We’ve all heard the expression “the next best thing to mother’s milk.” This implies, of course, that breast milk is a standard example of “best.” Yet, in a report published this year by the American Academy of Pediatrics, it was found that less than 60 percent of women breast-fed their newborns at the time of hospital discharge. And only 21 percent were nursing at six months, often adding formula supplements. As more and more studies are conducted, scientists give us increasingly persuasive reasons to breast-feed. Contributor and gynecologist, Dr. Judith Reichman, was invited to appear on “Today” to discuss why “breast is best” when it comes to the health of both baby and mom.
What is the difference between human breast milk and cow’s milk?
Human milk contains the “just right” proportions of protein, carbohydrates, fats, minerals, and vitamins for an infant’s optimal growth and development. The only thing that’s missing is Vitamin D and K (and all newborn infants are given vitamin K at birth). There is also something called a whey/casein ratio. These are both proteins; whey is easily changed in the infant’s stomach so that it forms soft curds, which are more easily digested than casein, which forms tough, hard-to-digest curds. The whey/casein ratio of human milk is approximately 72 to 28, whereas that in cow’s milk is 18 to 82. (Infant formulas range in their ratios from 18 to 82, to 100 percent whey.) Human milk also contains a high concentration of amino acids that are especially necessary for premature infants, whereas cow’s milk has amino acids which are poorly tolerated by some infants.
Human milk has less solid substance and is less likely to overload an infant’s kidneys. It also contains the lactose (milk sugar) that is necessary to enhance calcium and iron absorption. Lactose also promotes the growth of lactobacilli (the good bacteria that help prevent abnormal or disease-causing bacteria from multiplying in the infant’s gastrointestinal tract). A specific form of sugar called galactocrebroside is essential to brain development and this too is found in higher amounts in human milk. The fatty acids in human milk are “just right” for the infant’s energy requirements (which are enormous), immune function and the development of its gastrointestinal tract. And although human milk has only a small amount of iron, it is much more likely to be absorbed than that present in cow’s milk.
Infants fed cow’s milk also end up getting excessive amounts of sodium, potassium and protein. And finally (forgive me cows) bovine milk contains a protein which may increase destruction of certain cells (beta cells) in the pancreas and this can lead to the development of diabetes.
What else does human milk have?
It has cells that help fight infection — macrophages and lymphocytes — as well as antibodies and immune factors.
Going from content to effect, what does current medical evidence show that breast-feeding can do?
It has a major impact on preventing the following infections:
- Respiratory infections
- Otitis media (ear infection)
- Bacteremia (bacteria in the blood)
- Bacterial meningitis
- Urinary tract infection
- Necrotizing entrocolitis (severe infection of the intestine, which causes diarrhea and bleeding)
Breast milk also helps prevent asthma and allergies. Studies have shown that for infants at risk for developing allergies (the mother or other children are known to suffer from allergies), exclusive breast-feeding for six months may delay or possibly even prevent the onset of food allergies. It’s also advisable for the mother to avoid allergy-provoking foods while breast-feeding (especially nuts).
Breast-feeding works as an “anti-allergy therapy” in several ways. The initial breast milk secreted in the first few days after birth (colostrum) helps seal the gut and prevents the absorption of large, foreign proteins that can cause an allergic response. And with continued exclusive breast-feeding, the amount of foreign protein that is presented to the infant’s gastro-intestinal tract is, of course, reduced. Mother’s milk also gives mother’s antibodies to the infant. And while on the subject of guts, breast-feeding protects the babies intestinal tract from later damage and has been shown to decrease the risk for colitis and Crohn’s disease.
What about mental development? Does breast-feeding make a difference?
It does (although I myself was not breast-fed so I hesitate to consider the fact that this can support intellectual or psychological development). There are plenty of studies that show that breast-fed children have higher cognitive (mental) function than children who are formula-fed. And it appears that there’s a direct correlation between the duration of breast-feeding and mental development and that this positive effect may last for many years.
We have a terrible epidemic of childhood obesity. Will breast-feeding make a difference?
Breast-feeding may reduce childhood obesity. The “may” comes from the fact that the evidence has not been scientifically demonstrated in every study. However, breast-feeding has been shown to help diminish insulin dependent diabetes and a part of that effect may be through a decrease in weight gain. The more major anti-diabetic effect, however, is probably due to the fact that breast milk doesn’t contain the proteins that increase immune-attacks on the pancreas. The American Academy of Pediatrics recommends breast-feeding and avoidance of commercially available cow’s milks and products containing intact cow’s milk proteins during the first year of life in families with a strong history of insulin-dependent diabetes.
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Are there other health benefits?
Yes, the list goes on. Breast-feeding may protect against high blood pressure in later life. And finally, several studies indicate that breast-feeding decreases the risk of Sudden Infant Death Syndrome.
What are the health benefits to the mother?
While she’s breast-feeding, a nursing mother will usually not get her period for up to six or nine months. This helps protect her from anemia and also helps in child spacing, although breast-feeding alone and lack of a period should not be used as “certain” contraception.
Breast-feeding causes the uterus to contract and reduces postpartum bleeding. A nursing mother has a much easier time losing her pregnancy weight. Finally, because she is ovulating less (or not at all) while she’s breast-feeding, her future risk of ovarian cancer and breast cancer may be lower. A review of 47 studies, which included over 50,000 women, conducted in 30 countries, found that the relative risk of breast cancer decreased by 4.3 percent for every 12 months of breast-feeding, in addition to a decrease of 7 percent for each birth. The longer women breast-fed, the greater the protection.
Finally, we shouldn’t forget that there are economic benefits. Breast-feeding is far less expensive than formula feeding. It’s easy to do; you don’t have to wash bottles, warm them or be concerned about supply. The milk is always available and can be given at any time. And Mom doesn’t even have to be there. Breast milk can be pumped and stored for future use.
How soon, how often, and how long should a mother breast-feed?
The American Academy of Pediatrics recommends the following:
Breast-feeding should start right after delivery, if possible, within the first hour. (The initial colostrum is chock-full of antibodies and protective substances for the baby’s gut. And although these are present in later lactation, the concentration is less.)
Newborns should be nursed whenever they show signs of hunger, such as alertness, mouthing or rooting (that sweet motion of head and mouth to find a nipple whether it’s there or not). Crying is actually a late indicator of hunger, and obviously should not be ignored.
The newborn should be nursed eight to 12 times every 24 hours for 10 to 15 minutes on each breast. If the baby sleeps more than four hours it should be woken to nurse. (Sorry about that.)
Supplements such as sugar water, water or formula should not be given to breast-feeding newborns unless there’s a medical reason to do so.
Don’t use a pacifier until breast-feeding is well established.
It’s generally unnecessary to add water, juice or other foods in the first six months of breast-feeding. However, the pediatrician may want to add vitamin D and iron before six months of age.
It’s clear that these experts feel that infants should be exclusively breast-fed for the first six months of life. And they also recommend that breast-feeding be continued for 12 months with the addition of complementary food. Finally, breast-feeding for the first two years of life is encouraged.
How does a mother know that her breast-feeding is successful, especially in the beginning?
- The baby wakes up to nurse.
- The baby is swallowing.
- The baby eats eight times a day.
- There are at least two infant bowel movements per day.
- There are at least six wet diapers per day.
- The urine is pale and has no odor.
- The infant is alert and active.
- The baby is gaining weight.
Should some mothers not breast feed?
Yes, some women have contraindications to breast-feeding. These include mothers with untreated active tuberculosis. (Nor should they be in contact with their infants until appropriately treated.) Women who have the HIV virus should not breast-feed since the virus can be transmitted from the mother to the infant five to 20 percent of the time with this mode of nutrition. There are several drugs that are concentrated in breast milk or are very toxic. These include cytotoxic drugs (drugs used for cancer), radioactive agents (such as radioactive iodine), the antibiotics chloramphenicol and tetracycline. This list should also include illegal drugs or drug abuse.
There are some concerns about other medications that women are taking while breast-feeding, and their use should be discussed with the treating physician. They include anti-depressants, anti-convulsant and anti-clotting medications.
What about breast infection? Isn’t that fairly frequent in nursing mothers? If it occurs should the mother stop nursing, at least for a while?
No, many women develop breast engorgement (full, hard and painful breasts). Engorgement can be prevented by frequent nursing. It helps to pump out excess milk before nursing. Warm and cold compresses or even an ibuprofen will also relieve the pain.
Mastitis, or infection of a milk duct, occurs in about 1 to 5 percent of women. Again, this too can be due to lack of frequent breast-feeding and inadequate drainage. It also occurs after cracking of the nipples, or when a woman is extremely fatigued. This should be treated with heat, massage and if necessary, antibiotics, but breast-feeding should continue (it won’t hurt the baby). If mastitis is not treated appropriately, then an abscess can develop. This is a localized red, hard area that feels hot and can cause fever. The treatment consists of opening the abscess, draining it, and a course of antibiotics. The infant can certainly continue to feed on the opposite breast.
All this sounds great, but some women try and just don’t seem to be able to breast-feed. What is the current advice and at what point should they give up?
An inability to breast-feed may occur as a result of poor development of breast ducts and obviously there is nothing that can be done to change this. Breast ducts can also be “closed off” after reduction surgery. And that too, is not reversible. But in many women, lack of appropriate lactation is due to poor lactation technique, incomplete breast emptying, anxiety, exhaustion, inadequate diet or heavy smoking, and all those can be addressed.
Before giving up, a mother should consult a lactation expert who can help her learn how to get the baby to latch on to the nipple and suck. She should also attempt to nurse as frequently as possible (once every two hours) and if she still has problems expressing the milk, try using a mechanical pump. If this doesn’t work and the doctor suspects that the baby is not getting sufficient breast milk, she or he may prescribe a medication called domperidone which increases milk production.
However, if despite all this the baby’s weight gain is unsatisfactory or it becomes dehydrated, it’s time to supplement with the appropriate formula (not cow’s milk). The pediatrician will recommend a particular brand. One last breast-feeding injunction: Water or glucose water should not be used! This will reduce breast feeding frequency and milk production, decrease the infant’s caloric intake and can actually lead to starvation.
Breast-feeding gives your baby the best chance for health and development. Science has shown that what our ancestral mothers did was right: Breast is best.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.
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