WHO's recommendation vs. National recommendations.

The present breastfeeding recommendation here in Finland is exclusive
breastfeeding for 4 - 6 months, with continued breastfeeding for 6 -
12 months (total).

I just made a translation of the statement of the Finnish Pediatrics
Association (SLY) concerning breastfeeding. They didn't have an
English translation, so since I am not a translator, some sentences
may sound funny, sorry :) .

Of course the WHO's recommendation is 'just' a recommendation, and I
realize the nations may very well have their own recommendations, but,
still, I found this statement given by the Finnish Pediatrics
Association (SLY) quite amazing or better said apalling. I also do
realize that (some of) the facts they give are truthful according to
the studies, but it is the way things are represented. It is as if, in
their opinion, breastfeeding should have some even more miraculous and
superior qualities than it already has. They seem to consider formula
'safe' and the 'norm'. The burden of evidence is left to the
breastfeeding while formulafeeding doesn't have to prove anything from
its safety and supposed advantages.

My favourite part: "... we should take care of that the multinational
formula companies will not unnecessarily spread information about this
recommendation..."

Knowing the Finnish conditions and that the advertising and marketing
of formulas is pretty nicely under control, I assume the sentence
above concerns e.g. "baby's first solid meals" type of broschures made
by formula companies, broschures which tell new inexperienced moms how
to cook meals for their babies by themselves: "Take 2 dl (6 oz) of the
milk the baby uses, 4 potatoes,..." Anyway, these broschures have fine
charts of babies having 2 full meals at 4 months of age, 3 ones at 5
months, and 5 full meals after 6 months. After 8 months they forget to
mention babies may have 'all-breastmilk-meals' too, they just talk
about 'meals'. So, I am guessing the Finnish Pediatrics Association
might be worried that these broschures might talk about starting
solids at 6 months.

My other favourite: "Any other benefits of extending the breastfeeding
over six months of age have not been noticed either in a domestic
comprehensive study."

The head of information dept of Finnish Pediatrics Association (SLY)
is Ms Ritva Halila [log in to unmask] .

Sanna-Mari, mom to Rasmus 99 & and someone 5/02
a mom-to-mom, bf support group leader
Finland, Scandinavia


***

In Espoo, 19th October 2001

The fifty-fourth World Health Assembly decided to urge all member
states to strengthen activities and develop new approaches to protect,
promote and support exclusive breastfeeding for six months, with
continued breastfeeding for up to two years of age or beyond (WHA
54.2). This decision is based on the Expert Consultation of WHO
(A54/INF.DOC./4). The Expert Consultation's conclusions are based on a
relatively large review of the published literature on breastfeeding.
However, the studies varied in their extensiveness and quality, and
were mainly small and limited.The main argument of the recommendation
was that exclusive breastfeeding for six months reduces morbidity and
mortality from infectious diseases, especially those due to
gastrointestinal infection, compared to four months of exclusively
breastfeeding followed by complementary feeding. Comparative studies
especially outside developing countries were found to be scanty. In
the WHA's recommendation, however, there is a mention about a trial in
Honduras which demonstrated that exclusive breastfeeding for six
months increases the incidence of the iron deficiency.

According to the present Finnish recommendation, the complementary
feeding is started individually at 4 - 6 months of age. The child's
growth and willingness to eat should be taken into account. On the
grounds of the domestic studies, the [Finnish] experts'
recommendations state, that no advantages at all are gained by
breastfeeding for longer than 12 months (Visakorpi, 1997).

The Finnish Pediatrics Association suggestes that the present
officially recommended feeding practices will not be changed. The
recommendation given by WHA is reasonable considering the children in
the developing countries, but following the recommendation may even
cause actual hazard in the developed countries. It would increase the
incidence of malnourishment and iron deficiency in children of 4 - 6
months of age without giving them any real advantages. Based on the
comprehensive Finnish studies, we give reasons for our statement as
follows:

The composition of breastmilk varies. The breastmilk of all mothers is
not sufficient to ensure consistent healthy growth up to 6 months of
age. In a Finnish follow-up study of breastfed children the
researchers observed, that the growth of several children exclusively
breastfed for 6 months slowed down in an anomalous way at 4 - 6 months
of age. Breastmilk obviously was not sufficient to ensure growth: When
the complementary feeding was started, the growth was normalized
(Salmenpera et al., 1984). Pediatrics and nurses often face this
phenomenon nowadays.

Part of the children exclusively breastfed for 6 months have iron
deficiency anemia (Siimes et al., 1984).

There is little information about the adequacy of micronutrients
during a long breastfeeding. Also the intake of water-soluble vitamins
could be inadequate, if the mother doesn't take a very special care of
her own nourishment by eating a variety of foods.

Diarrhoeal diseases among children under 6 months of age are no longer
such a threat to a child in our country as they are in developing
countries. The likelihood of the risks mentioned at sections 1 and 2
is much greater in our country.

In the studies the researchers have not noticed any advantages in
preventing allergies or infections in Finnish conditions by
breastfeeding for longer than one year. Any other benefits of
extending the breastfeeding over six months of age have not been
noticed either in a domestic comprehensive study (Savilahti et al.,
1987). There is no clear evidence of benefits of exclusive
breastfeeding of six months for the children's health.

Breastfeeding extending over one year may be disadvantegous because
the hazardous substances accumulated in the mother's fat tissue, like
environmental poisons, may cause problems to the child (Alaluusua et
al., 1997, Alaluusua et al., 1999). Also mother's diet and the
medication and stimulants [alcohol, cigarettes] she uses may place
restrictions to the breastfeeding.

Recommending breastfeeding for longer than one year would
unnecessarily add to feelings of failure in several mothers.

Public child health clinics are excellent in following children's
growth and development. Our system of public child health clinics and
its resources should be maintained so that the growth and development
of infants will be guaranteed, for example, by individulized feeding
practises, and the follow-up information be used as ground for these
decisions.

The recommendation of World Health Assembly concerning breastfeeding
is global and aimed primarily at conditions in developing countries.
In Finland, we should take care of that the multinational formula
companies will not unnecessarily spread information about this
recommendation which is not applicable in our conditions.


***

Literature:

Visakorpi JK. Rintaruokinta. Neuvolakirja 5. painos (toim. Olli
Simell) Vammalan kirjapaino 1997. ss 135-153.

Salmenpera L, Perheentupa J, Siimes MA: Exclusively breast-fed healthy
infants grow slower than reference infants. Pediatr Res
1984;19:307-312.

Siimes MA, Salmenpera L, Perheentupa J: Exclusive breast-feeding for 9
months: Risk of iron deficiency. J Pediatr 1984;104:196-199.

Savilahti E, Tainio V-M, Salmenpera L, Siimes MA, Perheentupa J.
Prolonged exclusive breast-feeding and heredity as determinants in
infantile atopy. Arch Dis Child 1987;62:269-73.

Alaluusua S, Lukinmaa PL, Koskimies M, Pirinen S, Holtta P, Kallio M,
Hottinen T, Salmenpera L: Developmentel dental defects associated with
long breast feeding. Eur J Oral Sci 1996;104(5-6):493-7

Alaluusua S, Lukinmaa PL, Torppa J, Tuomisto J, Vartiainen T:
Developing teeth as biomarker of dioxin exposure. (Letter) Lancet
1999;353:206.


***

The first one (Visakorpi; Neuvolakirja, "public child health clinic
book") is a book published by a pharmaceutical company. [In my
opinion] it offers plenty of outdated information of breastfeeding in
its chapter of breastfeeding.

The last one (Alaluusua, 1999) about dioxins. Well, Alaluusua herself
stated last fall/autumn (2001) in newspapers that dioxins in the milk
of the Finnish mothers are not a problem anymore and not a reason to
limit breastfeeding.

'Salmenpera' is actually written with two little dots on the last 'a',
and 'Holtta' is written by two little dots both on 'o' and 'a'.

In one chapter of this statement the Finnish Pediatrics Assosiation
(SLY) mentions about faltering growth of children exclusively
breastfed for six months, and continues "Pediatrics and nurses often
face this phenomenon nowadays". I wonder how often, because only 15 %
of Finnish children are exclusively breastfed at 4 months of age, and
even less at 6 months of age, and sure not all of them have anomalous
problems with growth.

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