Breastfeeding Medicine

Physicians blogging about breastfeeding

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Should the AAP Sleep Alone?

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Some public health messages everyone can agree with: Never drink and drive. Always put your infant in a car seat. Other public health messages seem to ask us to do the impossible: Teenagers must never have sex. Mothers must never share a bed with their infants.

Advice around the US urges parents never to bed share, reinforced by the official stance of the American Academy of Pediatrics. Scary ads abound. One ad shows a queen-sized bed with a headstone in place of headboard reading “For too many babies last year, this was their final resting place.” Another shows a baby in an adult bed with a meat cleaver, stating “Your baby sleeping with you can be just as dangerous,” and another ad says “Your baby belongs in a crib, not a casket.”

The fact is, across the United States and the world, across all social strata and all ethnic groups, most mothers sleep with their infants at least some of the time, despite all advice to the contrary, and this is particularly true for breastfeeding mothers.1-4 Unfortunately, we also know that parents who try to avoid bed sharing with their infants are far more likely to feed their babies at night on chairs and couches in futile attempts to stay awake, which actually markedly increases their infants’ risk of suffocation.5 According to a 2010 study of nearly 5,000 US mothers, “in a possible attempt to avoid bed sharing, 55% of mothers feed their babies at night on chairs, recliners or sofas. Forty–four percent (25% of the sample) admit that they [are] falling asleep with their babies in these locations.”6 This is truly disturbing.

The advice to never sleep with your baby has backfired in the worst possible way. Rather than preventing deaths, this advice is probably even increasing deaths. In another study, parents of two SIDS infants who coslept on a sofa did so because they had been advised against bringing their infants into bed but had not realized the dangers of sleeping on a sofa.5 In fact, deaths from SIDS in parental beds has halved in the UK from 1984-2004, but there has been a rise of deaths from cosleeping on sofas.7 Read the rest of this entry »

Written by melissabartick

April 9, 2014 at 6:05 am

Posted in In the news, policy

What if we realized that food security is homeland security?

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I’m waiting for my flight home from the 1,000 Days U.S. Leadership Roundtable, a spectacular meeting that was held today at the Gates Foundation in Washington, DC. Stakeholders in nutrition and maternal-child health gathered to discuss how we can galvanize support for nutrition during the 1,000 days from conception to age 2. This is the time when our youngest citizens build their bodies and brains, laying the foundation for long-term health. Investing in optimal nutrition during these crucial days improves health and productivity across a lifetime.

For too many of our children, however, this foundation is fractured. Poverty, food insecurity, and commercial pressures prevent moms and babies from achieving their full potential. During the meeting, 1,000 Days executive director Lucy Sullivan shared daunting statistics about the challenges facing children in America. One in eight infants and toddlers in the US lives in deep poverty, defined as less than half the poverty line. Food insecurity affects 20% of families with children under 6. One in 20 children – 5% — experience very low food security, defined as multiple indications of disrupted eating patterns and reduced food intake. This food insecurity has lasting consequences, leading to chronic diseases, impaired school performance, and, paradoxically, increased risk of obesity.

Breastfeeding is one of the single best preventive health measures for mothers and children, Sullivan said, but families in poverty are less likely to initiate or sustain breastfeeding. The barrier is not lack of information – it is lack of support and policies that enable mothers to initiate and sustain breastfeeding, especially in areas with high rates of poverty and racial disparities.

How can this be, in one of the wealthiest nations in the world? As one roundtable participant noted, we don’t think of food insecurity as a problem in America, and certainly not as a threat to our nation’s future. Read the rest of this entry »

Written by astuebe

April 7, 2014 at 9:07 pm

Posted in In the news, policy

How ABM enables mothers and babies to breastfeed

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We know that in the first six months of life infant nutrition is very important for growth and development, but it doesn’t just end there. These early decisions about how babies are fed have an ongoing impact throughout childhood and into adulthood. Therefore, finding opportunities to optimize infant feeding during this period is crucial to ensure infants are able to reach their potential.

Exclusive breastfeeding for the first six months of life is the most appropriate method of infant feeding, yet many babies are not exclusively breastfed at all, or only for a limited time. This is in spite of the fact that most mothers are aware that breastfeeding is the best option for their babies, and the majority initiate breastfeeding immediately after birth.

Mothers who have the support of family, physicians, nurses and health workers are more likely to continue to breastfeed when they run into unexpected breastfeeding problems or are uncertain of what they should do. If these problems are complex, or the mother has specific medical issues, having a physician with breastfeeding knowledge and expertise is even more important. However, many physicians have not had the training or experience to provide the help and assistance mothers need. Read the rest of this entry »

Written by wbrodribb

March 21, 2014 at 6:13 am

World Breastfeeding Week – Now is the time to start planning!

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Whether you celebrate World Breastfeeding Week (WBW) or National Breastfeeding Month, and whether you choose the first week in August or October, the time to start planning is NOW!

The World Alliance for Breastfeeding Action (WABA) is perhaps best known for its global sponsorship of World Breastfeeding Week (WBW), but is much more: it is a global network of individuals and organisations concerned with the protection, promotion & support of breastfeeding worldwide. WABA’s actions are based on the Innocenti Declaration, the Ten Links for Nurturing the Future and the Global Strategy for Infant and Young Child Feeding, and is in consultative status with UNICEF and is also an NGO in Special Consultative Status with the Economic and Social Council of the United Nations (ECOSOC). Its Core Partners include ABM, IBFAN, ILCA, LLLI and Wellstart International, with a shared mission is “To protect, promote and support breastfeeding worldwide, in the framework of the Innocenti Declarations (1990 and 2005) and the Global Strategy for Infant and Young Child Feeding, through networking and facilitating collaborative efforts in social mobilisation, advocacy, information dissemination and capacity building.”

WBW logo 2014WABA’s goal is primarily to create an enabling environment for mothers and families worldwide to decide to optimally breastfeed and to succeed in that goal, so this year’s WBW theme is BREASTFEEDING: A Winning Goal - for Life! This theme highlights the importance of ongoing support for mothers breastfeeding intentions, carried forward by the global attention to this year’s Football World Cup, where hitting the goal is the only way forward! In addition, this year’s goal orientation supports the eight global development goals, the Millennium Development Goals (MDGs), set by governments and the United Nations to fight poverty and promote healthy and sustainable development with targets, or goals for 2015. This year’s WBW theme also responds to the latest MDG countdown by highlighting the importance breastfeeding for the post 2015 agenda, and by engaging as many groups, and people of various ages, as possible.

Now is the time to plan to inspire, empower and educate while we support, protect and promote breastfeeding. Set your goals now for World Breastfeeding Week 2014.  Please visit worldbreastfeedingweek.org for information on the theme, materials you can download, a photo contest and a pledge form to help you decide now what you might do for your local event.

Miriam Labbok, MD, MPH is Professor of the Practice of Public Health in the Department of Maternal and Child Health at the UNC Gillings School of Global School Public Health and Director of the Carolina Global Breastfeeding Institute. She is a Founder and member of the board of the Academy of Breastfeeding Medicine. 

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

Written by labbok

March 19, 2014 at 4:20 pm

Shame, guilt and the search for common ground

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In the fallout from the breastfeeding sibling study, I’ve been struck by the intensity of conversations about shame and guilt. A colleague and friend posted on Facebook:

This study is for my patients who have taken every tea, herb and drug to raise their milk supply, and are afraid to be seen in public giving their babies formula. They shun the social support they need from other mothers because bottle feeding has become so stigmatized. I see such relief on their faces when I tell them that they are outstanding mothers raising healthy babies, and am glad to have some evidence behind that.

A father commented on the ABM Blog:

I sat in pre-natal class with my wife as a bunch of women were given the implicit message that they were not real women or good mothers if they did anything but breast feed. And a lot of these women; young women, bought into that message wholeheartedly. I was appalled.

Others attacked the paper — and the conversations around it — for sugar coating the truth for mothers who formula feed:

Breast is best no matter what, now I understand there are mothers who have tried and fail. For medical reasons or another.But the truth is there is not that many. A lot of mommies make the choice to do formula over breastfeeding. But why should the breastfeeding community sugar coat the truth to spare a formula feeding mothers feelings by not saying the whole truth breastmilk benefits and nutrients far out way formula hands down. Except it firmuka mommies and companies we need to support mothers who can’t keep doing it find other options like donor milk from a fellow friend or a breast sister to keep this poison out of our babies bellies. I mean do you see cigarette companies saying smoking doesn’t really kill it just makes you sick. No they have to say smoking is harmful and we as adults have to make an informed choice. Which is what the breastfeeding community wants women to do. Do not just give formula because you hear it is the same as breastmilk because it is not even on the same playing field. It us like comparing apples to oranges IMO.

The study in question doesn’t actually speak to any of these concerns— Bimla Schwarz and I have blogged about the limitations of the analysis and its implications. Yet these issues of shame, guilt, autonomy and informed consent are crucial to understand and address if we want to improve health and wellbeing for mothers and infants.  There is tremendous anger and angst that poisons conversations about breastfeeding and prevents us from finding common ground. Read the rest of this entry »

Written by astuebe

March 4, 2014 at 2:40 pm

Reports on breastfeeding sibling study are vastly overstated

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A recent analysis of breastfeeding’s effects on child health is making headlines that some of the benefits of breastfeeding have been overstated.

The authors examined behavioral assessments of children born between 1978 and 2006. When they compared breastfed children with formula-fed children, they found that the breastfed kids were healthier and smarter, as many other studies have previously reported. However, they then looked at families in which only some of the children had been breastfed, and they found that whether or not siblings were breastfed did not significantly affect their health outcomes. The authors argue that this proves that a child’s family – not infant feeding – is what really determines long-term child health, and breastfeeding doesn’t really matter.

The biggest problem with this conclusion is that the study ignored anything that happened in these families before their children reached the age of 4, disregarding well-established links between ear infections, pneumonia, vomiting and diarrhea and the amount of human milk a baby receives. There’s strong biological evidence for these relationships, because formula lacks the antibodies and other immune factors in breast milk that block bacteria from binding to the infant gut and airway. For preterm infants, formula exposure raises rates of necrotizing enterocolitis, a devastating and often deadline complication of prematurity. And evidence continues to mount that formula feeding increases risk of Sudden Infant Death Syndrome. Furthermore, mothers who don’t breastfeed face higher rates of breast cancer, ovarian cancer, diabetes, high blood pressure and heart attacks. None of these outcomes were addressed by the recent sibling study. The paper’s authors note they were interested in longer-term outcomes in childhood, but that’s been lost in the news coverage, which has effectively thrown out the breastfeeding mom and baby with the bath water.

Read the rest of this entry »

Written by astuebe

March 1, 2014 at 2:25 pm

Academy of Breastfeeding Medicine urges AAP to end formula marketing partnership

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New Rochelle, NY, December 27, 2013—The Academy of Breastfeeding Medicine today asked the American Academy of Pediatrics to end its formula marketing relationship with Mead Johnson.

“AAP participation in formula marketing undermines consensus medical recommendations for exclusive breastfeeding for the first six months of life and is harmful to the health of mothers and infants,” wrote Wendy Brodribb, president of the Academy of Breastfeeding Medicine. “We urge the AAP to discontinue this relationship with Mead Johnson.”

In an email message to members of the AAP’s Section on Breastfeeding, AAP President Thomas McInerny stated, “The inclusion of formula in hospital discharge bags, along with the AAP educational materials Mead Johnson purchased, has sparked considerable discussion. The Academy has initiated conversations with Mead Johnson to ensure the AAP is not connected with distribution of formula samples in the future.”

The ABM executive committee urged the AAP to set strict guidelines regarding formula marketing, stating, “We further urge the AAP leadership to implement a formal policy prohibiting Academy participation in direct-to-consumer marketing of formula.”

As reported last week in The New York Times, the AAP has contracted with Mead Johnson to provide educational materials for the formula manufacturer’s hospital discharge bags. Rigorous studies have found that mothers who receive bags containing formula samples and coupons introduce formula earlier than mothers who receive non-commercial information.

Furthermore, families who plan to formula feed from the start perceive the brand-name discharge bags as an endorsement from their health care provider, leading them to spend hundreds of dollars on pricey brand-name formula, rather than equivalent generic products.

“Concern about these harmful effects of formula marketing has led two thirds of America’s 45 top hospitals to discontinue formula advertising in their maternity wards,” Dr. Wendy Brodribb, ABM President wrote. “It is therefore deeply troubling that the AAP has contracted with Mead Johnson to support this practice.”

Written by bfmed

December 27, 2013 at 2:01 pm

Online milk sales, beyond “buyer beware”

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A new study in Pediatrics has spawned provocative headlines, contrasting images of human milk as “a nourishing elixir, or a bacterial brew.”   Researchers anonymously bought breast milk from 102 online sellers. Milk orders were often packaged poorly, arrived well above freezing, and — as one might expect with milk unrefrigerated for days — were rife with bacteria.

But that’s really not the whole story. First, consider who participated in the study.  By design, the authors communicated with sellers only by email, and cut off the conversation if the sellers asked about the recipient infant or wanted to talk by phone or in person. Milk was shipped to a rented mailbox to make the process anonymous. Of the 495 sellers the authors contacted, 191 sellers never responded, 41 stopped corresponding before making a sale, and 57 were excluded because they wanted to communicate by phone or asked about the recipient baby. Another 105 did not complete a transaction, leaving 102 of the original 495 sellers approached who actually shipped milk. Of these, half the samples took more than 2 days to ship, and 19% had no cooling agent in the package.

It’s highly plausible that milk sent with no questions asked, via 2 day or longer shipment, and (in 1 and 5 cases) without any cooling whatsoever, was collected with less attention to basic hygienic precautions.  The bacterial load in study milk samples therefore doesn’t tell us about the relative safety of milk obtained following a conversation between buyer and seller about the recipient baby and then shipped overnight on dry ice in a laboratory-quality cooler.  Indeed, when the authors compared online milk purchases with samples donated to a milk bank after a screening and selection process, they found much lower rates of bacterial contamination.  The authors acknowledge this limitation in the study, but that subtlety has been lost in the media coverage. Read the rest of this entry »

Written by astuebe

October 21, 2013 at 5:38 pm

BLACK MOTHERS’ BREASTFEEDING ASSOCIATION RECEIVES GRANT TO HELP ERADICATE RACIAL BREASTFEEDING DISPARITIES

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PRESS RELEASE

6/10/2013

For Immediate Release
Contact:
Kiddada Green
800-313-6141
Black Mothers’ Breastfeeding Association

DETROIT – Black Mothers’ Breastfeeding Association (BMBFA) has received a $400,000 grant from the W.K. Kellogg Foundation. The funds will be used to strengthen organizational capacity by building management systems, expanding existing programs and developing new programs, leading to sustainable growth to improve the quality of life for vulnerable, poverty stricken children, while causing social change for the greater good. The funding period began on May 1, 2013 and ends on June 30, 2016.BMBFA’s community approach to breastfeeding support has been deemed innovative due to its explicit focus on narrowing the disparity gap that exists in breastfeeding rates.  In Michigan, only 50.9 percent of black children ever receive breast milk as compared to 68.5 percent of white children.  Strengthening BMBFA’s infrastructure will lead to long-term increases in breastfeeding rates and work to create a monumental social impact that restores the emotional, psychological and physical health of the Detroit community.”What a wonderful opportunity to service a very deserving community with culturally appropriate support for breastfeeding, leading to lifelong health and wellness,” says Kiddada Green, founding director of BMBFA.  Since 2007, BMBFA has strived to increase the number of black mothers who breastfeed and the amount of time spent doing so. BMBFA is the only organization of its kind in the state of Michigan.

So what’s the big deal? Why is breast milk so important to African Americans? African Americans have the lowest breastfeeding rates in the U.S. Yet, they are hit hardest by health problems that breastfeeding protects against: diabetes, obesity, heart disease, asthma and allergies – just to name a few. Building the capacity of BMBFA will help to increase breastfeeding initiation and duration rates of African Americans.

BMBFA’s expanding and new programs include:
1) Developing a replication model for Black Mothers’ Breastfeeding Club, a mother-to-mother support group that facilitates peer support,
2) Partnering with St. John Hospital to increase the number of black lactation consultants in Michigan through the Mother Nurture Lactation College,
3) Creating web-based seminars for professionals with an interest in maternal-child-health, focused on culturally competent breastfeeding support for mothers and babies.

Overall this project will enhance BMBFA’s services to eliminate breastfeeding disparities for African American families in Detroit by strengthening organizational capacity.

# # #

 

Black Mothers’ Breastfeeding Association (BMBFA) is a non-profit organization founded in 2007.  BMBFA’s mission is to increase awareness of the benefits of breastfeeding throughout the African American community. BMBFA will improve the quality of life and enhance self reliance by educating, providing valuable resources, offering on-going support, and joining forces with other organizations that share a similar interest. For more information, visit www.BMBFA.org.The W.K. Kellogg Foundation (WKKF), founded in 1930 as an independent, private foundation by breakfast cereal pioneer, Will Keith Kellogg, is among the largest philanthropic foundations in the United States. Guided by the belief that all children should have an equal opportunity to thrive, WKKF works with communities to create conditions for vulnerable children so they can realize their full potential in school, work and life.The Kellogg Foundation is based in Battle Creek, Mich., and works throughout the United States and internationally, as well as with sovereign tribes. Special emphasis is paid to priority places where there are high concentrations of poverty and where children face significant barriers to success. WKKF priority places in the U.S. are in Michigan, Mississippi, New Mexico and New Orleans; and internationally, are in Mexico and Haiti. For more information, visit www.wkkf.org.

Can Genetic Analysis of Breast Milk Help Identify Ways to Improve a Newborn’s Diet?

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PRESS RELEASE FROM BREASTFEEDING MEDICINE

Contact: Vicki Cohn
Mary Ann Liebert, Inc., publishers
(914) 740-2100, ext. 2156
vcohn@liebertpub.com

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Can Genetic Analysis of Breast Milk Help Identify Ways to Improve a Newborn’s Diet?

New Rochelle, NY, June 4, 2013—The composition of breast milk varies from mother to mother, and genetic factors may affect the levels of protective components in breast milk that could influence a newborn’s outcomes. The potential to perform genomic studies on breast milk samples is explored in a Review article in Breastfeeding Medicine, the Official Journal of the Academy of Breastfeeding Medicine, published by Mary Ann Liebert, Inc., publishers. The article is available free on the Breastfeeding Medicine website.

Kelley Baumgartel and Yvette Conley, University of Pittsburgh, PA, reviewed the scientific literature to determine whether breast milk is an appropriate source for genetic material—DNA and RNA—to perform gene expression and epigenetic studies.

In the article “The Utility of Breast Milk for Genetic or Genomic Studies: A Systematic Review,” the authors describe the potential value of the genetic information obtained from breast milk, which can be collected easily and noninvasively. It could lead to a better understanding of the variability in breast milk and to strategies for optimizing the neonatal diet through fortification of donor breast milk, supplementation of the mother’s diet, or maternal lifestyle changes that would affect breast milk composition.

“The great majority of mothers produces milk that matches the needs of her infant amazingly well,” says Associate Editor David S. Newburg, PhD, Professor, Department of Biology, Boston College, Chestnut Hill, MA. “But for those few infants with exceptional needs, such as premature infants, or for mothers with uncommon mutations whose milk lacks the full complement of beneficial components, genetic and genomic analysis would both identify the mismatch and provide the information to produce a personalized complementary fortifier or supplement.”

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