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Subject:
From:
Rachel Myr <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 14 Aug 2004 14:07:59 +0200
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Darillyn asks whether there are known risks to children in developing
countries in connection with weaning and the answer is yes.  Called 'sibling
syndrome' or 'sibling disease', it is well known among health workers in
developing countries and occurs when a young child loses access to
breastmilk because mother has had a new baby.  The older child is more
vulnerable to infection due to the loss of 1) a clean source of a very
nutritious food and 2) the passive immunity conferred through breastmilk.
While infants during the early months absorb maternal antibodies present in
milk, through the gut mucosa, these antibodies continue to play a
significant role in infection protection after the gut mucosa becomes
impermeable to these large molecules.  The antibodies attach to the cells
lining the gut, and act locally to fight microorganisms that otherwise cause
diarrhea.  The same mechanism in the upper airway protects against
respiratory infection.
There is a noticeable increase in child mortality due to infection among
children who have recently become big brothers or sisters.  Even in cases
where the child's growth may already have been faltering due to lack of
appropriate and/or available weaning foods, as long as the breastmilk is
available they generally do not fall prey to the most common infections.
This changes radically when they are weaned to make room at the breast for a
sibling.  In conditions of marginal nutrition, women don't get pregnant as
readily while breastfeeding, which prioritizes the child already born.  Once
the mother does get pregnant, her milk supply may dwindle or there may
simply not be enough calories around after birth to supply milk to both the
infant and the older sib.

Even when the infants are absorbing maternal antibodies into their
bloodstream, it is considered passive immunity because the antibodies are
not manufactured by the infant.  I don't believe that exposure to antibodies
'teaches' the infant's immune system to produce endogenous ones; it may be
that the protection offered by maternal antibodies gives the infant a safety
cushion, protecting the infant while its immune system matures and begins
producing its own antibodies as a result of exposure to minute amounts of
antigens while still being 'covered' by breastmilk.

Rachel Myr
Kristiansand, Norway

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