Facts vs. Myths
Current Research

Facts About Breastfeeding - 2002
Compiled by  the Center for Breastfeeding Information

Government recommendations can result in better health for infants and achieve substantial savings in health costs.

A minimum of $3.6 billion could be saved if current breastfeeding levels were increased to the recommendations of the U.S. Surgeon General: a 75% initiation rate and a 50% rate at six months. The prevention of otitis media, NEC, and gastroenteritis would result in these savings. Managed health care plans, which promote the prevention of illness, would also stand to benefit in the promotion of breastfeeding.
Weimer; J. The economic benefits of breastfeeding: A review and analysis. Economic Research Service, Food Assistance and Nutrition Research Report No. 132001-3; 1-20.

Consumption of human milk exclusively in the early months and in addition to solid foods for longer duration has been found to significantly reduce the onset of asthma in young children.

The susceptibility to asthma relates to conditions present in infancy. Mother's milk provides protective factors that bolster the infant's immune system, reduces exposure to external antigens when the infant is exclusively breastfed, and assists in the maturation of the gastrointestinal tract. Breastfeeding provides substantial protection against asthma in children with a family history of atopy.  
Gdalevich, M. et al. Breast-feeding and the risk of bronchial asthma in childhood: A systematic review with meta-analysis of prospective. J Pediatr 2001; 139: 261-66: 

The introduction of milk other than human milk prior to four months was found to be a risk factor for asthma at the age of six years. The beneficial effect of breastfeeding appears to be stronger with longer duration. 
Dell S. and To, T. Breastfeeding and asthma in young children. Arch Pediatr Adolesc Med 2001-11; 155(11): 1261-65.

A prophylactic effect of exclusive breastfeeding for a minimum of four months was found on all of the asthma, wheeze, and atopy end points at six years of age and the duration of breastfeeding was found to be of prime imporrance; these findings are significant for the potential prevention of asthma in children.
Oddy, W.H. Breastfeeding and asthma in children: Findings from a West Australian Study. Breastfeeding Rev 2000-3; 8(1):5-11.

Human milk supports optimal infant growth and development with many important health benefits extending well beyond infancy.  

Early nutrition can influence or program outcomes that have important biologic and public health consequences. Infants' diets during a critical window in the early stages of the brain growth spurt may have long term and probably permanent effects on cognition; human-milk-fed infants have a significant advantage.
Lucas, A. et al. Nutrition and mental development. Nutr Reviews 2001-8; 59(8): 524-533.

In the United Arab Emirates Cancer Centre Hospital, patients aged 2-14 with lymphoid malignancies had significantly fewer months of breastfeeding than did matched controls. Shorter periods of breastfeeding were associated with an increased risk of acute lymphocytic leukaemia, Hodgkins' lymphoma, and non-Hodgkins' lymphoma.
Bener; A. et al. Longer breast- feeding and protection against childhood leukaemia and lymphomas. Eur J Cancer 2001; 337(2): 234- 38. 

Breast milk consumption was associated with reduced diastolic and systolic blood pressure in an ongoing study of 13-16-year-olds born prematurely. Just one month of breastfeeding resulted in 3.2 points lower diastolic and 2.7 points lower systolic blood pressure in the teen years. Babies on the highest proportion of formula to mother's milk resulted in the highest blood pressure readings.
Singhal, A. et al. Early nutrition in preterm infants and later blood pressure: Two cohorts after randomized trials. Lancet 2001; 357: 413- 19.

Diabetes mellitus, celiac disease, childhood cancer, and inflammatory bowel disease were examined in relationship to early feeding practices. Because of the extensive anti-microbial and anti-inflammatory constituents in human milk, the human-milk-fed infants experienced less severe infection.
Davis, M. K Breastfeeding and chronic disease in childhood and adolescence. Pediatr Clin N A 2001-2; 48(1): 125-41. 

In a study of 749 postmenopausal women, having breastfed for 12 months or longer resulted in significantly increased levels of the hormone cortisol, which persisted beyond the childbearing years. The findings illustrate a relation- ship between extended breast- feeding, increased cortisol, and the possibility that breastfeeding can protect against rheumatoid arthritis.
Lankarani-Fard; A. et al. Cumulative duration of breast- feeding influences cortisol levels in postmenopausal women. J Womens Hlth & Gen-Based Med 2001-9; 10(7): 681-87. 

The unique components and specificity of colostrum and mature human milk serve to protect the human infant and enhance growth.

The concentration of insulin in human milk (60.23 µU/ml) is significantly higher than cow's milk (16% µU/ml) and is very low to almost absent in synthetic formula. Insulin is a biologically active growth factor which promotes intestinal growth and maturation, benefiting gut development in early infancy.
Shehadeh, N. et al. Importance of imulin content in infant diet: suggestion for a new infant formula, Acta Paediatr 2001-1; 90(1): 93-95. 

The multifunctional protein lactoferrin, produced during lactation, is one of the components of the mammalian defense system. It is the second most abundant protein in human milk and is released during inflammation, protecting the infant against antimicrobial activity through bacteriostatic binding of iron-requiring bacteria. Also lactoferrin has direct bactericidal effects against other pathogens. Researchers are examining the safety of commercial lactoferrin for oral and topical administration.
Conneely, O. M. Anti-inflammatory activities of lactoftrrin. J Am College Nutr 2000; 220(5): 3895-955. 

Interleukin-18 is significantly higher in the colostrum of mothers who deliver premature babies and those who experience pregnancy complications. This is significant for high-risk neonates, because IL- 18, possibly in concert with other cytokines in the interleukin family, may provide adaptive and innate immune responses against enteric or respiratory pathogens.
Takahata, Y et al. Interleukin-18 in human milk. Pediatr Res 2001-8; 50(2): 268-72. 

By the fourth postpartum day, B- endorphin concentrations are present in the milk of mothers who have experienced stress during a vaginal or preterm birth. These peptides act as an opioid available for the breastfed neonate, and may playa role in postnatal fetal adaptation.
Zanardo, V: et al. Effect of postpartum anxiety on the colostral milk B-endorphin concentrations of breastfeeding mothers. J Ob Gyn 2001; 21(2): 130-34.

A few breastfed toddlers develop dental caries in spite of breastfeeding, not because of it.

In a systematic review of the research on early childhood caries, methodology, variables, definitions, and risk factors have not been consistently evaluated. There is not a constant or strong relationship between breastfeeding and the development of dental caries. There is no right time to stop breastfeeding, and mothers should be encouraged to breastfeed as long as they wish.  
Valaitis, R et al. A systematic review of the relationship between breastfeeding and early childhood caries. Can J Publ Hlth 00-11/12; 91(6): 411-17. 

Human milk alone does not cause dental caries. Infants exclusively breastfed are not immune to decay due to other factors that impact the infant's risk for tooth decay. Decay causing bacteria (streptococcus mutans) is transmitted to the infant by way of parents, caregivers, and others.
Palmer; B. Breastfeeding and infant caries: No connection. ABM News and Views 2000; 6(4): 27,31.

The specificity of preterm human milk meets the needs of the low birthweight or ill infant.

Retinopathy of prematurity has increased with the survival of very low birthweight infants. In studying hospital records, it was found that human milk feeding correlated with reduced incidence of ROP.
Hylander, M. A. et al. Association of human milk feedings with a reduction in retinopathy of prematurity among very low birthweight infants. J PerinatoI2001-9; 21(6): 356-62.  

Although fresh mother's milk is best, pasteurized donor milk provides many of the same benefits and components. Pasteurization affects some of the immunologic components; freezing human milk does not appear to affect the nutritional or anti-infective qualities. Banked donor breast milk can prevent or reduce sepsis and NEC and could reduce the cost of health care. A NICU could save approximately $11 for each $1 spent on donor human milk.
Wight, N. E. Donor human milk for preterm infants. J Perinatol 2001-6; 21(4): 249-54. 

The quantity of human milk received by premature infants was the most significant outcome, in an investigation of feeding strategies. There was better feeding tolerance, less sepsis, less NEC, less need for medication, and briefer hospitalizations. Human milk modifies the gastrointestinal tract by providing a barrier to infectious agents and stimulates endogenous lactase activity.
Schan/er, R. J. J Nutr 2000; 130: 417S-19S. 

Research improves the management of breastfeeding.

Cup-feeding premature babies is a means to support breastfeeding when the mother is not present or before the infant is strong or mature enough to feed at the breast. Infants are able to pace their feedings and demonstrate better physiologic stability with less increased heart rate and better oxygenation when cup-fed rather than bottle-fed.
Marinelli, KA. et al. A comparison of the safety of cup feedings and bottle feedings in premature infants whose mothers intend to breastfeed. J PerinatoI2001-9; 21(6): 350-55.

Simultaneous pumping of the breast is more effective at increasing milk production than sequential pumping. Frequent and efficient milk removal promotes production of milk, which is important for mothers who wish to express their milk.
Jones, E. A randomized controlled trial to compare methods of milk expression after preterm delivery.Arch Dis Child Fetal Neonatal Ed 2001-9; 85: F91-95. 

Mastitis, when treated appropriately, is not a reason to stop breast- feeding. Antibiotics are helpful for infective mastitis, however conservative management of non-infective mastitis can be effective.
Fetherston, C. Mastitis in lactating women: Physiology or pathology? Breastfeeding Rev 2001; 9(1): 5-12. 

Breastfeeding is protective against SIDS  

While it is unclear why breastfeeding is protective against SIDS, it is clear that breastfed infants are healthier than their bottle-fed counterparts. Possibilities are the protective effect of IgA on bacterial toxins, the presence of long chain polyunsaturated fatty acids, faster development of the central nervous system, and the benefit of tactile stimulation during night feeds.
Kum-Nji, P et al. Reducing the incidence of Sudden Infant Death Syndrome in the delta region of Mississippi: A three-pronged approach. South Med J 2001-7; 94(7): 704-10. 

In Japan, environmental factors were examined with respect to the causes of SIDS, the third most frequent cause of infant death. Being placed or being found prone rather than supine, born parents being smokers, being premature and artificial feeding were risk factors. It is recommended that to breastfeed is preferable when both artificial and breastfeeding are possible.
Tanaka, T and Kato, N. Evaluation of child care practice factors that affect the occurrence of Sudden Infant Death Syndrome: Interview conducted by public health nurses. Env Hlth Prev Med 2001-07; 6: 117-20. 

Support from health professionals and lay counselors makes a significant difference in outcomes for the breastfeeding mother and her baby.

For mothers who give up breast feeding their first baby due to insufficient milk, there is evidence that with the second baby there is an increased output of milk. Health professionals can reassure mothers that it is worth trying to breastfeed a second time.
Ingram, J et al. Breastfeeding: It is worth trying with the second baby. Lancet 2001-9-22; 358(9286): 986-87. 

Infant mortality is related to breastfeeding. It is important to determine what factors inhibit breastfeeding among black women, who generally prefer bottle-feeding. If healthcare providers can successfully increase the rate of black infants being breastfed, the infant mortality difference between blacks and whites should close.
Forste, R. et al. The decision to breastfeed in the United States: Does race matter? Pediatrics 2001-8; 108(1): 291-96: 

New programs have been designed to provide postgraduate education on evidence-based breastfeeding to practicing physicians, leading to greater knowledge and increased professional support for breastfeeding. Further, the WIC program is in a position to offer counseling to women on breastfeeding as it serves a population in which education and breastfeeding promotion should be focused. The rates of breastfeeding have increased among African-American women who have been served by the WIC program.
Wright, A.L. and Schankr, R J. The resurgence of breastfeeding at the end of the second millennium. J Nutr 2001-2; 131(2): 421S-25S. 

In a survey conducted by the Australian Breastfeeding Association (Formarly NMM), there were five areas of need as defined by mothers' reports: reassurance (58.6%), feed frequency (26.5%), positioning and  attachment (18.1%), looking after yourself (16.3%), and fatigue/tiredness (15.3%). Peer counseling by skilled, trained women with supportive resources can build confidence as well as help mothers overcome technical difficulties, such as low milk supply.
Grieve, V. and Howarth, T The counseling needs of women. Breastfeeding Review 2000; 8(2): 9- 15. 

Among working mothers in Chile, in a population of women who received breastfeeding support the majority desired to exclusively breastfeed despite returning to employment. In the control group, only six percent were able to complete six months of exclusive breast-milk-feeding; while 53 percent in the study group were able to complete six months of exclusive breastfeeding. This study found that 100 percent of the women, if cared for and supported, would repeat the experience of combining exclusive breast-milk-feeding and working. 
Valdes, V. et al. Clinical support can make the difference in exclusive breastfeeding success among working women. J 1I-op Pediatr 1999; 46:149-54. 

Reliance on free formula and other products and gifts is a major obstacle to the Baby Friendly Hospital Initiative in the United States. Breastfeeding initiation rates can increase dramatically when the "Ten Steps" are followed. The authors state that the time has come for physicians to take a leadership role in the promotion of breastfeeding.
Philipp, B.L. et al. Pediatrics 2001- 03; 107(3): 584-88.

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