Oh boy, this one is from the dark ages. So you need evidence to prove
that breastmilk is not dairy. Like asking for proof that a horse is
not a goat. "Find me the studies that a horse is not a goat".
The first thing you should do is ask them where the proof is that you
need to stop breastfeeding when the baby has diarrhea or vomiting.
There ain't any. Burden of proof for the intervention, remember?
Then you could continue with all the evidence of antimicrobial factors
in breastmilk. There are lots of studies around. Use the Scientific
American article (December 1995) for this crowd since it is not
complicated. Original studies with numbers and statistics might be
too difficult for this group who probably have trouble with subtle
concepts like 2 + 2. Here are some articles anyway.
Duffy LC, Byers TE, Riepenhoff-Talty M, La Scolea L, Zielezny M, Ogra
PL. The effects of infant feeding on rotavirus-induced
gastroenteritis. A prospective study. Am J Pub Health 1986;76:259-63
Hanson LA, Lindquist B, Hofvander Y, Zetterstrom R. Breastfeeding as a
protection against gastroenteritis and other infections. Acta Pediatr
Scand 1985;74:641-2
Ruiz-Palacios GM, Calva JJ, Pickering LK, Lopez-Vidal Y, Volkow P,
Pezzarossi H, et al. Protection of breastfed infants against
Campylobacter diarrhea by antibodies in human milk. J Pediatr
1990;116:707-13
Cruz JR, Gil L, Cano F, Caceres P, Pareja G. Breastmilk
anti-Escherichia coli heat labile toxin IgA antibodies protect against
toxin-induced infantile diarrhea. Acta Pediatr Scand 1988;77:658-62
Gillin FD, Reiner DS, Wang C-S. Human milk kills parasitic intestinal
protozoa. Science 1983;221:1290-2
France GL, Marmer DJ, Steele RW. Breastfeeding and Salmonella
infection. Am J Dis Child 1980;134:147-52
Haffejee IE. Cow¹s milk-based formula, human milk and soya feeds in
acute infantile diarrhea: A therapeutic trial. J Pediatr Gastroenterol
Nutr 1990;10:193-8
Lerman Y, Slepon R, Cohen D. Epidemiology of acute diarrheal diseases
in children in a high standard of living rural settlement in Israel.
Pediatr Infect Dis J. 1994;13:116-22
Howie PW, Forsyth JS, Ogston SA, Clark A, Du V Florey C. Protective
effect of breastfeeding against infection. Br Med J 1990;300:11-6
Duffy LC, Riepenhoff-Talty M, Byers TE, La Scolea LJ, Zielezny MA,
Dryja DM et al. Modulation of rotavirum enteritis during
breastfeeding. Am J Dis Child 1986;140:1164-8
Haddock RL, Cousens SN, Guzman CC. Infant diet and salmonellosis. Am J
Pub Health 1991;81:997-1000
Jones EG, Matheny RJ. Relationship between infant feeding and
exclusion rate from child care because of illness. J Am Dietetic Assoc
1993;93:809-11
MacFarlane PI, Miller V. Human milk in the management of protracted
diarrhea of infancy. Arch Dis Child 1984;59, 260-65
Yoshioka H, Ken-ichi I, Fujita K. Development and differences of
intestinal flora in the neonatal period in breastfed and bottle fed
infants. Pediatrics 1983;72:317-21
Hernell O, Ward H, Blackberg L, Pereira MEA. Killing of Giardia
lamblia by human milk lipases: An effect mediated by lipolysis of milk
lipids. J Infectious Diseases 1986;153:715-20
Andersson B, Porras O, Hanson LA, Lagergård T, Svanborg-Edén C.
Inhibition of attachment of Streptococcus pneumoniae and Haemophilus
influenzae by human milk and receptor oligosaccharides. J Infectious
Diseases 1986;153:232-7
Bell LM, Clark HF, Offit PA, Slight PH, Arbeter AM, Plotkin SA.
Rotavirus serotype-specific neutralizing activity in human milk. Am J
Dis Child 1988;142:275-8
Schroten H, Lethen A, Hanisch FG, Plogmann R, Hacker J, Nobis-Bosch R
et al. Inhibition of adhesion of S-Fimbriated Escherichia coli to
epithelial cells by meconium and feces of breastfed and formula fed
newborns: mucins are the major inhibitory component. J Pediatr
Gastroentero Nutr 1992;15:150-8
Walterspiel JN, Morrow AL, Guerrero ML, Ruiz-Palacios GM, Pickering
LK. Secretory anti-Giardia lamblia antibodies in human milk:
protective effect against diarrhea. Pediatrics 1994;93:28-31
Torres O, Cruz JR. Protection against Campylobacter diarrhea: role of
milk IgA antibodies against bacterial surface antigens. Acta Pediatr
Scand 1993;82:835-8
Pickering LK, Morrow AL, Herrera I, O¹Ryan M, Estes MK, Suilliams SE,
et al. Effect of maternal rotavirus immunization on milk and serum
antibody titers. J Inf Dis 1995;172:723-8
You could further continue by stating that a study from the Hospital
for Sick Children showed you don't even have to stop formula when a
baby has diarrhea. See similar article by Haffejee above.
Finally, you could say that Unicef and WHO have put out statements on
continuing breastfeeding during diarrhea, so has the Canadian
Pediatric Society, and, so, probably has the American Academy of
Pediatrics.
If you can't convince them with that, you don't have the persuasive
powers of the formula company rep. Take them to lunch and pay for it.
Jack Newman, MD, FRCPC
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