Palm Beach County Breastfeeding Task Force

Facts vs. Myths
Current Research

Facts About Breastfeeding - 2004

Public health recommendations can result in optimal health for infants and substantial savings in health care cost.

It is a global public health recommendation that infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development, and health and should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.
World Health Organization. Global Strategy on infant and young child feeding. 2002-4;13.10.

Support from physicians and hospital staff results in a significant difference in initiation and duration of breastfeeding.

In this study 61% of women believed their physician had no preference on breast milk vs. formula; 42% felt that the hospital staff expressed no preference; 80% of mothers intending to breastfeed for a longer duration perceived that their physician favors breastfeeding. Neutrality of the medical community with respect to infant feeding can negatively affect breastfeeding initiation and duration.
DiGirolamo, A. M. et al. Do perceived attitudes of physicians and hospital staff affect breastfeeding decisions? Birth 2003;30 (2): 94-100.

Routine maternity care and skin-to-skin contact between mothers and their newborns were examined. Contact for 20 minutes resulted in 30% of the infants initiating suckling. For those infants whose contact with the mother was extended to 30 minutes, 81% initiated suckling. This was also found to impact breastfeeding duration, with exclusive breastfeeding continuing for 1½ months longer and weaning occurring more than 3 months later in infants who had extended contact.
Mikiel-Kostyra, K. et al. Effects of early skin-to-skin contact after delivery on duration of breastfeeding: a positive cohort study. Acta Paediatr 2002;91:1301-06.

Human milk has special value for premature infants but provides challenges to the health care team.

Human milk is beneficial for preterm babies especially because trophic factors in human milk promote intestinal maturation, hormonal responses occur, and probiotics colonize the gut. Feeding some human milk is better than none, and mothers can often be convinced to express their milk, which is like liquid gold for their babies, for a finite period of time.
Landers, S. Maximizing the benefits of human milk feeding for the preterm infant. Pediatric Annals 2003;32(5);298-306.

Pediatricians play a vital role in the initiation and duration of breastfeeding for mothers of small premature babies. Their support is critical in emphasizing the importance of human milk and reinforcing the mother’s choice to breastfeed with family members and health care providers. Strategies to calculate milk transfer and facilitation of feeding in the early period will help the mother sustain a longer period of breastfeeding.
Meier, P. Supporting lactation in mothers with very low birth weight infants. Pediatric Annals 2003;32(5):317-25.

In this study, cognition and motor development were compared in premature babies breastfed with human milk fortifier and babies fed formula. Although there was a steady decrease in the percentage of infants receiving human milk after discharge, improved cognition and motor development were associated with the intake of human milk. Provision of human milk and breastfeeding should be promoted in the special care nursery and following discharge.
Blaymore-Bier, J.-A. et al. Human milk improves cognitive and motor development of premature infants during infancy. J Hum Lact 2002;18(4):361-67.

Premature infants who received substantial amounts of human milk showed better neurobehavioral states, particularly motor maturity and range of state. Infants were more alert during social interactions. Maternal affectionate touch was found to be related to the amount of breastfeeding, which contributed indirectly to the development of preterm infants. Maternal depression was negatively related to the amount of human milk provided.
Feldman, R. and Eidelman, A.I. Direct and indirect effects of breast milk on the neurobehavioral and cognitive development of premature infants. Developmental Psychobiology 2003;43(2):109-19.

It is in the best interest of the health care system to prevent the occurrence of NEC through feeding protocols which include the use of human milk in the NICU. Banked donor milk is as effective in preventing NEC as the mother’s own milk, and survives heat processing which assures purity. Costs for donor milk with fortifier for a premature infant for 60 days can be $1350. Hospital cost for a premature baby with NEC can be $138,000 without surgery or $238,000 if surgery is required.
Arnold, L.D.W. The cost-effectiveness of using banked donor milk in the neonatal intensive care unit: Prevention of Necrotizing Enterocolitis. J Hum Lact 2002;18(2):172-77.

Postpartum stress is reduced among mothers who breastfeed their children.

Breastfeeding was associated with a decrease in negative mood and breastfeeding mothers reported significantly less stress. Mood was less positive after bottle-feeding than after breastfeeding. This effect could be mediated by the hormone oxytocin, released in the bloodstream during breastfeeding. Oxytocin levels are inversely related to negative moods and emotions.
Sibolboro, E. and Katki, E.S. Breastfeeding is associated with reduced perceived stress and negative mood in mothers. Health Psychology 2002;21(2):187-93.

Present data indicate that short-term attenuation of cortisol stress responses may have several protective functions for lactating mothers: isolating the mother from stressful stimuli, conserving energy for lactation, facilitating the immune system, and preventing inhibition of lactation caused by stress. Moreover, this mechanism may protect the infant against stress-related high cortisol concentrations in mother’s milk
Heinrichs, M. et al. Lactatione and stress: Protective effects of breast-feeding in humans. Stress 2002;5(3):195-203.

Women who breastfeed their babies have a reduced risk of breast cancer.

In countries where extended breastfeeding is frequent, a consistent association between lactation and reduced risk of breast cancer is documented. In Korea where 4% of a study population of women breastfed for over 24 months, cancer rates decreased in those who breastfed for 13 to 24 months, and the rates were reduced further for those who breastfeed for 24 months or longer.
Lee, S.Y et al. Effect of lactation on breast cancer risk: A Korean women’s cohort study. Int J Cancer 2003;105(3):390-93.

Oxford researchers reviewed 47 research papers on parity and breastfeeding. Women with breast cancer were found to have fewer births and mothers who failed to breastfeed had more incidence of cancer. The relative risk of cancer decreased by 4.3% for every 12 months of breastfeeding, in addition to a decrease of 7.0% for every birth.
Collaborative group on hormonal factors in breast milk. Breast cancer and breastfeeding: Collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96,973 without the disease. The Lancet 2002:360: 187-95.

Good evidence exists which documents reduced risk of premenopausal breast cancer for breastfeeding mothers, with extended breastfeeding showing best results. Women with genetic predisposition to breast cancer could potentially benefit most. Breast milk is the ideal nutrient for the newborn; since breastfeeding is a modifiable risk factor, all women should be encouraged to nurse their children.
Helewa, M. et al. Breast cancer, pregnancy, and breastfeeding, JOGC 2002;24(2):165-71.

Human milk has unique and long-term benefits for children, which affect health and health care costs.

Vaccines target specific pathogens, however human milk provides protection against a broad spectrum of illness. Breastfeeding may be important to the prevention of asthma. Formula feeding is associated with a 3.6 fold increase in an infant’s risk of hospitalization due to respiratory ailments. Each such hospitalization in infancy averages $3500, with more than 250,000 such admissions in 1996.
Bachrach, V.R. G. et al. Breastfeeding and the risk of hospitalization for respiratory disease in infancy: A meta-analysis. Arch Pediatr Adolesc Med 2003;157(3):237-43.

Human milk feeding reduces the risk of type 2 diabetes in Native Canadian children. Any prevention strategies should involve the mother during her pregnancy and the promotion of breastfeeding.
Young, T.K. et al. Type 2 Diabetes Mellitus in children. Arch Pediatr Adolesc Med 2002;156(7) 651-55.

Researchers adjusted for confounding factors (smoking, sleep position, and paternal employment) in this study, but a significant effect of very short breastfeeding on the risk of Sudden Infant Death Syndrome still remains. The mechanism of the protective effect of breastfeeding is not clear. It may be that breastfed infants had lower incidence of infections or that frequent feeding and closer contact with the mother decreases the risk of SIDS.
Alm, B. et al. Breastfeeding and the sudden infant death syndrome in Scandinavia, 1992-95. Arch kDis Child 2002;86:400-02

In this study population, breastfeeding resulted in the delayed onset of schizophrenia. In a subgroup of breastfed/mixed patients, age of onset of illness was later in those solely breastfed for at least four months when compared with others not breastfed.
Amore, M. et al. Can breast-feeding protect against schizophrenia? Biol Neonate 2003;83(2):97-101.

Infants with phenylketonuria were evaluated for the levels of long-chain polyunsaturated fatty acid and resultant neurodevelopment and visual acuity through the first year to determine the difference in infants bottle-fed and breastfed. Early feeds with LPUFAs, possibly by starting breastfeeding at birth, might more effectively repair and protect against damage while the infant’s brain still has plasticity.
Agostini, C. et al. Plasma long-chain polyunsaturated fatty acids and neurodevelopment through the first 12 months of life in phenylketonuria. Dev Med Child Neurol 2003;45(4):257-61.

Research shows a relationship between breastfeeding and weight control in later life.

In this time of high tech fitness clubs and interventional medicine, possibly the single most comprehensive and easily implemented treatment for a variety of health problems ranging from regulation of food intake to immunology is the inclusion of breast milk as a significant and sustained portion of the infant’s diet.
Locke, R. Preventing obesity: the breast milk-leptin connection. Acta Paediatr 2002;91(9): 891-96.

Programming is the process by which factors occurring in early life affect long-term health outcomes. Greater weight gain in infancy, and higher levels of leptin, can result in increased body fatness at a later time. The volume and percentage of human milk consumed in the neonatal period were significantly and negatively related to later leptin concentration relative to fat mass. The lower leptin resistance of babies fed mother’s milk may provide an additional mechanism for the long-term benefit of breastfeeding on adiposity.
Singhal, A. et al. Early nutrition and leptin concentrations in later life. Am J Clin Nutr 2002;75(6); 993-99.

Childhood obesity, related to obesity and cardiovascular disease in adulthood, is one of the most common nutritional disorders in industrialized countries. In this study of 33,768 Czech Republic children, the prevalence for obesity was 3.2 in breastfed children, compared with 4.4 in non-breastfed children. This finding has been consistent in research studies in Bavaria and in the USA.
Toschke, A. M. et al. Overweight and obesity in 6 to 14 year old Czech children in 1991: Protective effect of Breastfeeding. J. Pediatr 2002;141(6): 764-69.

There are individual components in human milk, which alone and in concert with other elements protect the breastfed infant.

Lactoferrin is a major nonimmune factor that is important in protecting infants from gastrointestinal infections. It is produced in human milk and other mucosal secretions and phagocytes. It has a bacteriostatic iron-binding capacity, it releases lipopolysaccharide, associated with bactericidal activity, it kills or slows bacterial growth synergistically with components in mucosal secretions including immunoglobulins, and binds Shigella porins in a way yet completely defined.
Gomez, H.F. et al. Human lactoferrin impairs virulence of Shigella flexneri. J Infect Dis 2003;187: 87-95.

Unlike infant formula, human milk has many antioxidants, catalase, superoxide dismutase, ascorbate, vitamin E, etc. Oxidative stress is intimately involved in pathologic processes of serious disease and is measured by the presence of urinary 8-hydoxy-2’-deoxyguanosine excreted in urine. This paper found that the presence of this chemical correlates with the percentage of formula intake, and was greatest in those fed infant formula as 90% breast milk as their diet.
Shoji, H. et al. Effect of human breast milk on urinary 8-hydroxy-2’-deoxyguanosine excretion in infants. Pediar Res 2003;53(5):850-52.

In a multi-layered defense system, human milk proteins and peptides have antimicrobial activity acting against pathogenic bacteria, viruses, and fungi. Hormones help to develop the intestinal mucosa and other organs of the newborn, limiting access. Oligosaccharides promote growth of Lactobacilli Bifidobacteria, beneficial bacteria which limit the growth of pathogens by decreasing intestinal pH. Cytokines, which are released in human milk, reduce inflammation. Further, the mother’s immunity to pathogens is transferred to her baby through sIgA, boosting the immature immune system of the newborn and this protection continues through the second year of lactation.
Lonnerdal, B. Nutritional and physiologic significance of human milk proteins. Am ;J Clin Nur 2003:77 (Suppl):1537S-43S.

The fatty acids in human milk are a “concerto” reflecting the quality of fat intake, the synthesis of carbohydrate-rich diets, and individual genetic disposition toward use, storage, and synthesizing of specific fatty acids. Each breastfed infant has a unique fat intake, both quantitatively and qualitatively, differing according to time of lactation, maternal diet, mothers’ genetic inheritance, culture, and country. This is one of the best examples of the non-reproducibility of human milk. The perfect formula already exists: Human Milk.
Agostoni, C. Compliance of present recommendations of fatty acids in formulas for term infants with the actual human milk fatty acid composition in different populations. Acta Paediatr 2003;92(7): 785-89.

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