Breast-Feeding Best Bet for Babies
by Rebecca D. Williams
USFDA

New parents want to give their babies the very best. When it comes to
nutrition, the best first food for babies is breast milk.

More than two decades of research have established that breast milk is
perfectly suited to nourish infants and protect them from illness.
Breast-fed infants have lower rates of hospital admissions, ear
infections, diarrhea, rashes, allergies, and other medical problems
than bottle-fed babies.

"There are 4,000 species of mammals, and they all make a different
milk. Human milk is made for human infants and it meets all their
specific nutrient needs," says Ruth Lawrence, M.D., professor of
pediatrics and obstetrics at the University of Rochester School of
Medicine in Rochester, N.Y., and spokeswoman for the American Academy
of Pediatrics.

The academy recommends that babies be breast-fed for six to 12 months.
The only acceptable alternative to breast milk is infant formula.
Solid foods can be introduced when the baby is 4 to 6 months old, but
a baby should drink breast milk or formula, not cow's milk, for a full
year.

"There aren't any rules about when to stop breast-feeding," says
Lawrence. "As long as the baby is eating age-appropriate solid foods,
a mother may nurse a couple of years if she wishes. A baby needs
breast milk for the first year of life, and then as long as desired
after that."

In 1993, 55.9 percent of American mothers breast-fed their babies in
the hospital. Only 19 percent were still breast-feeding when their
babies were 6 months old. Government and private health experts are
working to raise those numbers.

The U.S. Food and Drug Administration is conducting a study on infant
feeding practices as part of its ongoing goal to improve nutrition in
the United States. The study is looking at how long mothers breast-
feed and how they introduce formula or other foods.

Health experts say increased breast-feeding rates would save consumers
money, spent both on infant formula and in health-care dollars. It
could save lives as well.

"We've known for years that the death rates in Third World countries
are lower among breast-fed babies," says Lawrence. "Breast-fed babies
are healthier and have fewer infections than formula-fed babies."

Human Milk for Human Infants

The primary benefit of breast milk is nutritional. Human milk contains
just the right amount of fatty acids, lactose, water, and amino acids
for human digestion, brain development, and growth.

Cow's milk contains a different type of protein than breast milk. This
is good for calves, but human infants can have difficulty digesting
it. Bottle-fed infants tend to be fatter than breast-fed infants, but
not necessarily healthier.

Breast-fed babies have fewer illnesses because human milk transfers to
the infant a mother's antibodies to disease. About 80 percent of the
cells in breast milk are macrophages, cells that kill bacteria, fungi
and viruses. Breast-fed babies are protected, in varying degrees, from
a number of illnesses, including pneumonia, botulism, bronchitis,
staphylococcal infections, influenza, ear infections, and German
measles. Furthermore, mothers produce antibodies to whatever disease
is present in their environment, making their milk custom-designed to
fight the diseases their babies are exposed to as well.

A breast-fed baby's digestive tract contains large amounts of
Lactobacillus bifidus, beneficial bacteria that prevent the growth of
harmful organisms. Human milk straight from the breast is always
sterile, never contaminated by polluted water or dirty bottles, which
can also lead to diarrhea in the infant.

Human milk contains at least 100 ingredients not found in formula. No
babies are allergic to their mother's milk, although they may have a
reaction to something the mother eats. If she eliminates it from her
diet, the problem resolves itself.

Sucking at the breast promotes good jaw development as well. It's
harder work to get milk out of a breast than a bottle, and the
exercise strengthens the jaws and encourages the growth of straight,
healthy teeth. The baby at the breast also can control the flow of
milk by sucking and stopping. With a bottle, the baby must constantly
suck or react to the pressure of the nipple placed in the mouth.

Nursing may have psychological benefits for the infant as well,
creating an early attachment between mother and child. At birth,
infants see only 12 to 15 inches, the distance between a nursing baby
and its mother's face. Studies have found that infants as young as 1
week prefer the smell of their own mother's milk. When nursing pads
soaked with breast milk are placed in their cribs, they turn their
faces toward the one that smells familiar.

Many psychologists believe the nursing baby enjoys a sense of security
from the warmth and presence of the mother, especially when there's
skin-to-skin contact during feeding. Parents of bottle-fed babies may
be tempted to prop bottles in the baby's mouth, with no human contact
during feeding. But a nursing mother must cuddle her infant closely
many times during the day. Nursing becomes more than a way to feed a
baby; it's a source of warmth and comfort.

Benefits to Mothers

Breast-feeding is good for new mothers as well as for their babies.
There are no bottles to sterilize and no formula to buy, measure and
mix. It may be easier for a nursing mother to lose the pounds of
pregnancy as well, since nursing uses up extra calories. Lactation
also stimulates the uterus to contract back to its original size.

A nursing mother is forced to get needed rest. She must sit down, put
her feet up,and relax every few hours to nurse. Nursing at night is
easy as well. No one has to stumble to the refrigerator for a bottle
and warm it while the baby cries. If she's lying down, a mother can
doze while she nurses.

Nursing is also nature's contraceptive--although not a very reliable
one. Frequent nursing suppresses ovulation, making it less likely for
a nursing mother to menstruate, ovulate, or get pregnant. There are no
guarantees, however. Mothers who don't want more children right away
should use contraception even while nursing. Hormone injections and
implants are safe during nursing, as are all barrier methods of birth
control. The labeling on birth control pills says if possible another
form of contraception should be used until the baby is weaned.

Breast-feeding is economical also. Even though a nursing mother works
up a big appetite and consumes extra calories, the extra food for her
is less expensive than buying formula for the baby. Nursing saves
money while providing the best nourishment possible.

When Formula's Necessary

There are very few medical reasons why a mother shouldn't breast-feed,
according to Lawrence.

Most common illnesses, such as colds, flu, skin infections, or
diarrhea, cannot be passed through breast milk. In fact, if a mother
has an illness, her breast milk will contain antibodies to it that
will help protect her baby from those same illnesses.

A few viruses can pass through breast milk, however. HIV, the virus
that causes AIDS, is one of them. Women who are HIV positive should
not breast-feed.

A few other illnesses--such as herpes, hepatitis, and beta
streptococcus infections--can also be transmitted through breast milk.
But that doesn't always mean a mother with those diseases shouldn't
breast-feed, Lawrence says.

"Each case must be evaluated on an individual basis with the woman's
doctor," she says.

Breast cancer is not passed through breast milk. Women who have had
breast cancer can usually breast-feed from the unaffected breast.
There is some concern that the hormones produced during pregnancy and
lactation may trigger a recurrence of cancer, but so far this has not
been proven. Studies have shown, however, that breast-feeding a child
reduces a woman's chance of developing breast cancer later.

Silicone breast implants usually do not interfere with a woman's
ability to nurse, but if the implants leak, there is some concern that
the silicone may harm the baby. Some small studies have suggested a
link between breast-feeding with implants and later development of
problems with the child's esophagus. Further studies are needed in
this area. But if a woman with implants wants to breast-feed, she
should first discuss the potential benefits and risks with her child's
doctor.

Possible Problems

For all its health benefits, breast-feeding does have some
disadvantages. In the early weeks, it can be painful. A woman's
nipples may become sore or cracked. She may experience engorgement
more than a bottle-feeding mother, when the breasts become so full of
milk they're hard and painful. Some nursing women also develop clogged
milk ducts, which can lead to mastitis, a painful infection of the
breast. While most nursing problems can be solved with home remedies,
mastitis requires prompt medical care (see accompanying article).

Another possible disadvantage of nursing is that it affects a woman's
entire lifestyle. A nursing mother with baby-in-tow must wear clothes
that enable her to nurse anywhere, or she'll have to find a private
place to undress. She should eat a balanced diet and she might need to
avoid foods that irritate the baby. She also shouldn't smoke, which
can cause vomiting, diarrhea and restlessness in the baby, as well as
decreased milk production.

Women who plan to go back to work soon after birth will have to plan
carefully if they want to breast-feed. If her job allows, a new mother
can pump her breast milk several times during the day and refrigerate
or freeze it for the baby to take in a bottle later. Or, some women
alternate nursing at night and on weekends with daytime bottles of
formula.

In either case, a nursing mother is physically tied to her baby more
than a bottle-feeding mother. The baby needs her for nourishment, and
she needs to nurse regularly to avoid getting uncomfortably full
breasts. But instead of feeling it's a chore, nursing mothers often
cite this close relationship as one of the greatest joys of nursing.
Besides, nursing mothers can get away between feedings if they need a
break.

Finally, some women just don't feel comfortable with the idea of
nursing. They don't want to handle their breasts, or they want to
think of them as sexual, not functional. They may be concerned about
modesty and the possibility of having to nurse in public. They may
want a break from child care to let someone else feed the baby,
especially in the wee hours of the morning.

If a woman is unsure whether she wants to nurse, she can try it for a
few weeks and switch if she doesn't like it. It's very difficult to
switch to breast-feeding after bottle-feeding is begun.

If she plans to breast-feed, a new mother should learn as much as
possible about it before the baby is born. Obstetricians,
pediatricians, childbirth instructors, nurses, and midwives can all
offer information about nursing. But perhaps the best ongoing support
for a nursing mother is someone who has successfully nursed a baby.

La Leche League, a national support organization for nursing mothers,
has chapters in many cities that meet regularly to discuss breast-
feeding problems and offer support.

"We encourage mothers to come to La Leche League before their babies
are born," says Mary Lofton, a league spokeswoman. "On-the-job
training is hard to do. It's so important to learn how to breast-feed
beforehand to avoid problems."

Interested women or couples are welcome to attend La Leche League
meetings without charge. League leaders offer advice by phone as well.
To find a convenient La Leche League chapter, call (1-800) LA-LECHE.

Rebecca D. Williams is a writer in Oak Ridge, Tenn.

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Tips for Breast-Feeding Success
It's helpful for a woman who wants to breast-feed to learn as much
about it as possible before delivery, while she is not exhausted from
caring for an infant around-the-clock. The following tips can help
foster successful nursing:

Get an early start: Nursing should begin within an hour after delivery
if possible, when an infant is awake and the sucking instinct is
strong. Even though the mother won't be producing milk yet, her
breasts contain colostrum, a thin fluid that contains antibodies to
disease.
Proper positioning: The baby's mouth should be wide open, with the
nipple as far back into his or her mouth as possible. This minimizes
soreness for the mother. A nurse, midwife, or other knowledgeable
person can help her find a comfortable nursing position.
Nurse on demand: Newborns need to nurse frequently, at least every two
hours, and not on any strict schedule. This will stimulate the
mother's breasts to produce plenty of milk. Later, the baby can settle
into a more predictable routine. But because breast milk is more
easily digested than formula, breast-fed babies often eat more
frequently than bottle-fed babies.
No supplements: Nursing babies don't need sugar water or formula
supplements. These may interfere with their appetite for nursing,
which can lead to a diminished milk supply. The more the baby nurses,
the more milk the mother will produce.
Delay artificial nipples: It's best to wait a week or two before
introducing a pacifier, so that the baby doesn't get confused.
Artificial nipples require a different sucking action than real ones.
Sucking at a bottle could also confuse some babies in the early days.
They, too, are learning how to breast-feed.
Air dry: In the early postpartum period or until her nipples toughen,
the mother should air dry them after each nursing to prevent them from
cracking, which can lead to infection. If her nipples do crack, the
mother can coat them with breast milk or other natural moisturizers to
help them heal. Vitamin E oil and lanolin are commonly used, although
some babies may have allergic reactions to them. Proper positioning at
the breast can help prevent sore nipples. If the mother's very sore,
the baby may not have the nipple far enough back in his or her mouth.
Watch for infection: Symptoms of breast infection include fever and
painful lumps and redness in the breast. These require immediate
medical attention.
Expect engorgement: A new mother usually produces lots of milk, making
her breasts big, hard and painful for a few days. To relieve this
engorgement, she should feed the baby frequently and on demand until
her body adjusts and produces only what the baby needs. In the
meantime, the mother can take over-the-counter pain relievers, apply
warm, wet compresses to her breasts, and take warm baths to relieve
the pain.
Eat right, get rest: To produce plenty of good milk, the nursing
mother needs a balanced diet that includes 500 extra calories a day
and six to eight glasses of fluid. She should also rest as much as
possible to prevent breast infections, which are aggravated by
fatigue.
--R.D.W.

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Medicines and Nursing Mothers
Most medications have not been tested in nursing women, so no one
knows exactly how a given drug will affect a breast-fed child. Since
very few problems have been reported, however, most over-the-counter
and prescription drugs, taken in moderation and only when necessary,
are considered safe.

Even mothers who must take daily medication for conditions such as
epilepsy, diabetes, or high blood pressure can usually breast-feed.
They should first check with the child's pediatrician, however. To
minimize the baby's exposure, the mother can take the drug just after
nursing or before the child sleeps. In the January 1994 issue of
Pediatrics, the American Academy of Pediatrics included the following
in a list of drugs that are usually compatible with breast-feeding:

acetaminophen
many antibiotics
antiepileptics (although one, Primidone, should be given with
caution)
most antihistamines
alcohol in moderation (large amounts of alcohol can cause drowsiness,
weakness, and abnormal weight gain in an infant)
most antihypertensives
aspirin (should be used with caution)
caffeine (moderate amounts in drinks or food)
codeine
decongestants
ibuprofen
insulin
quinine
thyroid medications

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Drugs That Are NOT Safe While Nursing
Some drugs can be taken by a nursing mother if she stops breast-
feeding for a few days or weeks. She can pump her milk and discard it
during this time to keep up her supply, while the baby drinks
previously frozen milk or formula.

Radioactive drugs used for some diagnostic tests like Gallium-69,
Iodine-125, Iodine-131, or Technetium-99m can be taken if the woman
stops nursing temporarily.

Drugs that should never be taken while breast-feeding include:

Bromocriptine (Parlodel): A drug for Parkinson's disease, it also
decreases a woman's milk supply.

Most Chemotherapy Drugs for Cancer: Since they kill cells in the
mother's body, they may harm the baby as well.

Ergotamine (for migraine headaches): Causes vomiting, diarrhea,
convulsions in infants.

Lithium (for manic-depressive illness): Excreted in human milk.

Methotrexate (for arthritis): Can suppress the baby's immune system.

Drugs of Abuse: Some drugs, such as cocaine and PCP, can intoxicate
the baby. Others, such as amphetamines, heroin and marijuana, can
cause a variety of symptoms, including irritability, poor sleeping
patterns, tremors, and vomiting. Babies become addicted to these
drugs.

Tobacco Smoke: Nursing mothers should avoid smoking. Nicotine can
cause vomiting, diarrhea and restlessness for the baby, as well as
decreased milk production for the mother. Maternal smoking or passive
smoke may increase the risk of sudden infant death syndrome (SIDS) and
may increase respiratory and ear infections.

FDA
www.fda.gov