PUTTING OUR BABIES AT RISK

Did you know that the World Health Organization lists formula as only the fourth choice of infant feeding methods? They are, in order; a mother breastfeeding her own baby, another woman wet-nursing the baby, feeding human breastmilk acquired from a milk bank and lastly, formula.

Why am I mentioning this? Because most people do not fully understand the risks of not breastfeeding, even in a first-world country like the USA.

We were all appalled to hear that melamine was deliberately added to the milk used for baby formula in China. Equally shocking, however, is melamine being used in the USA as part of the actual formula manufacturing process. http://children.webmd.com/news/20081126/melamine-in-us-baby-formula

Last October, the FDA said it did not know of any safe level of melamine in baby formula. Then, on November 28, 2008, without any further research, the agency announced that melamine and cyanuric acid are safe in baby formula at levels up to 1 part per million. Nobody knows if ANY melamine is safe. We do know that similar concentrations of either melamine or one of its relatives in their products have been found in formula made by Abbott, Nestle, and Mead Johnson, who make almost all of the formula sold in the USA.

Why has the formula not been recalled?

That is the question being asked by Illinois Attorney General Lisa Madigan. Madigan revealed that the FDA “apparently withheld the results of its testing from the public for over three weeks, and then only disclosed the information in response to a FOIA request by The Associated Press.”
http://www.washingtonpost.com/wp-dyn/content/article/2008/11/26/AR2008112600386.html?hpid=sec-health

Consumers Union is asking the same question. Jean Halloran, the group’s director of Food Policy Initiatives, urged the FDA “to immediately make public all of the results of its tests for melamine contamination in food,” even those with levels below what would trigger agency action.”
http://www.ajc.com/health/content/health/stories/2008/11/28/infant_formula_recall.html

What a disgrace that the FDA needed to be forced to reveal this information to the public!
Not to worry though, because on December 3, 2008,” the FDA and WebMD today announced the first-ever partnership between a U.S. public health agency and a private health-information provider. The partnership will enhance the FDA's ability to get crucial information to the American public, FDA Commissioner Andrew von Eschenbach, MD, said in a news conference.”
http://www.webmd.com/news/20081203/fda-webmd-announce-partnership

Right…
And this will increase consumer confidence in the FDA?

Unfortunately, melamine is not the only problem.

There is a long history of formula being recalled because of manufacturing errors.
http://www.breastfeeding.com/advocacy/advocacy_recalls.html

Reasons include:
- black plastic particles being found in some cans of formula
- metal particles in formula cans
- peeling can liners
- cans did not contain the labeled amount of inositol, a nutrient required under 21 CFR section 107.100.
- concentrated infant formula being manufactured with lids intended for ready-to-feed formula. The potential existed for a consumer to follow the lid directions (DO NOT ADD WATER) and not properly dilute the formula prior to feeding.
- contamination with Salmonella.
- adulterateration because it may have been produced under unsanitary conditions whereby it may have been rendered injurious to health. Furthermore, the product appears separated and was been linked with mild gastrointestinal illness.
- contamination with glass particles

More recently, on December 2, 2008, the New Mexico Health Department reported that one baby died and another was hospitalized due to infections caused by different strains of the bacteria Enterobacter sakazakii. Both babies had been fed powdered formula, which the CDC says has been associated with contaminated powdered formula products.

Certain steps can be taken immediately, however, to prevent or mitigate E. sakazakii disease. In a joint conference on infant formula safety in February, 2004, the World Health Organization and Food and Agriculture Organization of the United Nations made the following recommendations:

1) encourage industry partners to develop a range of affordable sterile formula options;
2) consider setting an industry standard for Enterobacteriaecae and E. sakazakii in infant formula;
3) inform infant caregivers of the risks associated with nonsterile, powdered formula; and
4) consider feeding high-risk infants sterile formula if they cannot breast-feed. The findings of our case review suggest that all neonates as well as premature infants should be included in this high-risk infant category.< http://www.cdc.gov/ncidod/EID/vol12no08/05-1509.htm

Unfortunately, this information has not been widely disseminated. Even hospital maternity units continue to provide powdered formula for newborns, and so mothers go home with their babies and free samples, believing that it is safe. Of course this *free* formula is not really free at all. It is provided by the formula companies, who fight amongst themselves for the “privilege* of sharing their bounty, whilst passing on the costs to consumers. Hospitals act as middlemen in these marketing tactics, in return for “gifts” which include supplies and equipment, and even cash.
http://www.ibreastfeeding.com/Volume%2035.pdf#page=2v

Formula companies know that mothers trust their doctors. When a hospital provides a certain brand of formula, it is conferring on it its seal of approval, and mothers will almost always continue to use that brand when they go home.

Formula companies also know that babies who receive even one bottle of formula in the hospital are more likely to be weaned from the breast by the time of their first doctor’s check-up.
http://www.naba-breastfeeding.org/images/Just%20one.pdf

So why do the stats show an increase in breastfeeding?

Remember, those yearly charts which show how many babies are breastfed are produced by a formula company, Ross Labs. What they do NOT tell you is that the figures include every baby who was ever put to the breast, even once, whether or not there was any transfer of milk. They do not tell you that almost all of the babies that leave the hospital *breastfeeding* are also being bottle-fed formula. Compare this to the National Immunization Survey (NIS,) which provides important information on rates of breastfeeding, including exclusive breastfeeding, in the United States.
http://www.cdc.gov/breastfeeding/data/NIS_data/survey_methods.htm

And then we come to the most important question of all.
If formula feeding is so risky, why do hospitals and WIC give babies formula?

Even without the overt risks, there is also the problem of affordability.
On November 25, 2008, a baby in Tampa, Florida, almost died from water intoxication and malnourishment. At 5 months, the baby weighed only 8 pounds, 6 ounces. His mother had not received enough cans of formula from WIC to meet her baby’s growing needs. She could not afford the $16 to $18 for each of the additional five to seven cans, and so she had been diluting what she did have with water.
http://www.examiner.com/x-1022-Orlando-Parenting-Examiner~y2008m12d2-Diluted-formula-nearly-kills-Tampa-baby

This mother said she had no idea that watering down her baby’s feeds would hurt him. Many mothers are not aware that WIC is a SUPPLEMENTARY food program. It was never designed to provide all of the formula that a baby needs, only part of it.

How can we prevent further tragedies?

That is the subject for another column, but here are a few, proven, methods.
We can:
- offer all mothers accurate information and practical help to enable them to get breastfeeding off to a good start
- give teeth to the current laws protecting women’s rights to nurse in public and pump and nurse at work
- ensure a safe, sustainable and affordable supply of formula for mothers who cannot nurse.

These are such simple things to do. They are worth doing to save the lives of our children.

See also:

http://children.webmd.com/news/20081126/melamine-in-us-baby-formula

http://www.msnbc.msn.com/id/28000145

http://www2.tbo.com/content/2008/dec/01/011656/authorities-diluting-formula-save-cash-almost-kill/

http://babycafejapan.blogspot.com/2008/09/melamine-and-breastfeeding.html

http://www.nrdc.org/breastmilk/formula.asp

How to Choose a Lactation Consultant

You and your baby deserve the very best care possible, from a qualified, experienced, and compassionate health care professional. Unfortunately, not all mothers get accurate, up-to-date breastfeeding information or support in a timely manner. Many of them struggle unnecessarily and end up weaning their babies prematurely. They often blame themselves, but the opposite is true. Mothers do not fail at breastfeeding. It is our society that has let them down.

Pregnant parents are often encouraged to interview and choose a pediatrician before their baby is born. It is also a good time to interview and choose a Lactation Consultant.

For example, did you know that anybody can call themselves a Lactation Consultant? However, only those with extensive experience and training, and who have passed an rigorous exam, are entitled to put the letters IBCLC (International Board Certified Lactation Consultant) after their name.

It is a good idea to schedule an interview (which should be free of charge) to see if the Lactation Consultant is a good fit for your family’s needs. Be sure to include these questions on your list.

What are your qualifications?

How many years have you been practicing?

When did you last attend a breastfeeding conference to update your knowledge and meet the continuing education requirements for recertification?

What kind of experience do you have? Do you work in a hospital situation where you see mostly newborns, or do you have a more general practice where you see the whole range of breastfeeding, from newborns through to older nurslings?

Did you nurse your own children?

Do you encourage mothers to call anytime for general information and to determine if their concerns warrant an office visit?

How flexible are your office hours? Do you schedule your consultations around babies’ nursing patterns ?

Do you encourage mothers to bring their partners or other support people to consultations?

Do you allow enough time during consultations to put everyone at ease and to address all of the mother’s breastfeeding and parenting concerns?

Do you take a complete history, offer a written care plan and do follow up?

Do you offer prenatal consultations to teach breastfeeding basics and help to build mothers’ confidence in their ability to both nourish and nurture their babies at the breast?

Do you offer consultations so that mothers who will be returning to work or school can discuss their options?

Do you have the knowledge and expertise to help mothers and babies who are facing special breastfeeding challenges?

Do you follow the World Health Organization’s recommendations on weaning?

Do you abide by the World Health Organization’s Code of Marketing of Artificial Breastmilk Substitutes?

How much do you charge and when are fees payable?

Is there a sliding scale for low-income families?

Do you offer special packages and gift certificates?

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