Pam Morrison of Zimbabwe posted a quote from WHO/UNICEF training
     materials:

     "The l8 hour BFHI course (yellow manual, page 86) lists only seven
     'Acceptable medical reasons for foods other than breastmilk' -

     1) mother with active herpes lesion on breast/nipple
     2) 3) and 4) all relate to HIV but stress that where the use of safe
     alternatives to breastfeeding is not possible then breastfeeding
     should continue to be the feeding method of choice,
     5) mother who has severe psychosis, eclampsia or shock
     6) mother who is taking cytotoxic, radioactive or anti-thyroid drugs
     other than propylthiouracil and
     7) mothers who specifically refuse to breastfeed."

     I appreciate her making this material better known. However, it would
     also be important to note the complementary list on page 80 of the
     same manual, in the section  on babies who need special attention.
     [Please note that this manual was written in 1993; there are a few
     bits of it we would reword or update in a newer edition.]

     "Infants with medical conditions that do not permit exclusive
     breastfeeding need to be seen and followed by a physician.
     - Breastfeeding is not possible for a baby with galactosemia, because
     he cannot tolerate the galactose in the breastmilk. This is a rare
     condition, occurring in one out of 50,000 babies.
     - Babies with other inborn errors of metabolism (e.g. PKU, MSU
     disease) must be monitored for toxic serum metabolite levels for
     possible adjustment in the management of breastfeeds.
     - Babies with very low birth weight or who are born preterm, at less
     than 1000g or 32 weeks GA may require supplementation.
     - Supplementation may be necessary for babies with severe dysmaturity
     with potentially severe hypoglycaemia, or who require therapy for
     hypoglycaemia, and who do not imporve through increased breastfeeding
     or by being given breastmilk.
     - Babies with acute water loss may require water supplementation if
     increased breastfeeding/breastmilk cannot provide adequate hydration."

     However, lists are one thing and clinical management of the individual
     baby is another, and more important.  I salute the LactNet users who
     are skilled at helping parents and health care providers come to a
     reasoned arrangement for the care and breastfeeding of so many special
     infants.  Your accumulated wisdom on how to find a way around all
     sorts of obstacles is an international resource!

     Helen Armstrong, Consultant Infant Feeding & Care
     Nutrition Section, UNICEF New York

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html