Hi Everyone: Just received my latest issue of PEDIATRICS (Sept 1996, vol.98 , no. 3). Some interesting things I thought I should share. The 2nd page has full double page ad on the "new, advanced formula Enfamil with added nucleotides." Gee, wasn't M-J just suing Ross to keep Similac Advance off the market because lack on any research that added nucleotides do any good ? Humm... To quote the add "The addition of nucleotides to our formula is our latest improvement, designed to bring Enfamil compositionally closer to breast milk. Now, with birth of our new baby, parents can be sure that their new babies are getting a formula that's closer to breast milk than ever before in Mead Johnson history" Gag me! NO WHERE in this ad does it mention that breast milk is the prefered and superior choice of infant feeding. Clearing a major code violation. Also, it gives no research data to back up their claims that added nucleotides are beneficial. Remember, this is THE journal of the AAP, a peer-reviewed, research based, well-respected, leading authority publication. I'm steamed, anyone else? Next, on page 434 is a study on the "Breastfeeding Practices Among Resident Physicians" The purpose of this study was to learn how employment as a resident physician affects the breastfeeding practices and experiences of female residents who are new mothers. A subject near and dear to me (times 3). 80% of the residents initiated breastfeeding, and continued for the duration of their maternity leave (mean, 7 weeks). The breastfeeding rate dropped to 15% at 6 months. Work schedule was the most common reason for discontinuing breastfeeding. Only 54% who continued felt supported by their attending physicians for their efforts to breastfeed (we're talking fellow pediatricians!) and 67% felt colleagues (other residents) were supportive. They concluded that the high bf initiation rate suggests that these mothers are aware of the benefits of bf but the poor continuation rate suggests that residency programs are often not bf-friendly environments for resident mothers. They suggested that residency program directors set standard policies for resident mothers to encourage breastfeeding. (yeah!) I'll believe it when I see it though. The thing that program directors and chief residents hate is someone that goofs up the schedule or does something totally inconvienent like having a baby and then wanting to breastfeed it! My approach was always to go straight to the attending and explain that I have an infant at home that I'm breastfeeding. It is important to me and the health of my child that I continue to breastfeed. I will have to leave for short breaks during the day to pump breastmilk (by now they are looking at the floor). I will not neglect any of my duties or in any way have this affect patient care. I'm sure you, being a pediatrician, understand how important breastfeeding is. Then I walk away and mostly leave them dumb-founded but impressed (I hope) by my committment. Amazing though that we have to convince pediatricians that breastfeeding is important (even during the usual 80+ hour work week!) Looking back I can't believe I lived through those days. Oh by the way, they spelled your name wrong Kathleen...... Auerback (!) Finally, same journal has the Academy statement on "Evaluation and Preparation of Pediatric Patients Undergoing Anesthesia" They somewhat addressed the subject of the NPO period before surgery. Something that seems to come up all the time. I was disappointed to see that the breastfed infant was not discussed. All they said was that "recent studies have shown that the limited intake of a clear liquid (a liquid that you can see print through, such as sugar water or apple juice) up to 2 or 3 hours before anesthesia does not significantly increase the volume in the stomach or alter the pH of the gastric contents (both of which may increase the risk of aspiration pneumonitis)." So what do you do with that darn screaming breastfed infant who so inconvienently won't take a bottle of sugar water or apple juice? The research is out there. I use the 4 hour rule that is described in the Pediatric Clinics of North America, Pediatric Anesthesia. I wish, once again, that the AAP would address this issue so I wouldn't have so many frantic calls from parents after they've had a visit from the anesthesiologist. The AAP needs to teach what it preaches. If we want breastfeeding rates to go up we better support breastfeeding moms and infants in every way we can and stop the lip service. Karen Stepan, DO, IBCLC In beautiful Flagstaff AZ where the sky meets the San Francisco Peaks.