From Breastfeeding, A Guide for the Medical Profession, 4th Edition, Ruth Lawrence pp 343-344: "The report of Little et al regarding the effect of alcohol on the nursing infant implies that alcohol causes developmental delay. It should also be noted that the drinking would be classified as heavy in this group whose infants had slight gross motor delay at 1 year. Furthermore, the infants were subjected to the alcohol in utero as well. Heavy drinking should not be condoned; however it will be very important to follow the children in all the cohorts for at least 7 years until their learning centers are testable. A study in Mexico following 32 infants born to mothers who drank a mild Mexican alcoholic beverage called pulque (3% alcohol, up to 2 L per day) produced no infants with fetal alcohol syndrome, but there was a higher incidence of low birth weight (< 3rd percentile). Relative risk was 3.39. The infants were followed during lactation as well. Ethanol found in the milk accounted for 40 mg/day available to the infant. Postnatal growth was similar in both groups at 6 months. Developemental studies were not reported." "The recommendation regarding alcohol requires the physician to avoid the extremes and assist the mother in adjusting her alcohol consumption appropriately, avoiding prescribing or proscribing it" Infants continue to have brain development in the first two years of life. There is ongoing research to further evaluate the effect of alcohol on the developing fetus and infant. Although Fetal Alcohol Syndrome is the most devastating form of the effect of alcohol on the infant, Fetal Alcohol Effects are associated with learning problems. Although alcohol has been used since the beginning of time in celebration, ritual and to excess, it IS A PSCHOACTIVE DRUG (in the US one of the two most abused drugs-tobacco being the other). Ten percent of the US population has significant and serious problems with alcoholism. In the last few years of research it has also been discovered that alcohol is metabolized differently by women than men (slower, lower dose required for toxic effect). I am not advocating temperance for all, just reminding everyone that this is not an issue to be taken lightly. I think it is part of a good history to access mom's use of alcohol and drugs (as well as finding out if alcohol and drug use affects other members of the family). Not to be punitive but to have a clearer idea of whether mother and baby are at potential risk, and to refer to appropiate resources if necessary. An excellent way to screen for alcohol and drug problems is by using the CAGE questionaire: 1. Have you ever felt you ought to CUT down on your drinking (or use of drugs)? 2. Have people ANNOYED you by criticizing your drinking? 3. Have you ever felt bad or GUILTY about your drinking? 4. Have you ever had a drink first thing in the morning (EYE opening) to steady your nerves or get rid of a hangover? Two or more affirmative answers indicate probable alcoholism. Any single affirmative answer deserves further evaluation from Ewing JA, Detecting alcoholism. The CAGE Questionnaire. JAMA 1984,252:1907. Pierrette Mimi Poinsett MD FAAP Modesto CA