New parents want to give their
babies the very best. When it comes to nutrition, the best first food for
babies is breast milk.
BABY Making Good Choices For Your Child
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.
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."
Although breast-feeding is
still the best nourishment for infants, infant formula is a close enough
second that babies not only survive, but thrive!
|Commercially prepared formulas are regulated
by the Food and Drug Administration.
The safety of commercially prepared formula
is also ensured by the agency's nutrient requirements and by strict quality
control procedures that require manufacturers to analyze each batch of
formula for required nutrients, to test samples for stability during the
shelf life of the product, to code containers to identify the batch, and
to make all records available to FDA investigators.
The composition of infant formula is similar
to breast milk, but it isn't a perfect match, because the exact chemical
makeup of breast milk is still unknown.
Human milk is very complex, and scientists
are still trying to unravel and understand what makes it such a good source
of nutrition for rapidly growing and developing infants. However, John
C. Wallingford, Ph.D., an infant nutrition specialist with FDA's Center
for Food Safety and Applied Nutrition, notes that "infant formula is increasingly
close to breast milk."
More than half the calories in breast milk
come from fat, and the same is true for today's infant formulas. This may
be alarming to many American adults watching their intake of fat and cholesterol,
especially when sources of saturated fats, such as coconut oil, are used
in formulas. (In adults, high intakes of saturated fats tend to increase
blood cholesterol levels more than other fats or oils.) But the low-fat
diet recommended for adults doesn't apply to infants.
"Infants have a very high energy requirement,
and they have a restricted volume of food that they can digest," says Wallingford.
"The only way to get the energy density of a food up is to have a high
amount of fat."
While greater knowledge about human milk
has helped scientists improve infant formula, it has become "increasingly
apparent that infant formula can never duplicate human milk," write John
D. Benson, Ph.D, and Mark L. Masor, Ph.D., in the March 1994 issue of Endocrine
Regulations. "Human milk contains living cells, hormones, active enzymes,
immunoglobulins and compounds with unique structures that cannot be replicated
in infant formula."
Benson and Masor, both of whom are pediatric
nutrition researchers at infant formula manufacturer Abbott Laboratories,
believe creating formula that duplicates human milk is impossible. "A better
goal is to match the performance of the breastfed infant," they write.
Performance is measured by the infant's growth, absorption of nutrients,
gastrointestinal tolerance, and reactions in blood.
Wallingford agrees, explaining that while
FDA's regulations on what goes into infant formula are to ensure there
are enough nutrients, "that's just a starting point. What's really important
is how infants thrive."
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,
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 is 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. Women who are breast-feeding
can use barrier methods of birth control, such as condoms and diaphragms.
Hormone-containing methods are not first choice. These include injections
(such as Depo-Provera), implants (such as Norplant), and birth control
pills. A woman who breast-feeds should consult her doctor about which type
of contraception is appropriate for her 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 Is 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. 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.
Tough but Worthwhile
|For all its health benefits, breast-feeding
isn't always easy. 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 "Tips for Breast-Feeding Success").
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.
Some women alternate nursing at night and on weekends with daytime bottles
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.
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
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, an international support
organization for nursing mothers, has chapters in many cities that meet
regularly to discuss breast-feeding problems and offer support.
Most La Leche League chapters allow women
to come to a few meetings without charge. League leaders offer advice by
phone as well. To find a convenient La Leche League chapter, call (1-800)
|If the mother cannot or chooses not to
breast-feed, normal, full-term infants should get a conventional cow's-milk-based
formula, according to John N. Udall Jr., M.D., chief of nutrition and gastroenterology
at Children's Hospital of New Orleans. However, adverse reactions to the
protein in cow's milk formula or symptoms of lactose intolerance (lactose
is the carbohydrate in cow's milk) may require switching to another type
of formula, he says.
Symptoms that may indicate an adverse reaction
to cow's milk protein include vomiting, diarrhea, abdominal pain, and rash.
With lactose intolerance, the most common symptoms are excessive gas, abdominal
distension and pain, and diarrhea. Since some of the symptoms overlap,
a stool test may be necessary to determine the culprit. Usually, lactose
intolerance will produce acidic stools that contain glucose. If the protein
is the problem, stools will be nonacidic and have flecks of blood.
The main alternative to cow's milk formula
is soy formula.
The carbohydrates in most soy formulas
are sucrose and corn syrup, which are easily digested and absorbed by infants.
However, soy is not as good a protein source as cow's milk. Also, babies
don't absorb some minerals, such as calcium, as efficiently from soy formulas.
Therefore, according to the American Academy of Pediatrics, "Healthy full-term
infants should be given soy formula only when medically necessary."
For a child who can't tolerate cow's milk
protein, William J. Klish, M.D., chairman of the American Academy of Pediatrics
Committee on Nutrition recommends the use of hydrolyzed-protein formula.
Although hydrolyzed-protein formulas are made from cow's milk, the protein
has been broken up into its component parts. Essentially, it's been predigested,
which decreases the likelihood of an allergic reaction.
|The infant formulas currently available
in the United States are either "iron-fortified"--with approximately 12
milligrams of iron per liter--or "low iron"--with approximately 2 milligrams
of iron per liter.
"There should not be a low-iron formula
on the market for the average child because a low-iron formula is a nutritionally
deficient formula," says Klish. "It doesn't provide enough iron to maintain
proper blood cell counts or proper hemoglobin." (Hemoglobin is a blood
protein that carries oxygen from the lungs to the tissues, and carbon dioxide
from the tissues to the lungs.)
In addition, studies have shown that school
children who had good iron status as infants because they were fed iron-fortified
formula performed better on standardized developmental tests than children
with poor iron status. However, Wallingford says that "FDA has permitted
marketing of low-iron formulas because some pediatricians prefer to use
them, with the caveat that the physician would be monitoring iron status
and prescribing iron supplements when appropriate."
Why is there low-iron formula on the market?
"In the past there have been a lot of symptoms that have been attributed
to iron, including abdominal discomfort, constipation, diarrhea, colic,
and irritability," says Klish. "Also there was some concern about too much
iron interfering with the immune system. All of those concerns and questions
have been laid to rest with appropriate studies."
Another reason for originally producing
low-iron formulas was that human milk contains low amounts of iron--less
than a milligram per liter. However, it is now understood that an infant
absorbs virtually 100 percent of the iron from human milk, but considerably
less from infant formula.
|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
Get an early start: Nursing should begin within
an hour after delivery if possible, when the 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
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
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
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
Medicines and Nursing
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
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:
Drugs That Are NOT
Safe While Nursing
anti-epileptics (although one, Primidone,
should be given with caution)
alcohol in moderation (large amounts of alcohol
can cause drowsiness, weakness, and abnormal weight gain in an infant)
aspirin (should be used with caution)
caffeine (moderate amounts in drinks or food)
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
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.
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 and may increase respiratory and ear infections.
|Whole Milk for First Birthday
|The American Academy of Pediatrics 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 regular cow's milk, for a full year.
"There aren't any rules about when to stop
breast-feeding," 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 academy. "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
Formula, however, should not be continued
after the first birthday. That's the time to introduce milk. For all babies
the milk, however, should be whole milk. Low-fat and skim milk do not have
enough fat and calories to supply the nutritional needs of a 1-year-old,
explains John Udall, chief of nutrition and gastroenterology at Children's
Hospital of New Orleans. At that age, "the child is growing so quickly,
and the fat is so important for brain and central nervous system development,"
he says. "The recommendation that our daily intake of fat should compose
less than 30 percent of our caloric intake does not apply to children under
2 years of age."
New on the market are special toddler formulas
that claim to be better than milk. The formulas are good nutritionally,
says Udall, but they're not necessary. "A well-balanced diet with milk
and juices would be just as good in a healthy, normally active, normally
growing child," says Udall.
William Klish, chairman of the American
Academy of Pediatrics Committee on Nutrition, says that if a child needs
to take a vitamin supplement, the toddler formula, fortified with a full
range of vitamins and minerals, including iron, can serve that purpose.
In addition, the toddler formulas don't need refrigeration, making them
a convenient choice for snacks away from home.
Publication No. (FDA) 97-2309
|Article Source - U.S. FDA
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