Tuesday, September 11, 2012

Breastfeeding Infant Health Statistics

In my experience, nearly all parents and/or expectant parents are aware of the fact that pediatricians heavily favor breast milk as the best nutrition source for infants.
However, I'm not so sure we always do a great job explaining what evidence we have to support our strong preference or what factors lead to successful breastfeeding. 
Here is a slightly updated version of my 2013 blog post on the same topic.   

Current American Academy of Pediatrics (AAP) recommendation:
Exclusive breastfeeding for "about 6 months", then continued breastfeeding while complementary solid foods are introduced, and then continued breastfeeding until at least 1 year old, or as long as it is mutually desired by mother or infant.

So what is the evidence behind the current AAP recommendation?

ANY breastfeeding is associated with...
64% lower risk of gastroenteritis (viral vomiting/diarrhea infection)
40% lower risk of type 2 diabetes
40% lower risk of asthma, if any BF lasts > 3 mo AND there is a positive FH of asthma/eczema/allergies
36% lower risk of SIDS (sudden infant death syndrome), if any BF lasts > 1mo
31% lower risk of IBD (ulcerative colitis or Crohn's disease)
26% lower risk of Acute Lymphoblastic Leukemia (ALL), if any BF lasts > 6mo
26% lower risk of asthma, if any BF lasts > 3 mo AND no FH of asthma/eczema/allergies
24% lower risk of obesity (teen and adult)
23% lower risk of otitis media (ear infection)
15% lower risk of AML leukemia, if BF lasts > 6mo

EXCLUSIVE breastfeeding is associated with...
63% lower risk of URI (common cold), if 100% BF lasts > 6mo
52% lower risk of celiac disease, if gluten-containing foods are introduced before infant formula or cow's milk are started.
50% lower risk of otitis media, if 100% BF lasts > 3 mo.
42% lower risk of eczema, if 100% BF lasts > 3mo AND positive FH of eczema
30% lower risk of type 1 diabetes, if 100% BF lasts > 3 mo
27% lower risk of eczema, if 100% BF lasts > 3mo and no FH of eczema

So how are we doing in the US as far as breastfeeding rates?
75% initiate any BF.
44% continue any BF at 6 mo.
22% continue any BF at 12 mo.
34% continue exclusive BF at 3 mo.
14% continue exclusive BF at 6 mo.

What can we do to get mothers off to a better start with breastfeeding?
1. Encourage and promote breastfeeding and skin-to-skin contact within the first hour of life.
2. Avoid supplementing with any formula, water, or any other fluid besides human breast milk in the hospital.
3. Minimize separation of mother and newborn in the hospital (aka "rooming-in").
4. Avoid all pacifiers except when necessary to soothe during painful procedures such as male circumcision.
5. Provide written resources for post-hospital discharge breastfeeding support such as lactation consultant list with contact info before hospital discharge.

Take home messages:
1. Even just a partial diet of breastmilk through 1 mo lowers the SIDS risk by 36% and reduces the risk of gastroenteritis, type 2 diabetes, asthma, leukemia and obesity to varying degrees.
2. An infant diet of 100% breast milk until 3 mo lowers the risk of ear infections, eczema, type 1 diabetes.
3. The closer an infant can get to 6 months old without any other nutrition besides breast milk, the better.
4.  Infants who are introduced to gluten-containing foods before infant formula or cow's milk are introduced are substantially less likely to develop celiac disease.

Breastfeeding also has multiple known maternal health benefits such as decreased postpartum depression, decreased risk of maternal type 2 diabetes, and maternal cardiovascular disease.

Therefore, unless there is a medical contraindication to breastfeeding or the mother has a strong preference against breastfeeding, it makes sense to try breastfeeding and see how long it continues to make sense for both baby and mother.

Wednesday, September 5, 2012

Most US Measles Cases are Travel Related

In 2011 there were 222 cases of measles reported in the US which was the highest number since 1996. This included 72 imported cases, mainly from Western Europe. Most importantly, over 60% of the 2011 US cases occurred in patients who were eligible for the vaccine and therefore were likely preventable.

So which patients should get the MMR vaccine?
Current recommendations include a first MMR at 12-15 mo and a second MMR at 4-6 yo. The majority of my patients follow this recommendation. However, fewer families follow the recommendation that infants 6-12 mo who are traveling internationally also get at least one dose of MMR in addition to the other two MMR doses already mentioned. I think this is because many parents are not aware of the international travel recommendation for measles protection, especially when planning to travel to Western Europe, Canada, or Mexico.

The take home message is that parents should start the process for appropriate travel health planning as soon as possible after booking the travel. I suggest that parents first review the current US government recs for travel to the specific country or countries on their itinerary by looking it up on www.cdc.gov/travel and then contact our office or bring it up at the next well check (if time allows) so we can help make appropriate plans. These plans will include confirmation that maximum MMR protection is achieved.

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Sunday, May 20, 2012

Great website for breastfeeding and other newborn topics

Stanford University School of Medicine has an excellent website with explanations, pictures and videos on the do's and don'ts of breastfeeding.
I don't think it can replace a live lactation consultant, but it's very instructive and free.


Other newborn issues (especially dermatology) are also reviewed with excellent images and explanations.


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Sunday, May 13, 2012

An update on pediatric concussions

Think of a concussion as a blow or jolt to the brain that causes (temporary) brain dysfunction. In the acute setting, the symptoms usually include at least one of the following: confusion, memory loss (amnesia), or loss of consciousness (LOC).  LOC is NOT a requirement to diagnose a concussion.

As an avid sports fan and a parent of two young children, I have been particularly disturbed by the recent data on head injuries in sports.  As we learn more about both the short-term and long-term effects of concussions (aka minor traumatic brain injury or mTBI), parents, health care providers, coaches and especially young athletes themselves need to learn how to prevent concussions, how to recognize the concussions that do occur, and how to resist the temptation of too rapid return to learn (RTL) and play (RTP). Not knowing enough about these brain injuries can have catastrophic consequences. For example, failure to follow the guidelines for appropriate return to play can result in death by a process known as "second impact syndrome".

There are many resources on this topic, but one of the best places to look is www.cdc.gov/concussion. This is a rich resource (partially funded by the NFL) of written and multimedia information on concussion prevention, recognition, and appropriate management.
For individual stories about concussions and concussion management, check out: www.cdc.gov/concussion/sports/stories.html
Other sources of quality and continually updated information on this topic are: www.healthychildren.org; www.uptodate.com/patients; and www.chop.edu/service/concussion-care-for-kids/home.html.
Fortunately, we have a growing number of resources for the management of concussions in Houston, West Houston, and Katy. Contact our office at 713-467-1741 for more info on local pediatric sports medicine, neuropsychology, and neurology resources that focus on the age-appropriate management of these potentially life-altering injuries.

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March 26, 2013
Here is an interesting addendum to my original blog post above. The link is to a November 2012 blog entry on youth football safety by Dr. Jorge Gomez, a Sports Medicine Specialist at TCH West Campus and an assistant team physician for the University of Houston Cougars. www.texaschildrensblog.org/2012/11/is-youth-football-safe/

Wednesday, February 29, 2012

Acetaminophen (aka Tylenol) and infant vaccines.

I've had a lot of questions on this topic lately so I thought I should make a quick post.

Basically, there was a European study published in 2009 that investigated the response to acetaminophen after vaccination in young infants. The investigators compared the fever rate and the antibody immune response of infants who did and did not receive acetaminophen after the shots. They found that the infants who got 3 doses of acetaminophen in the first 24 hours after receiving vaccines had lower rates of fever, BUT their antibody immune response was lower than the response of the infants in the study who did not get acetaminophen.

Take home message: giving acetaminophen will reduce fever risk, but it also lowers the immune response. It is not clear if this "blunted" immune response is clinically significant. I have not advised that parents pre-medicate with acetaminophen (or ibuprofen for children 6 mo or older) even before this study. At least until more information is available, I would only give acetaminophen after the vaccines are given if the infant is more than mildly uncomfortable.

Check out this link: http://children.webmd.com/vaccines/news/20091015/tylenol-may-weaken-infant-vaccines

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Tuesday, January 17, 2012

Useful nutrition/healthy foods website

I just discovered the website www.eatright.org/kids while browsing on the AAP's parent website (www.healthychildren.org).

In my brief survey so far I think it will be a useful resource for families.

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