Effects of Exclusive Breastfeeding for Four versus Six Months on Maternal Nutritional Status and Infant Motor Development

Kathryn G. Dewey, Roberta J. Cohen, Kenneth H. Brown and Leonardo Landa Rivera

Journal of Nutrition. 2001;131:262-267.


To examine whether the duration of exclusive breastfeeding affects maternal nutrition or infant motor development, we examined data from two studies in Honduras: the first with 141 infants of low-income primiparous women and the second with 119 term, low birth weight infants.

In both studies, infants were exclusively breastfed for 4 mo and then randomly assigned to continue exclusive breastfeeding (EBF) until 6 mo or to receive high-quality, hygienic solid foods (SF) in addition to breast milk between 4 and 6 mo. Maternal weight loss between 4 and 6 mo was significantly greater in the exclusive breastfeeding group (EBF) group than in the group(s) given solid foods (SF) in study 1 (-0.7 ± 1.5 versus -0.1 ± 1.7 kg, P < 0.05) but not in study 2.
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The economic impact of breastfeeding

Ball TM, Bennett DM.
Pediatr Clin North Am. 2001 Feb;48(1):253-62.


Health care expenditures have increased dramatically from 5% to 13.5% of the Gross Domestic Product of the United States since 1960.16 As a result, more attention has focused on the costs of medical care, which, in turn, has led to interest in evaluating the cost-effectiveness of many medical and preventive health therapies.

Breastfeeding is associated with several health benefits for infants and mothers. Compared with formula-fed infants, breastfed infants experience less acute and chronic otitis media, bronchiolitis, diarrhea, meningitis, and necrotizing enterocolitis. Children who were breastfed during infancy suffer less recurrent wheezing, have a higher IQ, and develop insulin-dependent diabetes mellitus less frequently than those who are fed formula.
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A 35-Year-Old Woman Experiencing Difficulty With Breastfeeding

JAMA. 2001;285:73-80.

Ruth A. Lawrence, MD, Discussant

MRS C, A 35-YEAR-OLD COMMUNICATIONS PROfessional, has a 3-week-old child and has been experiencing difficulty with breastfeeding. Married and living in Boston, she receives care from an obstetrician-gynecologist, Dr T, at the Beth Israel Deaconess Medical Center and has commercial health insurance in a managed care plan.

Mrs C experienced menarche at age 12 years, had a miscarriage 2 years ago, and gave birth after an uncomplicated pregnancy to her first child. She ruptured membranes on her due date and had a vaginal delivery aided by oxytocin and epidural anesthesia. During pregnancy, she noted mild breast enlargement without nipple discharge.
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Effect of domperidone on milk production in mothers of premature newborns: a randomized, double-blind, placebo-controlled trial

da Silva OP, Knoppert DC, Angelini MM, Forret PA.
CMAJ. 2001 Jan 9;164(1):17-21.


Background: Varying degrees of success have been reported with strategies to increase milk production when lactation is failing. The objective of this study was to investigate the efficacy of domperidone in augmenting milk production in mothers of premature newborns.

Methods: Twenty patients were randomly assigned to receive either domperidone or placebo for 7 days. Milk volume was measured daily. Domperidone levels were measured in randomly selected milk and serum samples on day 5 of the study. Serum prolactin levels were measured before the start of the study, on day 5 and on day 10 (3 days after the last dose of the study medication).
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Promotion of Breastfeeding Intervention Trial (PROBIT): A Randomized Trial in the Republic of Belarus

Michael S. Kramer et al.
JAMA. 2001;285:413-420.


Context Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies. Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries.

Objective To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants.

Design The Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial conducted June 1996–December 1997 with a 1-year follow-up.

Setting Thirty-one maternity hospitals and polyclinics in the Republic of Belarus.

Participants A total of 17 046 mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed, 16491 (96.7%) of which completed the entire 12 months of follow-up.
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How exclusive is exclusive breastfeeding? A comparison of data since birth with current status data

Aarts C, Kylberg E, Hörnell A, Hofvander Y, Gebre-Medhin M, Greiner T.
Int J Epidemiol. 2000 Dec;29(6):1041-6.


BACKGROUND: There is no accepted and widely used indicator for exclusive breastfeeding since birth. Indeed, the difference between ‘current status’ data on exclusive breastfeeding and data on ‘exclusive breastfeeding since birth’ is rarely recognized. We used data from a longitudinal study to examine this issue.

METHODS: A descriptive longitudinal, prospective study design was used in which 506 mother-infant pairs were included. The mothers completed daily recordings on infant feeding during the first nine months after birth. A research assistant conducted fortnightly home visits with structured interviews.
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Cows’ Milk in Complementary Feeding


If breastfeeding is continued at a high rate into the second year of life, and if the complementary diet contains reasonable amounts of animal protein from meat, fish, or eggs, most infants will thrive without cows’ milk. This is the situation in some traditional societies, where milk is not available or where there is no tradition for feeding cows’ milk. However, in most populations in the world there is a strong tradition of using cows’ milk as an important part of the complementary diet. This article will discuss different aspects of the use of cows’ milk in complementary feeding and will highlight areas where there is a need for further research.
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Complementary Feeding and Breastfeeding


A key question that has been inadequately explored is: to what extent does or might complementary feeding affect breast milk intake and total breastfeeding duration? We assume that maintaining breastfeeding is desirable, but in designing interventions to improve complementary feeding, the potential impact on breastfeeding frequency and breast milk intake is often ignored.
PEDIATRICS Vol. 106 No. 5 Supplement November 2000, pp. 1301

A cikk a Pediatrics oldalán olvasható.
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Vannak-e negatív hatásai a túlzott fehérjebevitelnek?

A csecsemők testsúlykilogrammra számított fehérjeszükséglete – elsősorban a nagyobb mértékű növekedésnek köszönhetően – nagyobb, mint az idősebb gyermekeké és a felnőtteké. Az újabb becslések szerint egy 6-9 hónapos baba esetében a biztonságos fehérjebevitel 1,09 g/kg, 9-12 hónapos gyermek esetén 1,02 g/kg, míg egy felnőtt számára 0,8 g/kg.

A testsúlykilogrammra számított energiaszükséglet ehhez képest relatíve nagyobb. Egy 9-12 hónapos csecsemő energiaigénye 89 kcal/kg, ami majdnem háromszorosa egy közepes fizikai aktivitású felnőttének (kb. 30kcal/kg). Ily módon egy 9-12 hónapos csecsemő étrendje a teljes energiaszükséglet 5%-ának megfelelő mennyiségű fehérjét kell, hogy tartalmazzon ([1,02g fehérje*4kcal/g]/89kcal). 5E% az anyatej fehérjetartalma.
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Complementary Feeding and Enteropathies

Jacques Schmitz, MD

PEDIATRICS Vol. 106 No. 5 Supplement November 2000, pp. 1286


Since the discovery, in the early 1950s, that gliadin was the component of wheat responsible for celiac disease (CD), and, during the 1960s that cows’ milk proteins could also trigger severe enteropathies, it has been shown that early introduction of many other foreign proteins—from soy, rice, eggs, fish, and chicken—could have the same deleterious effect: a T-cell mediated immune reaction leading to mucosal inflammation with villous atrophy, diarrhea, and failure to thrive.

Research Priorities
1. At what age is the risk of developing a protein-induced enteropathy so low that feeding a foreign protein can be considered safe?
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