The Report on the WHO Collaborative
Study on Breastfeeding, Geneva, 1981.
Infant Metabolic Alkalosis and SoyBased 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.





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




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
 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
%
ever
BF
%
BF
6 mo
%
BF
12
mo
%
exclusive
BF
3 mo
%
exclusive
BF
6 mo
State child
care center
regulation
supports
lactation
US
75
44
24
35
15
TX
75
42
23
31
14
HP
82
2020
HP
75
2010
61
34
44
23
Not
optimal
N/A
50
25
40
17
N/A
 Nutritional: Excellent bioavailability, significant
nutrient-nutrient interactions not replicable in
formula
 Immunologic: Decreased risk 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

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
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







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

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
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
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

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






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






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.
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

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




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