Dear all:

It is not that long past in human history when in many areas of the world the infant death rates exceeded one in five infants.  There are still areas of the world where this is the case.  There are many practices that were, are and will continue to be harmful to infants.  Just because something is widely practiced and no one studied the impact doesn't mean that a negative impact did not exist.  If an impact does not occur immediately the event that caused it, humans are not all that good at determining causality.  

As for the example of encouraging drinking in the 1970s, I would hardly call the 1970s an ideal time interval for recommendations on mothering.  Formula use was far more common than now and smoking and drinking were common during pregnancy.  The excuses then were based on the exact same line of faulty logic -- if you can't see it and it is common, it must be just fine.  My mother had a zillion excuses about the emerging epidemiology of smoking.

To give you an example, it wasn't until the 1990s that the world started to recognize that it wasn't a tiny proportion of permanently stunted and brain damaged cretins that resulted from iodine deficiency.  It took really sophisticated research to show that the cognitive development of the whole population was permanently suppressed when mothers lived in areas of iodine deficiency.  If you put it in terms of IQ points - it is about a 10 IQ point difference.  You see about the same impact of iron deficiency.  This is not readily visible.  

Even less visible is the impact of vitamin A deficiency.  In areas of deficiency, the rate of childhood death is 30% higher among those who have mild subclinical deficiency -- the kind you can only detect with a blood test.  The death rate is about 90% when you have severe clinical vitamin A deficiency.  This fact was so hard to accept that even many scientists doubted its validity until 10s of millions of dollars were spent in an effort to disprove this possibility.  Turns out that all they managed to disprove was their own skepticism that vitamin A played such an important role in childhood survival.

Alcoholism is a disease that has probably always existed.  Now that we have recognized its existence and the harmful impact of its existence, I think we are much better off.  I see not reason why we should not encourage parents that are alcoholics or may become alcoholics to seek treatment or modify their drinking practices.  

There are many ways in which we can avoid scaring mothers to death while we also help them to realize that drinking should be done in moderation.   We also should realize that if we demand that pharmaceutical companies and formula companies are rightly called on their sloppy and deceptive science, we cannot then employ the same sloppy thinking when it comes to breastfeeding.  We do know that studies show that babies feed longer but drink less when their mothers have had alcohol.  At the very least it should be OK to have mothers consider the timing and frequency of their alcohol ingestion to minimize the impact on feeding and caring for their infants.

Sincerely,

Susan E. Burger, MHS, PhD, IBCLC

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