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.