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.