"Extensive research is being currently done on the anatomy and physiology of the lactating breast. More science has studied that of the pathological breast anatomy. We are just beginning to learn the science behind the lactating breast. These researchers lay claim to the science behind the breast structure when breastfeeding. The field of expertise of lactation consultants is in its adolescence. This means it's a young specialty and still experiencing growing pains. It is my job then to take this extensive research and make it applicable to common breastfeeding situations. I have done well with my outcomes. Most mothers continue to breastfeed with less problems. My patients are clearly a unique opportunity to format trend-setting by monitoring outcomes. Outcomes consist of increasing milk volumes, increased duration rates of breastfeeding, and improving breastpump uses. I enjoy having the ability to make a difference!" - Carol Chamblin

New Handouts
#10 How Breastfeeding Works (PDF)
#11 Inside the Lactating Breast (PDF)
#12 International Breastfeeding initatives and their Relevance to the Current State of Breastfeeding in the United States (PDF)

#1 Starting Solid Foods
#2 Sunlight Deficiencies
#3 Getting Enough Sleep
#4 Weaning your One-Year Old
#5 Flame Retardant Chemicals in Breast Milk
#6 If Your New Grandchild is Breastfed
#7 Breastfeeding Protects Against Asthma and Atopy
#8 Few Babies Breastfed Long Enough
#9 Breastfeeding a Baby with Downs (PDF)

# 1 Breastfeeding Handout: Starting Solid Foods

• American Academy of Pediatrics recommends waiting until about 6 months before adding solids to a healthy breastfeeding baby's diet.
• Even one exposure to a formula or cereal can trigger allergies that could have been avoided.
• Readiness to start solids include: ability to sit up, reach and grab for food from parents, able to take bolus of solid and move it back in mouth instead of tongue-thrusting out.
• Some 4 and 5 month olds are "mouth hungry", seeming to be eager to eat. They usually want to teethe, practice, or socialize with cups, spoons, plates, and mom and dad. Offer baby finger-foods if he/she seems eager to try.
• Other babies do not show an interest in solids until way past their 6 month mark.
• Often iron supplements are recommended at 6 months of age for the breastfeeding infant.
• Studies demonstrate that exclusive breastfeeding until 6 months, compared to only 4 months, resulted in increased weight loss for mom, longer duration of absence of menstruation, and earlier achievement of certain motor skills in infants, such as crawling and walking.
• There is no need to introduce solids in a certain order when baby starts taking them around 5 or 6 months of age. Offer foods of interest.
• There is no reason a baby needs both breast and solids every time he eats.
• Fruit juices offer no nutritional value to infants less than 6 months of age.
• Start with mashed bananas and rice cereal (1 tsp.) since it is the most intestinal-friendly grain because it is gluten-free, low protein, and high in carbohydrates.
• Use your finger as baby's first "spoon". Watch your baby with this…if food goes in with an approving smile, then your baby is ready and willing. If food comes back at you, accompanied by a disapproving grimace, then your baby may not be ready.
• Try offering solid foods toward the end of your day if breastfeeding because your milk supply is naturally less and baby may be more eager to eat.
• Other favorite solid foods include: pears, applesauce, carrots, sweet potatoes, squash, and avocados.
• Space introduction of new foods about 1 week apart so that signs of food allergy are easily recognized. Signs of allergy are: bloating, gassiness, runny nose and watery eyes, diarrhea or mucousy stools, a red rash around the anus, general crankiness, or vomiting.
• At about 9 months, finger-foods such as pieces of soft, peeled fruit, small cheese, cooked carrot pieces, whole grain cereal shapes, or bits of chicken can be given.

© Carol Chamblin, RN, MS, IBCLC - Breast 'N Baby Lactation Services, Inc. and Patricia Drazin, IBCLC - Lactation Support Group, Inc. , July 13, 2003

#2 Breastfeeding Handout: Sunlight Deficiencies Versus Vitamin D Deficiency

The American Academy of Pediatrics (AAP) has come out with an updated report on the need to supplement breastfeeding babies with Vitamin D. Their statement was published in the April 2003 issue of the medical journal, Pediatrics. The main focus has erroneously portrayed exclusive breastfeeding as the cause of rickets instead of targeting the real cause which is insufficient exposure to sunlight.

There are sure to be some questions about this from your patients and their families as there has been so much media coverage on this issue. We would like to help you address the concerns presented to you by offering the following fact sheet titled "Sunlight Deficiency Versus Vitamin D Deficiency". It was developed collaboratively by three International Board Certified Lactation Consultants in private practice. As a group we hope to save you time in your office from answering questions by confused, but well-
meaning parents. Even if you do not plan to supplement all breastfeeding babies with Vitamin D, questions may still arise. We hope the following information will help.

The American Academy of Pediatrics (AAP) has come out with an updated report on the need to supplement breastfeeding babies with Vitamin D.

• Exclusive breastfeeding is not the cause of rickets.|
• Lack of exposure to sunlight resulting from less time being spent outdoors is the cause of the increase in incidence of rickets. Vitamin D is a hormone that our bodies metabolize from the sun.
• Rickets, a deficiency in Vitamin D, is characterized by weak bones, poor bone development, and bowed legs.
• Concern is directed to infants with darker skin pigmentation, infants who are covered up, infants whose mothers cover up due to cultural beliefs and/or do not eat dairy products or supplement their diets with foods or vitamins containing Vitamin D and higher order infants. Partial exposure to the sun is like taking 10,000-25,000 IU of Vitamin D by mouth.
• The amount of sunlight needed to maintain normal Vitamin D levels is approximately 30 minutes a week in an infant wearing only a diaper, or 2 hours a week in a clothed infant without a hat.
• That's all it takes! Less than 20 minutes a day! Sitting in the cart while you load the groceries or other shopping in the car!
• Darkly pigmented infants may require 3-6 times the sunlight exposure of lightly pigmented infants. Remembering that excessive light exposure can cause skin cancer, so babies should not be exposed unnecessarily or excessively.
• Who is at risk for Vitamin D deficiency? Lack of exposure to sunlight puts everyone at risk. Situations such as indoor confinement during the day, as in exclusively indoor daycare, unsafe neighborhoods, living at higher altitudes, darker skin pigmentation, living in urban areas with pollution and/or buildings that block sunlight, sunscreen use, and exposure to lead.
• Lifestyles have changed in many parts of the country, and this is the reason Vitamin D deficiencies have been noted amongst some children. Breastfeeding is not to be blamed!

Do not stop breastfeeding! Discuss the need for supplementation for your infant with your primary care provider. It is not necessary for all breastfeeding infants.

" Our culture has come to expect that babies should sleep through the night as soon as possible and that, in fact, it is good for babies to do so. This expectation is highly influenced by the belief that the baby sleeping through the night as young as possible is good for parents too. Actually, both these "givens" are not based on scientific fact or parenting wisdom, but rather on cultural bias.

" Another little-known fact is that "sleeping through the night" is defined in medical research as 5 straight hours of sleep, not 8 or 10.

" Infants enter sleep differently than adults. We adults can "crash" rather quickly. We can go directly from the awake state into the state of deep sleep. Infants cannot do this. They enter sleep through an initial period of light sleep (lasting about 20-30 minutes), then enter a period of transitional sleep, and then drift into deep or non-REM sleep. If an arousal stimulus occurs during the first half hour of sleep, a baby will awaken easily because he has not yet reached the deep-sleep phase. This fact of infant sleep accounts for the baby with whom moms say "He has to be fully asleep before he can be put down."

" As babies mature, they begin to go more quickly into the state of deep sleep. The percentage of light sleep decreases and deep sleep increases, and the vulnerable periods of night waking lessen. Furthermore, light sleep during the first year is important for brain development.

" Your baby's sleep pattern is not a reflection of your parenting. It often reflects his basic temperament.

" Just as there are wide variations in babies' temperaments, there are wide variations in their sleep patterns. It is important to approach parenting without preconceived images of what a baby should be like, especially about how he should sleep.

" The first few months the average baby sleeps 14 to 18 hours out of 24, but that is not true for every baby. In their first 3 months, babies' sleeping patterns are poorly organized.

" Middle-of-the-Night Playtime - 18 month olds to 2 year olds are verbal enough to understand that nighttime is not playtime. It's okay to say no to your toddler.

" Find more time to sleep. If you are not getting enough sleep at night, you need to sleep during the day. Sleep when your baby sleeps. If baby wakes up cheerful and ready to play at sunrise, have Dad get up and take care of baby. If baby goes to bed an hour or 2 before you do, wake her and nurse her again when you're ready to sleep so you won't be awakened shortly after you drift off.

© 10/2003 Carol Chamblin, RN, MS, IBCLC - Breast 'N Baby Lactation Services, Inc.

Weaning is best when it is done gradually. Dropping only one feeding every week or so means that you'll be less prone for engorged breasts and it's easier on your baby, too. You may drop one feeding per 24-48 hours, choosing the first ones to cut as those sessions that are easiest to bypass without a struggle. Most babies want to hang onto the nursings associated with bedtime - the day's first feeding, naptime feeding, and bedtime.

You can either choose to totally wean your baby cold turkey, or you can choose to keep one or two nursing sessions a day, even after cutting out the rest. When you begin to drop nursings, you'll need to replace that time with another kind of cuddling or special time. Instead of regarding weaning as something to deny your child, think of it as a time to expand your child's horizons by offering new tastes and foods and customs. Instead of hurrying the process, let it take its own pace, and the transition will be easier on you both.

There's more to breastfeeding than nutrition: It represents love, comfort, trust, attachment. Try to keep a stack of picture books near the rocker, so you can find a new use together for a favorite chair. It's a good idea to cuddle in a position that's different from the one you typically used for nursing - ie. holding your child facing away from your chest as you read a picture book together, or balancing her on your feet or legs to play airplane. Perhaps a new spot to sit and enjoy a book prior to bedtime can become your new routine.

Though you've planned to wean, don't be surprised if you feel a little melancholy or sad during this process. It is officially a new phase in your relationship with your baby. Plus, your body will be going through hormonal changes that can produce some symptoms of depression.

Another suggestion that seems helpful, is by adding something to your usual routine. Instead of nursing prior to bedtime, add a reading time done by your husband after you nurse. Then after the story time becomes part of the routine, let your husband begin the routine alone, or gradually shorten the amount of time you nurse. His favorite nursing time should be the last one to go. If your baby wakes up during the night, it's best if your husband can go and respond to his cries, rather than you. Perhaps planning this activity for a weekend or period of a few days when your husband doesn't have to work would make the whole ordeal less stressful for you.

Weaning Tips:
" Change the routine. Have Dad take over the bedtime or nursing-time tasks that Mom formerly handled (dressing, reading stories).
" Take the weaning child for a long car ride at nursing time.
" Introduce a "transition object" - a toy, lullaby tape or book, for example - at 12-15 months, so the baby learns to associate something besides nursing with going to sleep. This will make it much easier to wean your baby.
" Offer a snack - juice and a favorite food - at nursing time.
" The favorite nursing sessions (ie. morning and bedtime) should be last to go.

© Carol Chamblin, RN, MS, IBCLC, Breast 'N Baby Lactation Services, Inc. 12/02

Vinny, a healthy breastfed 6 month old

Wean Me Gently
By Cathy Cardall

I know I look so big to you,
Maybe I seem too big for the needs I have.
But no matter how big we get,
We still have needs that are important to us.
I know that our relationship is growing and changing,
But I still need you. I need your warmth and closeness,
Especially at the end of the day
When we snuggle up in bed.
Please don't get too busy for us to nurse.
I know you think I can be patient,
Or find something to take the place of a nursing;
A book, a glass of something,
But nothing can take your place when I need you.
Sometimes just cuddling with you,
Having you near me is enough.
I guess I am growing and becoming independent,
But please be there.
This bond we have is so strong and so important to me,
Please don't break it abruptly.
Wean we gently,
Because I am your mother,
And my heart is tender.

© 10/2003 Carol Chamblin, RN, MS, IBCLC - Breast 'N Baby Lactation Services, Inc.

Breastfeeding Handout #5: Flame Retardant Checmicals in Breast Milk

Headlines are reporting flame retardant chemicals in breast milk because of recent published studies. They have highlighted the report by the Environmental Working Group that two studies have shown these chemicals in lactating women. While this headline is alarming, it must be put in perspective. It was decided by the Environmental Working Group that studying environmental chemicals in lactating women was the most economic and non-invasive way of monitoring environmental chemical levels in the general population in the United States. The reason is that human milk contains fat. It is the only way that a human excretes their fat. In order to measure chemical levels in fat depots in the general population, it would require the very invasive fat biopsy which would be technically difficult and extremely expensive or minimally blood draws.

A third study not referred to shows that newborns have the same level of these chemicals as their mothers. Pregnancy involves the important transmission of any chemical. The chemicals which are being reported are the bromine-based fire retardants that are used in many home and commercial settings. They are used in such things as television sets, automobiles, copy machines, hair dryers. The fire retardants are polybrominated biphenyl ethers or PBDE. They have been studied in small animals in large doses and been associated with nervous system damage and reproductive problems. There are no comparable studies in humans.

In two recent studies, a total of 67 women participated. 100% of the women who were involved had measurable amounts of PBDE's. The levels are much higher levels than those found in European women and in those noted five years ago. The Environmental Protection Agency suggests that PBDE's are doubling in humans every five years. Besides environmental sources, the EPA suspects that humans may be accumulating these chemicals from the animal fat they consume.

In the United States, California and Maine have begun to restrict the use of these chemicals. They are banned in Europe. What does this mean for our infants? The important thing to recognize is that all women are at risk for having these chemicals in their fat depots. Therefore, all infants are exposed in utero which is a far greater exposure than through human milk. There are no data regarding the levels in cow milk, water, and infant formula. There is no indication that breastfeeding would contribute substantially to the exposure of our infants. It is important to recognize the tremendous benefit of being breastfed. The value of the nutrient constituents of human milk, the constituents which promote brain growth and good development, the constituents which protect against infection, the constituents that offer immuno-protection against chronic disease and allergy cannot be duplicated. The tremendous value of breastfeeding far exceeds the theoretic risk of these recently reported chemicals.

The public can expect to hear about more environmental chemicals being found in human milk, only because human milk has been selected as the environmental modality for monitoring chemicals in the general population.

The Environmental Work Group says even though a woman has a high level of chemical in her milk, she should continue to breastfeed because of the tremendous value of human milk and the effects of the chemicals are related to fetal intrauterine exposure.

References:
International Lactation Consultant Association, Position on Breastfeeding, Breast Milk, and Environmental Contaminants, October 2001.
La Leche League, Breastfeeding Remains Best Choice In A Polluted World, October 13, 2003.
World Alliance for Breastfeeding Action (WABA) & International POPs Elimination Network (IPEN), Working Together for a Toxic-Free Future, May 2003.

© 10/2003 Carol Chamblin, RN, MS, IBCLC - Breast 'N Baby Lactation Services, Inc.

Breastfeeding Handout #6: If Your New Grandchild is Breastfed

Congratulations! It must be thrilling as you await the arrival of your new grandbaby! It probably seems like yesterday when you were holding your new baby!

If you are like many grandparents today, you may have bottlefed your baby. It used to be a common way to feed our newborns. Today, breastfeeding is often the feeding choice of new parents because the health benefits for mom and baby are tremendous! If you did nurse your children, then you will be a big support as you help your grandchild's mom learn to breastfeed.

Breastfeeding is natural - but learned - by both mom and baby. It is the best start on life your grandchild can get. We know so much more today about making the world safer for babies - remember when we didn't have car seats for children? Well, breastfeeding has been around since the beginning of times. It hasn't changed, but our world has changed. We no longer always have an informative mother, aunt, or other relative around to assist and support us as we begin to breastfeed.

That is why the profession of lactation consultants was born in the mid-1980's. Lactation consultants such as myself have furthered our education to practice within a specialty of assisting moms and babies with breastfeeding. It is a clinical expertise that requires ongoing education. Why? Because our society often times has complex situations surrounding the breastfeeding experience. For example, women today are able to get pregnant with our wealth of technology who couldn't get pregnant even a few years ago. As a result, hormonal complications can exist and affect her breastfeeding abilities. However, most women can overcome these challenges and be able to breastfeed if working with a knowledgeable lactation consultant. On the baby side of birth, many babies are surviving prematurity and other illnesses and conditions surrounding the birth. Breastmilk for these babies is considered the best "medicine" as it protects them from becoming more ill often times.

What can you do to help your grandchild breastfeed?

• Reassure mom that baby needs to nurse 8-12 times in 24 hours.
• Be reassured your grandbaby is getting enough to eat if having 6-8 wet diapers and 1-3 yellow, seedy stools in 24 hours.
• Breastmilk digests easily and your grandbaby's tummy is only about the size of its fist. Nursing frequently is normal!
• Reassure mom that baby is latched onto the breast properly if baby's mouth looks wide-open like a yawn, you hear swallows, and it doesn't hurt to nurse.
• Be reassured that the baby (not the clock) decides when the feeding is over. Some feedings last 20 minutes while others last 40 minutes.
• You can help the new mom by buying the groceries, cooking meals, doing a load of laundry, or helping with other chores around the house.
• You can show your love for your new grandbaby by cuddling, holding, bringing the baby to mom to nurse, bathing the baby, and talking to your baby as you adore its adoring little face.
• If you are concerned about your grandbaby or new mom, encourage mom to call Carol Chamblin, RN, MS, IBCLC - Lactation Consultant at Breast 'N Baby Lactation Services. Ph. (630) 513-1101.
• Call if mom experiences sore nipples, feedings lasting > 1 hour, baby has < 8 feedings in 24 hours, no or slow weight gain in baby, or mom is told to supplement baby.
• Unsure about how to use your newly purchased breastpump? Call Carol to learn to effectively use your pump to maintain your milk supply.

© Carol Chamblin, RN, MS, IBCLC December 2002

Breastfeeding Handout #7: Breastfeeding Protects Against Asthma and Atopy
Reuters Health Information 2004. © 2004 Reuters Ltd.

Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

NEW YORK (Reuters Health) Sept 14 - Children who are not exclusively breastfed have a higher risk of asthma and atopy, according to a report in the September issue of the American Journal of Public Health.

Dr. Wendy H. Oddy, of the University of Western Australia, West Perth, and colleagues examined the association between breastfeeding, asthma and atopy, and body mass index (BMI) in 2195 children prospectively followed from birth to 6 years.

The team defined asthma as doctor-diagnosed asthma and wheeze in the last year and skin prick tests were used to determine atopy for 1596 children.

A logistic regression model before adjustment revealed a significant association between a shorter duration of any breastfeeding and increased BMI at 6 years. The effect of longer breastfeeding did not significantly decrease a child's risk of being overweight after adjustment for gender, birthweight, and maternal smoking during pregnancy.

The researchers also observed an association between less exclusive breastfeeding and increased asthma and atopy after adjustment for BMI. With each additional month of breastfeeding, there was a 4% reduction in the risk of asthma. No significant effects of breastfeeding on atopy were observed.

After adjusting for known risk factors, increased BMI was significantly associated with asthma risk. "Reasons for an association between increased body weight and asthma are not clear, but an immunological mechanism has been suggested," Dr. Oddy and colleagues write. "In obese individuals, the biological activity of adipose tissue may increase the risk of developing asthma."

The investigators call for additional studies to confirm these findings and to understand the mechanism of the protective effect of breastmilk. In the meantime, they note that "public health interventions to promote exclusive breastfeeding for at least 6 months may reduce the prevalence and subsequent morbidity of asthma and atopy in early childhood."

Am J Public Health 2004;94:1531-1537.

Breastfeeding Handout #8: Few Babies Breastfed Long Enough
Michele Late, The Nation's Health 34(7), 2004. © 2004 American Public Health Association Posted 09/03/2004

Not enough U.S. moms are getting the message that "breast is best" when it comes to feeding their newborns and infants, new statistics from the Centers for Disease Control and Prevention show.

While U.S. health officials call for mothers to breastfeed their babies exclusively for the first six months of their infants' lives, few mothers actually do so, according to research gathered via CDC's 2003 National Immunization Survey. The Aug. 5 findings show that while most U.S. mothers breastfeed their babies at some time, few exclusively maintain the practice as long as recommended by health experts, instead supplementing or replacing breast milk with formula or juice.

Such choices can put babies' health at a disadvantage, according to a new campaign launched this summer by the U.S. Department of Health and Human Services to promote breastfeeding awareness. The national campaign, created by the Office on Women's Health and the Advertising Council, encourages mothers to begin breastfeeding as soon as their babies are born and to continue to exclusively breastfeed for at least six months.

The new campaign, which has a tag line of "Babies Were Born to Be Breastfed," is especially notable for two reasons: It is the first national public health campaign for breastfeeding since 1911, and it emphasizes the health consequences of not breastfeeding. Through a series of eye-catching images that subtly mimic the appearance of breasts, print ads in the campaign advise mothers that breastfeeding will help reduce their children's risk of ear infections, respiratory illness, obesity and other health risks.

"New parents are often discouraged from breastfeeding because of confusion about duration and doubts about their ability," said Cristina Beato, MD, acting U.S. assistant secretary of health. "These new public service announcements speak to parents clearly about the consequences of not breastfeeding, which may help encourage more mothers to initiate and continue to breastfeed exclusively for six months."

The ad campaign's tactic of highlighting the consequences of not breastfeeding — while obvious from a public health perspective — was not without controversy. While the campaign had originally been scheduled for launch in fall of 2003, it was delayed reportedly because the infant formula industry objected to its message. Lactation supporters and public health advocates rallied in support of the issue, however.

Among the many benefits of breastfeeding, research has shown that the practice improves infants' immune responses, prevents chronic disease, contributes to better cognitive skills, stimulates bonding between mother and child and promotes healthiness in premature infants. Mothers who breastfeed also have a lower risk of breast cancer. As long as a mother is physically able, the American Academy of Pediatrics recommends that babies be breastfed for at least a year, while the World Health Organization recommends the practice for two years.

Unfortunately, many U.S. women either are unaware of the benefits or choose not to breastfeed, often citing inconvenience, physical discomfort or social stigma as common barriers to breastfeeding.

Healthy People 2010, which sets health objectives for the nation to reach by 2010, calls for 75 percent of mothers to begin breastfeeding, 50 percent of babies to be breastfed for six months and 25 percent to be breastfed for 12 months.

According to the CDC statistics released in August, almost 70 percent of U.S. women reported breastfeeding their infants at some time; however, only 36 percent breastfed when their infants were six months of age. Rates for exclusive breastfeeding — where mothers fed their children nothing but breast milk — were also low, with 41 percent of mothers exclusively breastfeeding at three months and just 14 percent at six months.

Breastfeeding rates vary widely by race and ethnicity. At six months of age, 25 percent of Native Hawaiian and Pacific Islander babies were exclusively breastfed, the highest of any group, versus non-Hispanic black babies, fewer than 10 percent of whom were exclusively breastfed at six months.

To reach mothers at the local and community levels, the new HHS campaign includes 18 community demonstration projects, many of which are working specifically to reach out to black women and first-time mothers. The projects serve as clearinghouses for information on breastfeeding, handling calls from the public and media and promoting the campaign.

In Boston, where the Breastfeeding Center at Boston Medical Center is serving as the base for that region's demonstration project, health advocates have successfully placed public service ads from the national campaign into community newspapers that cater to black residents. Advocates are also working to reach residents via magazine, radio and television ads. The Boston team also distributed campaign advertisements to every Women, Infant and Children Program office in Massachusetts to reach low-income women.

APHA member Anne Merewood, MA, director of lactation services at the Boston Breastfeeding Center, said she has high hopes for the campaign and called for public health professionals to embrace the issue in their communities.

"It can be very effective," Merewood said. "It's really up to public health advocates to get this campaign going."

For more on the national campaign, visit www.4woman.gov/breastfeeding . For more on the new rates from CDC, www.cdc.gov/breastfeeding/nis_data . For more news from The Nation's Health, visit www.apha.org/thenationshealth .