The Pitfalls of Supplementing

By Cheryl Taylor, CBE

I hear from moms regularly that are planning on using both breastfeeding and bottle feeding. Some of them are well informed about the many dangers of formula and have a pump ready to use to provide expressed breastmilk. Some are not, and the first place we begin is with a lesson on the many inadequacies of infant formulas. For the ones that do know that breastmilk only is the goal, but want their husbands to “bond” with the baby, our lesson begins with all the many, many ways in which fathers can interact with their babies without using a bottle.

Regardless of what is being put in the bottle, there are several areas of impact that remain the same.

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The Identification and Treatment of Thrush

By Cheryl Taylor, CBE

Thrush is a yeast infection that can present itself in your baby’s mouth or on your nipples. When thrush is in either of these locations, you may also find the yeast deep in the breast tissue, vaginally or on your baby’s diaper area. When the yeast infection presents itself, it may be in all or one of these locations.

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Mother’s Milk, How to Increase Your Supply

By Cheryl Taylor, CBE

When in the course of a happy breastfeeding relationship you notice a supply change, it can cause momentary panic. The first course of action should be to assess a few basic things. Are you resting enough? Getting a good night’s sleep? Taking a nap if necessary? Are you drinking at least 64 ounces of water a day? Are you eating a good, healthy diet? These are some of the basics of a nursing relationship that have to be maintained to the very best of your ability. Our bodies aren’t necessarily so forgiving of being pushed to the limit when we’re nursing. They tend to give us a clear signal. One of those ways is with a dip in supply. Listen to your body and take some action.

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Ginseng, Is It Safe for Nursing Mothers?

By Dee Negron

Many pregnant and nursing moms want to stay as far away from synthetic medications as possible. As a result, they look into using herbs and other natural remedies as an alternative. Herbs can be a wonderful alternative and many are very helpful. The problem arises when the assumption is made that just because herbs are natural, they are 100% safe. This simply isn’t true. Herbs can be very powerful, some are potentially dangerous, and all should be taken while under the supervision of your doctor or a certified herbalist.

One of the herbs nursing women ask about most frequently is ginseng. Many new mothers find themselves stressed out and fatigued. They start to look for anything that will help them get through the next harried day and sleepless night. Ginseng seems to be the answer. However, most forms of ginseng are unsafe for nursing mothers.

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Tips for Pumping, Working and Nursing Successfully

By Cheryl Taylor, CBE

If breastfeeding is going to be combined with working, there are some things to consider that will give you greater success. A working mom can provide breastmilk for her baby without having to resort to the use of ABM (artificial baby milk). She has many balls in the air and every trick that makes any aspect of pumping a bit easier is worth consideration. Whether you’re planning on returning to work, or you’ve hit a bump in the road, I hope you’ll find a tip here that will make life easier and the milk flow.

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Nursing Strikes

By Cheryl Taylor, CBE

The identification of a strike, versus weaning, is simple. Weaning is something that happens gradually over several weeks or months with baby or child dropping a single nursing at a time. A strike is something that happens abruptly. Baby or child is nursing several times a day and suddenly stops completely. Sometimes it is impossible to ascertain the cause of a strike, but the solution is the same regardless of the cause.

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“Just One Bottle Won’t Hurt”—or Will It?

By Marsha Walker, RN, IBCLC

  • The gastrointestinal (GI) tract of a normal fetus is sterile.
  • The type of delivery has an effect on the development of the intestinal microbiota.

* Vaginally born infants are colonized with their mother’s bacteria.

* Cesarean born infants’ initial exposure is more likely to environmental microbes from the air, other infants, and the nursing staff which serves as vectors for transfer.

  • Babies at highest risk of colonization by undesirable microbes or when transfer from maternal sources cannot occur are cesarean-delivered babies, preterm infants, full term infants requiring intensive care, or infants separated from their mother.
  • Breastfed and formula-fed infants have different gut flora.

* Breastfed babies have a lower gut pH (acidic environment) of approximately 5.1-5.4 throughout the first six weeks that is dominated by bifidobacteria with reduced pathogenic (disease-causing) microbes such as E coli, bacteroides, clostridia, and streptococci o babies fed formula have a high gut pH of approximately 5.9-7.3 with a

variety of putrefactive bacterial species.

* In infants fed breast milk and formula supplements the mean pH is approximately 5.7-6.0 during the first four weeks, falling to 5.45 by the sixth week.

* When formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached.

* Breastfed infants who receive supplements develop gut flora and behavior like formula-fed infants.

  • The neonatal GI tract undergoes rapid growth and maturational change following birth.

* Infants have a functionally immature and immuno-naive gut at birth.

* Tight junctions of the GI mucosa take many weeks to mature and close the gut to whole proteins and pathogens.

* Open junctions and immaturity play a role in the acquisition of NEC, diarrheal disease, and allergy.

* sIgA from colostrum and breast milk coats the gut, passively providing immunity during the time of reduced neonatal gut immune function.

* Mothers’ sIgA is antigen specific. The antibodies are targeted against pathogens in the baby’s immediate surroundings.

* The mother synthesizes antibodies when she ingests, inhales, or otherwise comes in contact with a disease-causing microbe.

* These antibodies ignore useful bacteria normally found in the gut and ward off disease without causing inflammation.

  • Infant formula should not be given to a breastfed baby before gut closure occurs.

* Once dietary supplementation begins, the bacterial profile of breastfed infants resembles that of formula-fed infants in which bifidobacteria are no longer dominant and the development of obligate anaerobic bacterial populations occurs. (Mackie, Sghir, Gaskins, 1999)

* Relatively small amounts of formula supplementation of breastfed infants (one supplement per 24 hours) will result in shifts from a breastfed to a formula-fed gut flora pattern. (Bullen, Tearle, Stewart, 1977)

* The introduction of solid food to the breastfed infant causes a major perturbation in the gut ecosystem, with a rapid rise in the number of enterobacteria and enterococci, followed by a progressive colonization by bacteroides, clostridia, and anaerobic streptococci. (Stark & Lee, 1982)

* With the introduction of supplementary formula, the gut flora in a breastfed baby becomes almost indistinguishable from normal adult flora within 24 hours. (Gerstley, Howell, Nagel, 1932)

* If breast milk were again given exclusively, it would take 2-4 weeks for the intestinal environment to return again to a state favoring the grampositive flora. (Brown & Bosworth, 1922; Gerstley, Howell, Nagel, 1932)

  • In susceptible families, breastfed babies can be sensitized to cow’s milk protein by the giving of just one bottle, (inadvertent supplementation, unnecessary supplementation, or planned supplements), in the newborn nursery during the first

    three days of life. (Host, Husby, Osterballe, 1988; Host, 1991)

* Infants at high risk of developing atopic disease has been calculated at 37% if one parent has atopic disease, 62-85% if both parents are affected and dependant on whether the parents have similar or dissimilar clinical disease, and those infants showing elevated levels of IgE in cord blood irrespective of family history. (Chandra, 2000)

* In breastfed infants at risk, hypoallergenic formulas can be used to supplement breastfeeding; solid foods should not be introduced until 6 months of age, dairy products delayed until 1 year of age, and the mother should consider eliminating peanuts, tree nuts, cow’s milk, eggs, and fish from her diet. (AAP, 2000)

  • In susceptible families, early exposure to cow’s milk proteins can increase the risk of the infant or child developing insulin dependent diabetes mellitus. (IDDM) (Mayer et al, 1988; Karjalainen, et al, 1992)

* The avoidance of cow’s milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible individuals. (AAP, 1994)

* Sensitization and development of immune memory to cow’s milk protein is the initial step in the etiology of IDDM. (Kostraba, et al, 1993)

  • Sensitization can occur with very early exposure to cow’s milk before gut cellular tight junction closure.
  • Sensitization can occur with exposure to cow’s milk during an infection-caused gastrointestinal alteration when the mucosal barrier is compromised allowing antigens to cross and initiate immune reactions.
  • Sensitization can occur if the presence of cow’s milk protein in the gut damages the mucosal barrier, inflames the gut, destroys binding components of cellular junctions, or other early insult with cow’s milk protein leads to sensitization. (Savilahti, et al, 1993)

References

American Academy of Pediatrics, Work Group on Cow’s Milk Protein and Diabetes Mellitus. Infant feeding practices and their possible relationship to the etiology of diabetes mellitus.  Pediatrics 1994; 94:752-754

American Academy of Pediatrics, Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000; 106:346-349

Brown EW, Bosworth AW. Studies of infant feeding VI. A bacteriological study of the feces and the food of normal babies receiving breast milk. Am J Dis Child 1922; 23:243

Bullen CL, Tearle PV, Stewart MG. The effect of humanized milks and supplemented breast feeding on the faecal flora of infants. J Med Microbiol 1977; 10:403-413

Chandra RK. Food allergy and nutrition in early life: implications for later health. Proc Nutr Soc 2000; 59:273-277

Gerstley JR, Howell KM, Nagel BR. Some factors influencing the fecal flora of infants. Am J Dis Child 1932; 43:555

Host A, Husby S, Osterballe O. A prospective study of cow’s milk allergy in exclusively breastfed infants. Acta Paediatr Scand 1988; 77:663-670

Host A. Importance of the first meal on the development of cow’s milk allergy and intolerance. Allergy Proc 1991; 10:227-232

Karjalainen J, Martin JM, Knip M, et al. A bovine albumin peptide as a possible trigger of

insulin-dependent diabetes mellitus. N Engl J Med 1992; 327:302-307

Kostraba JN, Cruickshanks KJ, Lawler-Heavner J, et al. Early exposure to cow’s milk and solid foods in infancy, genetic predisposition, and risk of IDDM. Diabetes 1993; 42:288-295

Mackie RI, Sghir A, Gaskins HR. Developmental microbial ecology of the neonatal

gastrointestinal tract. Am J Clin Nutr 1999; 69(Suppl):1035S-1045S

Mayer EJ, Hamman RF, Gay EC, et al. Reduced risk of IDDM among breastfed children. The Colorado IDDM Registry. Diabetes 1988; 37:1625-1632

Savilahti E, Tuomilehto J, Saukkonen TT, et al. Increased levels of cow’s milk and blactoglobulin antibodies in young children with newly diagnosed IDDM. Diabetes Care 1993; 16:984-989

Stark PL, Lee A. The microbial ecology of the large bowel of breastfed and formula-fed infants during the first year of life. J Med Microbiol 1982; 15:189-203