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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.

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

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.