BREASTFEEDING IS THE FIRST LINE OF DEFENSE IN A DISASTER

ILCA UPDATED STATEMENT: January 28, 2010
BREASTFEEDING IS THE FIRST LINE OF DEFENSE IN A DISASTER

The Human Milk Banking Association of North America (HMBANA), United States Breastfeeding Committee (USBC), International Lactation Consultant Association/United States Lactation Consultant Association (ILCA/USLCA), and La Leche League International (LLLI) strongly affirm the importance of breastfeeding in emergency situations, and call on relief workers and health care providers serving victims of disasters to protect, promote, and support mothers to breastfeed their babies. During an emergency, breastfeeding mothers provide their infants with safe food and water and disease protection that maximize their chances of survival.

This week, the International Milk Bank Project and Quick International Courier coordinated a shipment of milk from the HMBANA member banks to supplement a mother’s own milk for the premature, medically fragile, and orphaned infants aboard the U.S. Navy ship Comfort stationed off the coast of Haiti. This milk will help this small group of infants. In this highly unusual circumstance the infrastructure associated with the Comfort’s resources allows U.S. sourced donor milk to help fragile Haitian babies.

Donor milk, however, is not a solution for the large number of infants and young children affected by the earthquake in Haiti. Members of the public who wish to promote the survival of mothers and babies in Haiti can donate money to the following organizations: UNICEF, Save the Children Alliance, World Vision, and Action Against Hunger. These organizations are using best practice to aid both breastfed and non-breastfed infants. Members of the public can be confident that donations to these organizations will support breastfeeding and help save the lives of babies.

Interventions to protect infants include supporting mothers to initiate and continue exclusive breastfeeding, relactation for mothers who have ceased breastfeeding, and finding wet nurses for motherless or separated babies. Every effort should be made to minimize the number of infants and young children who do not have access to breastfeeding. Artificially fed infants require intensive support from aid organizations including infant formula, clean water, soap, a stove, fuel, education, and medical support. This is not an easy endeavor. Formula feeding is extremely risky in emergency conditions and artificially fed infants are vulnerable to the biggest killers of children in emergencies: diarrhea and pneumonia.

As stated by UNICEF and WHO, no donations of infant formula or powdered milk should be sent to the Haiti emergency. Such donations are difficult to manage logistically, actively detract from the aid effort, and put infant’s lives at risk. Distribution of infant formula should only occur in a strictly controlled manner. Stress does not prevent women from making milk for their babies, and breastfeeding women should not be given any infant formula or powdered milk.

There are ongoing needs in the U.S. for human milk for premature and other extremely ill infants because of the protection it provides from diseases and infections. If a mother is unable to provide her own milk to her premature or sick infant, donor human milk is often requested from a human milk bank. American mothers can help their compatriots who find themselves in need of breast milk for their sick baby by donating to a milk bank that is a member of the Human Milk Banking Association of North America.

For more information about donating milk to a milk bank, contact HMBANA at www.hmbana.org. Additional information for relief workers and health care professionals can be provided from the United States Breastfeeding Committee at www.usbreastfeeding.org, ILCA/USLCA at www.ilca.org or www.uslca.org, or La Leche League International at www.llli.org. A list of regional milk banks is available on the HMBANA Web site at www.hmbana.org/index/locations.
Sincerely,
Angela Smith, President
ILCA Board of Directors

Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?

Breastfeeding is beneficial for infants and their mothers. Breastfeeding reduces the risk of gastrointestinal and respiratory infections. In some, but not all, countries SIDS prevention campaigns include breastfeeding.

This study shows that breastfeeding reduced the risk of sudden infant death syndrome by ~50% at all ages throughout infancy. We recommend including the advice to breastfeed through 6 months of age in sudden infant death syndrome risk-reduction messages.

PEDIATRICS Vol. 123 No. 3 March 2009, pp. e406-e410

Voldemort = Formula

‘Voldemort’ approach failing mothers
Monday 9 March 2009

Formula feeding should be clearly named in research showing its potential health risks to babies, according to a new study.

The study, led by Dr Julie Smith from the Australian Centre for Economics Research on Health at The Australian National University, shows that researchers reporting poorer health among formula-fed children too often shy away from including a mention of formula feeding in their titles or summaries.

“This is not helping properly informed health professionals and mothers,” Dr Smith said. “We looked at the findings of nearly 80 authoritative studies, all of which highlighted that formula-fed babies tend to be at higher risk of poor health than children fed on breast milk.

“Yet the vast majority of these studies did not mention formula feeding in the places that matter most for lasting impressions: headlines and abstracts. Rather than naming formula feeding as a significant risk factor, researchers seem to be treating this subject like Voldemort in the Harry Potter novels, as “He Who Shall Not Be Named.” For example, a study showing a higher incidence of a serious condition in formula fed infants was misleadingly named ‘Breastfeeding and necrotising enterocolitis,” she said.
Dr Smith and her colleagues stress that their research into how formula feeding is referred to in scientific studies was intended to ask an important rhetorical question about cultural attitudes and informed choice, and shows why blaming mothers for not breastfeeding is futile and misguided. They argue that initiatives to improve infant health by increasing breastfeeding have described the importance of accurate language, and the key role that well-informed health professionals play for women to breastfeed successfully.

“How can we expect physicians and other health professionals to be informed and convincing about the importance of breastfeeding if they themselves are not getting the facts on risks of formula feeding presented in a prominent and clear fashion?” Dr Smith said.

“Adopting the ‘Voldemort’ approach to describing the risks of formula feeding in published research harms the ability of physicians and other health professionals to support women, and reduces women’s ability to make informed choices. If a mother seeks support and reassurance that continuing breastfeeding is worthwhile, such non committal research reporting means she may get non committal advice from health professionals, even though the evidence is clear that formula feeding disadvantages infant health.”

Filed under: Media Release, ANU College of Medicine Biology and Environment, Health

Learn more: The research paper is online at http://www.acerh.edu.au/publications/ACERH_WP4.pdf

Formula For Tragedy

See video at: http://cbs2chicago.com/video/?id=51358@wbbm.dayport.com&cid=48

Nov 13, 2008 9:16 pm US/Central

Investigators: Formula For Tragedy

Powdered Baby Formula Could Be Dangerous For Some Infants

Dave Savini

CHICAGO (CBS) ― A warning for parents: Milk-based powdered formula
could put premature babies at risk.

And it is a possible cause for the death of an infant born at Rush-
Copley Medical Center in Aurora and other babies across the country.

Connor McGray and his twin brother, Logan, were born prematurely on
Nov. 16, 2007, at Rush-Copley.

Connor appeared to be the healthier of the two — until a week later
when their parents, Amanda Carlin and Tim McGray of Somonauk, received
a call from a doctor at the hospital, saying the infant was lethargic
and refusing to eat.

Doctors discovered Connor had meningitis, McGray said, and "they
basically told us, all we could do (was) pray."

The baby died at home on May 3, 2008, five months after he was born.
The cause of death listed on the baby's death certificate is
hydrocephalus and bacterial meningitis. The bacterial infection,
according to a memo from the Illinois Department of Public Health,
"may be associated with the consumption of a powdered breast milk
fortifier."

The Enfamil brand powdered formula was fed to the baby while he was
being cared for in the Neo-Natal Intensive Care Unit at Rush-Copley.
In a statement released Thursday, Rush-Copley said, "We have the
utmost compassion for the baby and his family.

"Rush-Copley delivers 4,000 babies a year and the procedures followed
here are consistent with the standards of care provided to prematurely
born infants in the U.S."

The danger with powdered formula is that, unlike the liquid kind, it
cannot be sterilized, making it vulnerable to bacteria growing in it,
according to the Centers for Disease Control and Prevention.

The most severe cases involve babies exposed to a bacteria called
Enterobacter sakazakii, or E-sak, which can lead to raging infections,
severe brain damage, and ultimately death, according to the CDC.
Amanda Carlin said son Connor died after the E-sak bacteria led to an
infection which caused the deadly form of meningitis.

The baby suffered from seizures and brain abscess. And his blood and
cerebral spinal fluid tested positive for the organism, the Health
Department document says.

During the week before Connor's illness, the Health Department memo
says, he was fed ready-to-feed liquid formula as well as breast milk
with powdered infant fortifier.

The powdered formula used by the hospital was Enfamil by Mead Johnson.
Connor consumed the product from Nov. 20 through Nov. 24 orally and
through a nasogastric tube, the Health Department says. The report
said the product was prepared at the hospital in a prep area/station,
not a dedicated formula preparation room.

On Dec. 3, 2007, Connor was transferred from Rush-Copley to the
University of Chicago because, McGray said, the family wanted the twin
boys together. Logan was being treated at the University of Chicago
for an intestinal condition.

Infants born prematurely, or those with weak immune systems, are at
greatest risk of being infected, according to the U.S. Department of
Health and Human Services. There is even a warning on powdered formula
containers. One brand warns: "... powdered infant formulas are not
sterile and should not be fed to premature infants or infants who
might have immune problems unless directed and supervised by your
baby's doctor."

Carlin said the hospital did not tell her about the risks of powdered
formula. She said she also didn't learn about her son being given the
powder, until she hired The Collins Law firm in Naperville.

"We didn't find out until afterward, when we got a hold of whatever
medical records we could get," McGray said. "That's the only way we
knew."

A CBS2/Beacon News investigation uncovered other cases in which
powdered formula was blamed for causing brain damage or death in
infants. There have been at least two Illinois cases, and cases in at
least 17 other states.

"It's not an isolated problem," said Ed Manzke, one of the attorneys
hired in Connor McGray's case. "There have been deaths all across the
country related to powder infant formulas. And what is so shocking
about it, is hardly anyone knows it."

A 2001 E-Sak outbreak in Tennessee led to a 2002 U.S. Food and Drug
Administration warning to health professionals. In a letter the FDA
wrote: ".. FDA recommends that powdered infant formulas not be used in
neonatal intensive care settings unless there is no alternative
available."

The FDA also said there are sterilized liquid fortifiers on the market
that can be used as an alternative. The FDA would not put a complete
ban on the powder and said it may be used in the NICU when no
appropriate liquid product is available.

Five years after this FDA warning, Connor McGray was given the
powdered formula, according to the Health Department document.
His family says he was getting stronger and doing well until he got
the powder.

Similar to Connor, Daniel Korte was born prematurely last year. He,
too, was fed powdered infant formula and was struck with the same
infection and meningitis. His parents said the contaminated formula
was fed to him at Mercy Medical Center in Des Moines, Iowa.

Daniel survived, but is living in a nursing facility on a ventilator.
"It basically turned his brain to mush," said Michelle Korte, Daniel's
mother. "He is ventilated and his upper brain is destroyed."

Korte said the hospital in this case also never warned her about the
risk associated with the formula. An attorney she hired, Andy
Weisbecker, said powdered formula manufacturers need to do a better
job of informing doctors and parents about the danger.

"More needs to be done to increase the level of knowledge about this
deadly bug," Weisbecker said. "Who knows how many parents are out
there with affected children who may still not be aware of a possible
connection between these illnesses and contaminated formula."

Federal regulators believe the number of cases are under-reported.
There may be other infants diagnosed with meningitis that have not
been checked for E-sak.

Babies are not just being sickened by formula in hospitals, however.
Parents unknowingly are buying the powdered formula for at-risk babies.
Stephen Meyer, an attorney at the Law Office of Nick Stein in Indiana,
has spent nine years working on E-sak cases. He said the FDA's warning
should have gone to consumers.

"Most moms would think 'If it's marketed to me, it's safe,'" said
Meyers. "Especially if it comes in a hospital gift bag."

Mead Johnson, manufacturer of powdered formula including Enfamil, said
its products are safe as long as they are used according to label
directions. The company said it has "taken the position that powdered
infant formula should not be used in neonatal intensive care settings
unless no alternative is available."

Tracey Noe, a spokesman for Abbott, which manufactures formula
including Similac, said it uses rigorous testing procedures, including
bacterial testing, on its powdered formulas.

"Abbott agrees with the U.S. Food and Drug Administration/Centers for
Disease Control and Prevention joint recommendation that powdered
formula should not be used in hospital neonatal intensive care units
— unless no nutritionally suitable alternative is available," Noe
said.
Both manufacturers have been sued by formula victims.

The parents of Connor McGray and Daniel Korte are also planning to
file lawsuits. In the meantime they are talking about what happened in
hopes of warning — and educating — doctors, hospital staff and
other parents about the potential danger of powdered formula.

"I want other people to be aware of it so they don't have to go
through what I did," Amanda Carlin said.

Christine Moyer of the Aurora Beacon News and Michele Youngerman and
Michelle Diotallevi of CBS2 contributed to this report.

http://cbs2chicago.com/local/baby.formula.tainted.2.863980.html

Feeding frenzy from The Guardian 27/8/08

Interesting article from the Guardian newspaper on the importance of human milk vs cow's milk formula. Should babies receive another mother's milk if they can't receive it from their own mother?

Why not?



Feeding Frenzy
Kate Garraway's revelation that she would feed her child another woman's breast milk has caused a furore - some people have called it repulsive. But given the health benefits, asks Joanna Moorhead, why all the fuss about wet-nursing?
Joanna Moorhead
Wednesday August 27 2008
The Guardian


At the weekend, GMTV presenter and mother of one Kate Garraway admitted that
she used to think that feeding other women's babies sounded pretty strange;
"a bit icky", was the way she would have described it. But making a Channel 4 documentary on the subject, and meeting women in the UK and US who had fed other women's offspring, she was prompted to rethink the entire debate. "Why are we happy about giving [our babies] something from a cow's breast, which is another species?" Garraway asked bullishly in a Guardian interview on Saturday. She continued to say that it was, in fact, "bonkers" to feel that letting your baby ingest another woman's
milk is beyond the pale, while being happy to let that same baby ingest cow's milk - "which is what formula milk is".

But many people still feel that babies receiving sustenance from any woman
other than their mother is deeply worrying and suspect. Among those who have
commented on the subject online over the past few days are a number of people
who have pronounced themselves "uncomfortable" at the notion. One mother I spoke to told me she felt "repulsed" at the idea of giving her milk to another baby, or having her baby fed with what is, after all, another woman's bodily fluid. Others feel that it could be psychologically undermining. "I think it would make me feel inadequate," says one friend. "There's so much pressure on you to breastfeed. If you find it
difficult, and ask another woman to do it for you, that would just reinforce the
inadequacy you're already feeling." I must admit that, the one time I tried swapping babies with a close friend, feeding her little boy felt weirdly intimate. The baby was hers, not mine: being in such close contact with him felt odd. His suck didn't feel anything like my baby's suck, and the whole experience made me feel a bit uncomfortable.

Alongside the detractors are those who find the idea perfectly normal.
"The words teacup and storm spring to mind," said a contributor to one
blog. Another pointed out that breastfeeding a child who wasn't your own was
once considered perfectly acceptable, with wet-nursing widespread just a few
hundred years ago. And while there's every reason to have been perturbed by
the class relationships that defined that practice in the west - working-class
women feeding the children of the upper classes - it could be argued that the
sharing of the breast milk itself wasn't actually such a problem. The reality is, kneejerk reactions apart, that research paper after research paper extols the health virtues of breast over formula milk. A baby who receives breast milk is less likely to suffer respiratory infections, gastroenteritis, urinary tract infections, ear infections or eczema. He or she is less likely to be overweight as a teenager and adult, is less likely to develop diabetes, and is likely to have a higher IQ. The list seems endless : so is the supplier really so important, provided the baby is receiving breast milk?

Among infant feeding professionals this current controversy is being met with a
guarded response. Many of those I spoke to had been approached by the makers of
Garraway's Channel 4 documentary but had declined to take part, fearing that - as happened with a similar documentary two years ago, focusing on mothers who breastfeed children as old as eight - the result would be a film that highlighted the crackpot and the batty, rather than the mainstream issues.

Alison Baum, of the breastfeeding charity Best Beginnings, expresses a typical
view. "There is value in making clear, as Garraway does, that formula is based on cow's milk - I think a lot of people don't realise that, and it does have mplications ... cow's milk is made to feed big baby calves, and we're giving it to tiny human infants. But there's a difference between acknowledging that there's an issue here, and seeing wet-nursing as the solution - I don't think that's the answer at all.

"What it's all about, for me, is shifting the pressures off individual women and on to society, so mothers themselves don't feel the weight of the debate so much. What I want to do is make it possible for mothers to go on breastfeeding for as long as they want to - because, at the moment, far too many women are stopping earlier than they would like."

Insiders say that some of Garraway's comments are misinformed, as well as naive. At one point in the Guardian interview, she says that despite her views having changed, she doesn't feel she'd be able to deal emotionally with another woman feeding her baby. So, she says, if the circumstances arose she'd simply buy human milk for her baby - from a milk bank.

What can she mean, asks Janet Fyle, professional policy advisor at the Royal College of Midwives. I suggest that maybe she's imagining that she'd call up one of the country's 17 milk banks, located at hospitals across Britain, credit card at the ready. Fyle snorts with laughter. "Is that what she means? Bless her!" she chuckles. Milk banks - which dwindled through the 1980s at the height of the Aids furore, but are now making a comeback - are specifically designed for the feeding of the tiniest premature babies in special-care baby units. These babies weigh as little as 2lbs, and have minute stomachs, so they need to be tube-fed a few millimetres of donated breast milk every few hours through a tube.

"It's a totally different ball-game from feeding a growing baby at term and beyond," explains Sally Inch, coordinator of the Oxford Human Milk Bank and infant feeding specialist for the Oxford Radcliffe Trust.

"A normal-size newborn would need something in the region of three-quarters to a litre a day of milk. It simply wouldn't be practical - and, more importantly, it's not what breast-milk banks exist to do."

What they are set up for, Inch explains, is to give premature babies the only milk they may be able to absorb - the gut of a pre-term infant is often too immature to tolerate any kind of formula. So do mothers of premature newborns ever get squeamish about their babies being given other mothers' milk - albeit after careful screening and pasteurisation? "That's certainly not a major problem," says Inch. "This milk can be life-saving - it's the best way of protecting against a condition called necrotising enterocolitis, which kills one in five premature babies who contract it. Who would mind their baby being given something that's going to save his or her
life?"

A much more common problem, she points out, is that milk banks don't have enough milk to meet demand, especially with premature birth on the increase. Women who donate milk have babies under six months old themselves - they usually collect a small amount of milk from each breast after each feed, and then freeze it to give to the milk bank later.

But what about modern-day, mouth-to-nipple wet-nursing - does it really go on,
behind closed doors? Fyle thinks it probably does. From time to time, she says,
the Royal College of Midwives gets an inquiry from someone who wants to know if
there are risks involved. (Since women are screened for conditions such as HIV
and hepatitis during pregnancy these days, there doesn't tend to be a huge health risk. If a woman is feeding her own baby, she's almost certainly no great risk to yours.) "There are probably situations in which women help one another out by feeding each other's babies," she says. "It happens all the time in Africa, and it happened all the time in the past in the west. But as far as the future is concerned, in the west, I don't think it's going to make a big impact - although I am a bit worried about the possibility of it happening for gain. I feel there are mothers out there who don't like the idea of using their own breasts for feeding, but feel for
health reasons they'd like their child to have breast milk. I wouldn't rule out a bit of a growth in wealthy women looking for women they could pay to feed their babies," she pauses. "I do find that disquieting."

The reality, though, is that while this may occasionally happen, the current furore says a lot more about the media interest in the extremes of human behaviour than it does about real issues around breastfeeding. Right now, only 2% of British babies are being exclusively breastfed to six months, as per official government advice. As far as I know, no one's making a documentary about that.

Copyright Guardian Newspapers Limited 2008

When mum is sick

Can you still breastfeed when you are sick yourself? With cold, flu and tummy bug season upon us in Japan, this is a common question.

There are very few illnesses which would require a mother to stop nursing. You may feel tired, run down and unable to be much of a good mother, but the recommendation is to tuck yourself in bed with your baby and continue breastfeeding, rest, keep up your fluids, and if you need to take medications, let your doctor know you are breastfeeding. Most medications are compatible with breastfeeding, but here in Japan the doctor often says you will need to wean for three (or more) days while taking any medications, even simple antibiotics. The research shows that this is basically not true in most cases, and it is not hard to find this information through a simple google search. And remember, if it is a cold you have, then antibiotics aren't going to do anything for you anyway! If it is mastitis (a breast inflammation), it is crucial to continue nursing while taking the medications to avoid the risk of developing an abscess.

Think about the logistics and agony of weaning just for three days. During those three days, your breasts will become engorged and painful if you don't express your milk. Your milk supply will diminish if you don't express your milk regularly because of the "use it or lose it" prinicple. Your baby will need to be fed an alternative which is not without health risks. Most likely they will be fed by bottle, which they may not have experienced before...and without the built-in comfort of nursing directly, a normal part of life for your baby till now, your baby may also become quite stressed. This is not what you need while you are sick!

Your doctor may not have mentioned any of these things to you while handing you the medications. Is your doctor really supportive of breastfeeding? Did he/she mention that not continuing breastfeeding and substituing infant formula presents a greater risk to your baby's health than the risk of the transfer of a small amount of medication in your milk?

Dr Thomas Hale, pharmacologist and author of Medications and Mother's Milk (a book which all doctors should have on their shelves) tells us that in order for medications to transfer into human milk, they need to be highly lipid soluble, attain high concentrations in maternal plasma, be low in molecular weight, low in protein binding and pass into the brain easily. After those considereations, then we look at the bioavailability of the medication in the infant. He says :"numerous medications are either destroyed in the infant's gut, fail to be absorbed through the gut wall, or are rapidly picked up by the liver. Once in the liver they are either metabolized or stored". (p9) So factors like whether the medication passes freely into the mother's milk and the half life of the drug all need to be considered before we can really tell whether the dose the infant would receive via the milk is harmful to them. And we should not ignore that there are larger risks associated with formula use.

For more information see the articles on breastfeeding while mother is sick at kellymom. There are lots of references there for further reading too.

If you decide to use a herbal remedy, remember that just because it is herbal doesn't always mean it is safe while breastfeeding. This book has more information on herbs and nursing.

Note: Antihistamines or contraceptives containing estrogen have been linked to low milk supply.

To supplement or not?

Some doctors are not as supportive of breastfeeding as you would wish. If you are having problems, and the doctor advises supplementing with formula without really investigating how and why breastfeeding is not going as well as it should, you may like to check out the information from the Academy of Breastfeeding Medicine. These are protocols written by doctors for doctors on important topics like supplementation (in English and Japanese) based on protecting the breastfeeding relationship. You might even consider sharing the information with your doctor.

Of course your doctor wants to see your baby growing and thriving, but in Japan the supplements are too often a quick-fix solution. Somewhat surprisingly, supplements are routinely offered at many hospitals if a mother complains she is too tired and wants to sleep after the birth. This is just bad practice. Everyone is tired after having a baby...but you learn to breastfeed by breastfeeding, not by having someone else take care of your baby and feed supplements. Then the mothers complain they don't have enough milk, but your breasts don't continue to produce milk if you don't use it! This is known as the "use it or lose it" principle.

Supplementation with formula changes the gut flora in the baby, and can seriously affect your baby's health both now and in the future (allergies, diabetes, ear infections...the list is very long) so it is not something that should be approached lightly. Supplementing with the mother's own milk is always a better first choice, and if supplementation is indicated, mothers need good advice and support on how to express and use their own milk. "Just one bottle won't hurt "...or will it?

To increase your baby's breastmilk intake, also see Dr. Jack Newman's recommendations and contact a local Lactation Consultant or your local La Leche League Leader.

glad to be breastfeeding...!

A reason to be glad you are breastfeeding.

That's pretty scary, isn't it?
Here's another and another and the list to end all others here.

And just after I posted the above, into my mailbox today came the new WHO report on Enterobacter sakazakii and Salmonella in powdered infant formula.

Seriously makes you glad you are breastfeeding!

Breastmilk: clean, safe, immune-boosting, the right temperature, attractively packaged, makes your baby healthy and bright and satisfies all their needs!
Human milk for human babies.