Research on breastfeeding and human milk

Voor de studiehoofden! Een uitgebreide lijst van links naar onderzoeken op het gebied van borstvoeding en moedermelk.

Inhoudsopgave Original published research News on research Protocols Reviews (not necessarily published in a scientific journal), letters, etc. Other overviews of research

Original published research

• The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment

Background
The role of bacterial pathogens in lactational mastitis remains unclear. The objective of this study was to compare bacterial species in breast milk of women with mastitis and of healthy breast milk donors and to evaluate the use of antibiotic therapy, the symptoms of mastitis, number of health care contacts, occurrence of breast abscess, damaged nipples and recurrent symptoms in relation to bacterial counts.

Methods
In this descriptive study, breast milk from 192 women with mastitis (referred to as cases) and 466 breast milk donors (referred to as controls) was examined bacteriologically and compared using analytical statistics. Statistical analyses were also carried out to test for relationships between bacteriological content and clinical symptoms as measured on scales, prescription of antibiotics, the number of care contacts, occurrence of breast abscess and recurring symptoms.

Results
Five main bacterial species were found in both cases and controls: coagulase negative staphylococci (CNS), viridans streptococci, Staphylococcus aureus (S. aureus), Group B streptococci (GBS) and Enterococcus faecalis. More women with mastitis had S. aureus and GBS in their breast milk than those without symptoms, although 31% of healthy women harboured S. aureus and 10% had GBS. There were no significant correlations between bacterial counts and the symptoms of mastitis as measured on scales. There were no differences in bacterial counts between those prescribed and not prescribed antibiotics or those with and without breast abscess. GBS in breast milk was associated with increased health care contacts (p = 0.02). Women with [greater than or equal to] 10^7 cfu/L CNS or viridans streptococci in their breast milk had increased odds for damaged nipples (p = 0.003).

Conclusion
Many healthy breastfeeding women have potentially pathogenic bacteria in their breast milk. Increasing bacterial counts did not affect the clinical manifestation of mastitis; thus bacterial counts in breast milk may be of limited value in the decision to treat with antibiotics as results from bacterial culture of breast milk may be difficult to interpret. These results suggest that the division of mastitis into infective or non-infective forms may not be practically feasible. Daily follow-up to measure the subsidence of symptoms can help detect those in need of antibiotics.

The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment; International Breastfeeding Journal 2008, 3:6 doi:10.1186/1746-4358-3-6; Linda J Kvist, Bodil Wilde Larsson, Marie-Louise Hall-Lord, Anita Steen, Claes Schalen; ISSN 1746-4358

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• A prospective study of iron status in exclusively breastfed term infants up to six months of age

Background
Can exclusive breastfeeding until six months of age maintain optimum iron status in term babies? We evaluated iron status of exclusively breastfed term infants in relation to breast milk iron and lactoferrin.

Methods
In this prospective study in Delhi, India, during the period 2003-2004, normally delivered babies of non-anemic [(Hemoglobin (Hb) greater than or equal to 11 g/dl, n = 68] and anemic (Hb 7 - 10.9 g/dl, n = 61) mothers were followed until 6 months of age. Iron parameters were measured in the cord blood at 14 weeks and 6 months. Breast milk iron and lactoferrin were measured at the same intervals.

Results
Iron parameters in babies of both groups were within normal limits at birth, 14 weeks and 6 months. Mean breast milk iron and lactoferrin in non-anemic (day 1: 0.89, 6 months: 0.26 mg/l; day 1: 12.02, 6 months: 5.85 mg/ml) and anemic mothers (day 1: 0.86, 6 months: 0.27 mg/l; day 1: 12.91, 6 months: 6.37 mg/ml) were not different on day one or at other times. No relationship was found between breast milk iron, lactoferrin and iron status of the babies.

Conclusions
Exclusively breastfed infants of non-anemic and anemic mothers did not develop iron deficiency or iron deficiency anemia by six months of age.

A prospective study of iron status in exclusively breastfed term infants up to 6 months of age Raj S, Faridi M, Rusia U, Singh O; International Breastfeeding Journal, 2008 3:3 (1 March 2008)

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• Mother-infant co-sleeping

A review of the evidence relating to the sleep practices of parents and infants over the last 20 years provides interesting reading and challenges normal wisdom related to infant sleep. The authors examine the historical and evolutionary background to assess mother and infant shared sleep, especially with regard to the impact on breastfeeding and the reduction of Sudden Infant Death Syndrome (SIDS). The authors call for further research, particularly from an anthropological perspective, into the potential consequences of caring for human infants in ways which appear to defy what nature intended.
Source: Baby Friendly Initiative

McKenna JJ, Ball HL, Gettler LT. (2007) Mother-Infant Cosleeping, Breastfeeding and Sudden Infant Death Syndrome: What Biological Anthropology Has Discovered About Normal Infant Sleep and Paediatric Sleep Medicine. Yearbook of Physical Anthropology; 50: 133-161

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• Benefits and harms associated with bed-sharing

A systematic review of the literature concludes that the evidence consistently suggests an association between bed sharing and SIDS among smokers, with the evidence not consistent for non-smokers. The evidence also suggests that bed sharing may be more strongly associated with SIDS for younger infants. The review identified a positive association between bed sharing and an increase in the rate and duration of breastfeeding. It is interesting to note that the study defined bed sharing as the practice of sharing a sleep surface and did not therefore identify those instances in which the baby was asleep with a parent on a sofa.
Source: Baby Friendly Initiative

Horsley T, Clifford T, Barrowman N et al (2007) Benefits and Harms Associated with the Practice of Bed Sharing. Arch Pediatr Adolecs Med; 161: 237-245

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• The management of late preterm infants

Infants born between 34 and 36+6 weeks gestation are often the size and weight of term infants. Therefore, late-preterm infants may be treated by parents, caregivers, and health care professionals as though they are developmentally more mature than they actually are. This paper identifies the increasing incidence of babies born at this gestation and proposes management plans for their care.
Source: Baby Friendly Initiative

Engle WA, Tomashek KM, Wallman C and the Committee on Fetus and Newborn. (2007) "Late-Preterm" Infants: A Population at Risk. Pediatrics; 120(6): 390-1401

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• Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective

Recommendation Nine

Mothers to breastfeed; children to be breasted

This is one of the first breastfeeding recommendations given in a cancer prevention report, and is based on convincing evidence that breastfeeding protects both the mother and child.

The report recommends that if women are able to, they should aim to breastfeed their baby exclusively for six months, and then continue with complementary breastfeeding after that.

There is convincing evidence that breast feeding protects against pre-menopausal and post-menopausal breast cancer. There is also limited evidence that it protects against cancer of the ovary.

There is also evidence that being breastfed probably protects babies from becoming overweight or obese in later life.

Scientists think that breastfeeding lowers the levels of some cancer-related hormones in the mother's body, which reduces the risk of breast cancer. At the end of breastfeeding, the body gets rid of any cells in the breast that may have DNA damage. This reduces the risk of breast cancer in the future.

The 1997 report did not make a specific breastfeeding recommendation.

Food, nutrition, physical activity, and the prevention of cancer: a global perspective

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• Optimal feeding of low-birth-weight infants: technical review

The Department of Child and Adolescent Health, in collaboration with the epidemiology unit of the London School of Hygiene and Tropical Medicine, conducted this systematic review of issues in feeding of low birth weight infants. The review addresses the following key questions: what to feed, when to start feeding, how to feed, how often and how much. These questions are answered for three subgroups of low birth weight infants - preterm infants of less than 32 weeks gestations, preterm infants of 32-36 weeks gestation and term low birth weight infants. The outcomes considered are mortality, severe morbidity, growth and development. The review clearly shows the benefits of exclusive breast milk feeding for the three subgroups of low birth weight infants. It summarizes the evidence for micronutrient supplementation for the different subgroups. Further, the review identifies safe alternative methods of feeding low birth infants who cannot yet breastfeed directly.


Optimal feeding of low-birth-weight infants: technical review [ISBN 92 4 159509 4]

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• Landmark report recommends breastfeeding to prevent cancer

The World Cancer Research Fund (WCRF) has published the most comprehensive report ever on the link between cancer and diet, physical activity and weight. One of only ten recommendations is that women should aim to breastfeed their baby exclusively for six months, and then continue with complementary breastfeeding after that. The authors state that 'there is convincing evidence that breastfeeding protects against pre-menopausal and post-menopausal breast cancer. There is also limited evidence that it protects against cancer of the ovary. There is also evidence that being breastfed probably protects babies from becoming overweight or obese in later life.'

Searches at nine academic institutions across the world for studies published since records began in the 1960s initially found half a million - 7,000 of which were judged to be the most relevant and robust for inclusion in the report.

It includes ten recommendations from a panel of twenty-one world-renowned scientists that represent the most definitive and authoritative advice that has ever been available on how the general public can prevent cancer. UNICEF and the World Health Organization were among the official observers of the report's process.

Food, nutrition, physical activity, and the prevention of cancer: a global perspective

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• Moderation of breastfeeding effects on the IQ by genetic variation in fatty acid metabolism

Children's intellectual development is influenced by both genetic inheritance and environmental experiences. Breastfeeding is one of the earliest such postnatal experiences. Breastfed children attain higher IQ scores than children not fed breast milk, presumably because of the fatty acids uniquely available in breast milk. Here we show that the association between breastfeeding and IQ is moderated by a genetic variant in FADS2, a gene involved in the genetic control of fatty acid pathways. We confirmed this gene-environment interaction in two birth cohorts, and we ruled out alternative explanations of the finding involving gene-exposure correlation, intrauterine growth, social class, and maternal cognitive ability, as well as maternal genotype effects on breastfeeding and breast milk. The finding shows that environmental exposures can be used to uncover novel candidate genes in complex phenotypes. It also shows that genes may work via the environment to shape the IQ, helping to close the nature versus nurture debate.

Moderation of breastfeeding effects on the IQ by genetic variation in fatty acid metabolism

Avshalom Caspi*, Benjamin Williams*, Julia Kim-Cohen, Ian W. Craig*, Barry J. Milne*, Richie Poulton, Leonard C. Schalkwyk*, Alan Taylor*, Helen Werts*, and Terrie E. Moffitt*

*Medical Research Council Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London SE5 8AF, England; {dagger}Departments of Psychology and Neuroscience, and Psychiatry and Behavioral Sciences, and Institute for Genome Sciences and Policy, Duke University, Durham, NC 27708-0086; Department of Psychology, Yale University, New Haven, CT 06520; and Dunedin School of Medicine, University of Otago, P.O. Box 913, Dunedin, New Zealand

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• The benefits of early skin-to-skin contact for mothers and their healthy newborn infants

A review of the available evidence regarding the benefits of skin to skin contact (SSC) in the early postnatal period has been carried out to assess its effects on breastfeeding, behaviour, and physiological adaptation in healthy mother-newborn dyads. Thirty studies involving almost 2000 participants were included in the review. The reviewers found statistically significant and positive effects of early SSC on breastfeeding at one to four months. In addition, trends were also noted for improved scores for maternal affectionate love/touch during observed breastfeeds and maternal attachment behaviour. Infants also cried for a shorter length of time. Late preterm infants had better cardio-respiratory stability with early SSC. No adverse effects were found. The authors conclude that despite limitations in methodological quality of the studies, SSC may benefit breastfeeding outcomes, early mother-infant attachment, infant crying and cardio-respiratory stability. SSC has no apparent short or long-term negative effects.

In other words:
Skin-to-skin contact between mother and baby at birth reduces crying, improves mother-baby interaction, keeps the baby warmer, and helps women breastfeed successfully. In many cultures, babies are generally cradled naked on their mother's bare chest at birth. Historically, this was necessary for the baby's survival. In recent times, in some societies as more babies are born in hospital, babies are separated or dressed before being given to their mothers. It has been suggested that in industrialized societies, hospital routines may significantly disrupt early mother-infant interactions and have harmful effects. The review was done to see if there was any impact of early skin-to-skin contact between the mother and her newborn baby on infant health, behavior and breastfeeding. The review included 30 studies involving 1925 mothers and their babies. It showed that babies interacted more with their mothers, stayed warmer, and cried less. Babies were more likely to be breastfed, and to breastfeed for longer, if they had early skin-to-skin contact. Babies were also, possibly, more likely to have a good early relationship with their mothers, but this was difficult to measure.

Moore E, Anderson G, Bergman N. (2007) Early skin-to-skin contact for mothers and their healthy newborn infants Cochrane Database Syst Rev, January 1, 2007; (3): CD003519.

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• Influence of organic diet on the amount of conjugated linoleic acids in breast milk of lactating women in the Netherlands

In conclusion, we show here that the levels of both rumenic acid and TVA in human breast milk were higher in the case of mothers following a diet that contained organic dairy and meat products, in comparison with mothers consuming a conventional diet. In view of the accumulating evidence pointing towards various positive effects of CLA on human health, in particular at a very young age, the present results are highly interesting. Further results of the KOALA Birth Cohort Study, in particular those concerning allergic sensitization and asthma in the children corresponding to the mothers that have participated in the present study, are awaited anxiously.

Acknowledgements: this study was financially supported by the Netherlands Organization for Health Research and Development (ZonMw, the Netherlands), Royal Friesland Foods (!!!) (the Netherlands), Triodos Foundation (the Netherlands), UDEA organic retail (the Netherlands), Biologica organization for organic farming and food (the Netherlands), the Consumer Association for Bio-Dynamic Agriculture Zurich (Switzerland) and Weleda AG Arlesheim (Switzerland).

Lukas Rist, Andre Mueller, Christiane Barthel, Bianca Snijders, Margje Jansen, A. Paula Simoes-Wust, Machteld Huber, Ischa Kummeling, Ursula von Mandach, Hans Steinhart and Carel Thijs, Influence of organic diet on the amount of conjugated linoleic acids in breast milk of lactating women in the Netherlands British Journal of Nutrition (2007), 97, 735-743 DOI: 10.1017/S0007114507433074

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• Biologische voeding heeft gunstige invloed op moedermelk

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• Overabundant milk supply: an alternate way to intervene by full drainage and block feeding

Background: Too much or too little milk production are common problems in a lactation consultant's practice. Whereas underproduction is widely discussed in the lactation literature, overabundant milk supply is not. In my practice I work with women who experience moderate to severe oversupply syndrome. In most cases the syndrome can be successfully treated with full removal of milk followed by unilateral breastfeeding ad lib with the same breast offered at every breastfeed in a certain time block ('block feeding'). Case presentations Four cases of over-supply of breast milk are presented. The management and outcomes of each case is described.

Conclusions: Overabundant milk supply is an often underdiagnosed condition in otherwise healthy lactating women. Full drainage and "block feeding" offers an adequate and user-friendly way to normalize milk production and treat symptoms in both mother and child.

Caroline GA van Veldhuizen-Staas (2007) Overabundant milk supply: an alternate way to intervene by full drainage and block feeding International Breastfeeding Journal 2007, 2:11 doi:10.1186/1746-4358-2-11; 29 August 2007

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• The complete article is available as a provisional pdf
• Hyperlactatie tijdens de lactatieperiode

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• Screening for hypernatraemic dehydration

A Dutch study (Van Dommelen et al) aimed to investigate whether a specific chart used to plot weight during the first week of life would increase accuracy of screening for hypernatraemic dehydration when compared with the traditional 'rule of thumb' of no more than 10% weight loss. The authors argue that using the 10% parameter can result in babies being readmitted to hospital unnecessarily. However, their claim is countered by a second author (Modi) who argues that, as 10% is simple and specific, this 'rule of thumb' is appropriate. This discussion is of interest for a number of reasons: Readmission to hospital with this condition is associated with previous poor breastfeeding management which, with better early support and assessment, could have been avoided. In addition, it is likely that many mothers would cease to breastfeed following readmission.

Both authors comment on the process of effective screening for this condition. They acknowledge that weighing alone is unlikely to prevent the problem and that assessment of the wellbeing of the baby and of breastfeeding is paramount. This should include monitoring of urine output, frequency and quality of stools and observation for lethargy or fractious behaviour, together with effective assessment of breastfeeding, including feeding pattern, effectiveness of attachment, sucking pattern and breast fullness. Neither author suggests that weighing babies is unhelpful or unnecessary.

Van Dommelen et al (2007) Reference chart for relative weight change to detect hypernatraemic dehydration Archives of Disease in Childhood; 92: 490-494-5

Van Dommelen et al (2007) Reference chart for relative weight change to detect hypernatraemic dehydration [pdf]

Modi N (2007) Avoiding hypernatraemic dehydration in healthy term infants Archives of Disease in Childhood; 92: 474-5

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• Does maternal obesity impact on breastfeeding outcomes?

An association has been suggested between maternal obesity and low breastfeeding rates. This is of public health concern because obesity is rising in women of reproductive age and because of the apparent association between increased artificial feeding and a greater risk of obesity in children. A systematic review was conducted to assess the association between maternal obesity and infant feeding intention, initiation, duration and delayed onset of lactation. The authors found that obese women plan to breastfeed for a shorter period than normal weight women and are less likely to initiate breastfeeding. Of the four studies that examined onset of lactation, three reported a significant relationship between obesity and delayed lactogenesis. The majority of larger studies found that obese women breastfed for a shorter duration than normal weight women, even after adjusting for possible confounding factors. The authors conclude that overweight and obese women are less likely to breastfeed than normal weight women. The reasons may be biological or they may be psychological, behavioural and/or cultural. They suggest that qualitative studies from women's perspective are urgently needed to help understand their behaviour and infant feeding decisions in this situation.

Amir L and Donath S (2007) A systematic review of maternal obesity and breastfeeding intention, initiation and duration BMC Pregnancy Childbirth; 7:9.

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• New evidence of the health benefits of breastfeeding

Two new reviews regarding the health benefits of breastfeeding have recently been published. To establish the impact of long term breastfeeding, the World Health Organisation; commissioned a review of the evidence available in the form of a series of systematic reviews. The available evidence suggests that breastfeeding may have long-term benefits. Subjects who were breastfed experienced lower mean blood pressure and total cholesterol, as well as higher performance in intelligence tests. Furthermore, the prevalence of overweight/obesity and type-2 diabetes was lower among breastfed subjects.

A review from the USA; investigated the effects of breastfeeding in developed countries. This is a particularly important piece of work as it reviews only those studies carried out in the developed world and therefore adds weight to the arguments that breastfeeding is vitally important for healthy outcomes outside of the developing world. The reviewers concluded that a history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis. For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer. Early cessation of breastfeeding or not breastfeeding was associated with an increased risk of maternal postpartum depression.
Horta B.L. et al (2007) Evidence on the long-term effects of breastfeeding. WHO
Ip S et al (2007) Breastfeeding and Maternal Health Outcomes in Developed Countries. AHRQ Publication No. 07-E007

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• Donor breast milk versus infant formula for preterm infants

A systematic review compared the effects of pasteurised donor breast milk and infant formula in preterm infants. Seven studies were found to comply with the inclusion criteria. Evidence from these studies suggests that donor milk reduces the risk of NEC by about 79%. The other main outcome measure of growth had mixed findings with more studies finding in favour of formula in terms of infant growth. One study however, tracked growth at 9 and 18 months and 7-8 years at which times no significant differences in a range of growth measurements were found. Importantly, this study found significantly slower growth in the donor milk group compared with the formula group during the early postnatal period. The authors suggest that further research is needed to confirm their findings and measure the effect of donor breast milk that is fortified or given as a supplement to mother's own milk.

Boyd C.A., Quigley M.A., Brocklehurst P (2007) Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis. Archives of Disease in Childhood; 92:F169-F175

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• Could the scent of mother's own expressed breastmilk improve breastfeeding in preterm infants?

A study was carried out to assess the effects of exposure to the odour of their mother's breastmilk on breastfeeding behavior of preterm neonates. Whilst the study was small (13 preterm babies born at 30-33 weeks gestational age), the results may show some promise for what is a simple and cost-free intervention. At 35 weeks, each baby was exposed to the appropriate odour stimulus (either their mother's own expressed breastmilk (EBM) or water) for 120 seconds on 5 consecutive days immediately prior to a breastfeeding attempt. Babies were weighed before and after each feeding session. During each breastfeeding session, babies in the EBM group displayed longer sucking bouts and consumed more milk than the control group infants. The authors concluded that brief exposure to the odour of mother's milk prior to breastfeeding had a positive effect on sucking behaviour and milk intake of preterm babies, which in turn resulted in a shortened hospital stay.

Raimbault C., Saliba E., Porter R.H. (2007) The effect of the odour of mother's milk on breastfeeding behaviour of premature neonates. Acta Paediatr;96: 368-71.

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• Breastfeeding and Hospitalization for Diarrheal and Respiratory Infection in the United Kingdom Millennium Cohort Study

Maria A. Quigley, MSca, Yvonne J. Kelly, PhDb and Amanda Sacker, PhDb

a National Perinatal Epidemiology Unit, Oxford University, Oxford, United Kingdom
b Department of Epidemiology and Public Health, University College London, London, United Kingdom

Objective: The objective of this study was to measure the effect of breastfeeding on hospitalization for diarrheal and lower respiratory tract infections in the first 8 months after birth in contemporary United Kingdom.

Methods: The study was a population-based survey (sweep 1 of the United Kingdom Millennium Cohort Study). Data on infant feeding, infant health, and a range of confounding factors were available for 15890 healthy, singleton, term infants who were born in 2000-2002. The main outcome measures were parental report of hospitalization for diarrhea and lower respiratory tract infection in the first 8 months after birth.

Results: Seventy percent of infants were breastfed (ever), 34% received breast milk for at least 4 months, and 1.2% were exclusively breastfed for at least 6 months. By 8 months of age, 12% of infants had been hospitalized (1.1% for diarrhea and 3.2% for lower respiratory tract infection). Data analyzed by month of age, with adjustment for confounders, show that exclusive breastfeeding, compared with not breastfeeding, protects against hospitalization for diarrhea and lower respiratory tract infection. The effect of partial breastfeeding is weaker. Population-attributable fractions suggest that an estimated 53% of diarrhea hospitalizations could have been prevented each month by exclusive breastfeeding and 31% by partial breastfeeding. Similarly, 27% of lower respiratory tract infection hospitalizations could have been prevented each month by exclusive breastfeeding and 25% by partial breastfeeding. The protective effect of breastfeeding for these outcomes wears off soon after breastfeeding cessation.

Conclusions: Breastfeeding, particularly when exclusive and prolonged, protects against severe morbidity in contemporary United Kingdom. A population-level increase in exclusive, prolonged breastfeeding would be of considerable potential benefit for public health.

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• Does expressing breastmilk enhance duration of breastfeeding?

In Australia, mothers who expressed breastmilk for their baby on one or more occasion were found to be more likely to continue breastfeeding at six months than those who had never expressed breastmilk. The study followed 587 women through their breastfeeding experience by conducting telephone interviews. The authors acknowledge that further work to examine cultural differences is needed but recommend that the appropriate use of expressed breastmilk may be a means to help more mothers achieve six months of exclusive breastfeeding.

Nwet N Win, Colin W Binns, Yun Zhao, Jane A Scott, Wendy H Oddy. Breastfeeding duration in mothers who express breastmilk: a cohort study. International Breastfeeding Journal 2006; 1(1): 28

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• Weight charts - do they influence breastfeeding behavior and the introduction of supplementary feeds?

Evidence of how weight charts are interpreted and used in practice has been limited and therefore a study using an ethnographic approach was conducted to investigate this issue. This consisted of observations in baby clinics followed by interviews with 14 women over a longitudinal period. The study raised a number of issues for consideration. Babies were weighed more often than officially recommended, with weighing and plotting being at the core of each clinic visit. Interventions aimed at increasing weight gain included the introduction of supplementary feeds of formula milk when improving breastfeeding effectiveness would have been more appropriate. The authors recommend that improvements in training are needed in weighing techniques, assessing growth patterns - particularly of breastfed babies - and in giving information to women, if the practice of routine weight monitoring is to support rather than under! mine breastfeeding.

Magda Sachs, Fiona Dykes, Bernie Carter. Feeding by numbers: an ethnographic study of how breastfeeding women understand their babies' weight charts. International Breastfeeding Journal 2006; 1(1): 29

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• Breastfeeding associated with a lower risk of being overweight at 7 years

Data on 2,347 Dutch children born in 1996-7 were collected. After adjustment for confounders, children breastfed for > 16 weeks were found to have a lower BMI at 1 year of age than children who were not breastfed. Although the association between breastfeeding and BMI between 1 and 7 years of age was found to be negligible, a high BMI at 1 year of age was strongly associated with a high BMI between 1 and 7 years of age. The authors conclude that these findings suggest that the lower BMI and lower risk of overweight among breastfed children later in life are already achieved by 1 year of age.

Salome Scholtens, Ulrike Gehring, Bert Brunekreef, et al. Breastfeeding, weight gain in infancy, and overweight at seven years of age. American Journal of Epidemiology 2007; doi:10.1093/aje/kwk083

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• Certain groups of babies may be at risk of vitamin D deficiency

The Welfare Food Scheme has recently been reviewed, and, although changes are being made, free vitamin supplements for children <4 years old will remain an important part of the new "Healthy Start" scheme. Establishing precise daily requirements for vitamins is not easy. However, achieving the reference nutrient intake (RNI) should be possible with a healthy balanced diet for all except vitamins K and D, which require additional physiological or metabolic processes. For vitamin K, there is a well-established neonatal supplementation programme, and clinical deficiency is extremely rare. For vitamin D, however, supplementation is inconsistent, and both clinical and subclinical deficiencies are not uncommon in young children in the UK, particularly infants of Asian and Afro-Caribbean ethnic origin and those with delayed introduction of solid foods. The author argues that future strategy should aim at education of the public and health professionals regarding dietary intake and physiological aspects of vitamin sufficiency, as well as increasing awareness and availability of supplements, particularly of vitamin D, for those at increased risk of deficiency.

A A Leaf on behalf of the RCPCH Standing Committee on Nutrition. Vitamins for babies and young children. Archives of Diseases in Childhood 2007; 92(2): p. 160-164

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• Ineffective sucking most likely cause of faltering growth

11 900 infants from the Avon Longitudinal Study of Parents and Children (ALSPAC), born at 37-41 weeks' gestation, without major malformations were studied. Weight gain was analyzed during the birth to 8 week period and 8 week to 9 month period. At all ages, ineffective sucking was associated with faltering growth. Before 8 weeks other factors included infant illness and after 8 weeks the duration of breastfeeding and difficulties in weaning were cited as having impact on the baby's weight.

David Pontin, Pauline Emmett, Colin Steer, Alan Emond. Postnatal factors associated with failure to thrive in term infants in the Avon Longitudinal Study of Parents and Children. Archives of Diseases in Childhood 2007; 92(2): p. 115-119

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• Support for breastfeeding - a systematic review

A Cochrane systematic review examined the effectiveness of support for breastfeeding mothers. The review which included 34 trials and in excess of 29,000 mothers concluded that additional professional or lay support was effective in prolonging any breastfeeding, but its effects on exclusive breastfeeding were less clear. WHO/UNICEF training courses appeared to be effective for professional training. Further trials are required to assess the effectiveness (including cost-effectiveness) of both lay and professional support in different settings, particularly those with low rates of breastfeeding initiation, and for women who wish to breastfeed for longer than three months.

C Britton, F McCormick, M Renfrew, A Wade, S King. Support for breastfeeding mothers. Cochrane Database Systematic Review 1 Jan 2007: p. CD001141

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• Breastfeeding and Developmental Delay: Findings from the Millennium Cohort Study

Sacker A, Quigley M, Kelly Y. | Pediatrics. 2006;118: e682-e689 (doi:10.1542?peds.2005-3141)

Breastfeeding is associated with a reduced risk of developmental delay. Findings from the Millennium Cohort Study have indicated that breastfeeding is positively associated with the attainment of gross motor milestones at nine months of age.
Data from 14660 infants born in the UK in the years 2000 - 2001 suggests 'a positive effect of breastfeeding on the attainment of gross motor milestones which is attributable to some component(s) of breastmilk or feature of breastfeeding and is not simply a product of advantaged social position, education or parenting style, because control for these factors did not explain any of the observed association.'
The authors call for policies to encourage the uptake and continuation of breastfeeding to reduce the likelihood of developmental delay.

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• Effect on rates of breast feeding of training for the Baby Friendly Hospital Initiative

A. Cattaneo, R. Buzzetti, BMJ 2001;323:1358-1362 (December)
Training for at least three days with a course including practical sessions and counselling skills is effective in changing hospital practices, knowledge of health workers, and breastfeeding rates.

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• Effect of the baby-friendly initiative on infant abandonment in a Russian hospital

Lvoff NM, Lvoff V, Klaus MH , in Arch Pediatr Adolesc Med 2000 May;154(5):474-7
Encouraging early mother-infant contact with suckling and rooming-in may provide a simple, low-cost method for reducing infant abandonment.

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• Mother and infant: early emotional ties

By Marshall Klaus. In: Pediatrics Vol. 102 No. 5 Supplement November 1998, pp. 1244-1246.
Recent behavioral and physiologic observations of infants and mothers have shown them ready to begin interacting in the first minutes of life. Included among these findings are the newborn infant's ability to crawl toward the breast to initiate suckling and mother-infant thermoregulation. The attachment felt between mother and infant may be biochemically modulated through oxytocin; encouraging attachment through early contact, suckling, and rooming-in has been shown to reduce abandonment.

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• Breast feeding and obesity: cross sectional study

R. von Kries, e.o. In: BMJ 1999;319:147-150 ( 17 July )
The prevalence of obesity in children who had never been breast fed was 4.5% as compared with 2.8% in breastfed children. A clear dose-response effect was identified for the duration of breast feeding on the prevalence of obesity.

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• Infant feeding and adult glucose tolerance, lipid profile, blood pressure, and obesity

A C J Ravelli, J H P van der Meulen, C Osmondc, D J P Barker, O P Bleker. Arch Dis Child 2000;82:248-252 ( March )
Exclusive breast feeding seems to have a protective effect against some risk factors for cardiovascular disease in later life.

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• Feeding by numbers: an ethnographic study of how breastfeeding women understand their babies' weight charts

Magda Sachs, Fiona Dykes and Bernie Carter
[International Breastfeeding Journal 2006, 1:29 22 december 2006].

Background: Weighing breastfed babies has been the subject of some controversy as the previous international growth chart was largely based on data from infants fed infant formula. The concern that professionals may be misled by the charts into suggesting to mothers that they supplement unnecessarily was a major impetus for the World Health Organization's investment in a new growth chart. Evidence of interpretation in practice has been scant.

Results: Mothers and health visitors focussed on weight gain with frequent weighing and attention to even minor fluctuations of the plotted line being evident. Women felt it important to ensure their baby's weight followed a centile, and preferred for this to be the fiftieth centile. Interventions included giving infant formula and solids as well as changing what the mother ate and drank. Women also described how they worried about their baby's weight. Little effective support by health professionals with breastfeeding technique was observed.

Conclusions: Babies were weighed more often than officially recommended, with weighing and plotting being at the core of each clinic visit. The plotted weight chart exerted a powerful influence on both women's and health visitors' understanding of the adequacy of breastfeeding. They appeared to rate the regular progression of weight gains along the chart centiles more highly than continued or exclusive breastfeeding. Thus weighing and visual charting of weight constituted a form of surveillance under the medical gaze, with mothers actively participating in self monitoring of their babies. Interventions, by mothers and health visitors, were targeted towards increasing weight gain rather than improving breastfeeding effectiveness. Improvements in training are needed for health visitors in weighing techniques, assessing growth patterns - particularly of breastfed babies - and in giving information to women, if the practice of routine weight monitoring is to support rather than undermine breastfeeding.

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• Breastfeeding duration in mothers who express breast milk

Nwet N Win, Colin W Binns, Yun Zhao, Jane A Scott and Wendy H Oddy. [International Breastfeeding Journal 2006, 1:29 22 December 2006]

Background: The expression of breast milk allows a mother to be away intermittently from her infant while continuing to breastfeed. The aim of this study was to investigate the association between expression of breast milk and breastfeeding duration

Results: A total of 587 mothers, or 55% of those eligible, participated in the study. Of these 93.5% were breastfeeding at discharge from hospital. Mothers who expressed breast milk (at one or more time periods) were less likely to discontinue any breastfeeding before six months (Relative Risk 0.71, 95% CI 0.52, 0.98) than those who had never expressed milk.

Conclusion: This study found that mothers who express breast milk are more likely to breastfeed to six months (any breastfeeding). While further research is required in different cultures to confirm these results, the appropriate use of expressed breast milk may be a means to help mothers to achieve six months of full breastfeeding while giving more lifestyle options.

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• Child feeding and human rights

[International Breastfeeding Journal 2006, 1:27]

Background: The human right to adequate food needs to be interpreted for the special case of young children because they are vulnerable, others make the choices for them, and their diets are not diverse. There are many public policy issues relating to child feeding.

Discussion: The core of the debate lies in differences in views on the merits of infant formula. In contexts in which there is strong evidence and a clear consensus that the use of formula would be seriously dangerous, it might be sensible to adopt rules limiting its use. However, until there is broad consensus on this point, the best universal rule would be to rely on informed choice by mothers, with their having a clearly recognized right to objective and consistent information on the risks of using different feeding methods in their particular local circumstances.

Summary: The obligation of the state to assure that mothers are well informed should be viewed as part of its broader obligation to establish social conditions that facilitate sound child feeding practices. This means that mothers should not be compelled to feed in particular ways by the state, but rather the state should assure that mothers are supported and enabled to make good feeding choices.
Thus, children should be viewed as having the right to be breastfed, not in the sense that the mother is obligated to breastfeed the child, but in the sense that no one may interfere with the mother's right to breastfeed the child. Breastfeeding should be viewed as the right of the mother and child together.

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• Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study

Dollberg S, Botzer E, Grunis E, Mimouni FB. Department of Neonatology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel. dolberg@post.tau.ac.il

Purpose: Ankyloglossia ("tongue-tie") occurs in nearly 5% of neonates, but its clinical significance relating to breast-feeding difficulties is controversial. We tested the hypothesis that in infants with ankyloglossia referred because of breast-feeding difficulties, frenotomy alleviates the symptoms.

Results: There was a significant decrease in pain score after frenotomy than after sham (P = .001). There was also a nearly significant improvement in latch after the frenotomy in these mothers (P = .06).

Conclusion: Frenotomy appears to alleviate nipple pain immediately after frenotomy. We speculate that ankyloglossia plays a significant role in early breast-feeding difficulties, and that frenotomy is an effective therapy for these difficulties. [PMID: 16952598 [PubMed - indexed for Medline]

See all to Akyloglossia related articles

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• Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence1,2,3

Christopher G Owen, Richard M Martin, Peter H Whincup, George Davey Smith and Derek G Cook

Conclusion: Breastfeeding in infancy is associated with a reduced risk of type 2 diabetes, with marginally lower insulin concentrations in later life, and with lower blood glucose and serum insulin concentrations in infancy.

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• Leptin concentration in breast milk and its relationship to duration of lactation and hormonal status

Leptin, a hormone present in breast milk, is involved in energy regulation and metabolism. The objectives of this study were to assess leptin concentrations in breast milk during the first 180 days postpartum, and to determine the relationship between the concentrations of milk leptin and circulating hormone levels in lactating women.

Conclusion: Leptin concentrations in breast milk decrease with time during lactation and show significant relationships with other maternal hormones.

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• Breastfeeding support for adolescent mothers: similarities and differences in the approach of midwives and qualified breastfeeding supporters

The protection, promotion and support of breastfeeding are now major public health priorities. It is well established that skilled support, voluntary or professional, proactively offered to women who want to breastfeed, can increase the initiation and/or duration of breastfeeding. Low levels of breastfeeding uptake and continuation amongst adolescent mothers in industrialised countries suggest that this is a group that is in particular need of breastfeeding support. Using qualitative methods, the present study aimed to investigate the similarities and differences in the approaches of midwives and qualified breastfeeding supporters (the Breastfeeding Network (BfN)) in supporting breastfeeding adolescent mothers.

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• Melk, macht en maatschappij: adviezen over zuigelingenvoeding in de afgelopen eeuw

Doctoraalscriptie van Grietje Keller [Universiteit van Amsterdam] over de adviezen die moeders krijgen betreffende de voeding van zuigelingen in relatie tot maatschappelijke factoren. Aandacht voor onder meer het interbellum en de relatie zuigelingenvoeding, moederschap en nationalisme; de invloed van het feminisme op de adviezen rond zuigelingenvoeding; milieuvervuiling in borstmelk in de jaren zestig en zeventig van de 20e eeuw; hedendaagse adviezen rond borst- en kunstvoeding in relatie tot gezondheid en verwantschap.

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• Lactational amenorrhoea in well-nourished Toba women of Formosa, Argentina

Valeggia C, Ellison PT. Department of Anthropology, Harvard University, Cambridge, MA, USA.
As the relative metabolic load hypothesis suggests, the variable effect of lactation on postpartum fertility may not depend on the intensity of nursing per se but rather on the energetic stress that lactation represents for the individual mother.

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• Duration of Lactation and Incidence of Type 2 Diabetes

Stube A et al (2005). JAMA 294: 2601-2610
Research from the USA suggests that breastfeeding is associated with a reduced incidence of type 2 diabetes in the mother. The longer the duration of breastfeeding the lower the incidence of diabetes according to a study published in JAMA.
Researchers from Harvard Medical School and Brigham Women's Hospital in Boston studied 83,585 mothers in the Nurses Health Study (NHS) and 73,418 mothers in the Nurses Health Study II (NHS II). An analysis of those who had given birth in the past 15 years revealed that for each additional year of lactation, women had a decreased risk of diabetes of 15% (95% confidence interval, 1%-27%) in NHS participants and of 14% (95% confidence interval, 7%-21%) in NHS II participants, after controlling for body mass index and other risk factors.
Conclusion: the authors concluded that lactation may reduce the risk of type 2 diabetes in young and middle aged women by improving glucose homeostasis.

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• Early initiation of breastfeeding and the risk of infant diarrhea in rural Egypt

John Clemens, MD, Remon Abu Elyazeed, MD, PhD, Malla Rao, MEngg, MP*, Stephen Savarino, MD, Badria Z. Morsy, MBBCh, Yongdai Kim, PhD, Thomas Wierzba, PhD, Abdollah Naficy, MD, MPH, and Y. Jack Lee, PhD. In: PEDIATRICS Vol. 104 No. 1 July 1999, p. e3.
Early initiation of breastfeeding was associated with a marked reduction of the rate of diarrhea throughout the first 6 months of life, possibly because of the salutary effects of human colostrum.

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• Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study

In: BMJ 1999;319:815-819 ( 25 September)
A significant reduction in the risk of childhood asthma at age 6 years occurs if exclusive breast feeding is continued for at least the 4 months after birth.

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• Evolution of immunologic functions of the mammary gland and the postnatal development of immunity

By: Armond S. Goldman, Sadhana, Cheda and R. Garofalo. Official Publication of American Pediatric Society European Society for Paediatric Research Society for Pediatric Research Featured Article February 1998 Volume 43 Number 2.
Although the protection provided by breast-feeding is due mainly to defense agents in human milk that compensate for those that are not sufficiently produced by the infant, the relationships may be more complex.

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• Breastfeeding Patterns in Relation to Thumb Sucking and Pacifier Use

By Clara Aarts, Agneta Hornell, Elisabeth Kylberg, Yngve Hofvander, and Mehari Gebre-Medhin. In: Pediatrics Vol. 104 No. 4 October 1999, p. e50.
Pacifier use was associated with fewer feeds and shorter suckling duration per 24 hours, shorter duration of exclusive breastfeeding, and shorter total breastfeeding duration compared with no pacifier use. These associations were not found for thumb sucking.

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• Pacifier Use and Morbidity in the first six months of life

By Kate North, Peter Fleming, Jean Golding, and the ALSPAC Study Team. Pediatrics Vol. 103 No. 3 March 1999, p. e34. "Although significant differences exist in the risk of experiencing several health symptoms between infants who do and infants who do not use a pacifier, stronger and more detailed evidence is required before recommendations can be made to discourage the use of pacifiers based purely on reducing occurrences of these symptoms.

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• Morphine Suppresses the Oxytocin Response in Breast-Feeding Women

By S.W. Lindow, M.S. Hendricks, F.A. Nugent, T.T. Dunne, Z.M. van der Spuy. In: Gynecologic and Obstetric Investigation 48:1:1999, 33-37.
In conclusion, oxytocin secretion to breast-feeding is inhibited by exogenous morphine when compared to a control group but the administration of naloxone did not produce a significant difference from control.

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• Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study

By: Anna Coutsoudis, Kubendran Pillay, Elizabeth Spooner, Louise Kuhn, Hoosen M Coovadia, for the South African Vitamin A Study Group. In: Lancet 1999; 354: 471 - 476.
Our findings have important implications for prevention of HIV-1 infection and infant-feeding policies in developing countries and further research is essential. In the meantime, breastfeeding policies for HIV-1-infected women require urgent review. If our findings are confirmed, exclusive breastfeeding may offer HIV-1-infected women in developing countries an affordable, culturally acceptable, and effective means of reducing mother-to-child transmission of HIV-1 while maintaining the overwhelming benefits of breastfeeding.

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• 15-month efficacy of maternal oral zidovudine to decrease vertical transmission of HIV-1 in breastfed African children

By: Ditrame ANRS 049 Study Group. In: Lancet 1999; 354: 2050 - 2051.
Two randomised trials have shown that mother-to-child transmission of HIV-1 can be effectively decreased in breastfed African children with a short maternal regimen of oral zidovudine.

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• Appropriate feeding methods for infants of HIV infected mothers in sub-Saharan Africa BMJ; 320: 1656-1660

Latham, M.C., Preble, E.A. (2000)
While we wait for research results, it seems that major efforts to promote exclusive breast feeding would do great good and no harm. Exclusive breast feeding is not widely practised in sub-Saharan Africa, certainly not for as long as six months, which is desirable. Exclusive breast feeding is clearly optimal for mothers who are not infected with HIV. For babies infected in utero, or during childbirth it would be the best feeding method unless the mother was too ill to do this. Furthermore, the data from South Africa suggests that HIV transmission is low in infants who are exclusively breast fed, at least for the first three months. Because the morbidity and mortality resulting from not breast feeding are higher in the first six months of life than at older ages, consideration might be given to reducing the duration of breast feeding by infected mothers.

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• Breastfeeding and urinary tract infection

Alfredo Pisacane, MD, MSc, Liberatore Graziano, MD Gianfranco Mazzarella, MD, Benedetto Scarpellino, MD, and Gregorio Zona. Journal of pediatrics, Volume 120 Number 1, Pages 87-89, January 1992.
The results of our study suggest that breast-feeding provides substantial protection against UTI during the first 6 months of life among children in an industrialized country.

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• Breastfeeding and urinary tract infection

By: Staffan Maarild Ulf Jodal Lars Aa. Hanson. In: The Lancet, Volume 336, Oct 13, 1990, Pag 942.
This enduring protective effect suggests that the host defence factors of breast milk must act not just via the directly functioning anti-adhesive capacity of secretory IgA antibodies and receptor analogues against bacteria. There must also be a longer lasting effect.

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• Breastfeeding and infant illness: a dose-response relationship?

Raisler J, Alexander C, O'Campo P. Am J Public Health. 1999 Jan;89(1):25-30.
The purpose of this study was to determine whether breast-feeding has a dose-related protective effect against illness and whether it confers special health benefits to poor infants. Full breast-feeding was associated with the lowest illness rates. Minimal (less) breast-feeding was not protective. Breast-feeding conferred similar health benefits in all economic groups.

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• Preliminary study of breastfeeding and bacterial adhesion to uroepithelial cells

Coppa GV, Gabrielli O, Giorgi P, et al. The Lancet 1990; 335:569-571.
These findings suggest that breastfeeding may have a preventative effect on urinary tract infection in both mother and infant.

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• Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome

By: Peter S Blair, Peter J Fleming, Iain J Smith, Martin Ward Platt, Jeanine Young, Pam Nadin, P J Berry, Jean Golding, the CESDI SUDI research group. In: BMJ 1999;319:1457-1462 (4 December)

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• Continued breastfeeding and child growth in the second year of life: a prospective cohort study in western Kenya

By: Adelheid W Onyango, Steven A Esrey, Michael S Kramer. In: Lancet 1999; 354: 2041 - 2045.

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• History of Breast-Feeding in Relation to Breast Cancer Risk: a Review of the Epidemiologic Literature

By: Loren Lipworth, L. Renee Bailey, Dimitrios Trichopoulos. In: Journal of the National Cancer Institute, Vol. 92, No. 4, 302-312, February 16, 2000.
It appears that the protective effect, if any, of long-term breast-feeding is stronger among, or confined to, premenopausal women.

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• Breast cancer and breastfeeding

Collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries including 50.302 women with breast cancer and 96.973 women without the disease Collaborative Group on Hormonal Factors in Breast Cancer, V Beral, D Bull, R Doll, R Peto, G Reeves. The Lancet, Volume 360, Number 9328 20 July 2002 .
The longer women breast feed the more they are protected against breast cancer. The lack of or short lifetime duration of breastfeeding typical of women in developed countries makes a major contribution to the high incidence of breast cancer in these countries.

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• Breastfeeding and Later Cognitive and Academic Outcomes

By: L. John Horwood and David M. Fergusson. In: PEDIATRICS Vol. 101 No. 1 January 1998, p. e9.
It is concluded that breastfeeding is associated with small but detectable increases in child cognitive ability and educational achievement.

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• The Association Between Duration of Breastfeeding and Adult Intelligence

Erik Lykke Mortensen, PhD; Kim Fleischer Michaelsen, MD, ScD; Stephanie A. Sanders, PhD; June Machover Reinisch, PhD . JAMA Vol. 287 No. 18, May 8, 2002.
Conclusion Independent of a wide range of possible confounding factors, a significant positive association between duration of breastfeeding and intelligence was observed in 2 independent samples of young adults, assessed with 2 different intelligence tests.

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• Breast feeding and cognitive development at age 1 and 5 years

N K Angelsen, T Vik, G Jacobsen, L S Bakketeig . Arch Dis Child 2001;85:183-188 (september)

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• Efficacy and safety of long-chain polyunsaturated fatty acid supplementation of infant-formula milk: a randomised trial

Alan Lucas, Mai Stafford, Ruth Morley, Rebecca Abbott, Terence Stephenson, Una MacFadyen, Alun Elias-Jones, Helena Clements. The Lancet, Volume 354, Number 9194 04 December 1999.
Babies fed formula with and without LCPUFA did not differ in cognitive or motor development, growth, infection, atopy or tolerance.

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• Effects of exposure to alcohol in mother's milk on infant sleep

By Julie A. Mennella and Carolyn J. Gerrish. Pediatrics Vol. 101 No. 5 May 1998, p. e2

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• Infection and disease

Food and Nutrition Bulletin Volume 17, Number 4, 1996 (UNU Food and Nutrition Bulletin, 1996, 163 pages);
Chapters: Protective effect of breastmilk against infection; Effects of breastfeeding on the baby and on its immune system; Infection and disease: The impact of early weaning; Breastfeeding child development.

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• Social and demographic aspects

Food and Nutrition Bulletin Volume 17, Number 4, 1996 (UNU Food and Nutrition Bulletin, 1996, 163 pages);
Chapters: The cultural context of breastfeeding and breastfeeding policy; The role of education in breastfeeding success.

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• Establishing lactation

Food and Nutrition Bulletin Volume 17, Number 4, 1996 (UNU Food and Nutrition Bulletin, 1996, 163 pages);
Chapters: Breast development and control of milk synthesis; Constituents of human milk ; Problems of establishing lactation ; Social and biological determinants of lactation.

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• Impact on fertility

Food and Nutrition Bulletin Volume 17, Number 4, 1996 (UNU Food and Nutrition Bulletin, 1996, 163 pages);
Chapters: Breastfeeding and the suppression of fertility ; Demographic effects of breastfeeding: Fertility, mortality, and population growth ; Effects of breastfeeding on maternal health and well-being.

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• Care as related to nutrition outcomes

Food and Nutrition Bulletin Volume 16, Number 4, 1995 (UNU Food and Nutrition Bulletin, 1995, 135 pages)
Chapters: Breastfeeding as the foundation of care; Sustained breastfeeding, complementation, and care; Optimal complementary feeding practices to prevent childhood malnutrition in developing countries; Child-feeding and appetite: What can programmes do? Nutritional management of diarrhoea; Psychosocial aspects of care and nutrition.

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• Effects of health and nutrition on cognitive and behavioural development in children in the first three years of life

Food and Nutrition Bulletin Volume 20, Number 1, 1999 (UNU Food and Nutrition Bulletin, 1999, 181 pages)
Part 1: Low birthweight, breastfeeding, and protein-energy malnutrition.

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• Enhanced Growth of Preterm Infants Fed a New Powdered Human Milk Fortifier: A Randomized, Controlled Trial

By Bridget Barrett Reis, Robert T. Hall, Richard J. Schanler, Carol L. Berseth, Gary Chan, Judith A. Ernst, James Lemons, David Adamkin, Geraldine Baggs, and Deborah O'Connor. Pediatrics Vol. 106 No. 3 September 2000, pp. 581-588.
Conclusion: a new powdered HMF was shown to enhance the growth of preterm infants, compared with a commercially available powdered HMF in the United States.

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• Pacifier as a risk factor for acute otitis media: a randomized, controlled trial of parental counseling

By Marjo Nieme, Outi Pihakari, Tytti Pokka, Marja Uhari and Matti Uhari. Pediatrics Vol. 106 No. 3 September 2000, pp. 483-488.
Conclusion: pacifier use appeared to be a preventable risk factor for acute otitis media in children. Its restriction to the moments when the child was falling asleep effectively prevented episodes of acute otitis media .

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• Breast feeding practices in relation to endometrial cancer risk

USA. Newcomb PA, Trentham-Dietz A . Cancer Causes Control 2000 Aug;11(7):663-7
Conclusion: this study suggests that, like breast cancer, endometrial cancer is modestly inversely associated with lactation.

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• Polyunsaturated fatty acid concentrations in human hindmilk are stable throughout 12-months of lactation and provide a sustained intake to the infant during exclusive breastfeeding: an Italian study

Marangoni F, Agostoni C, Lammardo AM, Giovannini M, Galli C, Riva E. Br J Nutr 2000 Jul;84(1):103-9

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• On the physics of the infant feeding bottle and middle ear sequela: Ear disease in infants can be associated with bottle feeding

Brown CE, Magnuson B . Int J Pediatr Otorhinolaryngol 2000 Aug 11;54(1):13-20

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• Antidepressants and breastfeeding: a review of the literature.

Dodd S, Buist A, Norman TR . Paediatr Drugs 2000 May-Jun;2(3):183-92

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• Protective effect of breast feeding against infection.

Howie PW, Forsyth JS, Ogston SA, Clark A, Florey CD. BMJ 1990 Jan 6;300(6716):11-6.
Breast feeding during the first 13 weeks of life confers protection against gastrointestinal illness that persists beyond the period of breast feeding itself.

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• Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study

Andrea C Wilson, research dietitian, child health, J Stewart Forsyth, consultant paediatrician,aStephen A Greene, consultant paediatrician, Linda Irvine, research nurse, child health, Catherine Hau, statistician, Peter W Howie, professor of obstetrics and gynaecology. BMJ 1998;316:21-25 (3 January).
This study found that exclusive breast feeding is associated with a significant reduction in childhood respiratory illness;
The early introduction of solids is associated with increased body fat and weight in childhood;
Exclusive bottle feeding is associated with higher systolic blood pressure in childhood;
Breast feeding and delaying the introduction of solids until after 15 weeks may have a beneficial effect on childhood health and subsequent adult disease.

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• Increasing breastfeeding rates to reduce infant illness at the community level

Anne L. Wright, Mark Bauer, Audrey Naylor, Emily Sutcliffe, and Larry Clark. Pediatrics Vol. 101 No. 5 May 1998, pp. 837-844.
Increasing the proportion of exclusively breastfed infants seems to be an effective means of reducing infant illness at the community level. The experimental design suggests that the increased incidence of illness among minimally breastfed infants is causally related to lack of breast milk, rather than being attributable to confounding.

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• Promotion of breastfeeding intervention trial, a randomized trial in the Republic of Belarus

M.S. Kramer e.a., JAMA, Vol. 285 No. 4, January 24/31, 2001.

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• Health care cost of formula-feeding in the first year of life

Ball, T. M., Wright, A. L. (1999). Pediatrics 103: 870-876.
Results. In the first year of life, after adjusting for confounders, there were 2033 excess office visits, 212 excess days of hospitalization, and 609 excess prescriptions for these three illnesses per 1000 never-breastfed infants compared with 1000 infants exclusively breastfed for at least 3 months. These additional health care services cost the managed care health system between $331 and $475 per never-breastfed infant during the first year of life.
Conclusions. In addition to having more illnesses, formula-fed infants cost the health care system money. Health care plans will likely realize substantial savings, as well as providing improved care, by supporting and promoting exclusive breastfeeding.

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• Representing infant feeding: content analysis of British media portrayals of bottle feeding and breast feeding

Lesley Henderson, Jenny Kitzinger, Josephine Green. BMJ 2000;321:1196-1198 ( 11 November ).
Henderson et al report on an analysis of the representation of infant feeding by the British media over one month. Bottle feeding was highly visible on television, whereas the image of a woman breast feeding appeared only once in the entire sample. Bottle feeding was associated with "ordinary" families whereas breast feeding was associated with middle class or celebrity women. Bottle feeding was represented as straightforward whereas breast feeding was represented as problematic. The health implications of different infant feeding practices were rarely mentioned.

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• Lactation reduces breast cancer risk in Shandong Province, China

Tongzhang Zheng1, Li Duan2, Yi Liu2, Bing Zhang3, Yan Wang2, Yongxiang Chen4, Yawei Zhang1 and Patricia H. Owens1 . American Journal of Epidemiology Vol. 152, No. 12 : 1129-1135

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• Early nutrition in preterm infants and later blood pressure: two cohorts after randomised trials

Atul Singhal, Tim J Cole, Alan Lucas . The Lancet, Volume 357, Number 9254 10 February 2001.

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• Solids and Formula: Association With Pattern and Duration of Breastfeeding

Agneta Hornell, PhD, Yngve Hofvander, MD, PhD, and Elisabeth Kylberg, PhD . PEDIATRICS Vol. 107 No. 3 March 2001, p. e38.
Results. Introduction of solids was associated with no or minor changes in breastfeeding frequency and suckling duration. Breastfeeding frequency remained constant the first month after the introduction and then declined slowly, while daily suckling duration started to decline slowly when solids were introduced. Breastfeeding duration was not associated with infants' age at introduction of solids. In infants given formula, as soon as regular formula feeds started, the breastfeeding frequency and suckling duration declined swiftly. The younger an infant was at the start of regular formula feeds, the shorter the breastfeeding duration.

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• Is Breastfeeding Really Favoring Early Neonatal Jaundice?

Giovanna Bertini, MD, Carlo Dani, MD, Michele Tronchin, PhD, and Firmino F. Rubaltelli, MD. PEDIATRICS Vol. 107 No. 3 March 2001, p. e41 .
The present study confirms the important role of fasting in the pathogenesis of neonatal hyperbilirubinemia, although breastfeeding per se does not seem related to the increased frequency of neonatal jaundice but to the higher bilirubin level in a very small subpopulation of infants with jaundice. In fact, in the breastfed infants, there is a small subpopulation with higher serum bilirubin levels. These infants, when starved and/or dehydrated, could probably be at high risk of bilirubin encephalopathy.

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• Duration of breastfeeding and arterial distensibility in early adult life: population based tudy

C P M Leeson, M Kattenhorn, J E Deanfield, and A Lucas. BMJ 2001;322 643-647.

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• Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial

Marko Kalliom, Seppo Salminen, Heikki Arvilommi, Pentti Kero, Pertti Koskinen, Erika Isolauri. The Lancet Volume 357, Number 9262 07 April 2001.
Lactobacillus GG was effective in prevention of early atopic disease in children at high risk. Thus, gut microflora might be a hitherto unexplored source of natural immunomodulators and probiotics, for prevention of atopic disease.

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• Maternal employment and the initiation of breastfeeding S Noble

Acta Paediatrica Volume: 90 Number: 4 Page: 423 -428.
The decision to breastfeed was not associated with "any" plans to work postpartum. However, women who planned to commence work prior to 6 wk postpartum were significantly less likely to initiate breastfeeding compared with those not intending to work postpartum.

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• Long chain polyunsaturated fatty acids (LC-PUFA) and perinatal development

B Koletzko; C Agostoni; SE Carlson; T Clandinin; G Hornstra; M Neuringer; R Uauy; Y Yamashiro; P Willatts . Acta Paediatrica Volume: 90 Number: 4 Page: 460 - 464.
For healthy infants we recommend and strongly support breastfeeding as the preferred method of feeding, which supplies preformed LC-PUFA. Infant formulas for term infants should contain at least 0.2% of total fatty acids as docosahexaenoic acid (DHA) and 0.35% as arachidonic acid (AA). Since preterm infants are born with much less total body DHA and AA, we suggest that preterm infant formulas should include at least 0.35% DHA and 0.4% AA. Higher levels might confer additional benefits and should be further investigated because optimal dietary intakes for term and preterm infants remain to be defined. For pregnant and lactating women we consider it premature to recommend specific LC-PUFA intakes. However, it seems prudent for pregnant and lactating women to include some food sources of DHA in their diet in view of their assumed increase in LC-PUFA demand and the relationship between maternal and foetal DHA status.

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