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