Dear all:

When I was doing my training in nutritional sciences we did read a fair bit of literature on bacterial growth in bottles and teats.  It is very hard to clean these, particularly when water supplies are limited, water is not potable and latrines are not prevalent.  I also want to hammer home the concept that even in so-called "developed" countries, we have situations when water and sanitation are not good -- Katrina being the most devastating example covered by the news media.  

At the same time, health care practitioners are supposed to assist women with appropriate methods when they have problems feeding from the breast.  I read this to mean that we should understand how to minimize risks and mimic normal to the extent possible.  This means that the standards should be breastfeeding.

For instance, a mother who must use a bottle, should be instructed in replacing the interaction and skin-to-skin contact she would have engaged in while feeding from teh breast -- e.g. for a newborn if you take the average 20-50 minutes, 8-12x/day, a bottle feeding mother should provide her newborn with 160 to 600 minutes a day of skin to skin contact.  She should be talking to her infant while feeding and carefully responding to assist her infant with breathing and pausing while feeding.  She will need information about shape, texture, and flow rates to minimize the risk of aspiration and abnormal development of the palate.  She should be taught how to use a cup in the event that a natural disaster disrupts water and sanitation services.  

Best, Susan Burger

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