The battle vs the bottle

Now, here’s one more life-and-death reason why breast-milk is best: Powdered infant formulas are not sterile products and may be contaminated with microorganisms that can cause serious illness such as meningitis, necrotising enterocolitis, sepsis, and even death. Fact is, a powdered milk product was traced as the source of the infection related to the pathogen Enterobacter sakazakii that was reported to have caused a number of outbreaks in hospital neonatal units. Reports also say that "little is known about the extent of infection outside hospital situations or in countries around the world where the routine capacity to trace and identify E. sakazakii and other pathogens from these products does not exist."

Most at risk for infection are premature, low-birth-weight, and newborn infants. But cases involving older infants have also been reported.

Even milk companies admit that nothing comes close to breastmilk as the best nutrition for babies. It’s the infant’s first immunization, providing him with antibodies against common infant illnesses like infection, diarrhea, and bacterial meningitis. Then there are the other benefits: It increases a child’s IQ, enhances emotional security, and reduces the risk of obesity. Breastfeeding is best for moms, too, as the increased levels of oxytocin released in the mother’s body due to the baby’s sucking cause contraction and toning of the uterus.

Breastfeeding is safe and has no contamination risks. To minimize the risk of infection or death when infants are fed powdered formula products, the World Health Organization (WHO) has issued strict guidelines for parents and care givers who may be using infant milk products (as a last resort?). But then, when breastfeeding is not available, donor human milk is a safe replacement for the feeding of infants.

The WHO guidelines are at: http://www.who.int/foodsafety/publications/micro/pif2007/en/index.html

Since the Milk Code (EO 51) was passed in 1986, milk manufacturers have come up with milk products for older infants and children, presumably to avoid getting labeled as "breastmilk substitutes." So, today, the market is flooded with milk formulas: There’s milk for babies from six months onwards, one year, three years, preschool age, school age, children who are hard to feed, etc. There’s milk even for adults — pregnant women, lactating women, diabetics, and seniors.

Pediatrician and breastfeeding advocate Dr. Jack Newman, can’t help but note, "We will all soon be on formula from birth to death."

Breastfeeding activists lament that the trouble with marketing these other milk products, even if they’re for children and not infants, is that they tend to create the notion in the public’s mind that powdered milk is an ideal food for children. In lower-income communities, mothers can’t distinguish between powdered milk for infants, toddlers, children, etc. When they don’t have the money to buy infant formula (which is more often than not), they switch to cheaper brands of powdered milk that are made for older children or even adults. Thus, marketing milk for older children seems to have the net effect of promoting powdered milk for young infants and babies as well. And then there are the milk companies’ aggressive advertising that shows infants who should still be breastfeeding, in blatant violation of the Milk Code, which states that: "Manufacturers and distributors shall not be permitted to give, directly or indirectly, samples and supplies of products within the scope of this Code or gifts of any sort to any member of the general public..." (Sec 6.b); and "Manufacturers and distributors shall not distribute to pregnant women or mothers of infants any gifts or articles or utensils which may promote the use of breastmilk substitutes or bottle feeding...." (Sec 6.d).

On a positive note, there are now a lot of hospitals in the country which are promoting/encouraging breastfeeding. The Pediatric Nutrition Practice Group of the American Dietetic Association has issued the following guidelines to health care facilities on the preparation of breastmilk:

• Mechanical expression needs to begin as soon as possible after giving birth, with the use of a hospital-grade electric breast pump.

• Human milk expression in the hospital can take place at the infant’s bedside or in designated private pump rooms.

• Mothers must be instructed in writing and/or verbally regarding appropriate pumping, labeling, storage, and transport technique.

• Human milk must be stored in "food-grade" plastic containers or glass.

• To prevent errors in breastmilk delivery, human milk supplied to the facility must be labeled with complete and accurate information, including infant’s name, medical record number, and date and time of pumping.

• Human milk transported to and from the hospital should be maintained at proper temperatures (2°-6°C, 35°F-42°F), to prevent loss of nutrients and to minimize bacterial growth.

• Human milk should be stored in separate labeled bins or zippered bags, to prevent misadministration of breastmilk and to prevent cross-contamination of that milk with other feedings.

• For proper breastmilk storage, refrigerator temperatures should be maintained at 2°C to 4ºC (35°F to 40°F) and freezer temperatures at -20ºC (-4°F).

• A written policy on access to breastmilk freezers and refrigerators should be established.

• Fresh human milk can be safely stored at 2°C to 4°C (35°F to 40°F) in the refrigerator for 48 hours.

• Fortified breastmilk should be stored in the refrigerator at 2°C to 4°C (35°F to 40°F) and should be used within 24 hours.

• Frozen breast milk can be safely stored in a home freezer for three months and in a -20°C (-4°F) freezer for 12 months.

• Infants should receive fresh breastmilk whenever possible, because of the enhanced activity of cellular components.

• Frozen breastmilk should be used in the order in which it was expressed (oldest milk first).

• Frozen breastmilk may be placed in the refrigerator to thaw gradually. The container must be labeled with the expiration date.

• Thawed breastmilk must be used within 24 hours.

• Containers of breastmilk may be warmed or thawed under running water. Microwaves or hot water should never be used to warm or thaw human milk.

• Hang time for feeding human milk should not exceed four hours. Syringe and tubing must be changed every four hours for continuous feedings.

• Breastmilk remaining in a bottle after feeding an infant should be discarded.

Indeed, the breast things in life are free.

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