Ignorant pediatrician's comment - help please - Page 2

[PatioGardener]

I like the AAFP policy - if I am remembering correctly that one actually says there are no negative effects from nursing into toddlerhood and beyond.

[mambera]

I've been looking for primary literature on extended breastfeeding for my own interest recently (because I am wondering how to balance nursing with TTC #2 for the future - don't want to shortchange DD on the BM but don't want to wait too long on the TTC either). I haven't been able to find much.

Originally Posted by elanorh

They must. Otherwise, why are there correlations pointed out in the AAFP policy about breastfeeding (that infants weaned prior to two years of age will be more likely to become sick), and why the WHO recommendations of breastmilk until the age of at least two?

I wonder whether it isn't more of a nutritional issue. A lot of the data on increased infant death/childhood illness for non-breastfed infants and children are from developing countries, and have a good deal to do with formula made with contaminated water, or bm replaced with nutritionally insufficient diets.

We are able to absorb probiotics that we ingest ourselves and have those impact our immune systems ....

What is a probiotic? The only other place I've heard that term is when formula companies say they put 'probiotics' (meaning amino acids) in their formula.

why else would our milk increase in its antibody levels when our kids are toddlers, eating more of other foods, and exposed to more germs? Our bodies are elegant machines (most of the time )- why are we expending our maternal energy making those antibodies of our babies can't absorb and use them?

IgA gets released in all kinds of bodily secretions like sweat, saliva, etc. Milk glands are modified sweat glands. I would think it was weirder if IgA were *not* in the milk, no?

We absorb antibiotics which we take orally as children and adults, I would expect that the same component is in play when infants/toddlers have antibodies in their mothers' milk.

But an antibiotic is really different from an antibody. One is an organic molecule while the other is a huge protein, hundreds of thousands of times larger. The gut sees proteins as food - it breaks them down into amino acids for reuse. You can't take IgG orally: when people need gamma-globulin it has to be given IV.

[Amila]

This is EXACTLY why I am going to school to be a LC. NOT because so many moms have trouble breastfeeding, but because they stop due to the ignorance of doctors and nurses!

[Tofu the Geek]

Originally Posted by mambera

What is a probiotic? The only other place I've heard that term is when formula companies say they put 'probiotics' (meaning amino acids) in their formula.

Probiotics are live, beneficial bacteria http://en.wikipedia.org/wiki/Probiotic

[mambera]

Originally Posted by Tofu the Geek

Probiotics are live, beneficial bacteria http://en.wikipedia.org/wiki/Probiotic

OK, so if you mean beneficial bacteria, then those aren't absorbed at all - they stay and populate the gut.

[elanorh]

Here's a direct quote from the AAFP position on extended breastfeeding:

Family physicians should be knowledgeable regarding the ongoing benefits to the child of extended breastfeeding, including continued immune protection

This passage cites #71 in the bibliography of studies included at the end of the statement. So if you're looking for a study which discusses the continued immune benefit of breastfeeding, this would be a place to start.

Here is a link to the entire position paper:
http://www.aafp.org/online/en/home/p...tionpaper.html

Kellymom always cites the studies she uses, and here's her page on extended breastfeeding, check out the research she cites as well:
http://www.kellymom.com/bf/bfextended/ebf-benefits.html

This link takes you directly to her links about immunological benefits of breastfeeding (extended): http://www.kellymom.com/bf/bfextende...#Immunological

I guess I'm a little surprised to hear anyone arguing that there's not research to back up breastfeeding beyond infancy having any immunological benefit once the gut is 'locked in' at 6ish months. There is a lot of research out there which shows that the immune properties are still impactful among breastfed infants beyond that age, not only for GI issues (e.coli or whatever) but for upper respiratory disease, etc.

80% of our immune system is located in our digestive tract, I've heard people say. If that's true, then obviously whether it's probiotics or the immune factors in breastmilk, it's getting put to effective use.

Also - I remember someone posting a link to UNICEF on the lactivism forum awhile ago, where their page on the USA stated that an estimated 770 babies die annually in the USA as a direct result of not being breastfed. So we may be a 'developed' nation where we can more safely feed formula to our kids, but breastmilk is still important enough that we have children in this country dying as a direct result of not having access to it. There are places in this country where the water is not safe to drink, and places in this country where access to quality medical care for an upper respiratory infection which might have been less severe had a child been breastfed, or for diarrhea which would not have led to such catastrophic dehydration if baby had been breastfed - still can result in a baby's life being jeopardized or lost. Breastmilk is important in the Developed world, too.

[mambera]

Originally Posted by elanorh

Here's a direct quote from the AAFP position on extended breastfeeding:

This passage cites #71 in the bibliography of studies included at the end of the statement. So if you're looking for a study which discusses the continued immune benefit of breastfeeding, this would be a place to start.

I read that study. It says that the concentrations of leukocytes and IgA are maximal in colostrum, fall at 8 weeks (leukocytes) to a few months (IgA), and are essentially steady thereafter until weaning.

Kellymom always cites the studies she uses, and here's her page on extended breastfeeding, check out the research she cites as well:
http://www.kellymom.com/bf/bfextended/ebf-benefits.html

This link takes you directly to her links about immunological benefits of breastfeeding (extended): http://www.kellymom.com/bf/bfextende...#Immunological

Kellymom cites four primary sources. One is from Bangladesh, and one is the study you mentioned above, showing no change in the immunological components of milk after the drop in IgA/leukocyte concentrations in the first few months. A second looks infants only, and ends at 19 weeks. The other one is from a journal to which my institution doesn't subscribe (Pediatric Nursing - would you happen to have access to this by chance? I'd love to have a look).

Like I said, the research is pretty thin.

[annekevdbroek]

That sounds very frustrating. I do encourage you to write a letter. If you include articles or reference to articles then look for information from peer-reviewed professional journals. These will carry far more weight with the doctor than a webpage or magazine article.

Here is a possible example (no abstract available though, so sorry)

http://www.ncbi.nlm.nih.gov/pubmed/1...m&ordinalpos=2

and these recent articles

http://www.ncbi.nlm.nih.gov/pubmed/18676572?ordinalpos=1&itool=EntrezSystem2.PEntrez. Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.P ubmed_Discovery_RA&linkpos=2&log$=relatedarticles& logdbfrom=pubmed

Check out pubmed.org for a good source of articles.

Since behavior happens to fall w/in my professioanl area I'd be all over that "negative attachments to mother" statement like white on bread and probably send him out of the exam room with his tail between his legs.

[elanorh]

Originally Posted by mambera

The other one is from a journal to which my institution doesn't subscribe (Pediatric Nursing - would you happen to have access to this by chance? I'd love to have a look).

Like I said, the research is pretty thin.

No, I don't have access to that. I would imagine that one could get access by subscribing or visiting a library which has access.

I think the immune-specific aspect of this discussion has probably gone far beyond the scope of the OP's question, but it's probably an aspect which is worth continuing to discuss. So, am going to spin the topic off into a new thread.

ETA:
Here's a link to the new thread I started for the immune-specific discussion, for anyone who wants to follow that thread:
http://mothering.com/discussions/sho...3#post14699113

[Peace+Hope]

not that you'd want to ask him, but i'd be SOOOO interested to hear about the pear-reviewed journal articles he's reading that back up his claims, namely that breastfeeding into toddlerhood or beyond creates issues for attachment and prevents normal toddler behaviors from developing.

um.... anyone else doubt that this research exists?


btw, i'm a lurker here, just reading and preparing...

[mambera]

Originally Posted by annekevdbroek

Here is a possible example (no abstract available though, so sorry)

http://www.ncbi.nlm.nih.gov/pubmed/1...m&ordinalpos=2

I don't think that would be helpful, because it is a lactivist letter without supporting data; and on the very next page the author replies:

"I thank Ms. Gubala for pointing out that some women continue to breastfeed babies through the toddler years, and I am personally grateful that my wife breastfed all six of our children beyond their first year. I agree that physicians should not discourage this decision, as there is no evidence that breastfeeding toddler-age children is harmful.

Unfortunately, the evidence for the benefit of breastfeeding beyond 12 months of age is scant and of poor quality. Although the World Health Organization (WHO) recommends breastfeeding through 24 months of age, this guideline is based on expert consensus and lower-quality cohort studies.[1] [2] [3] [4] WHO also focuses on developing countries, and notes that extended breastfeeding is controversial outside of sub-Saharan Africa and has been associated with malnutrition in some surveys.[5]

Although the American Academy of Pediatrics allows for breastfeeding beyond the first year of life, this should not be interpreted as a universal recommendation.[6] Scientific data on nutritional or other benefits in this age group are lacking. Finally, although I agree that more evidence is supporting decreased obesity as a positive benefit of extended breastfeeding, a careful review of the Grummer-Strawn analysis mentioned by Ms. Gubala reveals that “longer duration” of breastfeeding means six to 12 months, with no measurement beyond 12 months."

and these recent articles

http://www.ncbi.nlm.nih.gov/pubmed/18676572

The authors of that trial conclude:
"On the basis of the largest randomized trial ever conducted in the area of human lactation, we found no evidence of risks or benefits of prolonged and exclusive breastfeeding for child and maternal behavior."

(free full text at http://pediatrics.aappublications.or...ull/121/3/e435)

Basically, overall it sounds like there is neither benefit nor harm to extended breastfeeding, except a possible slight risk of malnutrition in older children who don't take much solid food.