ABM President responds to Vaccines and Breastfeeding

In response to confusion and misinformation regarding the recent report of:

Moon et al (Ped Inf Dis J 2010 29;919 ) entitled:
“Inhibitory effect of breast milk on infectivity of live oral rotavirus vaccines”

the following clarification is provided:

1. The study related only to oral rota virus vaccine and DOES not provide information on any other oral vaccine ( such oral polio) and surely has no relevance to standard non oral vaccines

2. The study of the neutralizing effect of breast milk was an IN VITRO study and the significant neutralizing effect was only found in milk from mothers from developing countries(Vietnam, South Korea, India) AND NOT from milk from US mothers. This reflects probably the high frequency of rotavirus infection in those countries and the high antibody levels in the adults of those countries and the low titers in US mothers.

3. Epidemiological studies have noted adequate efficacy of oral rotavirus vaccine in industrialized countries …the only issue is the somewhat lower efficacy in the developing countries

4. Oral polio vaccine is not the standard in North America so is not a relevant issue

5. At most the investigators recommend “evaluating” (STUDYING) the effect of delaying breastfeeding at the time of immunization (of rota virus ) and measuring the efficacy ( serum antibodies in the infants). “Delaying” means not breastfeeding simultaneously when ingesting the vaccine and delaying nursing for 2-3 hours. NO suggestion of substituting formula was made or should be made !

6. Bottom line: the study has absolutely NO relevance to nursing mothers in industrialized countries ( surely NOT the US and Canada) and therefore NO change in the routines of breastfeeding infants who are being vaccinated are being suggested! (and so spread the word!)

7. The possible benefit of a few hours wait between oral rota virus vaccination and nursing should be studied in populations in those geographic areas where there is a problem of efficacy. As there may be other factors effecting efficacy (e.g. related to the immunocompetence of the infants themselves) until we have the results of such IN VIVO studies one can not make any feeding recommendations even for those populations. The problem may not relate to breast milk at all! That why evidenced based data is needed!

8. For the nursing mother in the developed world there is no need to alter any feeding routines!

Arthur I Eidelman MD FAAP FABM

Arthur Eidelman is a neonatologist and president of the Academy of Breastfeeding Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Spread the ABM Holiday Cheer!

Warmest Holiday Wishes

to Mothers and Babies Worldwide

ABM Responds to The New York Times’ “AIDS-Free Generation”

To the Editor:

RE: “Clinton Aims for ‘AIDS-Free Generation’”, The New York Times, November 8, 2011

We applaud Secretary Clinton’s lofty vision of an AIDS-free generation. Halting vertical transmission will eliminate nearly all new childhood infections, approximately 370,000 in 2009. She hopes mothers won’t “infect their babies at birth or through breastfeeding” by 2015.

We’re concerned that readers may misinterpret the reports of her statement to suggest HIV-positive mothers should not breastfeed. On the contrary, the World Health Organization’s recommendations for infant feeding emphasize breastfeeding’s role as a pillar of child health, particularly in resource-poor regions where formula feeding lessens HIV-free survival. Making breastfeeding safer by providing antiretroviral drugs (ARVs) to the mother and infant, akin to preventive regimens used during pregnancy and childbirth, optimizes survival while minimizing HIV-transmission. Thus, supporting mothers to exclusively breastfeed for 6 months followed by continued breastfeeding until a year while providing ARVs is the wisest use of precious PEPFAR funds – and goes a long way towards fulfilling Secretary Clinton’s vision for an “Aids-free generation” and healthy babies worldwide.

Caroline Chantry MD
Arthur I Eidelman MD, President,
Academy of Breastfeeding Medicine

This letter was submitted to the editor of The New York Times

Conservative rhetoric masquerading as breastfeeding advocacy

A recent commentary in the National Review titled, “Fire the government wet nurse,” reads, at first blush, like breastfeeding advocacy. Author Julie Gunlock starts out by saying, “Breast milk is magic,” citing benefits for fighting infection and improving maternal health.

But then Gunlock takes aim at the WIC program, arguing that this safety net for poor families “encourages poor women to skip breastfeeding altogether and instead turn to formula for their children’s nutrition needs.” Gunlock notes that only one third of WIC mothers breastfeed for 6 months, and the program accounts for more than half of formula sales in the US. WIC, she argues, is yet another entitlement program that is hurting the very people it is supposed to help.

It’s a tidy argument – that safety net programs cause poverty, rather than help those who are most in need. The only problem is that it’s not true.

Improving the world, one breastfeeding dyad at a time

This fall, I had the honour to represent the Academy of Breastfeeding Medicine (ABM) at the 64th annual conference of the UNO DPI/NGO in Bonn (Germany). The theme of this conference was “Sustainable Societies, Responsive Citizens”. This theme was discussed in plenary discussions, panel discussions, Round Tables and workshops. Emphasis was also placed on youth participation. They partly had their own program but also joined in the regular discussions. There was a large NGO exhibition, and between the discussions and through an official invitation for a reception by the city of Bonn, there was much time to meet with persons of organisations from around the world.

Newest ABM Protocol Released from the International Meeting in Miami Today: Allergic Proctocolitis in the Exclusively Breastfed Infant

We are here in sunny Miami at the 16th Annual International Meeting of the Academy of Breastfeeding Medicine–our “Sweet Sixteenth” birthday party!  What better way for me, a member of the Board of Directors and the Chair of the Protocol Committee to celebrate the accomplishments of our organization than to see the e-pub release today, live from the meeting, of our newest clinical protocol, #24: Allergic Proctocolitis in the Exclusively Breastfed Infant?

Mountains and hills in infant nutrition

How do you imagine the Alps? Let’s have a look in Switzerland, Austria, Italy, France or Germany. Here you will find a wonderful panorama view: the mountains, lush green meadows, the flora and fauna, the rocks and stones, but also cultural elements like alpine farms, the goats and cows.

Breastfeeding is, in a way, the “Alps” in infant nutrition -- and not only in nutrition.

Breastfeeding is, in a way, the “Alps” in infant nutrition — and not only in nutrition. Just as the Alps are not only about the mountain tops, but the whole landscape, so is breastfeeding is more than nutrition. The german word “stillen”, which means “soothing” actually expresses this much more clearly than the word breastfeeding. It is interplay between mother and child with many contributing factors: nutrition, immunisation and most of all an intensive bonding between a mother and her child. It is the seamless transition from the intra-uterine environment with constant contact and constant nourishment to extra-uterine world, with lots of skin-to skin contact and a very frequent feeding. It is the normal adaptation process of a newborn, a baby, and at the same time the normal adaptation process of the mother.

I am from the Netherlands. And we, in the Netherlands, are longing for the Alps. We already have the beginning. The Vaalserberg, at the borders of the Netherlands, Germany and Belgium, would be suitable. But it is not quite what it should be. So this mountain should be heightened-up a little bit. We could make it a 100% higher. That would do, wouldn’t it?
Now this Vaalserberg is 326 meter above sea-level (360 meters with the tower on it), and even if we would heighten it up 100% it still doesn’t have the height of the Alps. Try to further heighten it up? You have to be honest: It is not just the height: essential elements of the Alps are failing in the Netherlands. Flora and Fauna will never be that of the Alps landscape. And you cannot solve this problem with heightening up. Of course it is a good alternative, when you cannot have the Alps. It is a good recreation area, it has its own value for the people in the region and for holidays, but you cannot honestly say it is the Alps (even when some hotel owners want us to believe this – they call their hotel: Alpenblik – Alpview).

The Vaalserberg will never be the Alps

And so we have the parallel: formula is infant nutrition of acceptable quality, and in principle this quality can be improved. But as much as you can (and should) enhance this quality, it never will reach the standard of the original. It brings risks with it and disadvantages, for mother, child and society. When we do have the quality of the Alps, we should not be content with the Vaalserberg.

Elien Rouw is a physician in Bühl, Germany, and a member of ABM

Opinions expressed on the ABM blog are those of individual members, not the organization as a whole.

What a difference five years makes

Breastfeeding advocacy has come a long way in the past five years. In 2006, then MA-Governor Mitt Romney shut down efforts to stop hospitals from marketing formula to new mothers, arguing that a ban on marketing of branded formula took choices away from parents. Five years later, news that fewer hospitals are distributing the bags was largely embraced in the press as progress for mothers and babies.

The shift reflects a powerful change in the way public health advocates have approached breastfeeding over the past decade. We’ve moved away from goading mothers to “try harder” to addressing the barriers that prevent mothers from achieving their own infant feeding goals. For example, consider the language around breastfeeding in the Healthy People 2010 goals, published in 2000. Commenting on progress from 1990 to 2000, the authors write:

…evidence is encouraging about increases in women’s use of health practices that can help their own health and that of their infants… The percentage of mothers who breastfeed their newborns also went up 18.5 percent between 1988 and 1998, with greater gains among African American and Hispanic women.

By framing the discussion as “women’s use of a health practice,” the implication was that women needed to try harder to breastfeed. Healthy People 2010 set goals to increase breastfeeding iniation and continuation at 6 and 12 months to 75%, 50% and 25%. Notably, none of the HP2010 goals addressed barriers that might influence whether mothers were able to meet those targets.

The difference in the Healthy People 2020 goals is striking. Again, there are goals for breastfeeding rates — but HP2020 also targets workplace lactation programs, unindicated formula supplementation in the hospital, and the Baby Friendly Hospital Initiative. We’re not telling mothers to try harder — we’re telling hospitals and workplaces to make it easier for mothers to succeed.

That difference in focus is making an impact in myriad ways. This summer, during world breastfeeding week, the CDC issued a report linking poor maternity care practices around breastfeeding to the childhood obesity epidemic. The tag line? “Hospital Support for Breastfeeding: Preventing obesity begins in hospitals.”

Last week, California Governor Jerry Brown signed legislation to require all maternity centers in California to adopt an infant feeding policy modeled on the Baby Friendly Hospital Initiative. Echoing the CDC’s approach, the legislation notes, “A growing body of evidence indicates that early infant-feeding practices can affect later growth and development, particularly with regard to obesity.”

This legislation shifts the onus for obesity prevention away from individual moms to the hospitals that set mothers and babies up to succeed — or fail.

It’s a breakthrough change, brought about by the thoughtful arguments of public health leaders working on the Surgeon General’s Call to Action to Support Breastfeeding and by bloggers that have made “booby traps” a trademarked phrase. We’ve got plenty of work left to do, but look how far we’ve come.

Alison Stuebe is an ABM member and a maternal-fetal medicine physician at the University of North Carolina in Chapel Hill.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Highlights from Third Annual Summit on Breastfeeding: First Food–The Essential Role of Breastfeeding

Riding home on the train from Washington DC Thursday night, I was utterly physically exhausted as my mind tumbled over everything I had heard during the past two days.  I was returning from the Third Annual Summit on Breastfeeding.  For those of you who aren’t familiar with this Summit, I am going to unapologetically copy from the announcement of this Summit, as they said it better than I can!

“The First Annual Summit, held in June 2009, marked the 25th anniversary of the Surgeon General’s Workshop on Breastfeeding and Human Lactation, a milestone event led by C. Everett Koop, MD in 1984. Dr. Koop also delivered opening remarks at this 21st century follow-up.

The Second Summit in June 2010 addressed the unmet health needs of underserved mothers and their vulnerable children associated with low rates of breastfeeding, working proactively toward reducing barriers to breastfeeding. The goal was to bring high-level visibility in order to generate timely and judicious policy recommendations for a national breastfeeding agenda under the new health reform plan.

The Third Annual Summit on Breastfeeding was just held June 29-30, 2011 to make sure that we continue our best efforts to guarantee support for First Food: The Essential Role of Breastfeeding.  The Summit again took place in Washington to ensure maximum visibility in the public policy arena.

With continued support from the Kellogg Foundation, key leaders in health and public policy, including high-level representatives from key federal agencies as well as hands-on grass roots administrators from important programs throughout the country and leaders from academic institutions, industry, nonprofits, and public agencies were invited.”

The significant accomplishments of the First Summit and the Second Summit are documented in special supplements of Breastfeeding Medicine.  The Third Summit will be published in detail in an upcoming issue of Breastfeeding Medicine—so be on the look-out for Volume 6 Issue 5 in October.

WIC Peer Counseling Program essential for public health

A proposed amendment to the Agriculture Appropriations Bill would eliminate funding for the WIC Peer Counseling Program, an important source of breastfeeding support in communities throughout this country.

“The science clearly shows that peer counselors increase breastfeeding success and this is a key tool in addressing current disparities,” says Jerry Calnen, president of the Academy of Breastfeeding Medicine.

The amendment, proposed by Virginia Foxx, (R-NC), would remove existing funding for the WIC Peer Counseling Program established under former President George W. Bush.

The WIC Program serves families with incomes less than $27,214 for a family of two. WIC serves over four million children, with two-thirds below the poverty line. These families are less likely to initiate breastfeeding, and less likely to continue breastfeeding. By now it is well-documented that peer counseling does make a difference.

Not breastfeeding is associated with substantial health risks for both mother and child. Infants who are not breastfed face increased risks of ear infections, diarrhea, pneumonia, obesity, diabetes, childhood leukemia and sudden infant death syndrome. Among mothers, not breastfeeding is associated with increased risks of type 2 diabetes, breast and ovarian cancer, high blood pressure, and heart attacks.

A recent study found that suboptimal breastfeeding rates incur $13 billion in excess health costs each year.

“Disparities in breastfeeding lead to lifelong disease burdens for mothers and children,” Calnen said. “Peer counseling programs to reduce these disparities are essential.”