Safe milk

Almost every child is best fed and nurtured when directly at breast. For all kinds of reasons for some children this is not possible for short or long time and they need expressed milk from their own  mother or a donor. Freshly expressed not manipulated milk is first choice, because it contains all vitamins and immunologic properties. When milk has to be stored there will be some loss of nutrients and immunologic properties, depending on time and temperature stored and material of storage container. Many institutions do not allow the use of raw milk for far of infection risks. Donor milk and sometimes even mom’s own milk, must be pasteurised. Common procedure is Holder pasteurization (63°C for 30 minutes). This will destroy all pathogens, but also a substantial part of immunologic factors. In studies in Europe, Africa and Northern America another pasteurisation method, Flash Heating or high-temperature short-time (HTST) pasteurization process (72°C for 16 seconds), proofed to be a safe way to destroy many pathogens, but safe most immunologic properties. In Flash Heating the glass milk container is put in a pan of cold water, which is brought to a boil and then removed from the heat source, rather then hated directly to  72°C and kept there for 16 seconds. This makes it a very safe and easy to use as an at home method of pasteurisation.
Akinbi H, Meinzen-Derr J, Auer C, Ma Y, Pullum D, Kusano R, Reszka KJ, Zimmerly K: Alterations in the Host Defense Properties of Human Milk Following Prolonged Storage or Pasteurization. Journal of Pediatric Gastroenterology & Nutrition 2010, 51(3):347–352
Terpstra FG, Rechtman DJ, Lee ML, Van Hoeij K, Berg H, Van Engelenberg FAC, Van't Wout AB: Antimicrobial and Antiviral Effect of High-Temperature Short-Time (HTST) Pasteurization Applied to Human Milk. Breastfeeding Medicine 2007, 2(1):27-33.
Chantry CJ, Israel-Ballard K, Moldoveanu Z, Peerson J, Coutsoudis A, Sibeko L, AbramsB: Effect of Flash-heat Treatment on Immunoglobulins in Breastmilk. J Acquir Immune Defic Syndr. 2009; 51(3):264–267.

More Mommy Milk

Throughout human history women have used all kinds of food products to support their milk supply. Scientific research has shown that accurate breastfeeding techniques, including frequent feeding and using adequate techniques to empty the breasts thoroughly are the basis for an ample milk supply. Foods, drinks and herbs can however give just that little extra, if only by boosting mom’s self-esteem and overall well-being. Many traditional galactogogues from all over the world can be categorized in one of these categories: ‘’increase overall immunity’’, ‘’increase gut function’’ and ‘’increase iron and calcium metabolism’’. All aimed at a better function of a mother’s body. Products that are somewhere around the world said to increase milk production include, but are not limited to aniseed, beer-yeast, hop, oats, mung beans, fenugreek, asparagus, apricots, leafy green vegetables (including dandelion greens), nuts like pecans, goat’s rue, milk thistle, blessed thistle, caraway, coriander, alfalfa.
Marasco, L. “Increasing Your Milk Supply With Galactogogues,” Journal of Human Lactation (24) 2008: 455‐56.
The Academy of Breastfeeding Protocol Committee: Protocol #9: Use of galactogogues in initiating or augmenting maternal milk supply. ABM 2004
http://www.drmomma.org/2010/08/lactation-cookies-recipe-increasing.html

Brain food

Brain development is enhanced during three developmental stages: foetal, infancy and adolescence. This intense development asks for optimal food. The wide-hl belief that the more positive intellectual development of breastfed children is mainly due to the fact that more intelligent woman breastfeed does not seem to be justifyable. A few generations back, in the ‘6o’s and ‘70’s off last century, highly educated women pertinently did not tend to breastfeed.  Fats are an elementary part of brain food, especially the fatty acids. Human milk contains the right fats and fatty acids for optimal brain development. Isaacs et al (including dr. Lucas from the early premature infants and human donor milk studies)  found that a minimum of 50% human milk in the diets of premature babies let to an improved verbal intelligence I all adolescents and to all forms of intelligence in male adolescents. . These data support the hypothesis that breast milk promotes brain development, particularly white matter growth. Mothers could even enhance the brain food quality of their milk by modelling their diets and possibly use supplements. Foods rich in omega 3 fatty acids can do this and provide for a more stable mental health for themselves. Helland at al found that maternal concentration of n-3 very-long-chain polyunsaturated fatty acids during pregnancy might be of importance for later cognitive function.
Isaacs EB, Fischl BR, Quinn BT, Chong WK, Gadian DG, Lucas A: Impact of Breast Milk on Intelligence Quotient, Brain Size, and White Matter Development. Pediatric Research 2010, 67(4):357-362.
Helland IB, Smith L, Blomen B, Saarem K, Saugstad OD, Drevon CA: Effect of Supplementing Pregnant and Lactating Mothers With n-3 Very-Long-Chain Fatty Acids on Children's IQ and Body Mass Index at 7 Years of Age. Pediatrics 2008 122: e472-e479

Breastfeeding without pregnancy

Breastfeeding is a natural and logical step in the sequence of conception, pregnancy and childbirth. However, a woman can breastfeed even without preceding pregnancy. (Szucs et al 2010, Biervliet et al 2001) This is named induced lactation. To induce lactation protocols are being used, where the use of hormonal medication plays an important part. The presupposition is that it is hardly, if at all, possible to create a full milk production, suitable to satisfy a child’s total nutritional needs. Gribble, however, found I her extensive review f the literature that in some cultures it seems to be no problem at all to relactate and subsequently fully breastfed for an extended period. Adoptive mothers in developing countries may have greater milk production than mothers in the west because they are more knowledgeable about breastfeeding, practice frequent breastfeeding, remain in close physical contact with their children and live in cultures that are supportive of breastfeeding. Adoptive mothers in the west should be encouraged to maximise their milk supply by emulating the mothering styles of women in developing countries and developing a strong support network for breastfeeding.
Gribble KD: The influence of context on the success of adoptive breastfeeding: developing countries and the west. Breastfeed Rev. 2004 Mar;12(1):5-13.
Szucs KA, Axline SE, Rosenman MA: Induced Lactation and Exclusive Breast Milk Feeding of Adopted Premature Twins. J Hum Lact August 2010 26: 309-313, first published on June 22, 2010
Biervliet FP, Maguiness SD, HayDM, Killick SR, Atkin SL: Induction of lactation in the intended mother of a surrogate pregnancy: Case report Hum. Reprod. (2001) 16(3): 581-583

Fortified milk

Human milk is the ideal food for human babies, with exactly the right amount of nutrients and energy for healthy growth and development. Often the value of mother’s milk is doubted and is thought to need fortifying. This is then often done by adding one or more scoops of powdered infant formula. This is a dangerous practice, because the still developing kidneys can’t yet process this mineral load, with disease as possible result. Children with restricted growth benefit more from optimisation of breastfeeding (more and better). For very small premature babies it may be true that they need more nutrients than the milk of their mothers can provide at that stage. Special mixtures of minerals and proteins (HMF: human milk fortifier) are used to supply with those, but it means they will get bovine milk based nutrition. This will increase their risk for health damage according to the research done by Chan and by Oval et al. Especially added iron prompted an increase of bacterial and fungal growth in the intestines. In another study Chan et al however found that HMF based on human milk did not lead to the negative consequences of bovine milk based HMF.
Chan GM: Effects of Powdered Human Milk Fortifiers on the Antibacterial Actions of Human Milk. Journal of Perinatology (2003) 23, 620–623
Oval F, Ciftci IH, Cetinkaya Z, Bukulmez A: Effects of human milk fortifier on the antimicrobial properties of human milk. Journal of Perinatology (2006) 26, 761–763.
Chan GM, Lee ML, Rechtman DJ: Effects of a Human Milk-Derived Human Milk Fortifier on the Antibacterial Actions of Human Milk. Breastfeeding Medicine. December 2007, 2(4): 205-208.

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 depression

Purpose and necessity of breastfeeding for the health and well-being of mother and child are well documented. Although breastfeeding is for both mother and child an inborn capability, it is also a learned skills and therefore open to disruption. Maternal depression is known to be an inhibiting factor for initiation and duration of breastfeeding. Dennis et al found in their review of the literature that women with depressive symptomatology in the early postpartum period may be at increased risk for decreased breastfeeding duration and increased breastfeeding difficulties. There is also beginning evidence to suggest that depressed women may be less likely to initiate breastfeeding and do so exclusively. Bogen c.s. found a strong correlation between the use of antidepressants during pregnancy, but hardly any between being depressed and breastfeeding outcomes. Use of SRI’s during pregnancy led to a decreased intention to start breastfeeding.
Dennis CL, McQueen K: The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review. Pediatrics. 2009 Apr;123(4):e736-51.
Bogen DL, Hanusa BH, Moses-Kolko E, Wisner KL: Are maternal depression or symptom severity associated with breastfeeding intention or outcomes? J Clin Psychiatry. 2010 Aug;71(8):1069-78. Epub 2010 Jun 15.