Infant feeding and safety

The safety of children is on top of the priority lists of parents, health care providers and governments. Parents are educated and governments try to legislate safety. WHO and UNICEF dedicate a prominent amount of their activities to this cause. In many resolutions and publications over and over again is emphasized that there is one single cheap and easy way to provide all children with a basic safety. A way that provides safe food, protection against infection and other diseases and applicable in all living conditions: to breastfeed children from birth on, much and often. A disadvantage to this apparent panacea is that not alone it does not cost any money, but no-one will financially profit from it. And thus, an intensive lobby from those who will gain from breastfeeding substitutes can cause governments to pay lip service, and even put into writing, to WHO’s visions, but still announce infant feeding a parent’s choice. Other safety interventions are being promoted with a lot more force and persuasiveness, where playing on feelings of guilt in parents is not dreaded. But parents who choose, or are made belief they can’t do anything else, to not breastfeed, choose to feed and care for their children in less safe way. By replacing breastfeeding, they refuse their child the protection human milk and suckling the breast offers, but on top of that expose them to a potential bacteriologic dangerous substance. Powdered infant formula (PIF) is not germ-free and children have died because of bacteriological contamination. Research shows that many parents do not read the labels on the PIF cans well or don’t fully comprehend what they read and many do not follow other hygiene precautions. Parents who care for the safety of their children will choose to breastfeed and they are entitled to all help needed to proceed doing so.
 Labiner-Wolfe J, Fein SB, Shealy KR: Infant Formula-Handling Education and Safety. Pediatrics 2008 122: S85-S90
Carletti C, Cattaneo A: Home preparation of powdered infant formula: is it safe? Acta Pædiatrica, 2008, 97(8):1131-1132

Galactogogues

The Academy of Breastfeeding Medicine (ABM), an organization by and for physicians about breastfeeding, develops and publishes protocols about handling many aspects of breastfeeding, in order to achieve a consequent and evidence based approach to breastfeeding care. These protocols are regularly updated. The latest newly edited protocol is about galactogoges, substances that enhance milk production. This new edition is remarkable and ABM blogger Marinelli explains is so different in comparison to the former version. As the revision group studied the research available it appeared that evidence for galactogoges was getting thinner and that health care workers who advise or prescribe them should be more careful and reconsider. Most striking is that the recommendations for daily practice start with the advice to first optimalise breastfeeding techniques and management (with a thorough list of how-to’s) and to examine for other, possibly medical reasons for failing milk production or inadequate growth. If medicinal support is necessary there fails to be one specific medicine to advise, nor any specific herbal remedy. Medications used for enhancing milk production appear to be a greater risk for negative by-effects than previously thought and as far as herbal remedies are concerned, those appear to be proven safe by centuries of use, but not proven to be effective.
Kathleen Marinelli MD, IBCLC, FABM: New Galactogogue Protocol–New Attitude?? http://bfmed.wordpress.com/2011/02/22/new-galactogogue-protocol-new-attitude/
The Academy of Breastfeeding Medicine Protocol Committee: ABM Clinical Protocol #9: Use of Galactogogues in Initiating
or Augmenting the Rate of Maternal Milk Secretion. BREASTFEEDING MEDICINE. 2011, 6(1) http://www.bfmed.org/Media/Files/Protocols/Protocol%209%20-%20English%201st%20Rev.%20Jan%202011.pdf

Professional and peer support

The promotion, protection and support for breastfeeding can be put into practice in many different ways. Breastfeeding support can be done both pre and post natally and be performed by professionals and peers. Researchers studied all varieties of breastfeeding support and even the studies were studied (reviews). The results differ widely. Ingham c.s. studied lay prenatal breastfeeding support. They found little effect from universal support programs (aimed at ‘’all’’ pregnant women of a certain socio-economic status), but measurable effects for target programs (aimed at pregnant women already decided to or considering to breastfeed).Chapman et al did not only consider breastfeeding initiation as an effect of peer counselling, but were interested to see any effects on infant health as well. In their review of the literature they found not only that peer counselling increased the incidence, exclusivity and duration of breastfeeding according to the vast majority of studies, but also a decrease in incidence of infant diarrhea and significantly increase the duration of lactational amenorrhea. A quite interesting study by Dennis, concluded that professional breastfeeding support may very well work out negatively when the professional’s advice is coloured by lack of breastfeeding knowledge and that even support by a knowledgeable professional only has a limited duration effect. Especially for those women who belong to the most vulnerable groups in regard to breastfeeding success (young, have a low income, belong to an ethnic minority, are unsupported, are employed full-time, decided to breastfeed during or late in pregnancy, have negative attitudes toward breastfeeding, and have low confidence in their ability to breastfeed) best chances to develop positive breastfeeding behaviour come from non-professional support.
Ingram L, MacArthur C, Khan K, Deeks JJ, Jolly K: Effect of antenatal peer support on breastfeeding initiation: a systematic review. CMAJ. 2010 Nov 9;182(16):1739-46.
Chapman DJ, Morel K, Anderson AK, Damio G, Pérez-Escamilla R: Breastfeeding peer counseling: from efficacy through scale-up. J Hum Lact. 2010 Aug;26(3):314-26.
Dennis CL: Breastfeeding initiation and duration: a 1990-2000 literature review. J Obstet Gynecol Neonatal Nurs. 2002 Jan-Feb;31(1):12-32.

Breastfeeding and development

In the large multi-year PROBIT study, Kramer et al researched they effects of increased breastfeeding upon intellectual development and academic results in 6,5 year olds. A total of 17.000 children born in 31 randomly chosen BFHI certified hospitals, that worked towards increasing incidence, exclusivity, and duration of breastfeeding, and traditional hospitals were enrolled. Children born in hospitals working according to BFHI standards had an increased chance to be exclusively breastfed at 3 months. IQ testing at 6,5 years showed an increased IQ score of 8 points for boys and 7 for girls compared to their counterparts born in non-BFHI hospitals. A very recent, smaller, but well-designed and prospective study by Oddy et al looked at the influence of exclusive breastfeeding for at least 4 months upon developmental milestones in the domains of gross and fine motor skills, adaptability, sociability and communication. Factors adjusted for in multivariable analyses included maternal sociodemographic characteristics, and stressful life events. Good results in these domains will enhance the chances of more complete development of intellectual potential. Oddy and collegues found small, but very significant differences in all studied domains after correction for confounding factors.
Kramer MS, Aboud F, Mironova E, Vanilovich I, Platt RW, Matush L, Igumnov S, Fombonne E, Bogdanovich N, Ducruet T, Collet JP, Chalmers B, Hodnett E, Davidovsky S, Skugarevsky O, Trofimovich O, Kozlova L, Shapiro S; Promotion of Breastfeeding Intervention Trial (PROBIT) Study Group: Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry. 2008 May;65(5):578-84.
Oddy WH, Robinson M, Kendall GE, Li J, Zubrick SR, Stanley FJ: Breastfeeding and early child development: A prospective cohort study. Acta Paediatr. 2011 Feb 7. doi: 10.1111/j.1651-2227.2011.02199.x. [Epub ahead of print]

Introduction of solids

Fewtrell et al caused quite a bit of fuss with their review of dated literature on the introduction of solids and their claim that exclusive breastfeeding for 6 months is outdated. Despite the expert comments in the professional journals and on the WWW, media keep on publishing articles for the lay public. The persuasiveness of the Fewtrell-crew, of which ¾ are or once were paid by the baby-food industry, is so huge that some governmental agencies and health institutions already change their advice back from 6 to 4 months to start solids. And all that because some allergic reactions seem to be less after earlier introduction of other foods than mothers milk. This completely fails to take into account the much more substantial risk of much more serious illnesses and conditions that can be caused by too early introduction of solids. Especially in the light of the, in the Western World, pandemic proportions of overweight (along with the accompanying conditions as diabetes and cardiovascular diseases) it is important that as many children as possible are exclusively breastfeed for 6 months and then being sensitively introduced to family foods while breastfeeding continues to be the primary food source up till the first birthday. Campaigns against overweight aimed at schoolchildren and adolescents come too late, even preschool age is late. Anzman et al found that interventions to prevent overweight in school children and adolescents for most of them come too late and that we’d better start focusing on pregnant women and parents of infants. Seach et al found that early introduction led to an increase in overweight in 10 year olds, as did parental smoking around the time of birth. Besides nutrition sleep is an important factor for healthy growth and development of infants and toddlers as well. At Harvard Nevarez et al studied factors that influence sleep duration in children up to 2 years. They concluded that factors that led to decreased infant sleep (up to 1 hour a day) at 12 and 24 months included maternal depression, early introduction of solids (<4m), the child watching TV, and child day care use.
Fewtrell M, Wilson DC, Booth I, Lucas A: Six months of exclusive breast feeding: how good is the evidence? BMJ 342:doi:10.1136/bmj.c5955 (Published 13 January 2011)
WHO Multicentre Growth Reference Study Group. WHO child growth standards based on length/height, weight and age. Acta Paediatrica 2006;Suppl 450:76-85.
Ruth A. Lawrence. Childhood Obesity (Formerly Obesity and Weight Management). August 2010, 6(4): 193-197.
Nevarez MD, Rifas-Shiman SL, Kleinman KP, Gillman MW, Taveras EM: Associations of Early Life Risk Factors With Infant Sleep Duration, Academic Pediatrics, 10:3, May-June 2010, Pages 187-193
Seach KA, Dharmage SC, Lowe AJ,  Dixon JB: Delayed introduction of solid feeding reduces child overweight and obesity at 10 years. International Journal of Obesity , (25 May 2010)
Anzman SL, Rollins BY, Birch LL: Parental influence on children's early eating environments and obesity risk: implications for prevention. International Journal of Obesity 34, 1116-1124 (July 2010)

SIDS and sleep environment

Blair in his editorial defines SIDS as an exclusion diagnosis: a child died and after studying all factors involved we cannot demonstrate an adequate cause of death. In 1969 Beckwith put down this definition and after the following 40 years of intense research there is no prospective of finding a single plausible cause for cot death. There are, though, factors that increase the SIDS risk, including, but not limited to, breastfeeding or not and sleep arrangements. In different research groups Blair et al studied the correlations between sleep arrangements and SIDS and between bed sharing and breastfeeding. Thy found that sleeping place sharing children who died of SIDS always also had other risk factors involved, like prematurity, being ill of not well, parents who smoked or were under the influence of alcohol or drugs, the use of head-covering, pillows or sofa’s. Bed sharing in the first 15 months (or longer) proved positive in better breastfeeding outcomes. Health behaviour education for parents about sleep arrangements should always take into account these positive outcomes for breastfeeding. Good information about safe bed-sharing seem to have the best potential to secure breastfeeding and prevent SIDS as much as possible.
Blair PS, Fleming PJ: Recurrence risk of sudden infant death syndrome. Arch Dis Child 2008;93:269-270
Blair PS,  Sidebotham P, Evason-Coombe C, Edmonds M, Heckstall-Smith EMA, Fleming P: Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. BMJ 2009; 339:b3666
Blair PS, Heron J, Fleming PJ: Relationship Between Bed Sharing and Breastfeeding: Longitudinal, Population-Based Analysis. Pediatrics 2010 126: e1119-e1126

Breastfeeding and employment

Working per se is not necessarily a breastfeeding barrier, but the separation of mother and child certainly is, as is the attitude towards breastfeeding in mom’s close and wider society. Cooklin, Donath and Amir analyzed the data from 3697 Australian children and their mothers and found a positive link between more work and less breastfeeding at 6 months. Other studies in other countries did and continue to point to similar results. Other researchers don’t stick with counting, but try and find factors that may lead to these mechanisms and how to avoid the decrease in breastfeeding duration. Fein et al found that mothers who were able to directly breastfeed their children during the working day had the best chances to succeed, directly followed by those who could express breastmilk during the day. Not feeding nor pumping understandably led to the less chances of breastfeeding success. They advise that mother-child separation is as short as possible and that there should be in-company child care facilities where mothers can go to breastfeed and/or means for working mothers to feed the child at their own workplace if the child is brought to them. Johnston and Esposito found in their literature review that the personal characteristics of the mother and her paln of action are key factors for breastfeeding success, aided strongly by a supportive social environment and support groups. Other positive factors included part-time work, lack of long periods of mother-child separation, supportive work conditions and breastfeeding supportive child care facilities. The New Zealand Payne and James study pointed to three key factors for continuation of breastfeeding: the presence or absence of the factors of space, time and support. Their advice towards employers is to create breastfeeding supporting work conditions, but they do recognize the need for ‘’the society’’ as a whole to change its attitude towards working women who breastfeed.
Cooklin AR, Donath SM, Amir LH: Maternal employment and breastfeeding: results from the longitudinal study of Australian children. Acta Paediatrica (2008), 97:620–623.
Fein SB, Mandal B, Roe BE: Success of Strategies for Combining Employment and Breastfeeding. Pediatrics 2008 122: S56-S62
Payne D, James L: Make or break. Mothers' experiences of returning to paid employment and breastfeeding: a New Zealand study. Breastfeed Rev. 2008 Jul;16(2):21-7.

Social breastfeeding barriers

WHO and UNICEF are working together in a deccenia-log efford to promote, protect and support breastfeeding. The promotion part is doing great, too great, perhaps. Some people think that breastfeeding is promoted so strongly that mother tell they feel cornered into breastfeeding even if they choose not to. Others do start, but have to quit prematurely, feeling disappointed, sad and angry, because ‘’this breastfeeding thing just doesn’t work out’’. All kinds of problems are mentioned, like nipple trauma, breast infections and low milk supply (or even ‘’milk without nutritional value’’). But the real culprit actually is societal negativity. Well, ofcourse it is admirable that there are these brave women who dare start out, but those ‘’fanatics’’ who just go on and on with it even after a couple of months, well they wouldn’t try and hold their breaths waiting for societal support any more. Bare breasts shown in public are quite well tolerated and multi-usable, just not with a baby attached. Taking care of one’s family supplying healthy foods and lifestyles is an absolute must, but not if that involves pumping your breasts in working time. phdinparenting.com posted a very thorough article on all kinds of societal barriers that make it impossible for many western-society moms to achieve  breastfeeding for a normal biological duration. Let’s consider promotion to be a mission accomplished and start focusing on protecting and supporting.
World Health Organization, UNICEF: Baby-Friendly Hospital Initiative; Revised, updated and expanded for integrated care. WHO/UNICEF 2009
http://www.phdinparenting.com/2009/09/10/societal-barriers-to-breastfeeding/

Cleft lip/palate and breastfeeding

Cleft lip and/or palate is an incomplete closure of the upper lip, upper jaw and/or the palate. Lips, jaws and palate play important roles in breastfeeding: the lips make an airtight seal, the jaws aid in massage and the palate in cooperation with the tongue provided compression of the breast. Massage, pressure and suction together trigger the let-down reflex, urging the milk to flow and the baby to swallow. Without means to seal the mouth airtight around the breast and/or toe massage and compress the breast it may be hard to make and keep the milk flowing. It is often thought (and likewise advised0 that breastfeeding will be hard if at all possible, but some researchers did get other information from their studies. With good guidance and counseling and possibly adapted techniques breastfeeding a cleft child is very well possible. In Thailand Pathumwiwatana et al found that especially mothers who had a demanding job away from their child were not able to continue exclusive breastfeeding. Garcez cs in Brazil found that mothers of a cleft child tended to have a longer exclusive breastfeeding period than the country’s statistics would predict. Mothers need to have themselves informed about the condition of their children and how breastfeeding will fit into that. A skilled lactation consultant can be of great help in finding ways to make breastfeeding work. Full at-breastfeeding will not always be possible, but breastmilk-feeding and non-nutritive breast suckling will always contribute to this special child’s health and well-being.
Pathumwiwatana P, Tongsukho S, Naratippakorn T, Pradubwong S, Chusilp K: The promotion of exclusive breastfeeding in infants with complete cleft lip and palate during the first 6 months after childbirth at Srinagarind Hospital, Khon Kaen Province, Thailand. J Med Assoc Thai. 2010 Oct;93 Suppl 4:S71-7.
Garcez LW, Giugliani ER: Population-based study on the practice of breastfeeding in children born with cleft lip and palate. Cleft Palate Craniofac J. 2005 Nov;42(6):687-93.

Breastfeeding vs formula feeding: BMI, health and food variety

Two totally different studies (1 in N Carolina, USA and 1 in Iceland/Denmark) aimed to increase the understanding of the connection between infant feeding, body weight and health. Gunnarsdottir c.s. in Iceland and Denmark looked at infants who received longer or shorter periods then 2 months of exclusive breastfeeding and found in Denmark more convincing than in Iceland a link between a shorter duration of exclusive breastfeeding and a higher BMI at age 6 and 12 months. They concluded that lifestyle and the sort of family foods probably are as important as which milk feeding an infant got. Strong & Strong did some more curious research: they asked themselves if the more varied tastes experience through breastfeeding would lead to a greater variation in tastes for fruits and vegetables in 2 and 3 year old toddlers. The results showed that higher educated mothers tended to have a lower BMI and to breastfeed more and that children ate a greater variation of fruits and vegetables. Their conclusion was that breastfeeding does not influence the development of taste. Stunning how you can make numbers say anything you like. Another hypothesis to explain the risk for overweight is that breastfed children can self-regulate their food intake (and will continue to do so) and bottle-fed children don’t. Li et al studied the validity of this hypothesis. The results showed that children fed by bottle (no matter the contents) later on are more prone to empty the bottle or cup they get served then children who are breastfed from birth. The ability to stop feeding if hunger and thirst are satisfied is an important protective factor in maintaining a healthy body weight.
Li R, Fein SB, Grummer-Strawn LM: Do Infants Fed From Bottles Lack Self-regulation of Milk Intake Compared With Directly Breastfed Infants? PEDIATRICS Vol. 125 No. 6 June 2010, pp. e1386-e1393
Gunnarsdottir I, Schack-Nielsen L, Fleischer Michaelsen K, Sørensen T, Thorsdottir I: Infant weight gain, duration of exclusive breast-feeding and childhood BMI ? two similar follow-up cohorts. Public Health Nutrition(2010), 13:201-207
Strong LCA, Strong E, West D, Brouwer R, Ostbye T, Lovelady C: Relationship of early infant feeding (breast vs. formula) and fruit and vegetable variety in dietary intake of 2–3 year olds. FASEB J. 24: 556.16

Exclusive breastfeeding

2 Different studies explored factors influencing the exclusivity of breastfeeding. In California Bramson et al studied the effects of postpartum skin-to-skin contact between mothers and babies and found that the longer the skin-contact episode, the greater the chance that the child was exclusively breastfed at discharge. Bai et al in Indiana studied factors that influenced exclusive breastfeeding for the first 6 months and they found that the vast maternal determination to exclusively breastfeed for a set period was a good predictor for exclusive breastfeeding duration. Their advice thus is to include pregnant women in prenatal pro breastfeeding campaigns. Another factor to challenge exclusive breastfeeding is delayed lactogenisis II (onset of mature milk), beyond the main 3 days, because the urge to supplement with other milk becomes more and more tempting as mom’s own milk does not seem to show up. Many first time mothers will have to wait more than 3 days after birthing before their milk ‘’comes in’’. Besides being a first time mom other factors to delay the onset of mature milk are in the mother being over 30 years of age, BMI over 30, postpartum edema, and the absence of nipple discomfort in the first 3 days, and in the baby being under 3600grams at birth and 2 or more episodes of inaccurate breastfeeding in the first days.
Bramson,  L, Lee JW, Moore E, Montgomery S, Neish C, Bahjri K, Lopez MelcherC:  Effect of Early Skin-to-Skin Mother—Infant Contact During the First 3 Hours Following Birth on Exclusive Breastfeeding During the Maternity Hospital Stay. J Hum Lact  May 2010   vol. 26  no. 2  130-137
Bai Y, Middlestadt SE, Peng C-Y J, Fly AD: Predictors of Continuation of Exclusive Breastfeeding for the First Six Months of Life.J Hum Lact. 26(1):26-34
Nommsen-Rivers LA, Chantry CJ, Peerson JM, Cohen RJ, Dewey KG: Delayed onset of lactogenesis among first-time mothers is related to maternal obesity and factors associated with ineffective breastfeeding.  Am J Clin Nutr (June 23, 2010).

SIDS prevention

Children who are not breastfed have double the chance to die of SIDS in comparison to their breastfed counterparts, according to Vonnegut & Mitchell in a German Ministry of Education and Science and the New Zealand Child Health Research Foundation funded study. The researchers thus advise that breastfeeding gets a prominent place in anti SIDS campaigns. The Edmund et al Oxford University research team added the knowledge that it is important to start breastfeeding as soon as possible following birth, for their research showed that 16%, respectively 22% of SIDS cases could be prevented if all children would start breastfeeding within the first 24 hours, respectively the first hour of life.  Other researcher found that the use of a dummy/pacifier just before sleeping is a strong preventive measure as well. The Cochrane group review several studies on this subject and they found that for every 2733 children that are put to sleep with a pacifier one cot death would be prevented. This study however did not take breastfeeding into account. Are breast and dummy evening out each other? Do they increase each other’s merits? Do they work against each other? For me, breastfeeding still is the strongest protection. Dummies only protect against SIDS, but they do increase the risk for less breastfeeding, incorrect oral and dental development, apnea, and ear infections, while breastfeeding lowers those risks and lowers the risk of SIDS as well significantly. Read more avbut breastfeeding and other oral obkects and their effects on child health: http://www.brianpalmerdds.com/articles.htm
M.M. Vennemann, T. Bajanowski, B. Brinkmann, G. Jorch, K. Yücesan, C. Sauerland, E.A. Mitchell,  and the GeSID Study Group: Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e406-e410
Hauck FR, Omojokun OO, Siadaty MS.: Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics. 2005 Nov;116(5):e716-23.
Vennemann MM,  Mitchell EA: Breast-Feeding May Reduce Risk for SIDS by Half Throughout Infancy. Pediatrics. 2009;123:e406-e410
Edmond KM, Zandoh C, Quigley MA, Amenga-Etego S, Owusu-Agyei S, Kirkwood BR: Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality. PEDIATRICS Vol. 117 No. 3 March 2006, pp. e380-e386

Nighttime eating and sleeping

Interrupted sleep and incomplete sleep cycles can lead to sub-standard functioning during the day. Parents can experience this kind of sleep disturbances because the needs of infants and toddlers and their sleeping patterns don’t fit well with those of adults. For mothers this is added to the sleep disturbances that started in pregnancy (Kohn et al, 2008). The Montgomery-Downs et al study showed that it is not the shorter sleep per se (in fact most parents have quite the same average of minutes of sleep as other adults) but rather the fragmented pattern of sleep. Doan et al already showed that breastfeeding mothers have an average of 45 minutes of sleep more per night than bottle-feeding mothers. Mothers who keep their babies close (in or directly besides their own beds) and breastfeed sleep best of all mothers in duration and quality of sleep. Bed sharing, however is strongly discouraged in anti-SIDS campaigns (although this is poorly underlined by research). A compromise is using a co-sleeper. A co-sleepier is a standard cot, with only one side barred. The other side is naild or tied very closely fitted to the side of the parental bed, without any traps or openings. Co-sleepers are a quite easy DIY projects or can be purchased ready to use. A very nice one is for sale at ikbenmam.nl. As pretty, made of pure wood and much more affordable are the co-sleepers sold by naturebabies.nl.
Kohn, M., & Murray, B. (2008). Sleep and Quality of Life in Pregnancy. In J. Verster, S. Pandi-Perumal, & D. Streiner, Sleep and Quality of Life in Clinical Medicine (pp. 497-504). Humana Press.
Montgomery-Downs, H., Insana, S., Clegg-Kraynok, M., & Mancini, L. (2010). Normative longitudinal maternal sleep: the first 4 postpartum months. American Journal of Obstetrics and Gynecology , in press.
Doan, T., Gardiner, A., Gay, C., & Lee, K. (2007). Breast-feeding Increases Sleep Duration of New Parents. Journal of Perinatal & Neonatal Nursing , 21(3):200-206.

Breastfeeding and hormones

Many people feel that hormones are kind of creepy substances and many hesitate to use them as medication. Both physicians and mothers look apprehensively at the use of hormonal pharmatherapeutica especially during the breastfeeding period. This hesitation in part is accurate. Hormones and hormone-like medications are powerful substances, especially so for small, still growing and developing children. But in hormonal therapies, like in most medications, medications a child gets through mothers’ milk and the effects it will have on him are much less dramatic than feared for. While during pregnancy the values in the fetuses blood may mimic those in maternal blood, what baby will digest from milk is more or less what his mother carries in her blood. In most cases that will be way too little to be any significant influence. Hormonal contraception may decrease milk production, though, especially those containing estrogens. Hormone replacement therapies, like in hypothyroidism only replaces mom’s own hormones and is therefore harmless to her child.  Corticosteroids can be used in moderation without harm for the child. Short duration an applications with less absorption, like inhalers and topical uses, are preferred. If used on the nipple make sure no cream is on the nipple left when the child latches on.
Hale T: Medications and Mothers’ Milk, Hale Publishing, Amarillo TX, 201014
Breastfeeding website van de afdeling Pediatrie van het Marina Alta Ziekenhuis, Denia, Spanje ‘’e-lactancia.org: http://www.e-lactancia.org/ingles/inicio.asp
Embryotox, Arzneimittelsicherheit in Schwangerschaft und Stillzeit (´´Schaefer online´´), http://www.embryotox.de

Breastfeeding and medications: drugs against bacteria, viruses and funguses

Many breastfeeding women seek medical care from general practitioners (GPs) for various health problems and GPs may consider prescribing medicines in these consultations. A lack of information from the manufacturers and of understanding the mechanics of drug transfer via human milk into the infant may lead to untimely cessation of breastfeeding or a breastfeeding mother may be denied medicines due to the possible risk to her infant, both of which may lead to unwanted consequences. With pathogen fighting drugs, actually, there isn’t much need for hesitation at all. Surpisingly few drugs need reconsideration about use in breastfeeding women and even fewer will need the mother to temporarily or definitely stop breastfeeding. With antibiotics it is always good to observe the infant for signs of diarrhea or thrush, because the antibiotics may destroy the yeast-restricting bacteria in the infant gut as well. Tetracyclines are probably safe for short duration and moderate doses, but should be avoided for high dosed and long term use. Breastfeeding needs to be postponed (bij expressing and discarding of the milk) for 1-3 days after the use of metronidazole and tinidazole. Maternal oral use of the antifungals nystatin, amphoterizin and fluconazole are all safe, the latter only reaching infant doses of 6-12% of the therapeutic dose used in premature infants.
Jayawickrama HS, Amir LH, Pirotta MV: GPs' decision-making when prescribing medicines for breastfeeding women: Content analysis of a survey. BMC Research Notes 2010, 3:82
Kristenson, J., & Ileth, K. (2007). Antibiotic, antifungal, antiviral, and antiretroviral drugs. In T. Hale, & P. Hartmann, Textbook of human lactation (pp. 513-521). Amarillo, Texas, USA: Hale Publishing L.P.

Breastfeeding and medication: antidepressants

Antidepressants belong to the most frequently prescribed medications n pregnant and lactating women. Many mothers and their physicians fear the use of medications for pshychiatric disorders during lactation for fear of damaging the child via breastmilk. Mothers tend to not have themselves treated and their doctors to treat them and discourage continuation of breastfeeding. Both options are unnecessary and unwanted. However little research has been performed considering the exact working of antidepressants and breastfeeding , there are reviews on recorded negative complications and monoloques on the pharmakinetics of several antidepressants. Gentille started making an index based upon recordings of adverse effects and came to a preliminary list of four preferential medications. Two of those, ‘’sertraline and paroxetine should be considered as first-line medications in women who need to start antidepressant treatment during the postpartum period and wish to continue breastfeeding. The utilisation of fluoxetine and citalopram seems conversely to be associated with a relatively higher risk of adverse events (with a low degree of severity, however)’’ (Gentille, 2007). The review of Kendall and Hale starts with explaining and emphasizing the health risks for both mother and child of not treating depression and of depriving both of breastfeeding. Based on the data on transmission into milk and reports on unwanted effects they, too, conclude that sertraline and paroxetine are the preferred medications during lactation. Especially in very young children fluoxetine is not first choice, but certainly not contra-indicated either.
Kendall-Tackett K, Hale TW: Review: The Use of Antidepressants in Pregnant and Breastfeeding Women: A Review of Recent Studies J Hum Lact May 2010 26: 187-195
Gentile S: Use of Contemporary Antidepressants during Breastfeeding: A Proposal for a Specific Safety Index. Drug Safety, 2007, 30(2):107-121(15)