FAQs, Myths, And Misconceptions About Breastfeeding

8/12/2019 FAQs, Myths, And Misconceptions About Breastfeeding

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FAQs, Myths, and

Misconceptions aboutBreastfeeding

Juliet Sio Aguilar, M.D., M.Sc.(Birm)Professor of Pediatrics

University of the Philippines Manila


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WHO and UNICEF: Global Strategy for

Infant and Young Child Feeding (2002)

To revitalize focus on impact of feeding practices on

nutritional status, growth and development and

health, and ultimately the survival of infants andyoung children

.health and other relevant sectors protect,

promote and support exclusive breastfeeding for sixmonths and continued breastfeeding up to two

years or beyond


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Why Exclusive BF for

First Six Months of Life Infants 0-5 months

Not BF

7-fold increased risk for diarrheal deaths

5-fold increased risk for death from pneumonia

Partially BF

2-fold increased risk for deaths from diarrhea orpneumonia

Black RE et al. Where and why are 10 million children dying

every year? Lancet 2003; 361: 226.


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Breastfeeding and Disease

PreventionExclusive breastfeeding for at least 6 mos

Dose-dependent effect of BF duration on obesityArenz S et al. Int J Obesity2004: 28: 1247.

Exclusive breastfeeding for at least 4 mos

Breastfeed for at least 6 mosHalken S. Pediatr Allerg Immunol2004: 15 Suppl 16: 9.

Caution in severe maternal asthma

Wright AL et al. Thorax2001; 56:192.

Exclusive breastfeeding for at least 4 mos

Delay introduction of cows milk until 4 mosKimpimaki et al. Diabetologia2001; 44: 63.


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Other Potential Problems of Non-

exclusive BF

Nipple confusion

High risk of lactation failure

92% of subjects felt milk output inadequate

Mathur GP et al. Indian Pediatr1992; 29: 1541.


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Im sick. Is it safe

to breastfeed my baby?


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Maternal Infections BF not contraindicated in most infections

Common minor infections

Varicella (onset within 6 days of delivery or 2 dayspostpartum)

Give ZIG to uninfected neonate and separation from motheruntil she is noninfectious

CMV Passive transfer of maternal antibodies

For as long as mothers are not recent converters if infant isterm

For preterms: benefits of BF outweigh risk of CMVtransmission

Freezing and pasteurization can significantly viral load inmilk

Toxoplasmosis

Antibodies found in breast milk


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Maternal Hepatitis B Carriers

With appropriate immunoprophylaxis: no

additional risk in breastfed infant even if

mother is HBeAg positive

Hill JB et al. Obstet Gynecol2002; 99: 1049.

Tseng AKY et al. Lancet1988; 2: 1032.

Beasly PR et al. Lancet 1975; 2: 740.


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Maternal Tuberculosis

Current Recommendations

Best way to prevent TB in infants of infected

moms: timely and properly administered

chemotherapy for moms Mothers can breastfeed exclusively for

Minimum of 4 mos

6 mos if infant is growing appropriately

Should continue BF with adequate complementary foodup to 2 years or beyond

Joint Statement of the Division of Child Health and Development, Global

Tuberculosis Programme, Global Programme for Vaccines and Immunization and

Reproductive Health of the World Health Organization. Update No. 23, Feb 1998.


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Breastfeeding and

Maternal Tuberculosis Management categories: Timing

of diagnosis of active PTB

Before delivery >2 mos


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Diagnosis of

Maternal Tuberculosis >2 mos before delivery

Get sputum smear just

before delivery Negative: Treat mom + BCG

at birth

Positive: Treat mom + INH 6

mos + BCG after INH


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Breastfeeding and

Maternal Tuberculosis

Additional key in management

Monitor infants health during the 1styear of

life for signs of TB

Continue breastfeeding whether or not child

develops TB

Joint Statement of the Division of Child Health and Development,

Global Tuberculosis Programme, Global Programme for Vaccines and

Immunization and Reproductive Health of the World Health Organization.Update No. 23, Feb 1998.


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Maternal HIV

Transmission Risks to Infants

Without any intervention before or duringdelivery: 15-30%

Breastfeeding: 10-20%

LINKAGES Project.Academy for Educational Development. April

2004.


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Should mothers with HIV be

advised to BF? It depends.

If BM substitutes are acceptable, affordable,feasible, sustainable and safe greater

chances of survival if fed artificially

If BM substitutes are prohibitively costly,

access to clean water poor, health carelimited exclusive BF safest option


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Reducing Risk of

HIV Transmission Reduce total duration of BF if being

breastfed Shift to BM substitutes as soon as resources

become affordable/available

Prevent and promptly treat oral lesions ininfants and breast problems

Take antiretroviral drugs Single dose of nevirapine to mother in labor and

infant after delivery (Uganda trial) 42% reduction at 6 weeks

35% reduction at 12 months


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Two-yr Morbidity & Mortality Among

Children Born to HIV-infected Mothers

Long-term safety of infant feeding interventions aimed atreducing breast milk HIV transmission in Africa (Cotedlvoire)

HIV-infected moms given peripartum antiretroviralprophylaxis

Infant feeding interventions Artificial feeding

Exclusive breastfeeding and early cessation from age 4 mos

PLUS nutritional counseling and clinical management for 2 yrs Outcome variables

Occurrence of morbid events (diarrhea, ARI, malnutrition) andsevere events (hospitalization or death)

Becquet R et al; Ditrame Plus Study Group. PLoS Med2007; 4: e17.


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Its hot in the Philippines.

Wouldnt my baby become

dehydrated if I do not give

extra water?


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Supplemental Water in

Breastfeeding?

Water

Lactose

Fat

Protein

OthersWater 88.1%

Lactose

7.0%

Fat

3.8%

Protein

0.9%

Lawrence RA. 1994. Breastfeeding: A Guide for the MedicalProfession.4thed. St. Louis: Mosby-Year Book, Inc.


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Im on medications. Can I

continue breastfeeding?


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Im underweight. Is my

breast milk adequate for mybaby?


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Maternal Malnutrition

Can malnourished mothers breastfeed

successfully?

Yes except in severe PEM

Babies may suck more vigorously, frequently

or longer if BM supply low

Easier and less expensive to feedmalnourished mom than to expose baby to

risk of bottle feeding

LINKAGES Project.Academy for Educational Development. July 2004.


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Maternal Micronutrient

Supplementation Vitamin A

Single dose of 200,000 IU after delivery (not

later than 6-8 weeks)

Thiamin, riboflavin, vit B6, vit B12, iodine,

selenium

Levels in breast milk easily affected by maternal

diet Folate, calcium, iron, copper, zinc

Remain relatively high in breast milk despite low

maternal reserves

Supplement to protect maternal reserves


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Appropriate

Complementary Feeding Foods rich in iron

Term infants: introduced around 6 mos

Preterms, LBW and infants with hematologicdisorders: earlier than 6 mos

Food diversity Especially for BF children beyond 1 yr old

Strongly and consistently correlated with growth

Early introduction of starchy gruels (< 6mos)associated with stunting

AAP Policy Statement on Breastfeeding. Pediatrics2005; 115: 496.

Onyango A et al. Int J Epidem1998; 27: 484.


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I cant beat my smoking and

drinking habit. Can I

breastfeed even if I smokecigarettes and take alcoholic

beverages?


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Maternal Smoking Infants exposed to environmental tobacco smoke

experience health risks

Components of tobacco in breast milk

BF moms should no. of cigarettes to


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Maternal Smoking Not a contraindication

Smoking hygiene

Avoid smoking within the home. Use air

purifier if cannot be avoided.Never smoke in the car or near the infant in

closed areas or take infant to smokyenvironment

Smoke only immediately after BF and at least1 hrs prior to BF


Pulley KR and Flanders-Stepans MB. J Perinatal Ed2002; 11: 28.


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Maternal Alcohol Intake

Alcohol

Concentrated in breast milk

Its use can inhibit milk production

Recommendation

Avoid alcohol

For occasional single, small drink:Avoid BF for 2 hrs after the drink



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Im very tired from work. Is it

safe to breastfeed my baby?


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Stress and Breastfeeding

Breast milk panis

No scientific basis

Impact of stress on milk supplyVariable among lactating moms

Some able to cope well despite extreme pressures

In early weeks of lactation Fatigue the most detrimental factor to milk

production

Lawrence RA. 1994. Breastfeeding: A Guide for the Medical Profession.

4th ed. St. Louis: Mosby-Year Book, Inc.


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I no longer have the energy to

breastfeed my baby. But I knowbreast milk is best.

What shall I do?


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Psychosocial Risk Factors Associated

with BF Discontinuation Prospective cohort study

Managed care setting

Sacramento, CA, USARCT to home visits vs clinic-based follow up

Face-to-face interview postpartum, telephoneinterviews at 2 wks and 12 wks

1163 mother-newborn pairs

Taveras EM at al. Pediatrics2003; 112: 108.


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Psychosocial Risk Factors Associated

with BF Discontinuation Results BF rates

87% initiated BF

75% BF at 2 wks

55% BF at 12 wks

Multivariate analysis BF at 12 wks

Encouragement from clinician to BF

OR = 0.6 [95% CI: 0.4, 0.8]

BF discontinued at 2 wks Lack of confidence to BF at 1-2 day interview

OR = 2.8 [95% CI: 1.02, 7.6]

Early BF problems

OR = 1.5 [95% CI: 1.1, 1.97]

Taveras EM at al. Pediatrics2003; 112: 108.


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Spousal Support Training

Parameters Intervention

Group (%)

Control

Group (%)

P

Full BF at 6 mos 25 15 0.05

Perceived milk

insufficiency

12 43 0.001

Mixed feeding 10 33 0.001Full BF at 6 mos

despite problems

24 4 0.001

Pisacane A et al. Pediatrics2005; 116: e494.


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Early Routine Clinic Visit on

Breastfeeding 1st4 weeks postpartum: period with greatest

decrease in BF rates

Single visit within 2 weeks after birth

226 mother-infant pairs in Chambery,France

Conducted by trained clinicians Multivariate analysis associated with

exclusive BF at 4 weeks

Labarere J et al.Pediatrics2005; 115: e139.


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Early Clinic Visit on eBF at 4 wks:

Multivariate Analysis

Characteristics Adjusted Odds

Ratio

95% CI

Intervention group 2.44 1.18-5.03

Epidural anesthesia 0.32 0.13-0.76

Gestational age at

delivery

3.44 1.2-9.82

Expected BF duration

of > 4 mos

2.49 1.12-5.53

Labarere J et al.Pediatrics2005; 115: e139.


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Lets all help bring back the

breastfeeding culture.

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FAQs, Myths, And Misconceptions About Breastfeeding