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Date: | Thu, 10 Feb 2005 06:53:42 EST |
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As a breastfeeding advocate, there is much to love in the revised AAP policy
on breastfeeding. One certainly has to recognize the difficulty in getting a
policy that is acceptable to not only the breastfeeding experts but also to the
medical community. This document is a wonderful reference in which a
breastfeeding advocates can use to dialogue with their communities.
Yet, I am very disappointed in at least 3 major areas of this policy. The
recommendation that "all breastfed infants should receive 200 IU of oral
vitamin D drop daily beginning during the first 2 months of life and continuing
until the daily consumption of vitamin D-fortified formula or milk is 500mL."
While this document supports exclusive breastfeeding, this recommendation in my
mind negates exclusivity. I believe we have strong evidence that the gut flora
of the newborn can easily be damaged by any foreign substance. What evidence
exists that all breastfed infants will benefit from the addition of vitamin
D? In fact, one might suggest that we have evidence that suggests that it is
likely that gut damage will happen and that under this policy exclusivity of
breastfeeding will not exist in the USA.
Second, I question the belief that women who are HIV infected in the USA
"should not breastfeed their offspring." (I think offspring is a strange word to
use--is it that hiv positive mothers have offspring and hiv negative mothers
have infants/babies?) This advisory is referenced to a study done by Read et al
that is a flawed. Read et al uses Ziegler et al. as early proof that hiv is
transmitted through breastmilk. Zielger et al. is a LETTER not a study
written to the Lancet in 1985. Letters are not peer reviewed and this letter is on
one infant--yes one infant. Read also bases her recommendations based on the
Nduati studies. The Nduati studies were a randomization of infant feeding in
Kenya (some people might consider the randomization of infant feeding in a
developing nation unethical).
If medical policy in the USA becomes one in which mothers have to have a
current HIV test in order to breastfeed (someone on this list mentioned that this
was occurring in her hospital) then the decision to breastfeed in the USA
will be placed on the ability to pass the HIV test. The need to have a current
HIV test coupled with policy that states HIV positive mothers should not
breastfeed will create or is creating a spillover effect in which breastfeeding will
be denied to those who are not infected with HIV.
Third, funding might be a reason for the difference in opinion regarding the
introduction of complementary foods. The Committee on Nutrition supports the
introduction to complementary foods between 4-6 months. One of the members
of that Committee, Dr. Nancy Krebs has received funding from Ross and Mead
Johnson for studies she has done. And also funding from the Cattlemen's Beef
Association for the years 2002-2004 ($98,561). see
http://www.uchsc.edu/peds/subs/nutri/resfund
Zinc, Fat and Calcium Balance in Term Infants Fed Milk-Based Formula and
Hydrolysate-Based Formulas
Principal Investigator: Nancy F. Krebs, MD
Source: Ross Products Division/Abbott Laboratories - CP-AJ72
Amount: $120,000
Term: 1999-2004
Funding may reflect how we approach a research problem or policy. Then
again, it may have nothing to do with it. Certainly, it is something we need to
look at and think about.
The AAP revised policy on breastfeeding has alot to offer us. It is a
revision of past policy and will be revised in the future. Which reminds us that
what is written is not set in stone but part of a process. It is certainly a
treasure of references and a document we can all use to make positive changes in
our community.
Valerie W. McClain, breastfeeding advocate
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