Monday, June 25, 2007

The Milk of Prudence

The scientific evidence is undeniable that breastfeeding of infants for at least the first six months of life is the ideal and holds outstanding benefits for both mother and child.picture of a woman and a baby The US Health and Human Services Dept. summarizes these benefits for baby:
Breast milk is the most complete form of nutrition for infants. A mother's milk has just the right amount of fat, sugar, water, and protein that is needed for a baby's growth and development. Most babies find it easier to digest breast milk than they do formula.
As a result, breastfed infants grow exactly the way they should. They tend to gain less unnecessary weight and to be leaner. This may result in being less overweight later in life.

Premature babies do better when breastfed compared to premature babies who are fed formula.

Breastfed babies score slightly higher on IQ tests, especially babies who were born pre-maturely.
The above article gives an even longer list of benefits for breastfeeding mothers and society as a whole.

But on ANC's Crossroads program last week, Tony Velasquez was interviewing a lady representative of the breastfeeding advocacy group, Aruga. When she was asked however, what conditions in the mother makes breastfeeding NOT a good idea, she said there was only one contra-indication, and that is when the mother is undergoing radioactive treatment therapy. Yeah, like how many Filipino mothers are in that category? Two? I was curious about this claim because I'd heard a different advocates say that "the only" contraindication was if the mother was sick with HIV/AIDS.

So I've looked it up and found the following apparently authoritative post from the Center for Disease Control in Atlanta, Georgia:
When should a mother avoid breastfeeding?

Health professionals agree that human milk provides the most complete form of nutrition for infants, including premature and sick newborns. However, there are rare exceptions when human milk is not recommended. Under certain circumstances, a physician will need to make a case-by-case assessment to determine whether a woman’s environmental exposure or her own medical condition warrants her to interrupt or stop breastfeeding.

Breastfeeding is NOT advisable if one or more of the following conditions is true:

  1. An infant diagnosed with galactosemia, a rare genetic metabolic disorder

  2. The infant whose mother:

    • Has been infected with the human immunodeficiency virus (HIV)

    • Is taking antiretroviral medications

    • Has untreated, active tuberculosis

    • Is infected with human T-cell lymphotropic virus type I or type II

    • Is using or is dependent upon an illicit drug

    • Is taking prescribed cancer chemotherapy agents, such as antimetabolites that interfere with DNA replication and cell division

    • Is undergoing radiation therapies; however, such nuclear medicine therapies require only a temporary interruption in breastfeeding

For additional information, visit American Academy of Pediatrics' Breastfeeding and the Use of Human Milk* or read: American Academy of Pediatrics Committee on Drugs. (2001) The transfer of drugs and other chemicals into human milk. Pediatrics 108:776-789. Available online at http://pediatrics.aappublications.org/cgi/content/full/108/3/776


Of possible concern is that USAID reports that the Philippines ranks ninth in the world in the incidence of tuberculosis . As for galactosemia, it seems one in 7500 live births involves babies with this inherited disorder.

Then there is the question that has arisen about whether many poor Filipino mothers are themselves healthy enough to produce enough milk for their infants. I am worried that the strong campaign launched by advocates of mother's milk is really another form of "motherhood and apple pie" that will cause malnutrition and illness not from the relatively low quality of infant formulae relative to mother's milk, but to the relatively low quantity of it available if mothers follow the advice of the advocates.


Naughtily Tony Velasquez also asked if the the current campaign might not become an occasion for "shaking down" the big infant formula makers, who obviously won't go away because there is a real demand for their product, driven perhaps by those unwarranted health and nutrition claims that the Supreme Court may now strike down and disallow.

5 comments:

The Purple Phoenix said...

Sir,

My father was delighted when I told him about your message and your blog! He remembers you very well as one of his best and brightest students.

Jowana Bueser

Jaxius said...

DJB,

The people who don't have the money to have their TB cured surely don't have the money to afford these pricey breastfeed substitutes.

The dangerous effects of galactosemia on infants, on the other hand, can be caused by breastmilk and ordinary breastmilk substitute. Based on the link you provided, the baby must be given soy-based formula which, I think are not those the kind of which are heavily advertised.

Poor people will just have to bear with Alaska, Carnation or other milk products as substitutes. To cut down on cost, they fortify it with "am". That's why many Filipinos jokingly call themselves Fil-ams, "Filipinong laki sa am".

baycas2 said...

Breastfeeding and maternal tuberculosis here.

The WHO statement only covers those mothers (and babies) who were seen by doctors. How about those mothers (and babies) who weren’t seen by doctors? The latter group, I think, we have multitude of…and that’s DJB’s cause for worry.

But come to think of it…considering the mode of transmission of TB, even bottle-feeding by the mother who has untreated active TB (or whoever has untreated active TB and is caregiving the child) is likewise dangerous…

Moral of the story is that there should be an effective TB Control Program to capture even the group who are not seen by doctors.

Amadeo said...

Before I left the old homeland in 1980, the incidences of primary complexes in small children in our part of the country (Northern Mindanao) was already alarmingly high. A primary complex could easily develop into TB when the child grows up, unless properly intervened early.

Even my eldest kid was diagnosed with primary complex, most likely infected by his classmates in a private school, the doctor said.

I am surmising that TB to this day continues to be an alarming specter in the overall health of the young in the old homeland.

manuelbuencamino said...

Seeing those women protesters baring their breasts on TV made the argument breast milk substitutes. I felt sorry for their sucklings