|
POSITION PAPER
ON BREASTFEEDING DEVICES AND BREASTMILK PUMPS
(Back to Top)
May 20, 2009 by Elisabet Helsing, Pamela Morrison and
Felicity Savage
Feeding at the breast is
important. Species specific milk provides babies with food,
care and immunological protection tailored to their
environment. Breastfeeding is more than “breast-milk
feeding”. Breastfed babies have skin to skin contact with
their mother many times a day, which calm and stabilize them
physiologically, and suckling releases hormones in the
mother which enhance her emotional response to her child.
All these effects are vital for a child’s neurological
development and psychological health.
Breastfeeding existed for thousands of years without any
special gadgets being judged necessary. Breast pumps and
nipple shields of various designs have been used since at
least the 16th Century, for upper class women who
experienced engorgement and other difficulties, or who
wanted to be away from their babies for a time. After the
Second World War came the nursing bra, primitive
breastfeeding pumps and other manufactured aids destined for
a dwindling market of breastfeeding mothers. In the 1970s
this market grew, as mothers in some countries took to
breastfeeding after a period of severe decline.
Today most mothers realize the importance and value of their
milk for their infants. However, with the loss of
breastfeeding skills, and resuming work a few weeks after
delivery, many have needlessly become breast pump users, and
breast milk feeders instead of breastfeeders.
WABA is concerned that
pumps and other devices are now marketed in a way that
induces women to use them unnecessarily, adversely affecting
breastfeeding and maternal and infant health. Many of those
who assist and advise mothers have also come to believe that
the use of devices and aids is normal and necessary. This is
particularly likely in societies where breastfeeding in
public is discouraged, where social constraints may make
breastfeeding cumbersome, and where weak maternity
protection laws result in short maternity leave and poor
facilities at work so that breastfeeding is difficult to
sustain.
Pumps and other devices
are of course useful in some cases: when a mother or baby
has severe problems, sometimes as a result of mismanagement
of breastfeeding, or they are unavoidably separated. These
are real needs which can be defined. This is the real
market.
However, markets do not automatically adjust to real need,
but may be both created and manipulated. The tendency for
those who live off markets is to do what they can to make
them grow, regardless of real need. In many cases this does
not negatively influence the health and well-being of
families. But using devices can disturb the fine balance
between mother and baby, in which babies regulate breast
milk production by suckling at the breast. Below a few
examples are given which by no means exhaust the number of
special items being marketed to the breastfeeding mother
today:
¨
Pacifiers (dummies or soothers)
The use of pacifiers can
lead to a baby suckling less, so that breast stimulation is
reduced, less milk is produced, and the mother may stop
breastfeeding prematurely. This is a risk, especially in the
first 6-8 weeks of the baby’s life, before suckling and the
use of the muscles in and around the mouth is well
established.
¨
Soft plastic nipple shields
Although sometimes used
to assist attachment to the breast in certain cases such as
inverted nipples and to reduce pain when nipples have become
damaged and painful, inappropriate use of these items may
also compromise a baby's ability to attach to the breast.
They should only be used if physiological methods of
improving attachment and/or treating sore nipples have been
tried and failed. Their use in individual cases should be
periodically reviewed with the aim of using them for the
shortest possible time so that breastfeeding can continue
without the use of a shield as soon as is practically
possible.
¨
Breastfeeding inlays or breast pads
These protect clothes
against leaking milk. Those
that have a plastic cover on the outside also keep
the skin moist and increase the chances of bacterial
proliferation leading to sore or infected nipples and their
use should be discouraged.
¨
Breast pumps
The need is generally for
pumps in situations when a mother and baby must be
separated, or when the physical health of a mother or her
baby is compromised. Pumps may also be needed by women
unable to effectively hand express their milk, some of whom
could not continue to breastfeed without them. In all cases,
a breast pump should be used for the shortest possible time
until effective hand-expression can be learned or normal
breastfeeding can be initiated or resumed. The aim should
always be to protect breastfeeding and preserve breastmilk
production, or to stimulate its increase.
The market for pumps
therefore should be clearly circumscribed. Over-zealous
marketing has however led to inappropriate and unnecessary
misuse and overuse of breast pumps and even to dependency on
pumping and breastmilk-feeding by bottle as a substitute for
feeding at the breast. In addition, the use of poor quality,
ineffective breast pumps, or the use of pumps too early, or
for too long, can lead to inadequate drainage of milk from
the breasts, contributing to lactation failure.
WABA is concerned about
creation of a potential conflict of interest if health
professionals and breastfeeding counselors receive funds or
sponsorship from manufacturers of breast pump and other
breastfeeding aids and devices. Health professionals and
breastfeeding counselors need to remain unbiased when they
give professional advice to women. The employment of such
devices should be confined to situations where there is
reasonable evidence that they will protect, preserve and
enhance breastmilk production and ultimately assist mothers
to breastfeed effectively. Recommendation of a product
should be determined by its known effectiveness and
appropriateness for the woman being advised. There should be
no possibility of commercial influence on this advice.
Final, May 20,
2009 by Elisabet Helsing, Pamela Morrison and Felicity
Savage
CDC: Rocket
fuel chemical found in baby formula
(Back to Top)
By MIKE STOBBE, AP Medical Writer - Fri Apr 3, 3:36 AM PDT
ATLANTA - Traces of a chemical used in rocket fuel were
found in samples of powdered baby formula, and could exceed
what's considered a safe dose for adults if mixed with water
also contaminated with the ingredient, a government study
has found.
The study by scientists at the U.S. Centers for Disease
Control and Prevention looked for the chemical, perchlorate,
in different brands of powdered baby formula. It was
published last month, but the Environmental Working Group
issued a press release Thursday drawing attention to it.
The chemical has turned up in several cities' drinking water
supplies. It can occur naturally, but most perchlorate
contamination has been tied to defense and aerospace sites.
No tests have ever shown the chemical caused health
problems, but scientists have said significant amounts of
perchlorate can affect thyroid function. The thyroid helps
set the body's metabolism. Thyroid problems can impact fetal
and infant brain development.
However, the extent of the risk is hard to assess. The
government requires that formula contain iodine, which
counteracts perchlorate's effects. The size of the infant
and how much formula they consume are other factors that can
influence risk.
The study itself sheds little light on how dangerous the
perchlorate in baby formula is. "This wasn't a study of
health effects," said Dr. Joshua Schier, one of the authors.
The largest amounts of the chemical were in formulas derived
from cow's milk, the study said.
The researchers would not disclose the brands of formula
they studied. Only a few samples were studied, so it's hard
to know if the perchlorate levels would be found in all
containers of those brands, a CDC spokesman said.
Earlier this year, the U.S. Environmental Protection Agency
said it was considering setting new limits on the amount of
perchlorate that would be acceptable in drinking water. A
few states have already set their own limits.
The EPA has checked nearly 4,000 public water supplies
serving 10,000 people or more. About 160 of the water
systems had detectable levels of perchlorate, and 31 had
levels high enough to exceed a new safety level the EPA is
considering.
How PCBs May
Alter In Utero, Neonatal Brain Development
(Back to Top)
ScienceDaily (Apr. 14, 2009) — In three new studies —
including one appearing online today in the Public Library
of Science - Biology (PLoS - Biology) — UC Davis researchers
provide compelling evidence of how low levels of
polychlorinated biphenyls (PCBs) alter the way brain cells
develop.
The findings could explain at last — some 30 years after the
toxic chemicals were banned in the United States — the
associations between exposure of the developing nervous
system to PCBs and behavioral deficits in children.
"We've never really understood the mechanism by which PCBs
produce neurobehavioral problems in children," said Isaac N.
Pessah, professor of molecular biosciences, director of the
UC Davis Center for Children's Environmental Health and
co-author of all three studies.
"With these studies we have now shown — from the whole
animal level to the molecular level — how PCBs alter the
development and excitability of brain cells. And that could
explain why PCBs are associated with higher rates of
neurodevelopmental and behavioral disorders," said Pessah,
who is also a researcher with the UC Davis M.I.N.D.
Institute.
Together, the studies — published within one month of each
other — make a compelling case for the mechanism behind
PCBs' harmful effects on human neurological development.
In a groundbreaking animal study appearing online in late
March in Environmental Health Perspectives, Pessah
and his colleagues found that low-level, in utero and
neonatal exposure to PCBs altered the development of brain
cells in rats.
A second study in Toxicology and Applied Pharmacology,
also appearing online in March, showed which PCBs affected
brain-cell circuits in the hippocampus, a region of the
brain known to be impaired in several complex
neurodevelopmental disorders including autism.
The third study, which appears online April 13 in PLoS -
Biology, describes in detail the molecular target of the
PCBs, the calcium channels known as ryanodine receptors, and
shows that PCBs lock these calcium channels in the open
position, which likely contributes to the over-excitations
on neural circuits observed in the two other studies.
PCBs were used in a wide variety of products including
transformers and capacitors and other electronic components,
pesticides and flame retardants, from the early to late 20th
century. Their production was banned in the 1970s due to the
high toxicity of most PCBs. They do not break down in the
environment and accumulate in animals' bodies. Exposure
occurs when chemicals dumped into the environment years ago
are released into the air or leach into groundwater and
contaminate fish that people eat.
"Not only will this help us deal with current exposures,"
Pessah said, "but we can also identify similar compounds
that have come on line since PCBs were banned and make
better decisions about which ones we restrict and which new
ones we allow to come to market."
PCBs have been implicated in epidemiological studies as an
environmental cause of diverse neurodevelopmental disorders,
including ADHD, learning disabilities, sensory deficits,
developmental delays and mental retardation
"There is a large body of scientific literature in humans
that points the finger at PCBs, linking them to
neurodevelopmental problems we see in kids," said Pamela
Lein, lead author of the Environmental Health Perspectives
animal study and a UC Davis associate professor of molecular
biosciences.
"The problem is that it has been difficult to establish a
cause-and-effect relationship from the human epidemiological
literature without a known mechanism," Lein said. " Now that
we have a plausible biological mechanism that could account
for neurodevelopmental deficits, we can use the information
for diagnosis and for developing potential treatments for
PCB exposure."
Environmental Health Sciences study
The study published in Environmental Health Sciences shows
that exposure to PCBs in utero and through mothers' breast
milk alters a characteristic of neuronal development called
dendritic plasticity in young rats. Dendrites are the small,
branch-like projections on a neuron that receive signals
from other cells in the body. The shape of dendrites changes
in response to signaling activity — the phenomenon known as
dendritic plasticity. Lein performed the exposure and
behavioral studies with colleagues while a researcher at the
Johns Hopkins University.
In the study, researchers tried to mimic the low levels of
PCB exposure that human children might experience.
Experimental rats were fed PCB-laced cookies, while control
rats ate normal cookies. Then, when rat pups were weaned
from their mothers, they were trained in a water maze to
test their ability to use visual cues to learn the location
of a platform hidden under the surface of the water. The
test has been used in other studies to stimulate dendritic
growth, which makes it ideal for measuring effects of
toxicants on dendritic plasticity.
The researchers looked at the pattern of dendritic growth in
trained and untrained animals from both the control and
experimental groups. They found that PCB exposure
accelerated dendritic growth in the untrained experimental
animals when compared to untrained controls. The trained
PCB-exposed animals, however, took longer to learn the water
maze and showed reversal of dendritic growth in response to
water-maze training. This was in contrast to controls, which
showed learning responses and increases in dendritic growth,
as predicted by other published studies.
"This tells us that PCBs are altering dendritic growth and
plasticity," Lein said.
The results are important because problems in dendritic
growth and plasticity have previously been implicated in
many neurodevelopmental disorders, including autism,
schizophrenia and mental retardation, she said.
"Dendritic plasticity is important to how we process
information and, when you perturb that, you interfere with
complex behaviors like learning and memory," Lein said.
Pessah and his colleagues showed that brain tissue from
untrained rats exposed to PCBs expressed higher levels of
the ryanodine receptors.
"We think PCBs are increasing the activity of these calcium
channels, which we know generate the signals needed for the
extension and branching of dendrites," Pessah said.
He said he believes PCBs lead to overgrowth of dendrites and
inhibition of neuronal pruning that takes place during
gestational development. Brain cells exposed to PCBs cannot
then respond properly to learning.
Toxicology and Applied Pharamacology study
In the study appearing in Toxicology and Applied
Pharmacology, Pessah and his colleagues examined the
hippocampus, one region of the brain involved in water-maze
learning. The researchers measured the excitability of
neurons in hippocampal brain tissue of rats before and
during exposure to two structurally different PCBs.
Neurons process and transmit information in the form of
electrical signals. Their electrical excitability is due to
the presence of voltage-sensitive ion channels that directly
communicate with ryanodine receptors that reside inside the
cell. When excitation is blocked, it is called inhibition.
Normal information processing involves a complex balance
between excitation and inhibition.
The researchers found that the two PCBs had different
effects. The more potent, PCB95, enhanced the excitability
of the brain cells. Researchers were able to decrease this
effect by adding a chemical that dampens ryanodine
signaling, again implicating the calcium channel as being
the key to the disruptions caused by PCBs. The second
compound, PCB170, first excited the circuitry, but then the
signals returned to baseline because of enhanced inhibition.
These results are significant to the understanding of the
potential impact of PCBs on human neurodevelopment, Pessah
said.
"We think that in autism, for example, at-risk children have
deficient inhibitory circuits. So, if you have a PCB that
promotes the excitatory side of the circuit, they would be
much more at risk of developing the disorder," he said. "In
fact, we chemically blocked inhibitory circuts that unmasked
the purely excitotoxic properties of PCB170."
PLoS - Biology study
In the collaborative study between researchers at Davis and
Harvard that appears in PLoS-Biology today, researchers
showed that PCBs dramatically stabilize the ryanodine
receptor in the "on position," which could explain how PCBs
are altering brain cell development (as seen in the first
study) and altering their excitability (as seen in the
second).
"We needed evidence that these compounds directly interact
with what we believed to be the target of PCBs," Pessah
said.
To that end, the researchers exposed purified ryanodine
recptors to PCBs and used electron microscopy to generate
extremely high-resolution images of this interaction.
"Our results show that PCB binds directly to ryanodine
receptors and locks the channel in the open state, causing
mayhem in calcium signaling," Pessah said. This, he added,
would account for the effects seen in the first two studies.
"These channels are a target for PCBs, and they are
contributing to brain cell dysfunction, even at the
behavioral level."
Pessah said that, as early as 1995, he and his colleagues
suspected ryanodine receptors were one of the principal
targets of PCBs.
"In cellular studies, we couldn't find a way to block the
effects of PCBs unless we blocked ryanodine receptors," he
said.
Many studies used high doses of PCBs to find subtle or no
changes from control. However, in the animal study, Lein
actually used both high and low doses. She found that the
low-dose group showed more pronounced effects on dendritic
growth in the weanling rats than the higher dose.
According to Pessah, the brain has ways of dealing with high
levels of toxicity.
"We think that one of the major reasons we have not seen
effects in previous studies is that at higher doses PCBs
become toxic to cells and the brain has defense mechanisms
to deal with disposing of these damaged cells," he said.
These processes, like programmed cell death, would not
necessarily be triggered if a neuron's shape is altered
rather than damaged, he added. Both Lein and Pessah agreed
that the current PCB studies have broader implications for
the future study and regulation of PCBs and other
environmental toxicants.
Future PCB studies
"Future studies of PCBs and related compounds should be
examined at lower doses more relevant to human exposures,"
Pessah said.
The researchers are planning to study PCB effects on mice
that carry some of the same genetic variations of the
ryanodine receptors that humans do.
"These studies are important if we are to determine if some
people are more susceptible to PCB toxicity than others,"
Lein said.
The team also will look at PCBs' effects on other ares of
the brain that control behavior as well as testing compounds
with structures similar to those of PCBs.
"We believe other PCB-like compounds in use today are also
capable of changing the structure of protein targets that
are contributing to neurobiological problems in humans,"
Pessah said, "and we hope to identify those and help get
them off the market."
In addition to Lein and Pessah, authors of the Environmental
Health Perspectives study include Dongren Yang (co-first
author) of Oregon Health & Science University, Kyung Ho Kim
(co-first author) and Andrew Phimister of UC Davis, Adam
Bachstetter and Ronald Mervis of the University of South
Florida, Thomas Ward and Prasada Kodavanti of the U.S.
Environmental Protection Agency, Robert Stackman of Florida
Atlantic University, Amy Wisniewski of the University of
Oklahoma Health Sciences Center, Sabra Klein of the Johns
Hopkins University Bloomberg School of Public Health, Kim
Anderson of Oregon State University, and Gary Wayman of
Washington State University. The study was funded by the
National Institutes of Health, Autism Speaks and the UC
Davis M.I.N.D. Institute.
In addition to Pessah, authors of the Toxicology and Applied
Pharmacology study include UC Davis researchers Kyung Ho
Kim, Salim Inan and Robert Berman. Inan is currently at the
University of Calgary. The study was supported by grants
from National Institutes of Environmental Health Sciences,
the U.S. Environmental Protection Agency, the UC Davis
M.I.N.D. Institute and Science-to- Superfund Basic Research
Program.
In addition to Pessah, authors of the Public Library of
Science-Biology study included Montserrat Samsó and P.D.
Allen of Harvard University's Brigham and Women's Hospital
and UC Davis' Wei Feng. The work was supported by the
American Heart Association, Brigham and Women's Hospital and
the National Institutes of Health.
Explosives
chemical found in US baby formula
(Back to Top)
AFP -
Saturday, April 4
WASHINGTON (AFP) - - A chemical used in explosives,
fireworks and rocket fuel has been found in powdered baby
formula in the United States, the non-profit Environmental
Working Group (EWG) said.
In "little-noticed findings," researchers at the US Centers
for Disease Control and Prevention (CDC) found that 15
brands of baby formula contained perchlorate, an oxidizer in
solid fuels used in explosives, fireworks, road flares and
rocket motors, the EWG said.
"Studies have established that the chemical is a potent
thyroid toxin that may interfere with fetal and infant brain
development," it said.
The EWG said the CDC study's findings raised "new concerns
about perchlorate pollution, a legacy of Cold War rocket and
missile tests."
The CDC study, which was conducted in 2006 and published
last month in the Journal of Exposure Science and
Environmental Epidemiology, said perchlorate could inhibit
the absorption of iodine by the thyroid and lead to growth
and developmental problems in infants.
For the study, researchers tested samples of baby formula
which they had picked up in a local shop.
The two most tainted brands, both cow's milk-based formulas
with lactose, had a nearly 90-percent share of the US
powdered baby milk market in 2000, the report found.
Mixing the tainted baby formula with perchlorate-contaminated
water -- which is present in more than half the 50 US
states, according to the study -- could boost "the resulting
mixture's toxin content above the level the Environmental
Protection Agency (EPA) considers safe," the EWG said.
But the CDC researchers told AFP: "Most infant formulas
mixed with perchlorate-free water (for the study) contained
perchlorate at levels below EPA's conservative estimate of
the highest daily dose of perchlorate that sensitive persons
can receive over a lifetime without experiencing an adverse
effect."
No attempt had been made to keep the findings of the study
quiet, the researchers told AFP.
The sample size of the study was too small to allow
generalizations to be made about entire brands of formula,
they added.
The study did not name any of the formula brands that were
tested.
"While this study increases our understanding of how infants
may be exposed to perchlorate, CDC has made no new
recommendations based on the findings," the researchers
said.
|