Better childhood immunity with fewer colds and ear infections, fewer allergies, and better infant growth rates are among some of the arguments in favor of breast-feeding. As far as maternal advantage goes, breast-feeding is associated with less post-partum bleeding, faster return to pre-pregnancy weight and lower risk for breast cancer. Further, nursing eliminates the need for having to travel with and heat bottles, as well as it significantly reduces the cost associated with feeding a newborn, which can be any where from $180.00-$300.00 per month. The benefits of nursing have been cited over and over again, and we felt that we were familiar with all of them. A recent study, however, has highlighted a potential new and substantial benefit in favor of breast-feeding... as much as a possible 50% decrease in the incidence of SIDS for infants whom are exclusively breast-fed.
Given that SIDS is the leading cause of death among infants aged one month to one year, and no obvious mechanism of disease has been discovered, it behooves us to look into as many promising protective agents as we can in order to decrease these statistics.
The Journal of the American Academy of Pediatrics has recently published a retrospective study done in Munich on 1331 infants from 1998-2001 to look at the association between risk for SIDS and nursing. For the 338 cases which resulted in SIDS, only 49% of mothers nursed. This was compared to 998 infants without SIDS, whom had an 82% nursing rate. The analysis suggested that the risk of SIDS could be cut in half with exclusive nursing. The data suggested some small advantage to partial breast feeding, however, sample sizes were not large enough to quantify the amount of nursing that might result in a given risk reduction. Further, the evidence showed that the effect was greatest within the first two months of life.
The authors adjusted for several confounding variables, like: maternal smoking, maternal family status, socioeconomic status, maternal age, previous live births, infant birth weight, co-sleeping practices, pillow in the infant bed, temperature of the child's room, pacifier use and sleep position. They do admit that the fact that this was a study that looked retrospectively at data, instead of prospectively, may have led to some inaccuracy in recall that might obscure findings. One other issue is that, thus far, there has been no solidly proposed mechanism as to why this advantage might exist with nursing. One Australian study of 43 infants looked at the two main cycles of sleep in infancy: quiet and active sleep. (These correspond to the adult non-REM and REM sleep cycles, respectively.) Infants are more able to arouse themselves from quiet sleep. However, in active sleep, they suffer from more heart and respiratory rate irregularities. It has been speculated that SIDS infants are less able to rebound from these episodes. In this study, the authors concluded that breast-fed infants were more easily aroused from active sleep, and, therefore, might be less susceptible to SIDS. They found this to be most profound during 2-3 months of age. While SIDS can occur between one and 12 months, it is highest between two and four months of age.
Other mechanisms provide possibilities. It's possible that since breast-milk is digested faster than formula, the infant awakes more frequently, and the mother is forced to check on her infant in accordance with this. This may afford the mother more opportunities to reposition and or re-ventilate the infant. Further, for many nursing mothers, they sleep beside their infants, improving their ability to be aware of problems or discomforts that the infant may be experiencing. Perhaps the fact that nursing requires a stronger oral effort from the infant makes their upper airways stronger and assists in respiration. Or could there be an, as yet unknown, component in breast milk that may protect against asphyxiation? Some have speculated that components within breast milk may be able to neutralize pro-inflammatory cytokines that may predispose the host to cardiac and respiratory infections. There is a lot that remains to be explained.
Despite these concerns, however, the data is powerful enough to compel researchers to look further into this theory. Further, based upon these findings, the authors of this study strongly recommend breast feeding for the first six months of life. Usually, researchers must be cautious in making recommendations based upon preliminary findings as certain treatments or preventive measures may carry risk. However, nursing is one of the few elements that carry virtually no threat to those utilizing it, and so there is little or no disadvantage in promoting nursing for everyone. Even in the absence of more complete studies, all of its potential benefits far outweigh the absence of risk.
If we were to even compare this type of recommendation to the "BACK TO SLEEP" recommendation, where it was recommended that ALL neonates be placed on their backs to sleep, as innocuous as that appeared, we found that this would become responsible for plagiocephaly (flattening of the cranium due to positional pressure). Nursing appears to have not even the slightest risk, and so there is no irresponsibility in recommending it strongly for all. If not for everyone, then certainly high-risk infant groups like infants born in the fall months and premature infants might benefit from a campaign of breast feeding based upon risk for SIDS. Certainly, nursing carries with it its own set of obstacles and challenges. It is not necessarily intuitive, many neonates do not latch on properly at first, and it can be frustrating for the mother whom has not been properly prepared or counseled. Despite the known benefits of nursing, there are still many who refuse to try it and many more who give up due to its difficulty. Examination of this new and promising possibility also gives us an opportunity to revisit the message that is being delivered to women about nursing as well as the support that they are given when trying. If even half of the suggestion of this study is true, it would behoove us to revamp the national breast-feeding campaign in order to recruit and retain more participants.
The general consensus is that "Breastmilk is the whey to go!"
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