By Isabel Simard, MS, RD, CLE
Breastfeeding offers many benefits. Some of the benefits for infants include protection against respiratory, gastrointestinal infections and otitis, higher IQ, reduced diarrhea and constipation, less allergies and better visual acuity. In the last few years, research observed that breast milk may also help in the prevention of obesity and overweight. The Surgeon General1 states that: "the normal growth pattern for breastfed infants is to gain less weight and to be leaner at 1 year of age than formula-fed infants, while maintaining normal activity and development. This early growth pattern may influence later growth patterns, resulting in less overweight and obesity among children who were breastfed."
The duration and amount of breastfeeding will influence the protective effect on preventing overweight and obesity. A dose response explains that the longer you breastfeed, the less your chances of becoming overweight or obese.2 For example, children who were exclusively or mostly breastfed for the first 6 months of life had significantly lower risk of being overweight than those exclusively or mostly formula-fed. Similarly, overweight risk was lower among the children who were breastfed for at least 7 months compared with children breastfed for 3 months or less. Table 1 shows the dose-response between the duration of breastfeeding and the prevalence of overweight or obesity.3
Inside This Issue
Breastfeeding: Healthy Mothers and Healthy Babies Page 2
Breastfeeding Around the World Page 2
Orange County Breastfeeding Coalition Website Page 3
No Butts about it: Women should avoid smoking while breastfeeding Page 4
Highlighting the Certified Lactation Educator Page 5
Table 1. Breastfeeding Protection on overweight and obesity3
Duration of Breastfeeding
Prevalence (%) of: Becoming Overweight
Becoming Obese
Never breastfed (n = 4022) 12.6 4.5
Ever breastfed (n = 5184) 9.2 2.8
Exclusively breastfed for:
2 months (n = 2084) 11.1 3.8
3-5 months (n = 2052) 8.4 2.3
6-12 months (n = 863) 6.8 1.7
> 12 months (n = 121) 5.0 0.8
continued on page 3
By Aimee Johnson, RD, CLE
Breastfeeding: Healthy Mothers and Healthy Babies1, underscores the urgent need to protect, promote and support the health and well being of mothers as well as the need to protect, promote and support breastfeeding for healthier babies and children.
Breastfeeding can be a means to promote good health of both mother and baby. For the mother, breastfeeding can protect a mom from certain health problems. Studies have shown that mothers who breastfeed are less likely to develop breast cancer, ovarian cancer and osteoporosis. For the baby, breastfeeding provides perfect nutrition by containing all the components to aid in the development of the baby's brain and nervous system. Also breastfeeding provides immunities for the baby to protect against infections and decreases the risk for certain diseases.
This years breastfeeding theme, Healthy Mothers and Healthy Babies1, sets the goal to improve mothers and babies health so they have a pleasurable breastfeeding experience while promoting their own health. Moms would benefit by being educated on the following:
Even when obstacles arise, breastfeeding can be maintained with the support of health care providers, family, friends and support groups such as La Leche League or the local WIC Agency.
References
1. World Alliance for Breastfeeding Action. World
Breastfeeding Week. www.waba.org
By Isabel Simard, MS, RD, CLE
Every year, the World Alliance for Breastfeeding Action (WABA) develops a theme for World Breastfeeding Week, which is held from August 1st to 7th. With this year's theme "Breastfeeding in a Globalized World: for peace and justice," we need to take a closer look at what goes on in other countries in regards to breastfeeding. It is important to also understand what is being done worldwide to promote, protect and support breastfeeding.
Breastfeeding rates vary greatly around the world. It is
important to take a closer look at what's going on to improve our
current initiation and duration breastfeeding rates. Countries such
as Sweden and Norway have breastfeeding initiation rates of
98% and about 55% and continue to exclusively breastfeed past
6 months of age.1 While in the United States, barely 60%
initiate breastfeeding, while less than 20% continue to breastfeed past
6 months.1 Breastfeeding rates in the United States are among
the lowest in the entire World. Many factors will contribute to
either
continued on page 4
Breastfeeding Times-Page
3
Now you can visit their website at: www.ocbreastfeedingcoalition.org
At this website you can find information on resources and directories for lactation clinics, equipment purchases or rentals, breastfeeding classes and support groups in Orange County. Also available are helpful links to websites such as The American Academy of Pediatrics and Lactational Pharmacology that provide breastfeeding information.
This website will also keep you current on Breastfeeding Laws and provide you with a calendar of upcoming events that focuses on breastfeeding education, promotion and support.
If you are interested in becoming a member of the Orange County Breastfeeding
Coalition you can obtain membership information and an application on-line.
continued from page 1
How do we explain the protective effect of breastmilk on
overweight and obesity?
It has been shown that levels of docohexanoique acid (DHA) and long chain polyunsaturated fatty acids in skeletal membrane are associated with insulin resistance and obesity in adults. A low concentration of these fats stimulate fat deposition and early development of fat cells (adipocytes). These fats are present in large amounts in breast milk but not found in most formulas. This may explain the protective effect of breast milk (Baur et al. Metabolism 1998 106-112).
Maternal control over feeding may also contribute to overweight/obesity. High levels of maternal control on what, when and how much the child eats is associated with an increase in overweight/obesity. Breastfeeding mothers don't control their infant's eating habits since they nurse when the child is hungry and the child decides when he is done eating. Formula-feeding mothers tend to feed their baby by the clock and they decide how much the child will drink by looking at what is left in the bottle.
It is important to keep in mind that breastfeeding is not the only factor influencing obesity later in life. Other factors include genetics, high food and fat intake, low education level, low socioeconomic status, etc.4 Even if breastfeeding is not the only factor influencing obesity, it gives the child a good start in preventing overweight/obesity later on in life.
References
Let's continue promoting breastfeeding! It does a body good!
1. HHS Blueprint for Action on Breastfeeding (can be found at www.4women.org)
2. Dietz WH. Breastfeeding may help prevent childhood overweight. JAMA. 2001 May 16; 285 (19):2506-7.
3. Von Kries R, Koletzko B., Sauerwalk T. von Mutius E, Barnert D, Grunert V, von Voss H. Breastfeeding and obesity; cross sectional study. BMJ. 1999 Jul 17; 319 (7203):147-50.
4. Butte NF. The role of breastfeeding in obesity. Pediatr Clin North Am 2001 Feb; 48(1): 189-98.
By Aimee Johnson, RD, CLE
It is well documented that smoking cigarettes during pregnancy is hazardous to the health of the baby. This might have been enough of an incentive for a pregnant woman to cut down or quit. Although with best intentions, it is recognized that there are some women who are unable to stop smoking cigarettes.1 These women may wonder how this will affect breastfeeding and their baby.2
Nicotine from smoking tobacco and its primary metabolite, cotinine, appear in breastmilk.1 Nicotine initially stimulates then depresses the central nervous system.3 The total amount of nicotine and metabolites present in breastmilk depends on the number of cigarettes per day and the time between the last cigarette and breastfeeding.3 The fewer the cigarettes smoked the less chance of difficulties that arise.2 In general, if a mother smokes less than a pack (20 cigarettes) a day, the amount of nicotine in her milk is usually not enough to cause a problem for the baby.2 Nicotine is not readily absorbed by the baby's intestinal tract.2 If intake is gradual over a day's time, the baby would metabolize it in the liver and excrete the chemical through the kidneys.
When a nursing mother smokes heavily (more than 20 cigarettes a day), the risks increase.2 Heavy smoking can reduce a mother's milk supply3 and on rare occasions can cause symptoms in the nursing baby such as nausea, vomiting, abdominal cramps and diarrhea.2
Prolactin, a hormone essential to milk production, has been shown to be in lower levels in nursing mothers who smoke versus non-smokers.2 When lactating women who smoked more than 15 cigarettes a day were compared with lactating women who did not smoke at all, the prolactin levels were significantly lower in smokers. Also nicotine has been shown to interfere with let-down reflex2-3 (the release of milk from the tiny sacs where milk is made). For these reasons, many smokers stop nursing and start supplementing with infant formula.
If a nursing mother smokes, her infant is more likely to have colic symptoms and more respiratory infections than if she didn't smoke. One study, by Matheson and Rivrud, showed that the relationship to colic in infants breastfed by a smoker is significant. Forty percent of infants breastfed by smokers (35 cigarettes/day) had infantile colic, defined as 2 to 3 hours a day of excessive crying compared with 26% of those breastfed by non-smokers.3
Breastfeeding reduces the risk of Sudden Infant Death Syndrome (SIDS) however smoking negates this advantage. SIDS is more common in infants of smokers.2 Breastfed infants of smokers have a SIDS rate equal to that of bottle-fed infants of nonsmokers.3
Nicotine patches or nicotine chewing gum are sources of nicotine to assist with smoking cessation. These however have not been studied sufficiently to make recommendations for or against their use by breastfeeding women.3
Pregnancy and lactation are ideal occasions for physicians and other health care workers to urge cessation of smoking. If a mom can't seem to quit she should (1) decrease smoking as much as possible, (2) avoid smoking just before nursing and (3) avoid smoking in the same room with her baby.
References
1. American Academy of Pediatrics Policy Statement. The Transfer of Drugs and Other Chemicals Into Human Milk. www.aap.org/policy/0063.html
2. La Leche League International. The Womanly Art of Breastfeeding. 6th Edition. Schaumburg, Illinois. pgs. 369-370.
3. Lawrence, Ruth, MD. Breastfeeding, A Guide for the Medical
Professional. 5th Edition. Mosby, New York. pgs. 533-535.
continued from page 2
improving or reducing initiation and duration rates. Some of
these factors are: family and healthcare support, lack of
education, strong marketing of formula companies and free artificial
baby milk (formula) as well as the length of maternity leave.
Many countries follow the International Code of
Marketing Breast milk Substitutes, which
"Aims to promote infant nutrition by
protecting breastfeeding
continued on page 5
Breastfeeding Times- Page
5
By Isabel Simard, MS, RD, CLE
Announcing new Certified Lactation Educators!
In April 2003, a total of 30 WIC staff from OCHCA, Planned Parenthood, Camino Health WIC Programs and OCHCA Public Health Nurses attended the UCLA extension Certified Lactation Educator (CLE) training program. Special funds obtained by OCHCA Nutrition Services/WIC Program allowed this specialized training to be brought to Orange County.
The UCLA extension CLE Training Program consists of 6 full days of classroom lectures, 12 hours of student clinical consultations, 10 hours of community observation and additional written assignments. The program provides comprehensive "hands-on" and theoretical training. After completing this training, CLEs will be able to conduct breastfeeding classes to the community, teach other professionals about lactation, provide practical information and assist women and their infants to successfully breastfeed (either via phone counseling or in person).
The work is intensive, but the payoff is worth it. Those who have completed the course testify to the exceptional training and experience they gained and show great pride in their accomplishments. Delia Aponte, CLE says, "Before taking the CLE class, we had the wish to help clients, and now we also have the knowledge. I feel more comfortable and can better help clients." Carmina Estrada, CLE adds, "It helped me realize the role that I play by experiencing how women feel. I learned more techniques and feel more comfortable in supporting breastfeeding." Patricia Sterling, RN, CLE and Margie Carrigan, RN, CLE both said that they now feel more comfortable assisting women in breastfeeding. These new CLE graduates serve as role models for others and have demonstrated enhanced skills and confidence in all aspects of breastfeeding support. Robin Bradley, Program Manager from Camino WIC, says, "I greatly appreciate the opportunity to provide this educational opportunity to my staff." And Andrea Aquino, Program Manager for Planned Parenthood WIC, adds, "This is a very practical and important training."
Most of those who attended the CLE Training Program are bilingual (Spanish/English and Vietnamese/English). Therefore, current breastfeeding support and promotion activities will be enhanced and linguistically appropriate. "Clients feel more comfortable discussing their breastfeeding problems in their native language," says Delia Aponte, CLE. With addition of these new CLEs, an increase in breastfeeding initiation and duration rates of OC can be expected.
Congratulations to all our new CLE Graduates on their achievements and contributions to promoting and supporting breastfeeding in Orange County!
Delia Aponte
Heather Bell
Aptril Boyle
Margie Carrigan
Blanca Casas
Aurora Chavez
Gloria Chavez
Myra Diaz
Gina Di George
Maria Eaton
Carmina Estrada
Monina Fournier
Kathy Garcia
Elizabeth Gomez-Bautista
Sylvia Holguin
Sandra Lara
Cynthia Martinez
Janette McMillin
Florine Miller
Maricela Quintana
Norma Ramirez
Katie Rankell
Flower Ray
Wendy Sherman
Julee Stand
Caroline Statzula
Patricia Sterling
Lacy Tubbs
Belen Uriarte
Janet Winter
continued from page 4
from inappropriate marketing of infant formula and other
breast milk substitutes."2 It is a minimum standard, enforceable
through "national legislation, regulations or other suitable
measures." Unfortunately, the United States shows no compliance with
this code.2 This makes it easy for formula companies to bombard
new mothers with free formula and discounts, making it easy for
them to quit nursing if any problems occur.
Many mothers in the United States are under the impression that once they return to work, they need to cease breastfeeding their child. They believe that working and breastfeeding is just not possible. In California, the Lactation Accommodation Law helps women returning to work successfully continue to exclusively breastfeeding their child. Unfortunately, many are not aware of this law and discontinue nursing upon their return to work. Many end up breastfeeding for a short period since the length of maternity leave is so short. In Norway, mothers can get 42 weeks of maternity leave with full pay or 52 weeks with 80% of pay.3 Canada also offers 1 year of maternity leave with 60 to 80% of pay. While in the United States there is currently no law that determines the salary and length for maternity leave. In most cases, a mother will get about 6 weeks, non-paid of family leave.
It clearly appears that the United States needs to take action to increase their breastfeeding rates. By modeling the advances in breastfeeding promotion and support of countries such as Sweden and Norway, we can have an impact on breastfeeding rates in our country. Everyone needs to play their part.
References/ Resources
1. www.childinfo.org/eddb/brfeed/test/database.htm
2. www.breastfeeding.asn.au/advocacy/who.html
3.
www.waba.org.br/countryfiles1.htm
Breastfeeding Times - Page
6
Breastfeeding Times is a newsletter published by the County of Orange Health
Care Agency/Nutrition Services.
Editors
Isabel Simard, MS, RD, CLE
Contributers
Aimee Johnson, RD, CLE
Isabel Simard, MS, RD, CLE
Breastfeeding Questions: (714) 834-7874
E-mail: isimard@ochca.com
FAX: (714) 834-8028
Pony: Building #50, Nutrition Services/ Breastfeeding Times
For information on the Orange County Breastfeeding Coalition: (714) 834-7986
Published by the Orange County Nutrition Alert Coalition
County of Orange Health Care Agency
Public Health Division
Nutrition Services Program
DTP260
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