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In response to confusion and misinformation regarding the recent report of:

Moon et al (Ped Inf Dis J 2010 29;919 ) entitled:
“Inhibitory effect of breast milk on infectivity of live oral rotavirus vaccines”

the following clarification is provided:

1. The study related only to oral rota virus vaccine and DOES not provide information on any other oral vaccine ( such oral polio) and surely has no relevance to standard non oral vaccines

2. The study of the neutralizing effect of breast milk was an IN VITRO study and the significant neutralizing effect was only found in milk from mothers from developing countries(Vietnam, South Korea, India) AND NOT from milk from US mothers. This reflects probably the high frequency of rotavirus infection in those countries and the high antibody levels in the adults of those countries and the low titers in US mothers.

3. Epidemiological studies have noted adequate efficacy of oral rotavirus vaccine in industrialized countries …the only issue is the somewhat lower efficacy in the developing countries

4. Oral polio vaccine is not the standard in North America so is not a relevant issue

5. At most the investigators recommend “evaluating” (STUDYING) the effect of delaying breastfeeding at the time of immunization (of rota virus ) and measuring the efficacy ( serum antibodies in the infants). “Delaying” means not breastfeeding simultaneously when ingesting the vaccine and delaying nursing for 2-3 hours. NO suggestion of substituting formula was made or should be made !

6. Bottom line: the study has absolutely NO relevance to nursing mothers in industrialized countries ( surely NOT the US and Canada) and therefore NO change in the routines of breastfeeding infants who are being vaccinated are being suggested! (and so spread the word!)

7. The possible benefit of a few hours wait between oral rota virus vaccination and nursing should be studied in populations in those geographic areas where there is a problem of efficacy. As there may be other factors effecting efficacy (e.g. related to the immunocompetence of the infants themselves) until we have the results of such IN VIVO studies one can not make any feeding recommendations even for those populations. The problem may not relate to breast milk at all! That why evidenced based data is needed!

8. For the nursing mother in the developed world there is no need to alter any feeding routines!

Arthur I Eidelman MD FAAP FABM

Arthur Eidelman is a neonatologist and president of the Academy of Breastfeeding Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

The latest edition of SCN News contains an article written by myself and Patti Rundall, our Policy Director, with this title. See page 51 of http://www.unscn.org/files/Publications/SCN_News/SCNNEWS39_10.01_high_def.pdf

SCN is the United Nations System Standing Committee on Nutrition. The theme of the journal is: Nutrition and Business - How to Engage?

There is a trend being followed by some policy makers at UN, government and civil society level to see working in partnership with corporations as the way to achieve goals relating to nutrition and tackling diet-related ill health, such as Non-Communicable Diseases or NCDs. NCDs include things like heart disease (responsible for 29% of global deaths) and diabetes, which are on the increase as more and more people become overweight and obese.

We see it with the baby milk issue and our latest newsletter, Update 44, examines some specific cases where a desire by policy makers to work with corporations (which sometimes includes accepting funding) has led to the rights of mothers and babies being neglected or even undermined. Baby Milk Action engages with companies such as Nestlé and Danone through ongoing correspondence regarding marketing practices that violate international standards. As we report in Update, Nestlé is not so keen to engage with our proposals for substantive meetings to discuss the need for it to make changes to its policies and practices, or even to resolve disagreements over interpretation of the marketing requirements.

The Editorial to SCN News is generally optimistic about working with corporations, stating, for example:

Nutrition and business interests are overlapping more and more. Businesses are increasingly including product and social innovation as well as sustainability into their core corporate strategies and supply chains. Business is also continuously reaching out to new consumers, including the urban and rural poor, exploring emerging markets and engaging with other nutrition stakeholders. While these overlaps create opportunities for cooperation and convergence of interests for achieving food and nutrition security, they also carry controversy, and sometimes cause heated debate, especially on transparency and accountability issues. There are cases of actual or perceived conflicts of interest that undermine such convergence and diminish trust, jeopardizing potentially fruitful initiatives.

The journal presents some cases of initiatives involving business that are deemed to be successful by the authors and also notes: "Millions of farmers and rural entrepreneurs form the bulk of agricultural production and investments. Private businesses, of all sizes, constitute the food supply chain as it evolves from the farm to the fork."

Like several other peer-reviewed articles in the journal, we warn that there is a failure in governance when it comes to nutrition and the industrialised food sector, which involves some of the world's largest transnational corporations.

Before even considering how to engage with business, we argue that policy makers need to understand that executives have a legal obligation to put their shareholders' interest before all others. If executives aren't looking for some advantage in engaging with policy makers, they are failing in this duty. That is not to question the ethics or morality of executives; it is to state what should be obvious. However, talk of win-win solutions sometimes seems to paint too rosy - or naive - a picture of the relationships.

So we set out and describe five key steps for policy makers to take when considering nutrition, health and other issues and the role of the private sector:

1. Understand the problem and the role played by the private sector

2. Determine the appropriate public-interest response

3. Decide the appropriate relationship with the private sector in this context

4. Identify the extent of conflicts of interest, minimise them and manage those that are consid- ered acceptable or unavoidable

5. If deciding to work with the private sector in some way, avoid the language of partnership, define the relationship clearly and ensure that your original objectives do not get subverted.

Read the full article for further details.

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Did you know that it is against the rules for television programmes to accept payment for showing baby milk in television programmes?

The ban is contained in the Ofcom Broadcasting Code.

Ofcom (the independent regulator and competition authority for the UK communication industries) introduced rules regarding product placement in television programmes in February 2011.

Products that cannot be placed in programmes include: "infant formula (baby milk), including follow-on formula". However, Ofcom does point out that some products may appear in programmes because they have been chosen by the producers as props. Companies can be fined for breaking the rules.

You can find the text of rules via the Law section of the Baby Feeding Law Group (BFLG) website and information on how to register a complaint in the Report violations section of the same site. Baby Milk Action coordinates the BFLG monitoring project.

Baby Milk Action submitted comments to the Ofcom and government consultations on the proposals, calling for all baby foods to be included in the ban. Our full submission can be downloaded by clicking here.

Was this useful? Please click here.

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Warmest Holiday Wishes

to Mothers and Babies Worldwide

To the Editor:

RE: “Clinton Aims for ‘AIDS-Free Generation’”, The New York Times, November 8, 2011

We applaud Secretary Clinton’s lofty vision of an AIDS-free generation. Halting vertical transmission will eliminate nearly all new childhood infections, approximately 370,000 in 2009. She hopes mothers won’t “infect their babies at birth or through breastfeeding” by 2015.

We’re concerned that readers may misinterpret the reports of her statement to suggest HIV-positive mothers should not breastfeed. On the contrary, the World Health Organization’s recommendations for infant feeding emphasize breastfeeding’s role as a pillar of child health, particularly in resource-poor regions where formula feeding lessens HIV-free survival. Making breastfeeding safer by providing antiretroviral drugs (ARVs) to the mother and infant, akin to preventive regimens used during pregnancy and childbirth, optimizes survival while minimizing HIV-transmission. Thus, supporting mothers to exclusively breastfeed for 6 months followed by continued breastfeeding until a year while providing ARVs is the wisest use of precious PEPFAR funds – and goes a long way towards fulfilling Secretary Clinton’s vision for an “Aids-free generation” and healthy babies worldwide.

Caroline Chantry MD
Arthur I Eidelman MD, President,
Academy of Breastfeeding Medicine

This letter was submitted to the editor of The New York Times

We have received shocking news from the United Reformed Church (URC) Secretary for Church and Society.
In July 2010 the URC Assembly renewed its long-running support for the Nestlé boycott until such time as Nestlé stops violating the international baby food marketing requirements.
The Resolution referenced inclusion in the FTSE4Good Index, an ethical investment listing from FTSE, as the criteria for ending support for the boycott.
Nestlé was included in the Index in March 2011 after the FTSE4Good criteria were changed in September 2010 - that is, after the URC Assembly Resolution - to allow companies that violate the marketing requirements into the Index. The stated aim was to weaken the criteria to bring half of the baby food sector into the Index on the grounds this would make it easier to engage with the companies.
Given this development, we expected the matter to go back to the URC Assembly so it could review the Resolution as the situation had changed. Nestlé would not have been included in the Index under the criteria in place at the time of the Resolution. It is not its marketing practices that have changed, but the FTSE4Good criteria.
Instead, URC Church and Society told us the Resolution was binding and had to be implemented as a matter of urgency.
Our press release regarding this shocking news can be found - along with a chronology of events - at:http://info.babymilkaction.org/pressrelease/pressrelease26nov11
It is for URC members to decide whether to take any action over this matter - we have to concentrate on assisting our partners in developing countries, particularly as Nestlé will undoubtedly the exploit the URC announcement to undermine efforts to stop its ongoing marketing malpractice.
I would be interested in the views of URC members, however, particularly those who supported the July 2010 Resolution. Was it the intention of members to end support for the boycott if FTSE weakened the FTSE4Good criteria? var sc_project=1935474; var sc_invisible=0; var sc_partition=17; var sc_security="650a9fb1";

A recent commentary in the National Review titled, “Fire the government wet nurse,” reads, at first blush, like breastfeeding advocacy. Author Julie Gunlock starts out by saying, “Breast milk is magic,” citing benefits for fighting infection and improving maternal health.

But then Gunlock takes aim at the WIC program, arguing that this safety net for poor families “encourages poor women to skip breastfeeding altogether and instead turn to formula for their children’s nutrition needs.” Gunlock notes that only one third of WIC mothers breastfeed for 6 months, and the program accounts for more than half of formula sales in the US. WIC, she argues, is yet another entitlement program that is hurting the very people it is supposed to help.

It’s a tidy argument – that safety net programs cause poverty, rather than help those who are most in need. The only problem is that it’s not true.

First, consider that WIC is the largest public breastfeeding support program in the United States. All WIC participants are encouraged to breastfeed, unless medically contraindicated, and WIC breastfeeding peer counselors work tirelessly to provide around-the-clock support. WIC recently revised its food package to provide extra food for nursing mothers to meet the caloric needs of breastfeeding. A growing number of local WIC offices provide free pumps for mothers returning to work.

Notably, Gunlock makes no mention of these programs in her commentary. Instead, she proposes a quick fix – “fire the government wet nurse” – in a not-so-subtle reference to “suckling at the teat of big government.” It’s rhetorically effective, but it has nothing to do with enabling mothers and infants to breastfeed.

Ideally, breastfeeding would be the cultural norm, and our society would provide paid maternity leave, affordable child care for older siblings, and adequate support to establish and sustain lactation. Instead, we live in a culture saturated with formula promotion by an industry that spends millions selling the idea that formula is just as good as breast milk.

Other nations have solved this problem by implementing the WHO Code of Marketing of Breastmilk Substitutes, which bans advertising of infant formula. In the US, we not only allow formula promotion – we struggle to convince health care providers not to participate in formula marketing campaigns.

Paid maternity leave is rare, and public assistance programs require mothers to return to work or lose benefits. Indeed, one analysis found without welfare reform in the 1990s, breastfeeding rates at 6 months would be 5.5% higher.

Gunlock doesn’t advocate for regulation of formula marketing, paid leave or maternity benefits for families receiving public assistance – instead, she implies that poor women formula-feed because they are lazy. She writes, “Because these WIC mothers know that they have access to free formula, there’s an obvious incentive for them to go ahead and use it rather than bothering to breastfeeding — which can be more time-consuming that bottle feeding. “

Gunlock contrasts these mothers with her personal experience: “I breastfed all three of my children, and while it wasn’t always easy, it was free and I knew my kids were getting the best food possible — the food I was designed to provide them.”

By framing the discussion in terms of “Good mothers breastfeed, bad mothers don’t,” Gunlock is fueling the mommy wars, instead of support strategies that enable mothers and infants to make an informed decision and achieve their own feeding goals. And the worst part is that, by touting breastfeeding as “magic,” she’s masquerading as a breastfeeding advocate.

I look forward to the day that WIC spends the overwhelming majority of its infant nutrition budget on breastfeeding protection and support, using formula for the rare-but-real cases where mothers are unable to produce enough milk to feed their babies. But “firing the government wet nurse” is not the way to get there. Cutting nutrition funding for the 22% of American children who live in poverty will instead send more women and children to bed hungry, while depriving at-risk mothers of critically important breastfeeding education and peer support.

Alison Stuebe is an ABM member and a maternal-fetal medicine physician at the University of North Carolina in Chapel Hill.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

This fall, I had the honour to represent the Academy of Breastfeeding Medicine (ABM) at the 64th annual conference of the UNO DPI/NGO in Bonn (Germany). The theme of this conference was “Sustainable Societies, Responsive Citizens”. This theme was discussed in plenary discussions, panel discussions, Round Tables and workshops. Emphasis was also placed on youth participation. They partly had their own program but also joined in the regular discussions. There was a large NGO exhibition, and between the discussions and through an official invitation for a reception by the city of Bonn, there was much time to meet with persons of organisations from around the world.

The themes of the workshops and roundtable discussions were very broad. “Sustainable consumption and production aspects of a globalizing world” “Climate justice”, “civic engagement and voluntary action” were but a few of the themes of the roundtables. The keynote speakers addressed such topics as “green economy”, “poverty eradication”, “role of women in economy”, “consumer action” “climate” and “role of peace”. This conference also aimed to involve the participants and inform the preparatory process towards the UN Conference on Sustainable Development (Rio + 20) in Rio de Janeiro, 4-6 June 2012. This aim was also clearly demonstrated at the final conference declaration.

I attended four workshops:
• Climate sustainability governance: ensuring greener economies, social wellbeing and ecological equity in a post-Rio+20 world.
• Population dynamics, reproductive health and rights and sustainability.
• Envisioning global future lifestyles and livelihoods for engaging citizens now
• What is the link between the 10YFJP, a green economy, MDGs, Poverty and happiness and sustainable consumption and production in the Rio + 20 Agenda?

From these themes it becomes clear what broad discussions were offered. And, as always, this world has its own abbreviations. MDGs stands for Millennium Development Goals, 10YFP stands for 10 Year Framework of Programs, developed by the UNEP, the “environmental” arm of UNO.

My personal input was rather small. I had the opportunity to share a document, written by Nancy Wight (of course with her permission) about the sustainability of breastfeeding on many occasions, especially in the working groups. In these smaller groups it also was easier to stress the importance of breastfeeding as a “sustainable” food. After all: which food is so perfectly delivered from producer to consumer, almost without production energy, without transportation, without waste?

What was bothering me at this conference was that these themes are so complicated, so intertwined, that it was not possible to have an overview. And of course: each group represented there was pushing “their” view, often in very abstract terms. Especially in the Round Table discussion the solutions that were offered were very broadly formulated. “The whole world should be changed” — but how to begin?

What became clearer and clearer for me in the course of the conference is that I as an individual or as an individual NGO (like the Academy) cannot change the world. But I can work on the small field that I understand — in our case the protection and promotion of breastfeeding, and this in itself will have an impact. In some discussions I brought this up as a possibility that can easily be shared with people as an opportunity to have a contribution themselves, both for health of mothers and children and for the sustainability of our society.

Especially after the workshops there were some good discussions with persons involved.
- I learned there are also Millenium Consumption Goals and breastfeeding would be a wonderful pattern of consumption for both societies with under consumption and overconsumption. It would perhaps be an opportunity to also find ways to connect here.
- On population dynamics I made contact with Dr. Siri Tellier and she emailed me after the conference both because of support of one of her students and because she would like to stay in touch about the role of breastfeeding in reproductive health.

In conclusion, conferences like this are too big to have a large impact for the ABM. Nevertheless it gives us an opportunity to have a broader perspective of the role of breastfeeding, not only as a health issue but also as a “sustainable way of life”.

Elien Rouw, MD, FABM, is a physician in Bühl, Germany, and member of the board of ABM

Opinions expressed on the ABM blog are those of individual members, not the organization as a whole.

We are here in sunny Miami at the 16th Annual International Meeting of the Academy of Breastfeeding Medicine–our “Sweet Sixteenth” birthday party!  What better way for me, a member of the Board of Directors and the Chair of the Protocol Committee to celebrate the accomplishments of our organization than to see the e-pub release today, live from the meeting, of our newest clinical protocol, #24: Allergic Proctocolitis in the Exclusively Breastfed Infant?

For those who do not know the process involved, all  protocols are the work of the Academy of Breastfeeding Medicine through the Protocol Committee, but have “lead contributors” who do all the primary research to first produce an annotated bibliography with levels of evidence.  The annotated bibliographies are available as a member benefit on the Members Only Web Page.  Then the lead contributors write the protocol.  For this protocol, those authors are my colleague Dr. Adam Matson at Connecticut Children’s Medical Center and the University of CT School of Medicine, and myself.  The process is long and labor-intensive — Not unlike gestation.  The protocol then goes to expert reviewers both in the United States and abroad.  These experts send us their comments, which are incorporated into the protocol.  It then goes to the Protocol Committee, a dedicated, hard-working group of eleven ABM members who review the document and each make their own comments.  These comments are then incorporated into the protocol.  Then it is sent to the ABM Board of Directors for THEIR comments.  And you guessed it–those are incorporated, or not, as deemed appropriate, as with previous commenters.  After these are incorporated, it may go back to the original primary contributors to make sure they are in agreement with all the comments/additions/deletions that have occurred.   Then, and only then, does it go to the ABM  Board for vote, and must pass by 2/3 majority vote, before it can be submitted in final form for publication in our journal Breastfeeding Medicine, posted on our website and released to all for use–the “birth”.  Do you think it stops there??  Well, it does–for 5 years.  At which point all protocols must be reviewed and revised as per any new literature that has been published.  So the process then repeats  itself.

Today’s release is all the more remarkable because it occurred with a super-human collaborative efforts of members of the Protocol Committee, staff of ABM, and the editors, publishers and staff of our journal publisher Mary Ann Leibert.  THANK YOU ALL!!!!  We were already working hard to get it through the process and voted on in the past few weeks so this release could happen here at the meeting.  And then Winter Storm Alfred hit the east coast of the United States, knocking out power to the publishing company, and yours truly (ask me about camping out in my own home with no power, lights, heat, water, toilets, etc after 12 inches of October snow and trees and power-lines down so you couldn’t even venture out of your own non-functioing home…) making email communication impossible, and essentially halting the whole process. It pays to be a life-long Girl Scout in situations such as this.  But I digress.  Team ABM prevailed despite everything, and out it went as an  e-pub, and was posted on the ABM website,  during our Board of Directors meeting, live, today!

So what about the protocol itself–Allergic Proctocolitis in the Exclusively Breastfed Infant?  Adam and I became interested in this subject a number of years ago when I was his attending neonatologist, and he was my fellow.   We kept seeing cases in the NICU of babies on own mothers’ milk who would be doing well, thriving, and then all of a sudden develop bloody stools.  Necrotizing enterocoltis (NEC)??  No!  Normal exams, normal labs, maybe a little fussy, ” just” blood in the stool.  They got made NPO, hadX-rays looking for pneumatosis intestinalis,  some labs, maybe even antibiotics until we were sure it was not NEC.  In the history, sometimes just before this happened they had been placed on commercial human milk fortifier, made from cow’s milk.  Or sometimes mom was an avid dairy product consumer.  Or sometimes it just happened.  In discussing at neonatology meetings, our colleagues were seeing this too.

In talking to pediatricians and family practitioners who took care of term healthy babies, they were also seeing something like this–babies on exclusive human milk feedings, who developed blood streaked or even bloody stools, who were otherwise healthy.  Thus was born our interest in the topic of allergic proctocolitis.  We have had a tremendous amount of interest in having such a protocol published by ABM.  It is apparently an issue many of you have seen or do see.  We hope you find this protocol useful.  We don’t have all the answers–our charge is to present the problem, give you some of the background, and condense for you what is known now in November 2011 concerning the cause, diagnosis and treatment.  We end with more questions and the need for research.  Like all good clinical “states of the art and science” we hope to leave you thinking, and maybe inspire someone out there to look into this area more.  (We know a great journal you can publish your research in–just ask us!  Hint: It starts with Breastfeeding and ends with Medicine).  We find the subject fascinating.  And it is a clinical dilemma that presents itself on your doorstep.

So, Happy Birthday ABM Conferences!  Sixteen is certainly a sweet number.  We are thrilled to have been a part of the celebration and contributed in our small way.   Check out the protocol, and all our protocols, on our website.  And wishes for many more birthdays!

Kathleen Marinelli MD, IBCLC, FABM is a neonatologist a Board member of the Academy of Breastfeeding Medicine, and Chair of the ABM Protocol Committee.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

How do you imagine the Alps? Let’s have a look in Switzerland, Austria, Italy, France or Germany. Here you will find a wonderful panorama view: the mountains, lush green meadows, the flora and fauna, the rocks and stones, but also cultural elements like alpine farms, the goats and cows.

Breastfeeding is, in a way, the “Alps” in infant nutrition -- and not only in nutrition.

Breastfeeding is, in a way, the “Alps” in infant nutrition — and not only in nutrition. Just as the Alps are not only about the mountain tops, but the whole landscape, so is breastfeeding is more than nutrition. The german word “stillen”, which means “soothing” actually expresses this much more clearly than the word breastfeeding. It is interplay between mother and child with many contributing factors: nutrition, immunisation and most of all an intensive bonding between a mother and her child. It is the seamless transition from the intra-uterine environment with constant contact and constant nourishment to extra-uterine world, with lots of skin-to skin contact and a very frequent feeding. It is the normal adaptation process of a newborn, a baby, and at the same time the normal adaptation process of the mother.

I am from the Netherlands. And we, in the Netherlands, are longing for the Alps. We already have the beginning. The Vaalserberg, at the borders of the Netherlands, Germany and Belgium, would be suitable. But it is not quite what it should be. So this mountain should be heightened-up a little bit. We could make it a 100% higher. That would do, wouldn’t it?
Now this Vaalserberg is 326 meter above sea-level (360 meters with the tower on it), and even if we would heighten it up 100% it still doesn’t have the height of the Alps. Try to further heighten it up? You have to be honest: It is not just the height: essential elements of the Alps are failing in the Netherlands. Flora and Fauna will never be that of the Alps landscape. And you cannot solve this problem with heightening up. Of course it is a good alternative, when you cannot have the Alps. It is a good recreation area, it has its own value for the people in the region and for holidays, but you cannot honestly say it is the Alps (even when some hotel owners want us to believe this – they call their hotel: Alpenblik – Alpview).

The Vaalserberg will never be the Alps

And so we have the parallel: formula is infant nutrition of acceptable quality, and in principle this quality can be improved. But as much as you can (and should) enhance this quality, it never will reach the standard of the original. It brings risks with it and disadvantages, for mother, child and society. When we do have the quality of the Alps, we should not be content with the Vaalserberg.

Elien Rouw is a physician in Bühl, Germany, and a member of ABM

Opinions expressed on the ABM blog are those of individual members, not the organization as a whole.

Researchers, using data from the Millennium Cohort Study, have found that babies who are breastfed are less likely to become children with behaviour problems by the time they reach the age of five than those who receive formula milk.

Nutrition during the first days or weeks of life may have long-term consequences on health, potentially via the metabolic programming effect,

A comprehensive report on the composition and monitoring of infant formula milks in the UK is now available to download from the Caroline Walker Trust website.

The US First Lady, Michelle Obama, has called for greater support for breastfeeding as a way to reduce childhood obesity.

You will find attached the latest (June 2009) UNHCR guidance on infant feeding and HIV in the context of displaced populations as produced by UNHCR and the IFE Core Group

Read new articles on Contaminants and Residues in Breast Milk

New versions of ICDC Focus on Emergencies in Arabic and Italian languages. You can read also supporting letters from UNICEF and WHO, meanwhile Nestle violates the Code in Pakistan during emergencies

The recall of about 5 million units of Similac by Abbott Laboratories is the latest in a long series of withdrawals of baby feeding products. It is not uncommon for powdered infant and follow-on formulas to be contaminated by bacteria, chemicals, insect parts and other foreign bodies.

Greenpeace Australia Pacific create a new campaign in demanding that the local Health Minister, Nicola Roxon, respect Australian parents' right to know if they are feeding their children genetically modified (GM) products.

gBICS in SCN News.