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Chapter 1 Index
A. General Information
about the well child examination B. Nutrition Issues |
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Breastfeeding – Advantages and Disadvantages
Introduction: Pediatricians are all aware that the most
advantageous way to feed babies is by breastfeeding. However, there are a
number of problems with breastfeeding and those need to be listed as well so
that we can deal with them.
Advantages of Breastfeeding:
- Protection from infection: diarrhea, otitis media,
respiratory infections such as bronchiolitis, meningitis; particularly
protective in very low birth weight babies.
- Reduced number and intensity of atopic diseases.
- Protection from SIDS.
- Protection from NEC and sepsis in the preterm
infant.
- More protein available to preterm infant for growth:
leads to higher IQ – one study found an 8 point increase.
- Protection for the mother: reduced risk of
premenopausal breast and ovarian cancer and postmenopausal osteoporosis.
Problems with and Contraindications to Breastfeeding:
- Mastitis and pain due to trauma, infection.
- Jaundice: produces undue concern in parents, but higher levels in
breastfed. Note the difference between breastfeeding jaundice
(dehydration) and breast milk jaundice (hormonal influence).
- Dehydration: hypernatremic: unfortunately not too uncommon; occ
hypoglycemia.
- Failure to thrive: remains a problem particularly for the nervous,
intense parents.
- Doesn’t always work: many factors that contribute to this, but when it
doesn’t work, mothers often feel like they have failed. Important are:
support systems at home, work, at the doctor’s office; stress, fatigue;
improper advice.
- Caries – less than formula fed but still high if nurse more than a
year.
- Rickets – much more common now – seen in darker skinned babies who
don’t get much sunlight. Recent article about Georgia babies.
- Contraindications: there are a number of contraindications that we
need to know:
a. Galactosemia in baby; PKU: can breastfeed but must follow levels.
b. Conditions in mother: HIV, breast cancer, tb, psychosis, neurosis,
syphilis, malaria; Interrupt: breast abscess, sepsis, mastitis, herpes of
nipple.
c. Medications: recent summary in Pediatrics Sept 2001 pg 776:
i. Cytotoxic drugs such as Cytoxan, Daunomycin, Methotrexate,
Cyclosporine
ii. Drugs of abuse: amphetamine, cocaine, heroin, marijuana
iii. Radioactive compounds
iv. Many drugs unknown or give with caution such as lithium,
Phenobarbital, primidone, antidepressants, antipsychotics
Conclusions: Breast milk is less allergenic, with less
polyunsaturated fat and is the best food for babies. However, the above list
must be recognized and treated appropriately.
Written 10/01
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