Protection for mother and child

In this issues some fragments from a Unicef document about the effect of infant feeding choice on the survival chances of children and women’s health. Unicef states: ‘’Breastfeeding Saves More Lives Than Any Other Preventive Intervention’’. And this is not only true in the developing world, but in our rich Western society as well. ‘’Non-breastfed children in industrialized countries are also at greater risk of dying - a recent study of post-neonatal mortality in the United States found a 25% increase in mortality among non-breastfed infants. In the UK Millennium Cohort Survey, six months of exclusive breast feeding was associated with a 53% decrease in hospital admissions for diarrhoea and a 27% decrease in respiratory tract infections.’’ Unicef cooperated with the WHO in formulating recommendations for optimal breastfeeding: ‘’Initiation of breastfeeding within the first hour after the birth; exclusive breastfeeding for the first six months; and continued breastfeeding for two years or more, together with safe, nutritionally adequate, age appropriate, responsive complementary feeding starting in the sixth month.’’ Formula is not an acceptable substitute for breastmilk because formula, at its best, only replaces most of the nutritional components of breast milk: it is just a food, whereas breast milk is a complex living nutritional fluid containing anti-bodies, enzymes, long chain fatty acids and hormones, many of which simply cannot be included in formula.  Furthermore, in the first few months, it is hard for the baby’s gut to absorb anything other than breastmilk. Even one feeding of formula or other foods can cause injuries to the gut, taking weeks for the baby to recover.‘’  The major problems for living up to the recommendations to exclusively breastfeed fo 6 months and continue for 2 years or more are the societal and commercial pressure to stop breastfeeding, including aggressive marketing and promotion by formula producers. ‘’These pressures are too often worsened by inaccurate medical advice from health workers who lack proper skills and training in breastfeeding support. In addition, many women have to return to work soon after delivery, and they face a number of challenges and pressures which often lead them to stop exclusive breastfeeding early.’’ Mothers and children need protection: children by being breastfed and mothers from being pressured to quit breastfeeding and from having to take hurdles and barriers to breastfeed.
http://www.unicef.org/nutrition/index_24824.html

Mother’s milk substitutes

Almost all mothers can breastfeed successfully, which according to WHO and Unicef includes initiating breastfeeding within the first hour of life, breastfeeding exclusively for the first 6 months and continuing breastfeeding (along with giving appropriate complementary foods) up to 2 years of age or beyond. Exclusive breastfeeding in the first six months of life is particularly beneficial for mothers and infants. Positive effects of breastfeeding on the health of infants and mothers are observed in all settings. Nevertheless, a small number of health conditions of the infant or the mother may justify recommending that she does not breastfeed temporarily or permanently. Whenever stopping breastfeeding is considered, the benefits of breastfeeding should be weighed against the risks posed by the presence of the specific conditions listed. When deciding to interrupt, stop or supplement breastfeeding it should be noted that feeding at breast is first choice, directly followed by alternatively feeding mom’s own milk. If, even after optimizing breastfeeding management and techniques first choice for an alternative is another mother’s milk (donor-milk) or feeding at breast by another mother (cross-nursing). The 4th option, if no human milk in any form is available, is a specialized non-human milk based substitute or formula. Only children who are incapable to digest human or non-human milk the first and only alternative is a highly specialized and adapted milk substitute. This includes children with classic galactosemia, maple syrup urine disease and with phenylketonuria. A very short list of maternal medications contra-indicates breastfeeding for the duration of the therapy. Mothers who have several acute or chronic diseases can breastfeed a long as they are able to handle their child. One true contra-indication is HIV+, but only if formula is AFASS (acceptable, feasible, affordable, sustainable and safe). Other situations like pre- and dysmaturity, increased risk of hypoglycemia need to be addressed with optimized breastfeeding management and techniques, possibly with own mother’s milk supplements, and only if these do not lead to the aimed results supplements of non-human milk based substitute is indicated.
HIV infection1: if replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS)
http://www.borstvoeding.com/problemen/medicijnen/medicijnlijst-nl.html
WHO/Unicef: Acceptable medical reasons for use of breast-milk substitutes. WHO/NMH/NHD/09.01. WHO/FCH/CAH/09.01

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