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8/12/2019 FAQs, Myths, And Misconceptions About Breastfeeding
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FAQs, Myths, and
Misconceptions aboutBreastfeeding
Juliet Sio Aguilar, M.D., M.Sc.(Birm)Professor of Pediatrics
University of the Philippines Manila
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WHO and UNICEF: Global Strategy for
Infant and Young Child Feeding (2002)
To revitalize focus on impact of feeding practices on
nutritional status, growth and development and
health, and ultimately the survival of infants andyoung children
.health and other relevant sectors protect,
promote and support exclusive breastfeeding for sixmonths and continued breastfeeding up to two
years or beyond
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Why Exclusive BF for
First Six Months of Life Infants 0-5 months
Not BF
7-fold increased risk for diarrheal deaths
5-fold increased risk for death from pneumonia
Partially BF
2-fold increased risk for deaths from diarrhea orpneumonia
Black RE et al. Where and why are 10 million children dying
every year? Lancet 2003; 361: 226.
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Breastfeeding and Disease
PreventionExclusive breastfeeding for at least 6 mos
Dose-dependent effect of BF duration on obesityArenz S et al. Int J Obesity2004: 28: 1247.
Exclusive breastfeeding for at least 4 mos
Breastfeed for at least 6 mosHalken S. Pediatr Allerg Immunol2004: 15 Suppl 16: 9.
Caution in severe maternal asthma
Wright AL et al. Thorax2001; 56:192.
Exclusive breastfeeding for at least 4 mos
Delay introduction of cows milk until 4 mosKimpimaki et al. Diabetologia2001; 44: 63.
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Other Potential Problems of Non-
exclusive BF
Nipple confusion
High risk of lactation failure
92% of subjects felt milk output inadequate
Mathur GP et al. Indian Pediatr1992; 29: 1541.
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Im sick. Is it safe
to breastfeed my baby?
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Maternal Infections BF not contraindicated in most infections
Common minor infections
Varicella (onset within 6 days of delivery or 2 dayspostpartum)
Give ZIG to uninfected neonate and separation from motheruntil she is noninfectious
CMV Passive transfer of maternal antibodies
For as long as mothers are not recent converters if infant isterm
For preterms: benefits of BF outweigh risk of CMVtransmission
Freezing and pasteurization can significantly viral load inmilk
Toxoplasmosis
Antibodies found in breast milk
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Maternal Hepatitis B Carriers
With appropriate immunoprophylaxis: no
additional risk in breastfed infant even if
mother is HBeAg positive
Hill JB et al. Obstet Gynecol2002; 99: 1049.
Tseng AKY et al. Lancet1988; 2: 1032.
Beasly PR et al. Lancet 1975; 2: 740.
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Maternal Tuberculosis
Current Recommendations
Best way to prevent TB in infants of infected
moms: timely and properly administered
chemotherapy for moms Mothers can breastfeed exclusively for
Minimum of 4 mos
6 mos if infant is growing appropriately
Should continue BF with adequate complementary foodup to 2 years or beyond
Joint Statement of the Division of Child Health and Development, Global
Tuberculosis Programme, Global Programme for Vaccines and Immunization and
Reproductive Health of the World Health Organization. Update No. 23, Feb 1998.
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Breastfeeding and
Maternal Tuberculosis Management categories: Timing
of diagnosis of active PTB
Before delivery >2 mos
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Diagnosis of
Maternal Tuberculosis >2 mos before delivery
Get sputum smear just
before delivery Negative: Treat mom + BCG
at birth
Positive: Treat mom + INH 6
mos + BCG after INH
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Breastfeeding and
Maternal Tuberculosis
Additional key in management
Monitor infants health during the 1styear of
life for signs of TB
Continue breastfeeding whether or not child
develops TB
Joint Statement of the Division of Child Health and Development,
Global Tuberculosis Programme, Global Programme for Vaccines and
Immunization and Reproductive Health of the World Health Organization.Update No. 23, Feb 1998.
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Maternal HIV
Transmission Risks to Infants
Without any intervention before or duringdelivery: 15-30%
Breastfeeding: 10-20%
LINKAGES Project.Academy for Educational Development. April
2004.
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Should mothers with HIV be
advised to BF? It depends.
If BM substitutes are acceptable, affordable,feasible, sustainable and safe greater
chances of survival if fed artificially
If BM substitutes are prohibitively costly,
access to clean water poor, health carelimited exclusive BF safest option
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Reducing Risk of
HIV Transmission Reduce total duration of BF if being
breastfed Shift to BM substitutes as soon as resources
become affordable/available
Prevent and promptly treat oral lesions ininfants and breast problems
Take antiretroviral drugs Single dose of nevirapine to mother in labor and
infant after delivery (Uganda trial) 42% reduction at 6 weeks
35% reduction at 12 months
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Two-yr Morbidity & Mortality Among
Children Born to HIV-infected Mothers
Long-term safety of infant feeding interventions aimed atreducing breast milk HIV transmission in Africa (Cotedlvoire)
HIV-infected moms given peripartum antiretroviralprophylaxis
Infant feeding interventions Artificial feeding
Exclusive breastfeeding and early cessation from age 4 mos
PLUS nutritional counseling and clinical management for 2 yrs Outcome variables
Occurrence of morbid events (diarrhea, ARI, malnutrition) andsevere events (hospitalization or death)
Becquet R et al; Ditrame Plus Study Group. PLoS Med2007; 4: e17.
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Two-yr Morbidity & Mortality Among
Children Born to HIV-infected Mothers
Becquet R et al; Ditrame Plus Study Group. PLoS Med2007; 4: e17.
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Two-yr Morbidity & Mortality Among
Children Born to HIV-infected Mothers
Becquet R et al; Ditrame Plus Study Group. PLoS Med2007; 4: e17.
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Its hot in the Philippines.
Wouldnt my baby become
dehydrated if I do not give
extra water?
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Supplemental Water in
Breastfeeding?
Water
Lactose
Fat
Protein
OthersWater 88.1%
Lactose
7.0%
Fat
3.8%
Protein
0.9%
Lawrence RA. 1994. Breastfeeding: A Guide for the MedicalProfession.4thed. St. Louis: Mosby-Year Book, Inc.
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Im on medications. Can I
continue breastfeeding?
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Im underweight. Is my
breast milk adequate for mybaby?
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Maternal Malnutrition
Can malnourished mothers breastfeed
successfully?
Yes except in severe PEM
Babies may suck more vigorously, frequently
or longer if BM supply low
Easier and less expensive to feedmalnourished mom than to expose baby to
risk of bottle feeding
LINKAGES Project.Academy for Educational Development. July 2004.
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Maternal Micronutrient
Supplementation Vitamin A
Single dose of 200,000 IU after delivery (not
later than 6-8 weeks)
Thiamin, riboflavin, vit B6, vit B12, iodine,
selenium
Levels in breast milk easily affected by maternal
diet Folate, calcium, iron, copper, zinc
Remain relatively high in breast milk despite low
maternal reserves
Supplement to protect maternal reserves
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Appropriate
Complementary Feeding Foods rich in iron
Term infants: introduced around 6 mos
Preterms, LBW and infants with hematologicdisorders: earlier than 6 mos
Food diversity Especially for BF children beyond 1 yr old
Strongly and consistently correlated with growth
Early introduction of starchy gruels (< 6mos)associated with stunting
AAP Policy Statement on Breastfeeding. Pediatrics2005; 115: 496.
Onyango A et al. Int J Epidem1998; 27: 484.
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I cant beat my smoking and
drinking habit. Can I
breastfeed even if I smokecigarettes and take alcoholic
beverages?
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Maternal Smoking Infants exposed to environmental tobacco smoke
experience health risks
Components of tobacco in breast milk
BF moms should no. of cigarettes to
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Maternal Smoking Not a contraindication
Smoking hygiene
Avoid smoking within the home. Use air
purifier if cannot be avoided.Never smoke in the car or near the infant in
closed areas or take infant to smokyenvironment
Smoke only immediately after BF and at least1 hrs prior to BF
AAP Policy Statement on Breastfeeding. Pediatrics2005; 115: 496.
Pulley KR and Flanders-Stepans MB. J Perinatal Ed2002; 11: 28.
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Maternal Alcohol Intake
Alcohol
Concentrated in breast milk
Its use can inhibit milk production
Recommendation
Avoid alcohol
For occasional single, small drink:Avoid BF for 2 hrs after the drink
AAP Policy Statement on Breastfeeding. Pediatrics2005; 115: 496.
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Im very tired from work. Is it
safe to breastfeed my baby?
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Stress and Breastfeeding
Breast milk panis
No scientific basis
Impact of stress on milk supplyVariable among lactating moms
Some able to cope well despite extreme pressures
In early weeks of lactation Fatigue the most detrimental factor to milk
production
Lawrence RA. 1994. Breastfeeding: A Guide for the Medical Profession.
4th ed. St. Louis: Mosby-Year Book, Inc.
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I no longer have the energy to
breastfeed my baby. But I knowbreast milk is best.
What shall I do?
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Psychosocial Risk Factors Associated
with BF Discontinuation Prospective cohort study
Managed care setting
Sacramento, CA, USARCT to home visits vs clinic-based follow up
Face-to-face interview postpartum, telephoneinterviews at 2 wks and 12 wks
1163 mother-newborn pairs
Taveras EM at al. Pediatrics2003; 112: 108.
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Psychosocial Risk Factors Associated
with BF Discontinuation Results BF rates
87% initiated BF
75% BF at 2 wks
55% BF at 12 wks
Multivariate analysis BF at 12 wks
Encouragement from clinician to BF
OR = 0.6 [95% CI: 0.4, 0.8]
BF discontinued at 2 wks Lack of confidence to BF at 1-2 day interview
OR = 2.8 [95% CI: 1.02, 7.6]
Early BF problems
OR = 1.5 [95% CI: 1.1, 1.97]
Taveras EM at al. Pediatrics2003; 112: 108.
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Spousal Support Training
Parameters Intervention
Group (%)
Control
Group (%)
P
Full BF at 6 mos 25 15 0.05
Perceived milk
insufficiency
12 43 0.001
Mixed feeding 10 33 0.001Full BF at 6 mos
despite problems
24 4 0.001
Pisacane A et al. Pediatrics2005; 116: e494.
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Early Routine Clinic Visit on
Breastfeeding 1st4 weeks postpartum: period with greatest
decrease in BF rates
Single visit within 2 weeks after birth
226 mother-infant pairs in Chambery,France
Conducted by trained clinicians Multivariate analysis associated with
exclusive BF at 4 weeks
Labarere J et al.Pediatrics2005; 115: e139.
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Early Clinic Visit on eBF at 4 wks:
Multivariate Analysis
Characteristics Adjusted Odds
Ratio
95% CI
Intervention group 2.44 1.18-5.03
Epidural anesthesia 0.32 0.13-0.76
Gestational age at
delivery
3.44 1.2-9.82
Expected BF duration
of > 4 mos
2.49 1.12-5.53
Labarere J et al.Pediatrics2005; 115: e139.
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Lets all help bring back the
breastfeeding culture.