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Infant Feeding

Infant Feeding. Kaili Stehel MD IBCLC Associate Professor Pediatrics UT Southwestern Medical School Chair, IBLCE Board of Directors AAP, Co-Chapter Breastfeeding Coordinator, Texas. Breastfeed?. “Artificial feeding has been described as the world’s largest experiment without controls.”.

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Infant Feeding

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  1. Infant Feeding Kaili Stehel MD IBCLC Associate Professor Pediatrics UT Southwestern Medical School Chair, IBLCE Board of Directors AAP, Co-Chapter Breastfeeding Coordinator, Texas

  2. Breastfeed?

  3. “Artificial feeding has been described as the world’s largest experiment without controls.” The Report on the WHO Collaborative Study on Breastfeeding, Geneva, 1981.

  4. Infant formula protection act Infant Metabolic Alkalosis and Soy-Based Formula -- United States • Three cases of a Bartter-like syndrome in infants were reported to CDC from Memphis, Tennessee, on July 26, 1979. The infants were less than 10 months of age and were failing to gain weight. They had poor appetites, and one had a history of constipation. All were hypochloremic and hypokalemic, with varying degrees of alkalosis and microhematuria. The 3 infants were taking the same brand of soy-based formula.

  5. Infant formula protection act • Passed in 1980 • Established nutrient requirements • Established “good manufacturing practices” • Since 1982 there have been ~50 formula recalls • Last major recall: 9-23-10 Wall Street Journal Headline 1st page Marketplace, “Beetles Spur Recall of Baby Formula” 5 million containers of powdered Similac, expected 100 million in lost sales 3rd quarter 2010

  6. AAPRecommendations • Human milk is species specific, markedly different from all substitute feeding preparations, and uniquely superior for infant feeding • “Exclusive breastfeeding is sufficient to support optimal growth and development for approximately the first 6 months of life and provides continuing protection against diarrhea and respiratory tract infection.” • “Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child.” • “There is no upper limit to the duration of breastfeeding and no evidence of psychological or developmental harm from breastfeeding into the third year of life or longer.” AAP. BF and the Use of Human Milk. 2005

  7. U.S. Public Health 2020 Goals • Raised the targets for BF initiation, duration and exclusivity to increase proportion of infants who are BF • Any BF • 82% in hospital • 61% at 6 months • 34% at 1 year • Exclusive BF • 44% at 3 months • 23% at 6 months Surgeongeneral.gov Healthypeople.gov

  8. US BF Report Card: CDC 2011

  9. Infant Benefits from BF • Nutritional: Excellent bioavailability, significant nutrient-nutrient interactions not replicable in formula • Immunologic: Decreasedrisk of infections: otitis media, gastroenteritis, bronchiolitis, respiratory tract infections, bacterial meningitis,bacteremia, UTI, and NEC • Immunomodulation: Decreased risk for asthma,atopic dermatitis, type 1 and 2 diabetes, leukemia, and lymphoma AHRQ. BF and Mat and Inf Health Outcomes in Developed Countries. 2007 AAP. BF and the Use of Human Milk. 2005

  10. Maternal Benefits of BF • Decreased post partum bleeding and anemia • Decreased risk of ovarian cancer and pre menopausal breast cancer • More rapid post-partum weight loss • Decreased maternal obesity • Lactational amenorrhea and improved child spacing AHRQ. BF and Mat and Inf Health Outcomes in Developed Countries. 2007 AAP. BF and the Use of Human Milk. 2005

  11. Early Childhood Obesity Prevention Policies • Section 4: Healthy Eating, IOM 2011 • BF results in a reduced risk of pediatric overweight • Duration of BF and exclusive BF inversely related to pediatric overweight • “Promote the consumption of a variety of nutritious foods and encourage and support breastfeeding during infancy” • “child care settings requiring program staff to support breastfeeding” • Rationale: association between breastfeeding and reduction in obesity risk during childhood • Does BF reduce the risk of pediatric overweight? CDC 2007 • BF results in a reduced risk of pediatric overweight • Duration of BF and exclusive BF inversely related to pediatric overweight • Persists into adulthood • Conclusive evidence not yet available

  12. The Burden of Suboptimal BF • If 90% of US women BF exclusively for 6 months • Prevent 900 deaths/yr • Save $13 billion/year in direct and indirect health care costs • 10 pediatric diseases: NEC, OM, viral gastro, hospitalization for LRI, atopic dermatitis, SIDS, asthma, leukemia, type 1 DM, obesity • Cost of formula not included • If 80% BF exclusively 6 months: 741 deaths, $10.5 billion • If 50% BF exclusive for 6 months: 142 deaths, $2.2 billion Pediatrics. 2010

  13. Child Care Provider Responsibilities • Support breast feeding and the use of expressed human milk • AAP, 2005 • Provide quality BF Support by accommodating mothers who wish to breastfeed or feed expressed breastmilk • HHS Blueprint for Action on BF, 2000 • “Critical role to play” in supporting employed mothers • Action # 16. Surgeon General’s call to Action to Support BF. 2011

  14. Caring For Our Children 3: National Health and Safety Performance Standards • encourage, provide arrangements for and support BF • “be the mother’s cheerleader and enthusiastic supporter for the mother’s plan to provide her milk” • “vigorous efforts…to promote and sustain breastfeeding” • Designated place to breastfeed & pump Breastfeedingsymbol.org

  15. 10 Steps to BF Friendly Child Care Centers 1 Designate an individual or group who is responsible for development and implementation of the 10 steps. 2 Establish a supportive breastfeeding policy and require that all staff be aware of and follow the policy. 3 Establish a supportive worksite policy for staff members who are breastfeeding. 4 Train all center staff to carry out breastfeeding promotion and support activities. 5 Create a culturally appropriate breastfeeding friendly environment. 6 Inform expectant parents, new families and visitors about your center’s breastfeeding friendly policies. 7 Stimulate participatory learning experiences with the children related to breastfeeding. 8 Provide a comfortable place for mothers to breastfeed or pump their milk in privacy, if desired. Educate families and staff that a mother may breastfeed her child wherever they have a legal right to be. 9 Establish and maintain connections with your local breastfeeding coalition or other community resources. 10 Maintain an updated resource file of community breastfeeding services and resources kept in an accessible area for families. Wisconsin DHS, 2008

  16. Human Milk Storage • Room Temperature • Freshly Expressed • 3-4 hours at 27-32°C (80-90°F) • 6-8 hours up to 25°C (77°F) • Ice pack in cooler • 24 hours at 15°C (59°F) • Refrigerated • 4°C (40°F) 5 days • Frozen • 2 weeks at -15°C (5°F) freezer inside refrigerator • 3-6 months at -18°C (0°F) separate compartment with doors • 6-12 months at -20°C (-4°F) separate freezer ABM. Human Milk Storage. 2010

  17. Human Milk Handling • Store in shared refrigerator with food • Label with infants name and date expressed • Defrost in refrigerator or warm water • Feed cool, room temperature, or warmed according to infant’s preference • Heat to a temperature <98.6°F in warm water <120°F, not in microwave, heat less than 5 minutes • Previously frozen, thawed 24 hours • Room temperature, discard after a few hours • After partially drunk, discard within 1-2 hours • Human milk does not require special handling • No gloves ABM. Human Milk Storage. 2010 and CFOC 3rd edition

  18. Complementary Foods • Exclusive BF minimum 4 mo preferable 6 mo • No nutritional indication to add complementary foods before 4-6 months • Introduce one single ingredient food at a time, at intervals of 3-5 days to observe for allergies • No evidence to support particular order • By 6 months introduce iron rich complementary foods (fortified rice cereal, meat added benefit of zinc, protein) • Try to offer variety, 8-15 exposures may be needed before new food accepted AAP. Pediatric Nutrition Handbook. 6th edition. 2009.

  19. Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. -Margaret Mead

  20. Resources • AAP. BF and the Use of Human Milk. Pediatrics. 2005 • AAP. Pediatric Nutrition Handbook. 2009. • ABM. Clinical Protocol: Human Milk Storage for Home Use for Full-Term Infants. BF Medicine. 2010 • AHRQ. BF and Mat and Inf Health Outcomes in Developed Countries. 2007 • Caring for our Children 3rd Edition. 2011 • CDC BF Report Card. 2011 • HHS Blueprint for Action on BF. 2000 • IOM. Early Childhood Obesity Prevention Policies. 2011 • The Surgeon General’s Call to Action to Support BF. 2011

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