As a breastfeeding advocate, there is much to love in the revised AAP policy 
on breastfeeding. One certainly has to recognize the difficulty in getting a 
policy that is acceptable to not only the breastfeeding experts but also to the 
medical community.  This document is a wonderful reference in which a 
breastfeeding advocates can use to dialogue with their communities.

Yet, I am very disappointed in at least 3 major areas of this policy.   The 
recommendation that "all breastfed infants should receive 200 IU of oral 
vitamin D drop daily beginning during the first 2 months of life and continuing 
until the daily consumption of vitamin D-fortified formula or milk is 500mL."  
While this document supports exclusive breastfeeding, this recommendation in my 
mind negates exclusivity.  I believe we have strong evidence that the gut flora 
of the newborn can easily be damaged by any foreign substance.  What evidence 
exists that all breastfed infants will benefit from the addition of vitamin 
D?  In fact, one might suggest that we have evidence that suggests that it is 
likely that gut damage will happen and that under this policy exclusivity of 
breastfeeding will not exist in the USA.

Second, I question the belief that women who are HIV infected in the USA 
"should not breastfeed their offspring." (I think offspring is a strange word to 
use--is it that hiv positive mothers have offspring and hiv negative mothers 
have infants/babies?) This advisory is referenced to a study done by Read et al 
that is a flawed.  Read et al uses  Ziegler et al. as early proof that hiv is 
transmitted through breastmilk.  Zielger et al. is a LETTER not a study 
written to the Lancet in 1985.  Letters are not peer reviewed and this letter is on 
one infant--yes one infant.  Read also bases her recommendations based on the 
Nduati studies.  The Nduati studies were a randomization of infant feeding in 
Kenya (some people might consider the randomization of infant feeding in a 
developing nation unethical). 

If medical policy in the USA becomes one in which mothers have to have a 
current HIV test in order to breastfeed (someone on this list mentioned that this 
was occurring in her hospital)  then the decision to breastfeed in the USA 
will be placed on the ability to pass the HIV test.  The need to have a current 
HIV test coupled with policy that states HIV positive mothers should not 
breastfeed will create or is creating a spillover effect in which breastfeeding will 
be denied to those who are not infected with HIV.

Third,  funding might be a reason for the difference in opinion regarding the 
introduction of complementary foods.  The Committee on Nutrition supports the 
introduction to complementary foods between 4-6 months.  One of the members 
of that Committee, Dr. Nancy Krebs has received funding from Ross and Mead 
Johnson for studies she has done.  And also funding from the Cattlemen's Beef 
Association for the years 2002-2004 ($98,561). see
http://www.uchsc.edu/peds/subs/nutri/resfund

Zinc, Fat and Calcium Balance in Term Infants Fed Milk-Based Formula and 
Hydrolysate-Based Formulas
Principal Investigator: Nancy F. Krebs, MD
Source: Ross Products Division/Abbott Laboratories - CP-AJ72
Amount: $120,000
Term: 1999-2004

Funding may reflect how we approach a research problem or policy.  Then 
again, it may have nothing to do with it.  Certainly, it is something we need to 
look at and think about.  

The AAP revised policy on breastfeeding has alot to offer us.  It is a 
revision of past policy and will be revised in the future.  Which reminds us that 
what is written is not set in stone but part of a process.  It is certainly a 
treasure of references and a document we can all use to make positive changes in 
our community.
Valerie W. McClain, breastfeeding advocate  

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