I missed the first post in this series, but saw this:

>I agree wholeheartedly regarding our putting a finger into a =
baby's mouth. The oral area is highly sensitive--therefore, we may be =
doing harm to the sucking mechanism/reflexes through this intrusion. The =
only time I think it might be necessary is when we have observational =
data that says there may be an oral abnormality---i.g.cleft of the soft =
palate. But we have very little data to support suck assessment using =
our finger and no research to support intervention using the finger. So, =
before we put our finger into an infant's mouth we need more data to =
support what we are doing!<

I think that in the light of what we think we know about the mechanisms of
transmission of HIV during breastfeeding (assuming that we accept the
orthodox position that HIV causes AIDS and that the virus can be transmitted
through breast milk) it seems that any disturbance to the infant mucosal
surfaces causes trauma and can increase the likelihood of challenges to the
infant via the disturbed mucosa.  Assuming that this is how HIV transmission
risk is increased in *mixed* feeding (as demonstrated in the Coutsoudis
study of last year), are we not bound to examine the results in a more
general sense?  Where are studies of babies who have had procedures (e.g.
suctioning, digital examination) which might impact on their mucosal
surfaces, compared to babies who have not had these procedures, with health
outcomes studied when each set of babies are subsequently exclusively
breastfed or breastfed with supplements or exclusively replacement fed???

Seems to me that one of the spin offs of the intense scrutiny of breastmilk
transmission of HIV is that there are many lessons we can learn about what
we don't know about breastfeeding and, yet, what areas might increase our
knowledge.

Of course, I think there is a common sense 'in the absence of data'
presumption we could make about the role of preserving the integrity of the
infant mucosal surfaces, unless and until we know better and unless and
until there is evidence that invasive procedures (such as sticking a finger
in the baby's mouth in the earliest days of life) do more good than harm.

Magda Sachs
Breastfeeding Supporter, The Breastfeeding Network, UK

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