Breastfeeding Questions & Answers

If you are experiencing difficulty with breast pain or latch-on 3 to 5 days postpartum, it is probably due to engorgement. Advil is safe for breastfeeding and contains an anti-inflammatory that may reduce some swelling and discomfort. Your best friend during this time is a hot compress. Turn the tap water and let it run until hot. Take two disposable baby diaper and swipe it under the tap three or four times. Mold the diapers around your breast. Repeat this procedure before each feeding. Commercial hot packs are also available, but the diapers work just as well so you may want to save your money for a good breast pump. If the areola is still too hard for the baby to grasp, use a quality breast pump for three to five minutes before latching the baby on. If the baby goes to sleep before emptying the breast, finish pumping afterward. Take heart! Engorgement only lasts for 48-72 hours.

Early onset of nipple soreness can be due to a number of things. Poor positioning, poor latch-on, not breaking the suction properly, bras and pads that aren't cotton or changed infrequently, or bad breast pumps. Make sure that the baby's ear, shoulder, and hips are aligned. Make sure the baby has 1 - 1 1/2" of the areola in his/her mouth. Make sure you break the suction when you take the baby off the breast by releasing the seal with your finger. Keep the baby from slipping down by supporting the breast during the entire feeding. Use a firm pillow or nursing pillow to the baby's body from becoming too heavy to hold. Air dry the nipples after each feeding. Use expressed milk or hospital grade lanolin sparingly on sore spots. Comfortgel pads can also be used to speed healing. Use only 100% cotton or paper, breathable nursing pads and change them frequently. Nipples may still be uncomfortable for a few seconds after latch-on, but they should be getting better daily.

If nipples are cracked or bleeding, follow the steps above for sore nipples, but use breast shells to keep the skin from pulling away when you change bra pads. A little blood won't hurt the baby because breast milk is blood product. A new product is now available that had been used to treat burn victims in the past. These hydrogel Comfortgel pads are extremely helpful in healing wounded nipples.

Your body makes milk on a supply and demand basis. We don't need ounce markers on the side of our breasts, to know the baby is getting enough. When your baby is first born, his wet diapers should increase daily. On day one, he should have at least one, day two, he should have two, up until day six. After six days of age, they have six to eight pale wet diapers daily and three to four "cottage cheese and mustard" stools. Other ways we can tell the baby is getting enough milk is that he makes quiet swallowing sounds at the breast. The breast feel full before the feeding and softer afterward. The baby seems satisfied after twenty minutes of swallowing. Babies may loose 7-10% of their birth weight, but begin regaining at day 6 and gain 5-7 ounces per week on the average until 6 months of age. The stools can change at 4-6 weeks of age. See growth spurts. Make sure you are drinking to thirst and still taking your prenatal vitamins. If you want a boost increasing milk supply, Fenugreek is safe and effective. It increases milk supply in about 48 hours. Blessed thistle and Mother's Milk Tea can also be helpful in milk production. Click on links below for more info on the most widely used of this herbs, Fenugreek.

You can almost set your watch by a baby's growth spurt. The first one occurs anywhere from 10 days to 3 weeks of age. The following ones come at 6 weeks, 3 months, and 6 months. When babies go through growth spurts, their feeding times change from every two to three hours to every hour on the hour. You just finish feeding them and they go rooting around again and act like they are starving. During the 3 week growth spurt, you can definitely see that the baby is pooping 4+ times daily and having lots of wet diapers. What goes in, must come out, so we know the baby is getting enough. The 6 week growth spurt can really floor you because at that time their digestive system matures and they have fewer dirty diapers. Some babies only have one every 3-5 days. Don't dismay, you can still tell he/she has plenty of fluids by the fact that the baby is still having six to eight wet diapers daily. The three month and six month growth spurts are pretty typical. Growth spurts usually only last 5 days if you don't interfere with imposed schedules and supplements. Make sure to keep drinking to thirst and taking your prenatal vitamins. If you want a boost for your milk supply, try Fenugreek.

Waiting until you baby is three to four weeks old to start a bottle is the best way to get him/her to learn to suckle the breast first. When you do begin a bottle, use your own expressed milk as not to interfere with your milk supply and use a silicone bottle nipple that doesn't have a smell and taste. Choose a slow flow nipple. To calculate how much to put in a bottle, see our chart under milk intake. Make sure to express you milk if you skip a feeding. The rule of thumb for a baby under six months of age is to pump every three hours with a pump that imitates you baby's suck cycle. After six months, if your baby is on solids, you would only need to pump twice on an eight hour workday instead of three times.

Plugged milk ducts feel like a pebble or a pea under the skin or areola. They are best treated with hot compresses, breast massage during feeding , and pumping after the feeding. Place the baby's chin toward the plug if possible, massage from behind the plug towards the nipple, and pump for ten minutes after each nursing until resolved. Make sure you are not wearing a nursing bra that is too tight or that has an under wire pushing into your milk ducts.

Mastitis is an infection of the breast usually following an untreated plugged milk duct. Watch for chills, fever, and flu-like symptoms. Use the same techniques as for a plugged milk duct and call the doctor for an antibiotic. If you have been wearing tight-fitting or under wire bras, treat yourself to a supportive nursing bra that won't plug your milk ducts. Remember...heat, rest, empty the breast.

This is a common concern for newborn infants. First I would take a look at any painkillers you are taking. Pain medication from the hospital can cause the baby to be sleepy. Tylenol, Advil, and Aleve are all safe for breastfeeding and will not make the baby sleepy. Next, be aggressive. New moms tend to be very gentle, but newborns don't always know when they are hungry, so you have to wake them up every two to three hours with no more than one five hour stretch in any 24 hour period. Techniques for waking a baby include, stripping him/her down to a diaper, using the clutch/football hold so the baby is more upright, washing their face before nursing, changing their diaper, rubbing their hands, face, feet, or back. My personal favorite is alternate breast massage. As soon as the baby stops sucking or swallowing and begins to fall asleep. Massage the breast from underneath towards the nipple. This wiggles the nipple and "milks" the breast into the baby's, reminding him or her to start nursing again.

Before beginning collection of breast milk, always wash your hands. Make sure the pump parts that will touch the milk are sterile (can be sterilized in the top rack of the dishwasher, a microwave sterilizer or boiling water for 5-10 minutes). After pumping store milk in 2-4 oz increments to reduce waste. Pump directly into hard plastic or glass bottles that you will seal with a solid or ring and disk lid or freezer bags that are specifically designed for storing mothers' milk. Breast milk is good at room temperature for 6-10 hours, refrigerator for 5-7 days, freezer for 3-6 months and deep freeze for 6-12 months. Make sure to freeze refrigerated milk within 24 hours if you are not going to use it within the 5-7 day time frame. Refrigerate milk immediately if you are not going to use it within the 6-10 hours that it is good at room temperature. Never refreeze breast milk or put milk back in the fridge. Never put milk on the stove or in the microwave. To thaw or warm, simply place the milk in warm water. To determine more closely how much breast milk to put in each bottle for a baby who is less than six months old, take the baby's weight and multiply by 2.5. Then divide by the number of feeding per day. After the age of six months, the baby needs 24-32 oz per day which is approximately 5-6 oz per feeding 5-6 times per day.

To position baby at the breast make sure that the baby's body is turned in to mother. For example, in the cradle hold, the baby would be tummy to tummy with mom so that he/she doesn't have to turn his/her head to swallow. The baby's ear, shoulder, and hips should be in a straight line. Use a pillow and stool to make sure baby is at breast level.

There is no set list of foods that every nursing mother should/should not eat. Some baby's however are more sensitive to certain gassy foods especially in the early weeks or months. If you are experiencing a gassy baby, look for correlations when the baby is gassy and you have eaten these foods in the last 24 hours: green leafy vegetables, broccoli, tomato or sauce, citrus juices or fruit. If you cut out these foods temporarily, the baby should feel relief in the next 24 hours if that food was the culprit. If the problem is dairy products, you won't find relief for 10 days to 3 weeks.

Solids should not be started until the age of six months in most cases. Waiting until this age greatly reduces the incidence of allergies. Developmental phases should also be taken into consideration. The baby should not only have doubled his/her birth weight, but should be sitting alone without support. Readiness signs include grasping at the parents plate or food. Breast milk is still the main source of nutrition so always breastfeed immediately before offering solids as to ensure a healthy milk supply and a healthy appetite for the superior breast milk.

After positioning the baby properly (see Positioning Baby at Breast), make sure that your hands are supporting the breast with your thumb on top and the rest of your fingers near the chest wall, well behind the areola. If you can't tell where your fingers are, practice your breast hold in front of a mirror before you start. Then tickle down in the same direction towards the baby's chin until the baby opens wide like a yawn or a cry. Make sure the baby's tongue is down and then bring the baby to the breast swiftly.

The issue of buying or selling used pumps is something some breastfeeding moms encounter. Although a used pump may be more affordable than a new one, there are possible legal and health implications involved. Below you will find more on the legality of selling used breast pumps, what some pump manufacturers say about used pumps.

If you are thinking about buying or selling a used pump, we urge you to read over this information before making your decision.

U.S. Food and Drug Administration's Position on used breast pumps:
According to the FDA, if a breast pump is labeled a "single user" or "single patient" device, that pump is only intended for one user and cannot legally be resold. By selling a pump that has been designated "single user" by the FDA, the pump is not being used in accordance with the FDA and is being "mis-branded," which is against the law, and the FDA could take action.

The reason the FDA designates many breast pumps as "single user" devices, is that there is no complete way to clean certain pumps to ensure that the breast milk of the original user is not still within the pump system. Because some diseases have been shown to exist in breast milk, the possibility of transmitting diseases through a used breast pump does exist, although it appears that no such cases have been documented.

To find out if your breast pump has been designated "single user" by the FDA, please consult the operating instructions that came with the breast pump when you purchased it.

Here are some common breast pumps that are labeled "single user" devices: Isis and Isis iQ Breast Pumps by Avent,
The Ameda ^®Purely Yours Breast pump, WhisperWear^® Breast pump, The Medela Pump In Style^® Breast pump
Some breast pumps that are not labeled "single user" devices:
Medela Classic^™Breast pump^,Medela Lactina^®Breast pump, Medela Symphony^®Breast pump, Ameda SMB ^® Breast pump, Ameda Lact-E ^® Breast pump, Ameda Elite^® Breast pump, Hygeia EnDeare Breast pump, Hygeia EnJoye Breast pump

Breast pumps purchased at department stores (Wal-Mart, Target, Babies R Us, Baby Depot, etc.) baby stores and maternity stores are often "single user" breast pumps. Pumps that are designated by the FDA to be safe for multiple users are generally hospital grade breast pumps and often used specifically as rental pumps.

If you have a breast pump you are considering selling, please consult the product information first, to be sure the pump is not labeled "single user." And, if you are considering buying a used breast pump, please determine whether or not the pump is a "single user" pump before purchasing it. You could ask the seller to check the product information to be sure.

Medela's Position:
Many mothers have asked if they can safely sell, purchase, or use a previously owned breast pump. Medela is concerned about the health and welfare of breastfeeding mothers and their babies. Breastfeeding is certainly the best way to feed your baby, and is the gold standard of infant nutrition. There is some evidence, however, that certain serious viruses* may be transmittable through breast milk. For this reason, it is not advisable to use a previously owned breast pump. Breast pumps are single-user products, or personal care items, much like a toothbrush, and are registered with the FDA as single user items.

For safety, breast pumps should never be shared, resold, or lent among mothers. Medela strongly discourages mothers from re-using or re-selling previously owned breast pump equipment. The Medela Pump In Style^® Breast pump has an internal diaphragm that cannot be removed, replaced, or fully sterilized. Therefore, the risk of cross-contamination associated with re-using a previously owned pump such as the Pump In Style cannot be totally dismissed. Multiple use of single-user breast pump automatically voids the warranty of the Medela product. Each mother who wishes to express milk with a pump should use a clean, uncontaminated breast pump. This is the safest way to eliminate any risk of cross-contamination.

Rental pumps such as the Ameda Lact-E and Elite, the Hygeia EnDeare as well as the Medela Classic^™ , Symphony and Lactina^® pumps are made to be safely used by repeated clients who each use their own clean personal rental kit, therefore avoiding any possible cross-contamination. Rental pumps, when used according to the instructions, are safe to use by multiple mothers who have their own personal kits. Ameda and Hygeia have personal pump kits approved by the FDA and Hygeia's EnJoye is the only lightweight pump under $250 that is approved for re-sale or re-rental.

We are invested in continuing health and safety of mothers and babies. Many mothers who wish or need to express milk regularly find that using a high quality breast pump can help avoid the costly alternative of using artificial baby milk, which sometimes approaches or exceeds $1000 for the first year of baby's life. Mothers who pump frequently may find that the cost of a high quality breast pump, when compared to the price of artificial baby milk is reasonable, and a wise investment in the present and future health of their children and themselves.

1. *It is believed by some physicians and researchers that human breast milk can possibly contain viruses if the mother is infected. Such viruses may include CMV (Cytomegalovirus), HIV-Human Immunodeficiency Virus (AIDS), and HTLV-1 (Human T-Cell Leukemia Virus Type 1.)

1. Ruth A. Lawrence, MD, Breastfeeding: A Guide for the Medical Profession
(St. Louis, Missouri: Mosby-Year Book, Inc., 1999), pp. 225.

Avent America's Position:
We at Avent America are always striving to provide mothers with quality products at reasonable prices to help them breastfeed longer. Research has shown that breast milk can transmit many contagious viruses. It is for this reason that we strongly recommend that you NEVER use a previously owned breast pump. The Isis Breast Pump is considered to be a personal care item and has been designed to be for single use only. Mothers should never share breast pumps. Sharing or using a previously owned breast pump could put you and your baby at a potential risk for exposure to serious health risks.

Some of the viruses that can be within breast milk are:

When you are using a previously owned breast pump you create the risk of cross contamination. It is for this reason that AVENT AMERICA STRONGLY SUGGESTS NEVER USING, BORROWING, PURCHASING OR SELLING A PREVIOUSLY USED/PRE-OWNED BREAST PUMP.

Since a mother's breast milk is the most precious gifts of nutrition/health she can give her baby, DON'T take the chance of sharing someone else's viruses with your baby. Quality affordable breast pumps can be purchased for less than the cost of two months worth of formula.

Babies under the age of six months will normally nurse every 2-3 hours from the beginning of one feeding to the beginning of the next which is usually 8-10 times per day. During growth spurts at 3 weeks, 6 weeks, and 3 months, they will up their feedings to 10-12 times per day. Between 6 and 12 months, babies will normally feed 4 or 5 times daily.

Breast milk intake depends on the age and weight of that baby, but at any age it takes approximately 20 minutes of swallowing for the baby to take in enough milk for proper growth. Below is a chart for babies under six months. Use these numbers if you are expressing a bottle for work or other times away from baby. Divide the second number below by the number of feedings your baby takes if it is a number other than 8. This is only an average amount. You may adjust to the next ounce, but usually not more than that. Babies over six months who are on solid foods three times daily still need 24-32 oz per day which is either five and six ounces if you expressing for a cup or bottle.

Vaginal yeast infections are something every woman wants to avoid. Mothers may get yeast infections on their nipples as well if the conditions are right for yeast to overgrow. Antibiotics are the culprit in many situations. If you find yourself on an antibiotic for any reason or if your baby has thrush, it is important to protect yourself from a yeast infection by limiting wheat, refined sugar, honey and of course alcohol in your diet. Acidophilus is a supplement that can be helpful in maintaining normal intestinal flora. If you do get a yeast infection on your nipples, symptoms may include a red "sunburned" area around the nipple covering part of the areola, white bumps on this nipple or areola, OR you may have neither of these visible signs, but you have sharp shooting burning pains even in-between
feedings, not just when the baby latches on. Healing always necessitates that you and the baby are treated simultaneously. If the pediatrician has prescribed oral Nystatin for oral thrush or Nystatin cream for a yeast diaper rash, these products can be used on your nipple as well. Diflucan may be prescribed by your OB-GYN or family doctor, but if you have topical symptoms, treat them as well with cream or Gentian Violet. If you are using over-the counter-medications, Monistat cream can be used on your nipples after the baby nurses and on the baby's bottom. The baby's mouth would need to be treated with Gentian Violet which is a purple substance obtained at a pharmacy. It usually comes in 1% solution, but need to be diluted to .5% by using half Gentian Violet and half water. If using Gentian Violet, it is not necessary to use another product on the same area. Paint the baby's mouth or your nipples with the diluted solution. Wait for the purple to disappear before re-applying. Do not apply more than three times! If you are using a cream instead, you may want to rinse the nipples in a glass bowl filled with warm water and a tablespoon of vinegar.

Many medications are safe for breastfeeding and alternatives are usually available for those that are not so it is unusual to have to stop breastfeeding due to a short term drug regimen. Thomas Hale, PHD is the foremost authority on medications and mothers milk and his book is vital for nursing mothers and health care professionals alike. This information is intended for reference only and is in no way to take the place of the individualized care of a qualified physician. If copying this information for publication, please include references at the bottom and a link to our web site: www.lactationconnection.com

We are listing some common medications which are approved by the AAP for use in breastfeeding mothers:

ANESTHETIC - Bupivacaine, Fentanyl, Halothane, Ketorolac, Lidocaine, Lorazepam, Metoclopramide, Morphine, Thiopental Sodium

CARDIAC ARRHYTHMIAS - Atenolol, Digoxin, Disopyramide, Lidocaine, Metoprolol, Mexiletine HCL, Phenytoin, Procainamide, Propranolol, Quinidine, Sotalol, Verapamil, Warfarin

CONGESTIVE HEART FAILURE - Captopril, Digoxin, Enalapril Maleate, Hydralazine, Metoprolol, Nifedipine, Verapamil

HYPERTENSION - Atenolol, Captopril, Enalapril Maleate, Hydralazine, Labetalol, Metaprolol, Nifedipine, Propranolol, Sotalol, Verapamil

INSUFFICIENT MILK SUPPLY - Metoclopramide (Reglan: short term only - use for less than 2 months), Domperidone

MIGRAINE - Butorphanol, Ketorolac, Metoprolol, Nifedipine, Propranolol, Valproic Acid, Verapamil

RADIOPAQUE/RADIOCONTRAST AGENTS - Trade names: Conray, Chlolebrine, Telepaque, Oragrafin, Bilivist, Hypaque, Gastrografin, Renovue-Dip, Angiovist, Optiray

RADIOACTIVE PROCEDURES - The following are approved with temporary cessation of breastfeeding: Technetium-99M Pertechnetate (pump and dump for 24 hours), Iodine 123 (pump and dump for 24 hours), Thallium 201 (pump and dump for 2 weeks)

RHEUMATOID ARTHRITIS - Hydroxychloroquine, Ibuprofen, Ketorolac, Piroxicam, Prednisone

A list of drugs which are usually contraindicated in lactating women follows:

Pseudoephedrine (preliminary unpublished studies indicate inhibition of prolactin and milk production)

References: Clinical Therapy in Breastfeeding Patients, Thomas W Hale, PHD; Medications and Mother's Milk 10th Edition, Thomas W Hale, PHD

The Center for Disease came out with growth charts for 2000 that include breastfed babies! Previous charts were based on only formula fed girls. To print this growth chart, print page 13 of this file.

The Center for Disease came out with growth charts for 2000 that include breastfed babies! Previous charts were based only on formula fed boys. To print this growth chart, print page 15 of this file.

This is a condensed version of 101 Reasons to Breastfeed, written by Leslie Burby for those of us with too little time. For the full version along with explanation and references, visit promom.org.

Pumps not listed here are not generally recommended by Lactation Consultants including but not limited to the Playtex Embrace, Bailey Nurture III, Whittlestone Breast Expresser, Evenflo, and others.

Breast pumps can be useful tools for the modern nursing mother. They can be used to offset engorgement, store milk, work and breastfeed, allow date nights, increase milk supply and more. With formula costing around $150 per month, there is no reason not to invest in a quality double pumping fully automatic pump. They can range in price from $150-$300, but look for name brands such as Ameda, Medela, and Avent. Make sure the pump is fully automatic with variable speed of up to 60 cycles per minute and variable suction of up to 220 mg of mercury. Models for personal use that meet that criteria are the Ameda Purely Yours, the Medela Pump In Style and the Avent Duo.

Most name brand baby bottles like Evenflo, Ameda, Medela and Avent are made from FDA approved food-grade plastic and are considered safe. However, recent studies are showing small amounts of poly-bisphenol A leaching in some plastic containers. Manufacturer's are starting to lean towards polypropylene soft plastic bottles instead of the hard plastic polycarbonate due to these studies. None have been proven to be detrimental in humans, but as a nursing mother, you want the very best for your baby. Therefore food grade polycarbonate is considered safe, BPA-free polypropylene bottles and bag are considered safer, and as always, glass bottles are the safest. Ameda and Avent have begun the process of changing over to the pba-free plastic. If you already have Ameda, you can buy new bottles and breast shields that are BPA-free. If you already own Avent bottles, don't throw out your Avent nipples, just use the 7 oz magic cups or the new BPA-free bottles. For a less expensive option, Avent nipples work with BPA free Hygeia bottles as well. Newer Ameda bottles are BPA free, but older crystal clear bottles are not. Milk bags by Ameda & Hygeia are also PBA free. The Ameda store and pour system also work with Medela breast pumps.

Below is a summary of the risks. Continue to scroll down for detailed information on each as well as medical references.

Risks to infant and child

Risks to infant and child (cont)

Risks to the Mother

Risks to Society

Risks to infant and child

Cognitive Development:

CD (review): Andraca I, Uauy R. Breastfeeding for optimal mental development. Simopoulos AP, Dutra de Oliveira JE, Desai ID (eds): Behavioral and Metabolic Aspects of Breastfeeding. World Rev Nutr Diet. Basel, Karger, 1995;78:1-27

CD (review): Gordon N. Nutrition and cognitive function. Brain and Development 1997;19:165-70

CD-1: Morrow-Tlucak M, Haude RH, Ernhart CB. Breastfeeding and cognitive development in the first 2 years of life. Soc Sci Med 1988;26:635-9

CD-2: Taylor B, Wadsworth J. Breastfeeding and child development at five years. Dev Med Child Neurol 1984;26:73-80

CD-3: Lucas A, Morley R, Cole TJ, Lister G, Leeson-Payne C. Breastmilk and subsequent intelligence quotient in children born preterm. Lancet 1992;339:261-4

CD-4: Nettleton JA. Are n-3 fatty acids essential nutrients for fetal and infant development. J Am Diet Assoc 1993;93:58-64

CD-5: Rogan WJ, Gladen BC. Breastfeeding and cognitive development. Early Hum Dev 1993;31:181-93

CD-6: Silver LB, Levinson RB, Laskin CR, Pilot LJ. Learning disabilities as a probable consequence of using chloride-deficient infant formula. J Pediatr 1989;115:97-9

CD-7: Willoughby A, Moss HA, Hubbard VS, Bercu BB, Graubard BI, Vietze PM, et al. Developmental outcome in children exposed to chloride deficient formula. Pediatrics 1987;79:851-7

CD-8: Wing CS. Defective infant formulas and expressive language problems: a case study. Language, Speech and Hearing Services in Schools 1990;21:22-7

CD-9: Crawford MA. The role of essential fatty acids in neural development: implications for perinatal nutrition. Am J Clin Nutr 1993;57(suppl):703S-10S

CD-10: Temboury MC, Otero A, Polanco I, Arribas E. Influence of breastfeeding on the infant's intellectual development. J Pediatric Gastroenterol Nutr 1994;18:32-36

CD-11: Pollock JI. Longterm associations with infant feeding in a clinically advantaged population of babies. Dev Med Child Neur 1994;36:429-40

CD-12: Makrides M, Neumann MA, Byard RW, Simmer K, Gibson RA. Fatty acid composition of brain, retina and erythrocytes in breast and formula fed infants. Am J Clin Nutr 1994;60:189-94

CD-14: Anderson GJ, Connor WE, Corliss JD. Docosohexaenoic acid is the preferred dietary n-3 fatty acid for the development of the brain and retina. Pediatr Res 1990;27:87-97

CD-15: Neuringer M, Connor WE, Lin DS, Barstad L, Luck S. Biochemical and functional effects of prenatal and postnatal fatty acid deficiency on retina and brain in rhesus monkeys. Proc Natl Acad Sc USA 1986;83:4021-5

CD-16: Florey C Du V, Leech AM, Blackhall A. Infant feeding and mental and motor development at 18 months of age in first born singletons. Int J Epidem 1995;24 (Suppl 1):S21-6

CD-17: Wang YS, Wu SY. The effect of exclusive breastfeeding on development and incidence of infection in infants. JHL 1996;12:27-30

CD-18: Greene LC, Lucas A, Livingstone BE, Harland PSEG, Baker BA. Relationship between early diet and subsequent cognitive performance during adolescence. Biochem Soc Trans 1995;23:376S

CD-19: Riva E, Agostoni C, Biasucci G, Trojan S, Luotti D, Fiori L, et al. Early breastfeeding is linked to higher intelligence quotient scores in dietary treated phenylketonuric children. Acta Pædiatr 1996;85:56-8

CD-20: Niemelä A, Järvenpää A-L. Is breastfeeding beneficial and maternal smoking harmful to the cognitive development of children? Acta Pædiatr 1996;85:1202-6

CD-21: Rodgers B. Feeding in infancy and later ability and attainment: a longitudinal study. Devel Med Child Neurol 1978;20:421-6

CD-22: Horwood LJ, Fergusson DM. Breastfeeding and later cognitive and academic outcomes. Pediatrics 1998;101:p. e9

CD-23: Paine BJ, Makrides M, Gibson RA. Duration of breastfeeding and Bayley's mental developmental Index at 1 year of age. J Paediatr Child Health 1999;35:82-5

CD-24: Fergusson DM, Beautrais AL, Silva PA. Breastfeeding and cognitive development In the first seven years of life. Soc Sci Med 1982;16:1705-8

CD-25: Vestergaard M, Obel C, Henriksen TB, Sørensen HT, Skajaa E, Østergaard J. Duration of breastfeeding and developmental milestones during the latter half of Infancy. Acta Paediatr 1999;88:1327-32

CD-26: Rao MR, Hediger ML, Levine RJ, Naficy AB, Vik T. Effect of breastfeeding on cognitive development of infants born small for gestational age. Acta Paediatr 2002;91:267-74

Neurologic Outcome:

N-1: Lanting CI, Fidler V, Huisman M, Touwen BCL, Boersma ER. Neurological differences between 9 year old children fed breastmilk or formula milk as babies. Lancet 1994;344:1319-22

N-2: Lanting CI, Patandin S, Weisglas-Kuperus N, Touwen BCL, Boersma ER.Breastfeeding and neurological outcome at 42 months. Acta Paediatr 1998;87:1224-9

SIDS:

SIDS-1: Mitchell EA, Scragg R, Stewart AW, Becroft DMO, Taylor BJ, For RPK, et al. Results from the first year of the New Zealand cot death study. NZ Med J 1991;104:71-6

Insulin Dependent Diabetes:

JD-1a: Working Group on Cow's Milk Protein and Diabetes Mellitus of the American Academy of Pediatrics. Infant feeding practices and their possible relationship to the etiology of diabetes mellitus. Pediatrics 1994;94:752-4

JD-1: Karjalainen J, Martin JM, Knip M, Ilonen J, Robinson BH, Savilahti E, et al. A bovine albumin peptide as a possible trigger of insulin-dependent diabetes mellitus. N Eng J Med 1992;327:302-7 (Editorial: 1992:327:348-9)

JD-2: Mayer EJ, Hamman RF, Gay EC, Lezotte DC, Savitz DA, Klingensmith J. Reduced risk of IDDM among breastfed children. Diabetes 1988;37:1625-32

JD-3: Virtanen SM, Räsänen L, Ylönen K, Aro A, Clayton D, Langlholz B, et al. Early introduction of dairy products associated with increased risk of IDDM in Finnish children. Diabetes 1993;42:1786-90

JD-4: Virtanen SM, Räsänen L, Aro A, Lindström J, Sippola H, Lounamaa R, et al. Infant feeding in Finnish children <7 yr of age with newly diagnosed IDDM. Diabetes Care 1991;14:415-17

JD-5: Gerstein HC. Cow's milk exposure and type I diabetes mellitus. Diabetes Care 1994;17:13-9

JD-6: Kostraba JN, Cruickshanks KJ, Lawler-Heavner J, Jobim LF, Rewers MJ, Gay EC, et al. Early exposure to cow's milk and solid foods in infancy, genetic predisposition, and risk of IDDM. Diabetes 1993;42:288-95

JD-7: Pérez-Bravo F, Carrasco E, Gutierrez-López MD, Martínez MT, López G, García de los Rios M. Genetic predisposition and environmental factors leading to the development of insulin-dependent diabetes mellitus in Chilean children. J Mol Med 1996;74:105-9

JD-8: Gimeno SGA, De Souza JMP. IDDM and milk consumption. Diabetes Care 1997;20:1256-60

JD-9: Hammond-McKibbon D, Karges W, Gaedigk R, Dosch H-M. Immunological mechanisms that link cow milk protein and insulin dependent diabetes: a synopsis. Can J Allergy and Clin Immunol 1997;2:136-46

JD-10: Shehadeh N. Gelertner L, Blazer S, Perlman R, Solovachik L, Etzioni A. Importance of insulin content in infant diet: suggestion for a new infant formula. Acta Paediatrica 2001;90:93-5

Cow milk Allergy and Intolerance:

CM-1: Høst A. Importance of the first meal on the development of cow's milk allergy and intolerance. Allergy Proc 1991;12:227-32

Respiratory Illness:

RI-1: Pullan CR, Toms GL, Martin AJ, Gardner PS, Webb JKG, Appleton DR. Breastfeeding and respiratory syncytial virus infection. Br Med J 1980;281:1034-6

RI-2: Chiba Y, Minagawa T, Mito K, Nakane A, Suga K, Honjo T, Nakao T. Effect of breastfeeding on responses of systemic interferon and virus-specific lymphocyte transformation with respiratory syncytial virus infection. J Med Virology 1987;21:7-14

RI-3: Wright AL, Holberg CJ, Martinez FD, Morgan WJ, Taussig LM. Breastfeeding and lower respiratory tract illness in the first year of life. Br Med J 1989;299:946-9

RI-4: Porro E, Indinnimeo L, Antognoni G, Midulla F, Criscione S. Early wheezing and breastfeeding. J Asthma 1993;30:23-8

RI-5: Burr ML, Limb ES, Maguire JM, Amarah L, Eldridge BA, Layzell JCM, Merret TG. Infant feeding, wheezing, and allergy: a prospective study. Arch Dis Child 1993;68:724-28

RI-6: Pisacane A, Graziano L, Zona G, Granata G, Dolezalova H, Cafiero M, et al. Breastfeeding and acute lower respiratory infection. Acta Pædiatr 1994;83:714-18

RI-7: Beaudry M, Dufour R, Marcoux S. Relation between infant feeding and infections during the first six months of life. J Pediatr 1995;126:191-7

RI-8: Okamoto Y, Ogra PL. Antiviral factors in human milk: implications in respiratory syncytial virus infection. Acta Pædiatr Scand Suppl 1989;351:137-43

RI-9: Downham MAPS, Scott R, Sims DG, Webb JKG, Gardner PS. Breastfeeding protects against respiratory syncytial virus infections. Br Med J 1976;2:274-6

RI-10: Wright AL, Holberg CJ, Taussig LM, Martinez FD. Relationship of infant feeding to recurrent wheezing at age 6 years. Arch Pediatr Adolesc Med 1995;149:758-63

RI-11: Yue Chen. Synergistic effect of passive smoking and artificial feeding on hospitalization for respiratory illness in early childhood. Chest 1989;95:1004-07

RI-12: Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW. Relation of infant diet to childhood health: seven year followup of cohort of children in Dundee infant feeding study. Br Med J 1998;316:21-5 (also shows higher blood pressure in formula fed children)

RI-13: Oddy WH, Holt PG, Sly PD, Read AW, Landau LI, Stanley FJ, Kendall GE, Burton PR. Association between breastfeeding and asthma in 6 year old children: findings of a prospective birth cohort study. Br Med J 1999;319:815-9

RI-14: César JA, Victora CG, Barros FC, Santos IS, Flores JA. Impact of breastfeeding on admission for pneumonia during postneonatal period in Brazil: nested case-control study. Br Med J 1999;318:1316-20

RI-15: Pisacane A, Impagliazzo N, De Caprio C, Criscuolo L, Inglese A, da Silva MCMP. Breastfeeding and tonsillectomy. BMJ. 1996 Mar 23;312(7033):746-7.

RI-16: López-Alarcón M, Villalpando S, Fajardo A. Breastfeeding lowers the frequency and duration of acute respiratory infection and diarrhea in infants under 6 months of age. J Nutr 1997;127:436-43

RI-17: Gdlavevich M, Minouni D, Minouni M. Breastfeeding and the risk of bronchial asthma in childhood: a systematic review with meta-analysis of prospective studies. J Pediatr 2001;139:261-6

Otitis Media (ear infections):

OM-1: Saarinen UM. Prolonged breastfeeding as prophylaxis for recurrent otitis media. Acta Pediatr Scand 1982;71:567-71

OM-2: Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective cohort study. J Infect Dis 1989;160:83-94

OM-3: Duncan B, Ey J, Holberg CJ, Wright AL, Martinez FD, Taussig LJ. Exclusive breastfeeding for at least 4 months protects against otitis media. Pediatrics 1993;91:867-72

OM-4: Owen MJ, Baldwin CD, Swank PR, Pannu AK, Johnson DL, Howie VM. Relation of infant feeding practices, cigarette smoke exposure and group child care to the onset and duration of otitis media with effusion in the first two years of life. J Pediatr 1993;123:702-11

OM-5: Harabuchi Y, Faden H, Yamanaka N, Duffy L, Wolf J, Krystofik D. Human milk secretory IgA antibody to nontypeable Hæmophilus influenzæ: Possible protective effects against nasopharyngeal colonization. J Pediatr 1994;124:193-8

OM-6: Aniansson G, Alm B, Andersson B, Håkansson A, Larsson P, Nylén O, et al. A prospective cohort study on breastfeeding and otitis media in Swedish infants. Pediatr Infect Dis J 1994;13:183-8

OM-7: Paradise JL, Elster BA, Tan L. Evidence in infants with cleft palate that breast milk protects against otitis media. Pediatrics 1994;94:853-60

OM-8: Sassen ML, Brand R, Grote JJ. Breastfeeding and acute otitis media. Am J Otolaryn 1994;15:351-7

OM-9: Dewey KG, Heinig J, Nommsen-Rivers LA. Differences in morbidity between breastfed and formula fed infants. J Pediatr 1995;126:696-702 (risk also increased in FF infant for diarrhea)

OM-10: Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States. Pediatrics 1997;99:e5

Risks for the premature baby:

P-1: Lucas A, Cole TJ. Breastmilk and neonatal necrotizing enterocolitis. Lancet 1990;336:1519-23

P-2: El-Mohandes AE, Picard MB, Simmens SJ, Keiser JF. Use of human milk in the intesive care nursery decreases the incidence of nosocomial sepsis. J Perinatol 1997;17:130-4

P-3: Daniels L, Gibson R, Simmer K. Selenium status of preterm infants: the effect of postnatal age and method of feeding. Acta Pædiatr 1997;86:281-8 (M:23)

P-4: Uauy RD, Birch DG, Birch EE, Tyson JE, Hoffman DR. Effect of dietary omega-3 fatty acids on retinal function of very low birth weight neonates. Pediatr Res 1990;28:485-92 (M:18)

P-5: Lucas A, Morley R, Cole TJ, Lister G, Leeson-Payne C. Breastmilk and subsequent intelligence quotient in children born preterm. Lancet 1992;339:261-4 (CD: 3)

P-6: Bishop NJ, Dahlenburg SL, Fewtrell MS, Morley R, Lucas A. Early diet of preterm infants and bone mineralization at age five years. Acta Paediatr 1996;85:230-6

P-7: Carlson SE, Rhodes PG, Ferguson MG. Docosahexaenoic acid status of preterm infants at birth and following feeding with human milk or formula. Am J Clin Nutr 1986;44:798-804

P-8: Foreman-van Drongelen MMHP, van Houwelingen AC, Kester ADM, Hasaart THM, Blanco CE, Hornstra G. Long-chain polyunsaturated fatty acids in preterm infants: status at birth and its influence on postnatal levels. J Pediatr 1997;126:611-8

P-9: Bier JB, Ferguson AE, Morales Y, Liebling JA, Oh W, Vohr BR. Breastfeeding infants who were extremely low birth weight. Pediatrics 1997;100:p e3

P-10: Morley R, Cole TJ, Powell R, Lucas A. Mother's choice to provide breastmilk and developmental outcome. Arch Dis Child 1988;63:1382-5

P-11: Singhal A, Cole T, Lucas A. Early nutrition in preterm infants and later blood pressure: two cohorts after randomised trials. Lancet 2001;357:413-9

Childhood Cancer:

CC-1: Schwartzbaum JA, George SL, Pratt CB, Davis B. An exploratory study of environmental and medical factors potentially related to childhood cancer. Med pediatr Oncol 1991;19:115-21

CC-2: Davis MK, Savitz DA. Graubard BI. Infant feeding and childhood cancer. Lancet 1988;2:365-8

CC-3: Freudenheim JL, Marshall JR, Graham S, Laughlin R, Vena JE, Bandera E, et al. Exposure to breastmilk in infancy and the risk of breast cancer. Epidemiology 1994;5:324-31

CC-4: Shu XO, Linet MS, Steinbuch M, Wen WQ, Buckley JD, Neglia JP, Potter JD et al. Breastfeeding and the risk of childhood acute leukemia. J Nat Cancer Institute 1999;91:1765-72

CC-5: Davis MK. Review of the evidence for an association between Infant feeding and childhood cancer. Int J Cancer 1998;Supplement II:29-33

Gastrointestinal Disease and Infections:

GI-1: Koletzko S, Sherman P, Corey M, Griffiths A, Smith C. Role of infant feeding practices in the developement of Crohn's disease in childhood. Br Med J 1989;298:1617-8

GI-2: Greco L, Auricchio S, Mayer M, Grimaldi M. Case control study on nutritional risk factors in celiac disease. J Pediatr Gastroenterol Nutr 1988;7:395-8

GI-3: Duffy LC, Byers TE, Riepenhoff-Talty M, La Scolea L, Zielezny M, Ogra PL. The effects of infant feeding on rotavirus-induced gastroenteritis. A prospective study. Am J Pub Health 1986;76:259-63

GI-4: Hanson LA, Lindquist B, Hofvander Y, Zetterstrom R. Breastfeeding as a protection against gastroenteritis and other infections. Acta Pediatr Scand 1985;74:641-2

GI-5: Ruiz-Palacios GM, Calva JJ, Pickering LK, Lopez-Vidal Y, Volkow P, Pezzarossi H, et al. Protection of breastfed infants against Campylobacter diarrhea by antibodies in human milk. J Pediatr 1990;116:707-13

GI-6: Cruz JR, Gil L, Cano F, Caceres P, Pareja G. Breastmilk anti-Escherichia coli heat labile toxin IgA antibodies protect against toxin-induced infantile diarrhea. Acta Pediatr Scand 1988;77:658-62

GI-7: Gillin FD, Reiner DS, Wang C-S. Human milk kills parasitic intestinal protozoa. Science 1983;221:1290-2

GI-8: France GL, Marmer DJ, Steele RW. Breastfeeding and Salmonella infection. Am J Dis Child 1980;134:147-52

GI-9: Haffejee IE. Cow's milk-based formula, human milk and soya feeds in acute infantile diarrhea: A therapeutic trial. J Pediatr Gastroenterol Nutr 1990;10:193-8

GI-10: Lerman Y, Slepon R, Cohen D. Epidemiology of acute diarrheal diseases in children in a high standard of living rural settlement in Israel. Pediatr Infect Dis J. 1994;13:116-22

GI-11: Howie PW, Forsyth JS, Ogston SA, Clark A, Du V Florey C. Protective effect of breastfeeding against infection. Br Med J 1990;300:11-6

GI-12: Duffy LC, Riepenhoff-Talty M, Byers TE, La Scolea LJ, Zielezny MA, Dryja DM et al. Modulation of rotavirum enteritis during breastfeeding. Am J Dis Child 1986;140:1164-8

GI-13: Haddock RL, Cousens SN, Guzman CC. Infant diet and salmonellosis. Am J Pub Health 1991;81:997-1000

GI-14: Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States. Pediatrics 1997;99, June 1997;e5 (also for otitis media)

GI-15: Heacock HJ, Jeffery HE, BAker JL, Page M. Influence of breast versus formula milk on physiological gastroesophageal reflux In healthy, newborn Infants. J Pediatr Gastroenterol Nutr 1992:14:41-6

GI-16: Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, et al. Promotion of breastfeeding intervention trial. JAMA 2001;285:413-20 (also shows less eczema) (study shows that baby friendly Interventions do work)

Urinary Tract Infection:

UT-1: Pisacane A, Graziano L, Mazzarella G, Scarpellino B, Zona G. Breastfeeding and urinary tract infection. J Pediatr 1992;120:87-9

Malocclusion:

MA-1: Labbock MH, Hendershot GE. Does breastfeeding protect against malocclusion? An analysis of the 1981 child health supplement to the national health interview survey. Am J Prev Med 1987;3:227-32

MA-2: Palmer B. The influence of breastfeeding on the development of the oral cavity: A commentary. J Hum Lact 1998;14:93-8

Formula as a heavy metal cocktail:

HM-1: Koo WWK, Kaplan LA, Krug-Wispe SK. Aluminum contamination of infant formulas. J Parenteral Enteral Nutrition 1988;12:170-3

HM-2: Davidsson L, Cederblad Å, Lönnerdal B, Sandström B. Manganese absorption from human milk, cow's milk and infant formulas in humans. Am J Dis Child 1989;143:823-7

HM-3: Dabeka RW, McKenzie AD. Lead and cadmium levels in commercial infant foods and dietary intake by infants 0-1 year old. Food Additives and Contaminants 1988;5:333-42

Other Contamination due to bottle feeding:

C-1: Mytjens HL, Roelofs-Willemse H, Jaspar GHJ. Quality of powdered substitutes for breastmilk with regard to members of the family Enterobacteriaceæ. J Clin Microbiol 1988;26:743-6

C-2: Biering G, Karlsson S, Clark NC, Jonsdottir KE, Ludvigsson P, Steingrimsson O. Three cases of neonatal meningitis caused by Enterobacter sakazakii in powdered milk. J Clin Microbiol 1989;27:2054-6

C-3: Westin JB. Ingestion of carcinogenic N-nitrosamines by infants and children. Arch Environmental Health 1990;45:359-63

C-4: Schwarz KB, Cox JM, Sharma S, Clement L, Witter F, Abbey H, et al. Prooxidant effects of maternal smoking and formula In newborn Infants. J Pediatr Gastroenterol Nutr 1997;24:68-74

Allergy:

A-1: Lucas A, Brooke OG, Morley R, Cole TJ, Bamford MF. Early diet of preterm infants and development of allergic or atopic disease: randomized prospective study. Br Med J 1990;300:837-40

A-2: Kajosaari M, Saarinen UM. Prophylaxis of atopic disease by six months' total solid food elimination. Acta Pediatr Scand 1983;72:411-14

A-3: Ellis MH, Short JA, Heiner DC. Anaphylaxis after ingestion of a recently introduced hydrolyzed whey protein protein formula. J Pediatr 1991;118:74-7

A-4: Saarinen UM, Kajosaari M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet 1995;346:1065-69

A-5: Saylor JD, Bahna SL. Anaphylaxis to casein hydrolysate formula. J Pediatr 1991;118:71-4

A-6: Marini A, Agosti M, Motta G, Mosca F. Effects of a dietary and environmental prevention programme on the incidence of allergic symptoms in high atopic risk infants: three years' followup. Acta Pædiatr 1996;Suppl 414 vol 85:1-19

A-7: Wright AL, Holberg CJ, Martinez FD, Halonen M, Morgan W, Taussig LM. Epidemiology of physician diagnosed allergic rhinitis In childhood. Pediatrics 1994:94:895-901

A-8: Bloch AM, Mimouni D, Minouni M, Gdalevich M. Does breastfeeding protect against allergic rhinitis during childhood? A meta-analysis of protective studies. Acta Paediatr 2002;91:275-9

Cardiovascular Risks:

M-3: Kramer MS. Do breastfeeding and delayed introduction of solid foods protect against subsequent obesity? J Pediatr 1981;98:883-7

M-13: Osborn GR. Stages in development of coronary disease observed from 1,500 young subjects. Relationship of hypotension and infant feeding to ætiology. Watson Smith Lecture, delivered to the Royal College of Physicians of London, January 11, 1965

M13a: Bergström E, Hernell O, Persson LÅ, Vessby B. Serum lipid values in adolescents are related to family history, infant feeding, and physical growth. Atherosclerosis 1995;117:1-13

M-25: Routi T, Rönnemaa T, Lapinleimu H, Salo P, Viikari J, Leino A, et al. Effect of weaning on serum lipoprotein (a) concentration: the STRIP baby study. Pediatric Research 1995;38:522-27

M-26: Bergströme E, Hernell O, Persson LÅ, Vessby B. Serum lipid values in adolescents are related to family history, infant feeding and physical growth. Atherosclerosis 1995;117:1-13

M-27: Von Kries R, Sauerwald T, von Mutius E, Barnert D, Grunert V, von Voss H. Breastfeeding and obesity: cross sectional study. Br Med J 1999;319:147-50

M-32: Tulldahl J, Pettersson K, Andersson SW, Hulthén. Mode of Infant feeding and achieved growth In adolescence: early feeding patterns In relation to growth and body composition In adolescence. Obesity Research 1999;7:431-7

M-35: Gillman MW, Rifas-Shiman SL, Camargo CA, Berkey CS, Frasier AL, Rockett HRH, et al. Risk of overweight among adolescents who were breastfed as infants. J Am Med Assoc 2001;285:2461-7 (Editorial by WH Dietz, 2506-7)

P-11: Singhal A, Cole T, Lucas A. Early nutrition in preterm infants and later blood pressure: two cohorts after randomised trials. Lancet 2001;357:413-9

Miscellaneous Risks:

M-1: McJunkin JE, Bithoney WG, McCormick MC. Errors in formula concentration in an outpatient population. J Pediatr 1987;111:848-50

M-1a: Abrams CAL, Phillips LL, Berkowitz C, Blacket PR, Priebe CJ. Hazards of overconcentrated milk formula. JAMA 1975;232:1136-40

M-1b: Potur AH, Kalmaz N. An investigation into feeding errors of 0-4 month old infants. J Trop Pediatr 1995;41:120-2

M-1c: Green HL, Moyer VA. Improper mixing of formula due to reuse of hospital bottles. Arch Pediatr Adolesc Med 1995;149:97-9

M-1d: Coodin Fj, Gabrielson IW, Addiego JE. Formula fatality. Pediatrics 1971;47:438-9

M-1e: Wilcox DT, Fiorello AB, Glick PL. Hypovolemic shock and intestinal ischemia: a preventable complication of incomplete formula labeling. J Pediatr 1993;122:103-4

M-2: Specker BL, Tsang RC, Ho ML, Landi TM, Gratton TL. Low serum calcium and high parathyroid hormone levels in neonates fed "humanized" cow's milk-based formula. Am J Dis Child 1991;145:941-5

M2a: Jochum F, Fuchs A, Menzel H, Lombeck I. Selenium in German infants fed breastmilk or different formulas. Acta Paediatr 1995;84:859-62

M-3: Kramer MS. Do breastfeeding and delayed introduction of solid foods protect against subsequent obesity? J Pediatr 1981;98:883-7

M-4: Dick G. The etiology of multiple sclerosis. Proc Roy Soc Med. 1976;69:611-5

M-4b: Pisacane A, Impagliazzo N, Russo M, Valiani R, Mandarini A, Florio C, Vivo P. Breastfeeding and multiple sclerosis. Br Med J 1994;308:1411-2

M-5: Birch E, Birch D, Hoffman D, Hale L, Everett M, Uauy R. Breastfeeding and optimal visual development. J Pediatr Ophthalmol Strabismus 1993;30:33-8

M-6: Makrides M, Simmer K, Googin M, Gibson RA. Erythrocyte docosahexaenoic acid correlates with the visual response of healthy, term infants. Pediatr Res 1993;34:425-7

M-7: Sullivan SA, Birch LL. Infant dietary experience and acceptance of solid foods. Pediatrics 1994;93:271-77

M-8: Cochi SL, Fleming DW, Hightower AW, Limpakarnjanarat K, Facklam RR, Smith JD, et al. Primary invasive Hæmophilus influenzæ type b disease: A population-based assessment of risk factors. J Pediatr 1986;108:887-96

M-9: Arnold C, Makintube S, Istre GR. Day Care Attendance and other risk factors for invasive Hæmophilus influenzæ type b disease. Am J Epidemiol 1993;138:333-40

M-9a: Takala AK, Eskola J, Palmgren J, Rönnberg P-R, Kela E, Rekola P, Mäkelä PH. Risk factors of invasive Haemophilus influenzae type b disease among children of Finland. J Pediatr 1989;115:694-701

M-10: Michaelsen KM, Johansen JS, Samuelson G, Price PA, Christiansen C, Skakkebæk NE. Serum bone Gla protein (BGP, Osteocalcin) in infants: Values positively correlated with human milk intake. Mechanisms Regulating Lactation and Infant Nutrient Utilization. (Picciano MF, Lönnerdal B, editors). Volume 15 of Contemporary Issues in Clinical Nutrition, pages 419-23.

M-11: Jones EG, Matheny RJ. Relationship between infant feeding and exclusion rate from child care because of illness. J Am Dietetic Assoc 1993;93:809-11

M-12: MacFarlane PI, Miller V. Human milk in the management of protracted diarrhœa of infancy. Arch Dis Child 1984;59, 260-65

M13a: Bergström E, Hernell O, Persson LÅ, Vessby B. Serum lipid values in adolescents are related to family history, infant feeding, and physical growth. Atherosclerosis 1995;117:1-13

M-14: Keating JP, Schears GJ, Dodge PR. Oral water intoxication in infants. Am J Dis Child 1991;145:985-90

M-14a: Bruce RC, Kiegman RM. Hyponatremic seizures secondary to oral water intoxication in infancy: association wiht commercial bottled drinking water. Pediatrics 1997;100; p e4

M-15: Finberg L. Water intoxication. (editorial). Am J Dis Child 1991;145:981-2

M-16: Shannon MW, Graef JW. Lead intoxication in infancy. Pediatrics 1992;89:87-90

M-17: Nako Y, Fukushima N, Tomomasa T, Nagashima K. Hypervitaminosis D after prolonged feeding with a premature formula. Pediatrics 1993;92:862-3

M-18: Uauy RD, Birch DG, Birch EE, Tyson JE, Hoffman DR. Effect of dietary omega-3 fatty acids on retinal function of very low birth weight neonates. Pediatr Res 1990;28:485-92

M-19: Hahn-Zoric M, Fulconis F, Minoli I, Moro G, Carlsson B, Böttiger M, et al. Antibody responses to parenteral and oral vaccines are impaired by conventional and low protein formulas as compared to breastfeeding. Acta Pædiatr Scand 1990;79:1137-42

M-20: Arnon SS, Damus K, Thompson B, Midura TF, Chin J. Protective role of human milk against sudden death from infant botulism. J Pediatr 1982;100:568-73

M-21: Mason T, Rabinovich E, Fredrickson DD, Amoroso K, Reed AM, Stein LD, et al. Breastfeeding and the development of juvenile rheumatoid arthritis. J Rheumatol 1995;22:1166-70

M-22: Hasselbalch H, Jeppesen DL, Engelmann MDM, Fleischer-Michaelson K, Nielson MB. Decreased thymus size in formula-fed compared with breastfed infants. Acta Pædiatr 1996;85:1029-32

M-22a: Hasselbalch H, Engelmann MDM, Ersbøll AK, Jeppesen DL, Fleischer-Michaelson K. Breastfeeding Influences thymic size In late Infancy. Eur J Pediatr 1999;158:964-7

M-23: Daniels L, Gibson R, Simmer K. Selenium status of preterm infants: the effect of postnatal age and method of feeding. Acta Pædiatr 1997;86:281-8

M-24: Pettitt DJ, Forman MR, Hanson RL, Knowler WC, Bennett PH. Breastfeeding and incidence of non-insulin-dependent diabetes mellitus in Pima Indians. Lancet 1997;350:166-8

M-25: Routi T, Rönnemaa T, Lapinleimu H, Salo P, Viikari J, Leino A, et al. Effect of weaning on serum lipoprotein (a) concentration: the STRIP baby study. Pediatric Research 1995;38:522-27

M-26: Bergströme E, Hernell O, Persson LÅ, Vessby B. Serum lipid values in adolescents are related to family history, infant feeding and physical growth. Atherosclerosis 1995;117:1-13

M-27: Von Kries R, Sauerwald T, von Mutius E, Barnert D, Grunert V, von Voss H. Breastfeeding and obesity: cross sectional study. Br Med J 1999;319:147-50

M-28: Håkansson A, Zhivotovsky B, Orrenius S, Sabharwal H. Apoptosis induced by a human milk protein. Proc Natl Acad Sci USA 1995;92:8064-68

M-29: Håkansson A, Andréasson J, Zhivotovsky B, Karpman D, Orrenius S, Svanborg C. Multimeric alpha lactalbumin from human milk induces apoptosis through a direct effect on cell nuclei. Exps Cell Research 1999;246:451-60

M-30: Fitzpatrick M, Mitchell K, et al. Soy formulas and the effects of Isoflavones on the thyroid N Z Med J. 2000 Feb 11;113(1103):24-6.

M-31: Lambertina W, Freni-Titulaer MD, Cordero JF, Haddock L, Lebron G, Martinez R, Mills JL. Premature Thelarche In Puerto Rico. Am J Dis Child 1986;140:1263-7

M-32: Tulldahl J, Pettersson K, Andersson SW, Hulthén. Mode of Infant feeding and achieved growth In adolescence: early feeding patterns In relation to growth and body composition In adolescence. Obesity Research 1999;7:431-7

M-33: Erickson PR, Mazhari E. Investigation of the role of human breastmilk in caries development. Pediatr Dent 1999;21:86-90

M-34: Setchell KDR, Zimmer-Nechmias L, Cai J, Heubi JE. Exposure of infants to phyto-oestrogens from soy-based infant formula. Lancet 1997;350:23-27

M-35: Gillman MW, Rifas-Shiman SL, Camargo CA, Berkey CS, Frasier AL, Rockett HRH, et al. Risk of overweight among adolescents who were breastfed as infants. J Am Med Assoc 2001;285:2461-7 (Editorial by WH Dietz, 2506-7)

M-36: Type 2 diabetes in Children: prenatal and early infancy risk factors among Native Canadians. Arch Pediatr Adolesc Med 2002;156:651-55

Breastmilk as "antimicrobial":

AM-1: Yoshioka H, Ken-ichi I, Fujita K. Development and differences of intestinal flora in the neonatal period in breastfed and bottle fed infants. Pediatrics 1983;72:317-21

AM-2: Hernell O, Ward H, Bläckberg L, Pereira MEA. Killing of Giardia lamblia by human milk lipases: An effect mediated by lipolysis of milk lipids. J Infectious Diseases 1986;153:715-20

AM-3: Andersson B, Porras O, Hanson LA, Lagergård T, Svanborg-Edén C. Inhibition of attachment of Streptococcus pneumoniæ and Hæmophilus influenzæ by human milk and receptor oligosaccharides. J Infectious Diseases 1986;153:232-7

AM-4: Bell LM, Clark HF, Offit PA, Slight PH, Arbeter AM, Plotkin SA. Rotavirus serotype-specific neutralizing activity in human milk. Am J Dis Child 1988;142:275-8

AM-5: Schroten H, Lethen A, Hanisch FG, Plogmann R, Hacker J, Nobis-Bosch R et al. Inhibition of adhesion of S-Fimbriated Escherichia coli to epithelial cells by meconium and feces of breastfed and formula fed newborns: mucins are the major inhibitory component. J Pediatr Gastroentero Nutr 1992;15:150-8

AM-6: Walterspiel JN, Morrow AL, Guerrero ML, Ruiz-Palacios GM, Pickering LK. Secretory anti-Giardia lamblia antibodies in human milk: protective effect against diarrhea. Pediatrics 1994;93:28-31

AM-7: Torres O, Cruz JR. Protection against Campylobacter diarrhea: role of milk IgA antibodies against bacterial surface antigens. Acta Pediatr Scand 1993;82:835-8

AM-8: Pickering LK, Morrow AL, Herrera I, O'Ryan M, Estes MK, Suilliams SE, et al. Effect of maternal rotavirus immunization on milk and serum antibody titers. J Inf Dis 1995;172:723-8

AM-9: Grover M, Giouzeppos O, Shnagl RD, May JT. Effect of human milk protaglandins and lactoferrin on respiratory syncytial virus and rotavirus. Acta Pædiatr 1997;86:315-6

AM-10: Delneri MT, Carbonare SB, Silva MLM, Palmeira P, Carneiro-Sampaio MMS. Inhibition of enteropathogenic Escherichia coli adhesion to EHp-2 cells by colostrum and milk from mothers delivering low birth weight neonates. Eur J Pediatr 1997;156:493-8

Risks to the Mother

Ovarian Cancer:

MO-1: Hartge P, Schiffman MH, Hoover R, McGowan L, Lesher L, Norris HJ. A case control study of epithelial ovarian cancer. Am J Obstet Gynecol 1989;161:10-6

MO-2: Gwinn ML, Lee NC, Rhodes PH, Layde PM, Rubin GL. Pregnancy, breastfeeding and oral contraceptives and the risk of epithelial ovarian cancer. J Clin Epidemiol 1990;43:559-68

MO-3: Rosenblatt KA, Thomas DB, and the WHO collaborative study of neoplasia and steroid contraceptives. Lactation and the risk of epithelial ovarian cancer. International J Epidemiol 1993;22:192-7

Osteoporosis:

MO-4: Aloia JF, Cohn SH, Vaswani A, Yeh JK, Yuen K, Ellis K. Risks factors for postmenopausal osteoporosis. Am J Med 1985;78:95-100

MO-5: Melton LJ, Bryant SC, Wahner HW, O'Fallon WM, Malkasian GD, Judd HL, Riggs BL. Influence of breastfeeding and other reproductive factors on bone mass later in life. Osteoporosis Int 1993;3:76-83

MO-6: Cumming RG, Klineberg RJ. Breastfeeding and other reproductive factors and the risk of hip fractures in elderly women. International J Epidemiol 1993;22:684-91

MO-6a: Blaauw R, Albertse EC, Beneke T, Lombard CJ, Laubscher R, Hough FS. Risk factors for the development of osteoporosis in a South African population. S Afr Med J 1994;84:328-32

MO-6b: Krieger N, Kelsey JL, Holford TR. O'Connor T. An epidemiologic study of hip fractures in potmenopausal women. Am J Epidemiol 1982;116:141-8

Endometrial Carcinoma:

MO-7: Petterson B, Hans-Olov A, Berström R, Johansson EDB. Menstruation span-a time-limited risk factor for endometrial carcinoma. Acta Obstet Gynecol Scand 1986;65:247-55

MO-7a: Rosenblatt KA, Thomas DB, and the WHO collaborative study of neoplasia and steroid contraceptives. Prolonged Lactation and endometrial cancer. Int J Epidemiol 1995;24:499-503

Breast Cancer:

MO-8: Layde PM, Webster LA, Baughman AL, Wingo PA, Rubin GL, Ory HW and the cancer and steroid hormone study group. The independent associations of parity, age at first full term pregnancy, and duration of breastfeeding with the risk of breast cancer. J Clin Epidemiol 1989;42:963-73

MO-9: Ing R, Ho JHC, Petrakis NL. Unilateral breastfeeding and breast cancer. Lancet July 16, 19977;124-27

MO-10: McTiernan A, Thomas DB. Evidence for a protective effect of lactation on risk of breast cancer in young women. Am J Epidemiol 1986;124:353-74

MO-11: Yuan J-M, Yu MC, Ross RK, Gao Y-T, Henderson BE. Risk factors for breast cancer in Chinese women in Shanghai. Cancer Res 1988;58:99-104

MO-12: Yoo K-Y, Tajima K, Kuroishi T, Hirose K, Yoshida M, Miura S, Murai H. Independent protective effect of lactation against breast cancer: a case-control study in Japan. Am J Epidemiol 1992;135:726-33

MO-13: Reuter KL, Baker SP, Krolikowski FJ. Risk factors for breast cancer in women undergoing mammography. Am J Radiol 1992;158:273-8

MO-14: United Kingdom National Case-Control Study Group. Breastfeeding and risk of breast cancer in young women. Br Med J 1993;307:17-20

MO-15: Newcomb PA, Storer BE, Longnecker MP, Mittendorf R, Greenberg ER, Clapp RW, et al. Lactation and a reduced risk of premenopausal breast cancer. N Eng J Med 1994;330:81-7

MO-16: Tao S-C, Yu MC, Ross RK, Xiu K-W. Risk factors for breast cancer in Chinese women of Beijing. Int J Cancer 1988;42:495-98

MO-17: Siskind V, Schofield F, Rice D, Bain C. Breast cancer and breastfeeding: results from an Australian case-control study. Am J Epidemiol 1989;130:229-36

MO-18: Romieu I, Hernández-Avila M, Lazcano E, Lopez L, Romero-Jaime R. Breast cancer and lactation history in Mexican women. Am J Epidemiol 1996;143:543-52

MO-18b: Furberg H, Newman B, Moorman P, Millikan R. Lactation and breast cancer risk. Int J Epidemiol 1999;28:396-402

MO-18c: Tryggvadóttir L, Tulinius H, Eyfjord JE, Sigurvinsson T. Breastfeeding and reduced risk of breast cancer in an Icelandic cohort study. Am J Epidemiol 2001;154:37-42

Maternal Weight:

MO-19: Dewey KG, Heinig MJ, Nommsen LA. Maternal weight loss patterns during prolonged lactation. Am J Clin Nutr 1993;58:162-6

Risks to Society

S-1: Thapa S, Short RV, Potts M. Breastfeeding, birth spacing, and their effects on child survival. Nature 1988;335:679-82

S-2: Short . Breastfeeding (contraceptive effect). Scientific American 1984;250:35-41

S-3: Bitoun P. The economic value of breastfeeding in France. Les Dossiers de l'Obstetrique. 1994;#216 (available on request)

S-4: Radford A. The ecological impact of bottle feeding. (available on request)

S-5: Gross BA. Is the lactational amenorrhea method a part of natural family planning? Biology and policy. Am J Obstet Gynecol 1991;165:2014-9

S-6: Kennedy KI, River R, McNeilly AS. Consensus statement on the use of breastfeeding as a family planning method. Contraception 1989;39:477-96

Compiled by Dr. Jack Newman
Revised: August, 2002

For babies 12 months who weigh 20 lbs or more, should take in 16-20 oz of milk; more if they are underweight. Normal weight gain during this period is 2 oz per week. A typical schedule would be nursing or feeding expressed milk 4 x daily, feeding solids 3 x daily with one or two healthy snacks in between. If you are weaning to cows milk, it should be whole milk unless advised by your pediatrician otherwise.

For toddlers 2-3 years, typical milk intake is 3 servings per day. After 24 months, most pediatricians recommend switching to 2% milk if you have weaned from breast milk. Toddlers 24-36 months should gain approximately 1 oz per week and eat 3 meals per day with one healthy snack.

Good baby syndrome is defined as when babies seldom cry which sounds like a dream, but it can be a disaster if the baby does not cry or fuss to be fed. It is imperative that newborns under 6 months get 20 minutes of swallowing 8 times per day. Do not let these babies fool you into thinking they are just efficient enough to feed in 5-10 minutes. The proof is always in the pudding. They should be gaining 5-7 oz per week. Also, these babies need to be guided to feed 10-12 times per day during typical growth spurt ages such as 3 weeks, 6 weeks, 3 months and 6 months. After 6 months, they should still be feeding 5 times per day and gaining 4-6 oz per week.

Below you will find a shopping list for your breastfeeding supplies that may be helpful to new mothers:

__1 auto-cycling double electric breast pump (for stay at home moms, you can get a brand like Ameda that does not come with the tote bag, but always opt for a good double pump)

Nipple confusion can occur when a baby is given a bottle before they have learned to breastfeed well. It is important to wait to feed breast milk from a bottle until the baby is at least 4-6 weeks old and is latching on and nursing well. If nipple confusion occurs, one remedy is to follow these steps. Purchase a nipple shield and change the bottle nipple to a wide mouth silicone style like Avent. For 24-48 hours, turn the baby tummy to tummy with you and with your bra flap down, hold the bottle tight against your breast while feeding. Once the baby stops fighting being held tightly, use a nipple shield on your breast to get them to take your nipple. Drip breast milk onto the tip of the nipple shield or fill the nipple shield with milk while holding your finger over the holes prior to putting on the breast in order to give the baby the immediate gratification he or she is used to with the bottle. This process will take several days, but be patient and don't show stress or the baby will sense your tension. See more info on the topic of Nipple Shields in our Q & A list.

The most common misconception is that nipple shields are a barrier to protect your nipple from pain if the baby latches on incorrectly or if you already have an abrasion. This is a myth. If the baby latches on wrong to your nipple, he will also latch on and cause pain through a nipple shield. Nipple shields are a tool for use if the baby is nipple confused and should be used for short term transition from bottle to breast. If nipple shields are used for more than 3-4 days, it is imperative to double pump twice a day for 10-15 minutes to offset the decrease in milk supply that they will cause.

Overactive milk supply is diagnosed when a mother who is more than 8 weeks postpartum has extreme leakage or has a baby who gags from the forceful letdown of her overabundant supply. Some remedies include less stimulation if she is nursing and pumping a combination of more than 8 times per day for more than 10 minutes of double pumping. Lifting the baby above breast level to feed using pillows or leaning back in a recliner may also help this problem. Moms should also wear a nursing sleep bra at night to avoid the additional let downs gravity or no support can cause.

Some moms choose to pump exclusively and a good pump and good scheduling can keep up milk supply. However, before you choose this option, you need to know that moms who pump exclusively tend to wean faster due to the cleaning of the pump parts and bottles instead of the have milk will travel option of moms who can nurse when they are with their baby and only pump at work. If you choose this option, you need to pump no less than 10-15 minutes of double pumping 8 times per day until your baby is 6 months old. You also need to pump 11-12 times per day for 5 days in a row during typical growth spurt times which are 3 weeks, 6 weeks, 3 months, and 6 months. At 6-12 months, you should pump no less than 5 times per day.

There are many considerations when deciding to wean your baby. The American Academy of Pediatrics recommends breastfeeding for at least one year. If you choose to wean before one year, first make sure your baby tolerates other foods well. Next absolutely, positively, do not wean cold turkey. Before you wean, consider your alternatives such as pumping at work or partial weaning. Partial weaning works well when a baby is older than 4 months. Moms can choose to use formula during the day while at work and still nurse in the morning and at night. This only works after milk supply is well established which is why you should wait until at least 4 months of age before employing this method and always follow the same schedule seven days per week. You cannot put the baby to the breast in the middle of the day, if you have weaned that feeding. Whether you choose to partially wean of fully wean, drop one feeding every three to five days. For example, if you are nursing 8 times per day, drop one feeding in the middle of the day, substitute formula, and continue that schedule for at least three days. At the end of the three days, if your breast have no plugged ducts or pain, you can drop a second feeding. If you feel discomfort, wait until the 5th day to drop another feeding. You continue dropping on feeding every 3-5 days until all feeding are dropped. After the last feeding is stopped, you may need to nurse or pump one or both breast a final time within the next week to make yourself comfortable. One pumping or nursing in a 24 hour period will not increase your milk supply and helps to alleviate any discomfort. This method is slow, but pain free. Sudden weaning can lead to clogged milk ducts, breast infections and even breast abscess. Both you and baby will be happy with gradual weaning.

Knowing your breastfed baby is getting enough is key to the new moms breastfeeding success. What goes in must come out so counting wet and poopy diapers initially is essential to keeping breastfeeding on the right track. When the baby comes home from the hospital poop is like tar and very sporadic so start by counting wet diapers. A newborn from day 1-5 should have the number of wet diapers as days they are old. For example a one day old will have at least one wet diaper, two day old will have two, etc. After day 6, your baby should have six to eight wet diapers per day and at least three two four poopy diaper per day. If you can't tell if a diaper is wet, hold a new one in one hand and the old one in the other. You will be able to feel a weight difference if the diaper is wet. Poop diapers should only be counted if the poop is silver dollar size or larger, not just a stain. So as I said before, what goes in must come out. If you baby is nursing well and getting enough milk, the proof will be in the pudding or in this case in the diaper. And yes, there is an App for that: http://www.ivillage.com/nursing-tracker/6-b-166991 A notebook works just as well if you aren't glued to your phone.

Breastfeeding Questions & Answers:

How To Guide to Breastfeeding

Below is a summary of the risks. Continue to scroll down for detailed information on each as well as medical references.

Risks to infant and child

Cognitive Development:

Neurologic Outcome:

SIDS:

Insulin Dependent Diabetes:

Cow milk Allergy and Intolerance:

Respiratory Illness:

Otitis Media (ear infections):

Risks for the premature baby:

Childhood Cancer:

Gastrointestinal Disease and Infections:

Urinary Tract Infection:

Malocclusion:

Formula as a heavy metal cocktail:

Other Contamination due to bottle feeding:

Allergy:

Cardiovascular Risks:

Miscellaneous Risks:

Breastmilk as "antimicrobial":

Risks to the Mother

Ovarian Cancer:

Osteoporosis:

Endometrial Carcinoma:

Breast Cancer:

Maternal Weight:

Risks to Society

Compiled by Dr. Jack Newman
Revised: August, 2002

Breastfeeding Questions & Answers:

How To Guide to Breastfeeding

Below is a summary of the risks. Continue to scroll down for detailed information on each as well as medical references.

Risks to infant and child

Cognitive Development:

Neurologic Outcome:

SIDS:

Insulin Dependent Diabetes:

Cow milk Allergy and Intolerance:

Respiratory Illness:

Otitis Media (ear infections):

Risks for the premature baby:

Childhood Cancer:

Gastrointestinal Disease and Infections:

Urinary Tract Infection:

Malocclusion:

Formula as a heavy metal cocktail:

Other Contamination due to bottle feeding:

Allergy:

Cardiovascular Risks:

Miscellaneous Risks:

Breastmilk as "antimicrobial":

Risks to the Mother

Ovarian Cancer:

Osteoporosis:

Endometrial Carcinoma:

Breast Cancer:

Maternal Weight:

Risks to Society

Compiled by Dr. Jack Newman Revised: August, 2002

Compiled by Dr. Jack Newman
Revised: August, 2002