other iron-rich vegetables. Apple syrup (traditional Dutch treat: very thick syrup made of apple juice) contains 3 times as much, but who eats 100grams of that on a daily basis. There’s quite some iron in meat, too, not as much as in spinach, but in a better available form. Human milk contains iron as well, not too much, in different forms and accompanied by a protein (lactoferrin) that prevents the iron being eaten by gut pathogens. This is one of the reasons breastfed children have fewer intestinal infections. (Infant formula contains an exces of iron, due to its poor availability and is thus a great food source for pathogens causing intestinal infection.) The iron content of human milk is relatively low, but it suffices for maintaining iron levels during the exclusive breastfeeding period, without feeding the gut germs. For most children this works out just fine, but not for some. In order for the child to have enough iron with these small amounts in his mom’s milk he needs to be term born at 3kg or more, without complications that cause hemorrhage (forceps, vacuum birth) and the cord be allowed to stop pulsing before being clamped. According to the outcomes of the Yang et al study in countries in Europe, Africa, Middle and South America boys with a birth weight under 3 kg are at highest risk for anemia with exclusive breastfeeding. Based on the high prevalence of anemia in American infants (especially those of Hispanic origin) the American Academy of Pediatrics (AAP) developed new recommendations for prevention of iron deficiency and iron-deficiency anemia stating that “exclusively breastfed term infants [should] receive an iron supplementation of 1 mg/kg per day, starting at 4 months of age.” Not all physicians agree, as vocalized by Furman (2011), because it does not take into account the preventable causes for anemia and the enhanced risk of intestinal infections due to too much dietary iron. Chapparro (2009) states that iron supplements are not needed for children without the obeve mentioned risk factors and who are optimally exclusively breastfeed and that those children will have enough iron for the first 6-8 months of life.
Yang Z, Lönnerdal B, Adu-Afarwuah S, Brown KH,
Chaparro CM, Cohen RJ, Domellöf M, Hernell O, Lartey A, Dewey KG: Prevalence and predictors of iron deficiency in fully breastfed infants at 6 mo of age: comparison of data from 6 studies Am J Clin Nutr 2009 89: 5 1433-1440
Lydia M. Furman: Exclusively Breastfed Infants: Iron Recommendations Are Premature. Pediatrics 2011; 127:4 e1098-e1099; doi:10.1542/peds.2011-0201B
Camila M. Chaparro: Setting the Stage for Child Health and Development: Prevention of Iron Deficiency in Early Infancy J. Nutr. 2008 138: 12 2529-2533

Taking care of yourself

To become a mother means to get and take responsibility for the care of another person. But women who become mothers are taking care for themselves as well. Pregnancy, childbirth and lactation are health increasing factors in a woman’s life. Women who birth children and breastfeed lower their chances of developing several kinds of potentially life threatening illnesses. Stuebe et al (2005) found that women who had breastfed had a lower risks for diabetes type II up to their middle age years. In their analysis of 1 very large cohort studies (totaling over 150,000 women) they found that in women who reported at least 1 live birth in the last 15 years each subsequent year of breastfeeding lowered their diabetes risk with 15%. Not having children and no breastfeeding is a bad health choice for women. Schwartz c.s. (2009) compared the lifestyle and health data of almost 130,000 post-menopausal women who had birthed at least 1 live child. They found that women who reported a lifetime history of more than 12 months of lactation were less likely to have hypertension, diabetes, hyperlipidemia, or cardiovascular disease than women who never breast-fed, but they were not less likely to be obese. With such positive outcomes, one would presume all mothers would want to take could care of herself and every health care professional to support her in doing so. Indeed, over 80% of Dutch women indicate the wish to breastfeed, less than 80% actually do so and within a month half of them quit. The numbers of mothers exclusively breastfeeding for 6 months are so low they don’t even show up in the latest official national records. One of many possible actors for these low numbers for incidence and duration of breastfeeding may be found in the childbirth and maternity care are carried out. Women who give birth in a hospital setting hardly get a minute of rest a day. Morrison et al counted all disturbances in a standard single maternity room between 8:00 and 20:00h. Recorded interruptions totaled 1,555, yielding a mean of 54 interruptions each averaging 17 minutes in length. Half of the 24 episodes of time alone per dyad were less than or equal to 9 minutes; most commonly only 1 minute long. This does not enhance a good start wih breastfeeding and thus not for mother taking good care of herself and her baby.
Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB: Duration of Lactation and Incidence of Type 2 Diabetes. JAMA. 2005;294(20):2601-2610.
Schwarz EB, Ray RM, Stuebe AM, Allison MA, Ness RB, Freiberg MS, Cauley JA: Duration of lactation and risk factors for maternal cardiovascular disease. Obstet Gynecol. 2009 May;113(5):974-82.
Morrison, B., Ludington-Hoe, S. and Anderson, G. C. (2006), Interruptions to Breastfeeding Dyads on Postpartum Day 1 in a University Hospital. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 35: 709–716.

Corparate espionage

After Sheep Dolly and Bull Herman Chinese scientists managed to clone a complete herd of cow (well, herd, 17 of them, the rest of the 45 cloned calves didn’t survive the experiment) that are said to produce human milk. What they did, in fact, was putting loads of money, time and energy into altering the DNA of cows so that in their milk those cows will produce 3 (three!) natural human resembling protective proteins. Yang et al underline in their article that the modified milk resembles normal cow’s milk as in lactose, protein contents and the like. The excellent work by professor Hanson (2007) has shown clarly that the way breastfeeding protects babies has a lot more in it than 3 isolated proteins in cow’s milk. It encompasses both the process of breastfeeding and the product human milk and is a duet by mother and child. The maternal breast is much more than just a milk-making organ, it is an important,  proactive and interactive functioning, provider of specific and a-specific protective substances, amongst which living blood cells. An important trigger for the production of  specific antibodies is the actual drinking at the breast by the baby, who, while doing so, colonizes his mother with potential pathogens. (As do a cow’s udders for her calve, and the dog-mom’s nipples for her pups.) It is an exhibition of utter arrogance and unscrupulous money-greediness that any scientist may pretend to be able to reproduce this.
Yang B, Wang J, Tang B, Liu Y, Guo C, et al. 2011 Characterization of Bioactive Recombinant Human Lysozyme Expressed in Milk of Cloned Transgenic Cattle. PLoS ONE 6(3): e17593.
Hanson, L. (2007). The role of breastfeeding in the defense of the infant. In T. Hale, & P. Hartmann, Textbook of Human Lactation (pp. 159-192). Amarillo, TX: Hale Publishing, L.P.

Science and practice

Gonzalez et al analyzed all issues in one year of every five years since The Journal of Human Lactation, the peer-reviewed journal of the International Lactation Consultants Association, first issued in 1985. An important finding was that were in the early years articles mainly consisted of those targeting the Lactation Consultant Practice, through the years focus more and more was put on scientific articles. According to the researcher this shows that lactation Consulting has evolved into a more medical profession, which improves its credibility as a new healthcare profession. But is medicalization of breastfeeding something worthy striving for? And does medicalization lead to better breastfeeding numbers, as in more mothers and babies enjoying breastfeeding for longer durations? No, knowing that another 10-syllable ingredient of human milk has been identified doesn’t make more mothers start breastfeeding, nor more babies being breastfed for the recommended time. Studies around the experience of breastfeeding and reasons for early discontinuation for decennia have shown similar outcomes: mothers do not need more scientific evidence, nor more pushing and promoting to start breastfeeding (most moms want to breastfeed anyway). What they do need is support, help and encouragement. Brand et al compared 2 groups of early postpartum mothers with problematic breastfeeding. The mothers who continued breastfeeding despite problems were those who felt to have a support system, professional and/or lay. Hegney c.s. concluded similarly. they found in both their cohorts that women started out with idealistic expectations. Those who continued breastfeeding despite problems were women who felt they had a health care professional they could trust on breastfeeding matters and had a social network with peers to exchange experiences. They also found that mothers who did not continue felt alone and had feelings of guilt and inadequacy. Mothers and babies need health care professionals who can empathize with them, have a solid knowledge of basic breastfeeding physiology and normal infant and toddler behavior.  They do  ot need HCPs who can reproduce all hundreds of ingredients of human milk.
Gonzalez PA: The Development of Professional Healthcare Support for Breastfeeding: A Content Analysis of the Journal of Human Lactation. Poster Presentation. University of South Florida, 2011
Brand E, Kothari C, Stark MA: Factors Related to Breastfeeding Discontinuation Between Hospital Discharge and 2 Weeks Postpartum. Journal of Perinatal Education, 2011 , 20(1):36-44(9)
Hegney, D., Fallon, T. and O’Brien, M. L. (2008), Against all odds: a retrospective case-controlled study of women who experienced extraordinary breastfeeding problems. Journal of Clinical Nursing, 17: 1182–1192.

Milk, mom or interaction?

Heikkilä et al found more problematic behavior amongst children who were not breastfed as infants. Based on their research data they were unable to identify the cause for these findings: the milk or other mother related factors. Breastfeeding often is seen as solely a way to shove superior food into an infant. Of course it isn’t. Breastfeeding is a process that is carried out by two persons and that influences and is influenced by the hormonal systems of both participants. The milk is a collateral benefit. Because this idea is not common yet, results like those of Heikkilä et al are often trivialized by explaining it is probably because mothers who tend to choose to breastfeed are commonly more attentive and aware and therefor raise better functioning kids. Other studies (like one by Kim c.s., 2011) point out that the act of breastfeeding alters maternal brain function, resulting in better responses towards their offspring. therefore, it could very well be the process of breastfeeding that influences the behavior of children, but not so much the act of being breastfed, but more that of maternal breastfeeding. Mothers who choose to breastfeed are not better mothers, but the act of breastfeeding can help make them better moms.
Heikkilä K, Sacker A, Kelly Y, Renfrew MJ, Quigley MA: 012 Breast feeding and behavioural development in children: findings from the Millennium Cohort Study. J Epidemiol Community Health 2010;64:A5
P Kim, R Feldman, LC Mayes, V Eicher, N Thompson, JF Leckman, and JE Swain (2011). Breastfeeding, brain activation to own infant cry, and maternal sensitivity. J Child Psychol Psychiatry, April 18, 2011

And what about me?

It is often argued that breastfeeding means that a mother is sacrificing her personal being to het child; breastfeeding apparently being the healthiest choice  and every mother surely wants only the best for her child. But breastfeeding is not only for the child’s wellbeing, it’s good for mom, too. Research already showed that breastfeeding aids in lowering breascancer risk in women and osteoporosis and certain forms of cancer int the female reproductive organs are seen more in women who never breastfed. More recent studies by Swedisch researcher Uvnäs-Moberg and her team (Handlin et al, 2009; Jonas et al, 2008) show that on the short term breastfeeding is beneficial for women. During and after breastfeeding her bloodpressure lowers and that is not bad at all for many. The combination of breastfeeding and skincontact increases oxytocin levels and lowers the levels of stress hormones cortisol and ACTH in het blood. Allthough not explicitely stated in the stusies boh lowered bloodpressue and lower stresshormone levels and icreasedd oxytocin levels might very well be interconnected.
Handlin L, Jonas W, Petersson M, Ejdebäck M, Ransjö-Arvidson AB, Nissen E, Uvnäs-Moberg K: Effects of sucking and skin-to-skin contact on maternal ACTH and cortisol levels during the second day postpartum-influence of epidural analgesia and oxytocin in the perinatal period. Breastfeed Med. 2009 Dec;4(4):207-20.
Jonas W, Nissen E, Ransjö-Arvidson AB, Wiklund I, Henriksson P, Uvnäs-Moberg K: Short- and long-term decrease of blood pressure in women during breastfeeding. Breastfeed Med. 2008 Jun;3(2):103-9.

Breastfeeding and work rerun

Due to illness no fresh newsflash today. In honour of the Aruban symposium linked to the implementation of breastfeeding and employment regulation today an overview of newsflashes around the breastfeeding and work theme. Also take a look at Aruban Breastfeeding Mama's: http://arubanbreastfeedingmamas.blogspot.com/ ; Bella Sophia Carriers:
http://www.bellasophiacarriers.blogspot.com/ ; the symposium announcement: http://www.arubachamber.com/events/2011/Expo2011May5.htm
http://eurolacen.blogspot.com/2011/05/breastfeeding-and-work.html
http://eurolacen.blogspot.com/2011/01/breastfeeding-and-work.html
http://eurolacen.blogspot.com/2011/02/breastfeeding-and-employment.html

Breastfeeding and work

(Photo: Miranda Kerr, taking a nursing brake during her work as model)

Around the world organizations like WHO, governments and physicians organizations advise that children are exclusively breastfed for the first 6 months of life and breastfed combined with suitable other foods into the second year of life or beyond. Many moms really want to do so, but in daily practice many don’t even start and within a month half of children who started out on breastfeeding are weaned to formula, and by 6 months very children are exclusively breastfed. Multiple causes can be pinpointed, some very clear, others less. Working outside the home is a major obstacle for making their breastfeeding goals for many mothers in industrialized countries. In fact, only in countries, like those in Scandinavia, with extended maternity leaves moms have far less trouble reaching those goals. Studies, amongst others by Guendelmans et al, shows that the shorter maternity leave the higher the risk of premature weaning. Breastfeeding promotion alone will not suffice, mothers need to be facilitated to get breastfeeding off to a good start en well-established. Working conditions are a significant actor, too. Many employers are not aware of legal regulations, they may fear jealousy amongst their employees because some can come and go for nursing and others not, and for less productivity when breastfeeding mothers are on and off nursing or pumping. Chow c.s. did find however, that some employers do realize that installment of a breastfeeding friendly protocol may actually lead to more loyal employees. In interesting view comes from Payne&Nicholls, who used Foucauldian analysis to interpret interview data of nursing mothers. They found that breastfeeding women feel they have to juggle to combine work and being a mother and do so while staying invisible for their co-workers and perform to be a good mother and a good employee. A less positive effect of this behavior, according to Payne and Nicholls, is that breastfeeding continues to be invisible, and the combination of work and motherhood stays difficult. In other words: mothers don’t do themselves, each other and their children a favour by juggling their roles and tasks in way that ‘‘they don’t bother anyone’’ with it.
Payne D, Nicholls DA: Managing breastfeeding and work: a Foucauldian secondary analysis. Journal of Advanced Nursing, 2010, 66:1810–1818
Chow T, Smithey Fulmer I, Olson BH: Perspectives of Managers Toward Workplace Breastfeeding Support in the State of Michigan J Hum Lact March 9, 2011
Guendelman S, Kosa JL, Pearl M, Graham S, Goodman J, Kharrazi M: Juggling Work and Breastfeeding: Effects of Maternity Leave and Occupational Characteristics. Pediatrics 2009 123: e38-e46 

Magical milk

Doing magic with milk is a nice science project: pour some milk in a flat bowl, add some singled food colouring drops randomly around and 1 drop of dish detergent in the middle. The detergent will alter the surface tension of the fluids and change protein and fat molecules and then magic shows itself as a colourful twirling in the milk. Mothers work wonders with milk on a daily basis without ever having to use extra tools and without making the milk undrinkable. Breastfeeding mothers work magic creating milk with magical powers for their children. Human milk is vaccination, protection against infections, GI tract primer, nerve path builder, and food. It will come as no surprise that mom’s milk is seen as substance that needs be handled with all regards in order to keep it from breaking down. But the most magical of human milk is that it is a very robust substance, that is not easy to destroy. Many of the often rigid guidelines for the handling and storage of mom’s milk turn out to be based on nothing substantial. Not in the fridge door? Only way back in the freezer? Not a shred of evidence that the door actually is hazardous place! Partially thawed milk? No evidence that that will spoil the milk right away. Throw away any left-overs? Is only true for dead formula, not for living human milk. Never shake to mix the separated milk fat? It takes a lot more than a vigorous household shake to break down protein cells. Magical Mom’s Milk: most wonderful right from the source, but invincible even when pumped, stored, thawed and refrozen, shaken and bottled.

Clinical Lactation

Breastfeeding is a physical function for mothers and infants. The societal relevance ought to be undoubted en as a medical discipline it should belng among the highest ranked, for its population (all newborn children!) is huge. In daily practice the knowledge of human lactation and the counseling of breastfeeding dyads amongst medical and nursing health professionals is on average rather low. Many advices and treatments are not based on scientific evidence, but on tradition, hear-say and the influences of pharmaceutical and infant formula industries. And this is not so for a lack of available  scientific knowledge. Most medical and nursing professional journals do publish about breastfeeding research and even more knowledge surrounding human lactation and breastfeeding counseling is published in specialized peer reviewed lactation journals. Today I would like to highlight some articles from the Fall, 2010 issue of Clinical Lactation. Genna, Walker and Kendall-Tackett are great names in lactation science. They write about breastfeeding as the norm in feeding and caring for infants and young children. Kendall-Tackett addresses sense and non-sense in her article about safe-sleep campaigns, and stresses that it is not sharing a bed with a parent that raises SIDS risks, but other factors, mostly a combination of factors. Walker discusses the special needs late-premature infants have and the special care breastfeeding them is needed for breastfeeding counseling. Genna addresses the importance of maternal and infant positions in order to facilitate the baby to use his hands in finding the breast and latching on.
Kathleen Kendall–Tackett, Zhen Cong, Thomas W. Hale: Mother–Infant Sleep Locations and Nighttime Feeding Behavior; U.S. Data from the Survey of Mothers’ Sleep and Fatigue. Clinical Lactation Vol. 1, Fall 2010
Marsha Walker: Breastfeeding Management for the Late Preterm Infant; Practical Interventions for “Little Imposters”. Clinical Lactation Vol. 1, Fall 2010
Catherine Watson Genna, Diklah Barak: Facilitating Autonomous Infant Hand Use During Breastfeeding. Clinical Lactation Vol. 1, Fall 2010.

Research and development

Research around the health outcome effects of certain interventions follows a certain structure an complicated mathematics to diminish the influence of  ‘’confounding factors’’ on the study findings, in order for the researcher to be sure it is his intervention that made the difference. SES (socio-economic situation) and education level are well known and often used variables used to dim study-results. Result from targeted studies comparing results from developing and developed countries show that these variables are not as stable and sure as they are traditionally accounted for. A large-scaled study by Brion et al Compared results from studies varying countries with different SES and educational structures about the influence of breastfeeding on blood pressure, obesity and diabetes in children. In more developed countries A higher SES was positively correlated to higher breastfeeding rates, but not in less developed countries. In developed countries a clear positive correlation was found between breastfeeding and lower blood pressure, better BMI’s and higher IQ’s, but in less developed countries this was only true for breastfeeding and higher IQ. IQ positively turns out to be not only a matter of inherited benefits, but of infant feeding choices as well. And evenly evident it seems to be that besides and after breastfeeding BMI and blood pressure in later life are influenced by more than infant feeding alone. The COHORTS study revealed amongst others that in the developing countries participating in these studies breastfeeding or not hardly has any measurable influence on blood pressure, obesity and diabetes later in life. The researchers point out that more research, that fine-tunes the categories of ‘’ever or never breastfed’’, duration of breastfeeding and of exclusive breastfeeding might change these findings. In many developing countries breastfeeding incidence is high, but breastfeeding duration and more so duration of exclusive breastfeeding may be quite low.
Brion M-JA, Lawlor DA, Matijasevich A, Horta B, Anselmi L, Araújo CL, Menezes AMB,
Victora CG, Smith GD:  What are the causal effects of breastfeeding on IQ, obesity and blood pressure? Evidence from comparing high-income with middle-income cohorts Int. J. Epidemiol. (2011) dyr020 first published online February 24, 2011
Fall CHD, Borja JB, Osmond C, Richter, Bhargava SK, Martorell R, Stein AD, Barros FC, Victora CG, and the COHORTS group: Infant-feeding patterns and cardiovascular risk factors in young adulthood: data from five cohorts in low- and middle-income countries Int. J. Epidemiol. (2011) 40(1): 47-62 first published online September 17, 2010

Growth, overweight and menarche

According to Kramer c.s. of the large PROBIT study (Belaraus) children who are breastfed show slower growth than those who are not (however it would be more correct to phrase this as ‘’children who are not breastfed will grow faster than breastfed children or even grow too fast). The fact that parents, too, will compare the growth of their breastfed infants with the growth of their formula fed counterparts, may according to the researchers lead to the phenomenon of starting earlier than planned with formula supplements or weaning to formula altogether. ‘’More is better’’ seems to be a well-established adagio in both health care providers and parents, but in the case of body weight this may very well be untrue. Several studies have linked a higher body weight in young girls to early onset of puberty. Early puberty exposes girls to an increased risks of prolonged exposure to estrogens. Duration of breastfeeding and of exclusive breastfeeding, too, are linked to the age at menarche. It is possible that more than breastfeeding per se, the role of breastfeeding in weight gain as infant and the effect of not breastfeeding on obesity in pre-puberal children is the central factor in this theme.
Kramer MS, Moodie EEM, Dahhou M, Platt RW: Breastfeeding and Infant Size: Evidence of Reverse Causality Am. J. Epidemiol. (2011) first published online March 23, 2011
Al-Sahab B, Adair L, Hamadeh MJ, Ardern CI, Tamim H: Impact of Breastfeeding Duration on Age at Menarche Am. J. Epidemiol. (2011) kwq496 first published online March 23, 2011 
Terry MB, Ferris JS, Tehranifar P, Wei Y, Flom JD: Birth Weight, Postnatal Growth, and Age at Menarche Am. J. Epidemiol. (2009) 170(1): 72-79 first published online May 13, 2009

Is breast best?

(Photo: my dog Dora and her first and only litter)

Does breastfeeding make smarter kids? Does breastfeeding cause less infection? Are breastfed children less often and less severe ill? No. Doesn’t breastfeeding have any benefits then? No, that’s right: breastfeeding does not have any benefits. Breastfeeding can not have benefits, because it is the norm for feeding, nurturing and protecting newborns and children in their first years of life. Biologically speaking, humans are mammalians. Most significant feature of mammalians is that the young are fed from the mammae (milk secreting glandular tissue clusters) of their mothers for a certain amount of time following birth. In the course of hundreds of thousands of years of evolution this has become a tried and proven  system, which has led to, amongst others, the great overall success of mammalian species. Part of this perfection is specialization: the lactation process and the composition of milk are fine tuned to the specific needs of the young of each single species. The duration of the lactation period, for example is linked to the eruption of teeth: many mammalians start eating other foods besides milk around the time the first teeth start erupting and drink their last drops of milk around the time the teeth start changing. The composition of milk is related to the way the young are cared for and the needs for developing systems that are crucial for the survival of the species. Species who leave their young in nests provide milk low in water, but very high in energy and protein; carriers on the other hand feed their young with milk high in water and milksugar, but very low in protein. Animals who need to run with the herd get milk with lots of protein and calcium, while species who survive because they’re smarter than others provide their young with nutrients that promote mind-development. Being breastfed by his own mother, or at least a mother from his own species, is essential for every young animal, inclusing the human. Breastfeeding is not an added bonus; non-breastfeeding is the deprivation of a basic need. Non-breastfeeding has disadvantages.