complementary feeding Archives

February 12, 2023

Breastfeeding is not binary.

–This post is part of our 10-year anniversary series “Breastfeeding is…” When we initially curated this series, we planned for 10 weeks, but breastfeeding is so many things that we just couldn’t fit it all in. Thus, two bonus weeks in our anniversary series! —

Breastfeeding is not binary.

There’s solid evidence that direct breastfeeding offers the most protective and beneficial effects to mothers, babies and ultimately society.

When breastfeeding, a baby’s saliva transfers chemicals to their mother’s body that causes her milk to adjust to meet the changing needs of the baby. [Al-Shehri, et al 2015]

Even more fascinating, the combination of baby saliva and fresh breastmilk generates enough hydrogen peroxide to inhibit growth of Staphylococcus and Salmonella. Read about the science behind it all here.

Breastfeeding encourages proper mouth and jaw development and promotes oral health.

When babies breastfeed, they are less likely to become obese for reasons like self-regulation of milk intake and seeding of their gut microbiomes. [Pérez-Escamilla, 2016]

Infants at the breast, compared to bottle-fed infants, have better heart and respiratory rates and higher oxygen saturation rates because breastfeeding consumes less energy.

Breastfeeding has implications on mother-infant bonding and children’s future behavior. One study found that “compared to children whose mothers breastfed them, children who were not breastfed showed an increased number of internalizing behavioral problems, particularly anxious/depressed and somatic symptoms… A duration effect (dosage effect) appeared such that breastfeeding for 10 months or longer had the strongest impact on reducing anxious/depressed and somatic symptoms in children.”

Direct breastfeeding does not require feeding paraphernalia that may be vectors for disease.

Even if the contents of a bottle contain human milk, the effects achieved through direct breastfeeding may not be possible.

However, the reality of families’ lives, and sometimes choice, mean that most babies in the U.S. will not exclusively breastfeed or go on to breastfeed in conjunction with appropriate complementary feeding as recommended.

The most recent CDC Breastfeeding Report Card acknowledges, “Numerous barriers to breastfeeding remain, and disparities persist in breastfeeding duration and exclusivity rates by race, ethnicity, and socioeconomic status. Policy, systems, and environmental changes that address breastfeeding barriers, such as better maternity care practices, paid leave policies, and supportive ECE centers, can help to improve breastfeeding rates and reduce disparities.”

For these reasons and others, infant feeding often takes many forms. Infant feeding in America is not either/or, it’s both/and.

Fiona Jardine and Aiden Farrow present experiences that do not fit into how we often generalize the infant feeding experience.

Jardine’s work follows those who exclusively pump human milk. Farrow too pumped milk for their child born with cleft complications and then went on to directly chestfeed their baby.

Farrow has explained: “Feeding methods are not mutually exclusive. There are always windows and doors.”

Lactation care providers, other care providers, health policies and procedures must all acknowledge the incredibly diverse experiences of families while honoring the very ubiquitous human desire that we all want what’s best for our babies.

___

Our 10-year anniversary giveaway has ended. Thank you to everyone who participated!

January 22, 2023

Breastfeeding is flavor learning.

–This post is part of our 10-year anniversary series “Breastfeeding is…”—

Breastfeeding is flavor learning.

Through mother’s milk, human infants are “exposed to a bewildering variety of flavors that influence subsequent liking and choice.” [Beauchamp & Menella]

Differently, baby milk substitutes (BMS) or baby formulas offer static flavor. Formula manufacturers are only able to add flavoring to follow-on formulas at which point, it is too late to stimulate flavor detection, explains Dr. Julie Menella.

A breastfed baby experiences textural variations such as viscosity and mouth coating so “breastfeeding provides an even richer variation in oral sensory stimulation,” as recorded in Flavor Perception in Human Infants.

Before birth, flavor learning begins around the sixth month of gestation when the fetus begins to inhale and swallow amniotic fluid marking its first chemosensory experiences. [Thomas, 2022]

The flavors a baby is exposed to signal things like the flavors of one’s culture, which foods are safe to eat, and biodiversity which later impacts food choice thereby affecting overall health and wellness.

Mennella makes clear, “breastfeeding confers greater acceptance of healthy foods…only if they are part of the mothers’ diet…”

One study which looked at the effects of maternal garlic ingestion on the odor of milk and the suckling behavior of the infant, found that the nursling detected changes in mother’s milk and stayed attached to the breast for longer periods of time, sucked more when the milk smelled like garlic, and tended to ingest more milk.

Similar findings were noted when vanilla ingestion was investigated.

Just as infants can detect the flavors of healthy and aromatic foods in their mother’s milk, they can also detect those of potentially harmful substances. For instance, Menella found that “infants can readily detect the flavor of alcohol in mother’s milk but…the decrease in consumption at the breast after maternal alcohol consumption is apparently not due to the infants rejecting the flavor of alcohol in their mothers’ milk.”

It has also been found that babies can detect the flavors in cigarettes in breastmilk. Still, the researchers note, “We do not suggest that lactating women who smoke occasionally should stop nursing. However, the knowledge that the milk of mothers who smoke smells and may taste like cigarettes provides an additional reason to avoid smoking.”

As artificial sweeteners gain prevalence in the food industry, Philip O. Anderson’s How Sweet It Is: Sweeteners in Breast Milk summarizes current knowledge regarding the transmission of sweeteners into human milk.

Dr. Anne Eglash points out in a 2019 Clinical Question of the Week:

“There is preliminary research evidence that a maternal diet high in fructose may increase body weight and fat mass in breastfed infants. When mothers consume foods or beverages high in fructose, the level of fructose rises in breastmilk. This is not true for glucose, because maternal insulin rapidly normalizes the maternal glucose level after glucose ingestion. Insulin does not moderate the fructose level like it does for glucose.

And increasing sweetness of breastmilk via artificial or natural sweeteners in the maternal diet might predispose to later obesity. This may be partially mediated by an alteration in the gut microbiome by the sweeteners.”

As infants transition to complementary feeding at six months of age, the flavors they’ve already been exposed to in utero and through breastmilk will help them to explore a breadth of healthy table foods. While human milk is meant to be the primary staple of infants’ diets, human milk alone cannot provide everything babies need nutritionally, especially micronutrients like zinc and iron. [More on appropriate complementary feeding here— Food before one is NOT just for fun.]

Newer research is starting to investigate odor-active volatile compounds in preterm breastmilk and the effect of smell and taste of milk during tube feeding of preterm infants. Find some of those studies here, here, and here.

——–

As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:

Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.

This week, in the body of the email, tell us: Do you have a funny infant feeding story?

Subsequent weeks will have a different prompt in the blog post.

We will conduct a new drawing each week over the 10-week period. Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.

October 23, 2022October 14, 2022

Foundation for Mother & Child Health (FMCH) India tackles maternal child malnutrition by empowering women

Tomorrow is Diwali, a five-day festival that celebrates the victory of light over darkness.

The Foundation for Mother & Child Health (FMCH) India reported that almost eight lakh (hundred thousand) children in India are not able to celebrate their first Diwali due to poor nutrition and health outcomes.

FMCH works to empower families from vulnerable communities with actionable information and services, resulting in health seeking behavior and nutritious food choices in order to tackle maternal child malnutrition, ultimately breaking the cycle of poverty.

“FMCH India’s work empowers women – it gives confidence and encouragement to an FMCH field officer, adds to the skills and knowledge of a government frontline worker, and builds agency and support for mothers in the community,” Shruthi Iyer, CEO and Co-founder, FMCH India tells Our Milky Way.

When Our Milky Way first interviewed FMCH in 2018, the organization had reached 10,000 women and children in Mumbai and Thane districts of Maharashtra. To date, FMCH has now worked with 60,000 families across low income neighborhoods of Mumbai.

Still, in 2020, more than 40 percent of children in India were undernourished and 50 percent of women were anemic.

Community engagement event
Photo credit: FMCH

Within the first 1,000 Days, FMCH strives to implement education sessions in the community, home based counseling, and the strengthening of systems, each strategy with a strong emphasis on monitoring and maintenance of quality. Sustainability has been built into the program through community engagement and government systems.

Because malnutrition and maternal health are complex forces, FMCH engages in a variety of programs. Read in detail about them here.

For instance, as part of Project Poshan, the organization identified that in Mumbai, “only 53 percent of newborns are breastfed within one hour of birth, displaying a serious lack of early initiation of breastfeeding. On the other hand, the percentage of breastfed children aged 6 to 23 months receiving an adequate diet is as low as 6.4 percent in the city.” [ Retrieved from https://www.fmch-india.org/wp-content/uploads/2021/10/FMCH-Annual-Report-2021-Interactive.pdf]

Most recently, in the last year, FMCH “worked with close to 25,000 families, and recorded an increase in early initiation of breastfeeding – 74% from 59%… The national average is 57%,” documented in the latest Annual Report. What’s more, 70 percent of mothers started complementary feeding at the appropriate age of six months.

Their work supporting healthy infant feeding recognizes that breastfeeding is not only the responsibility of the mother though and aims to educate the network of people around the breastfeeding dyad.

FMCH’s most recent annual report describes the success stories of health care providers and the families they serve. Explore them here.

Iyer says the way forward is to establish more direct interventions, build out indicators for their theory of change and to conduct more trainings for Anganwadi workers. (Anganwadis are rural child care centers started by the Indian government as part of the Integrated Child Development Services program.)

In the earliest Indian literature, the Vedas (a large body of religious texts originating in ancient India) recognize the life-giving powers of breastmilk.

As documented in The Religious and Cultural Bases for Breastfeeding Practices Among the Hindus “…Milk and breast are symbolic of longevity and nectarine sweetness” and “‘Drinking of the milk, whose sap is the sap of immortal life divine, may your baby gain long life, as do the gods by feeding on the beverage of immortality!’ (Susruta, III, 10).”

Extolling breastmilk in modern India and globally, through programs like FMCH, is like the light over darkness during Diwali, the FMCH vision achieved: “Healthy mothers and thriving children for a world of unlimited possibilities.”

July 26, 2020July 26, 2020

No single solution nor single source of the problem

There’s a recent TED Talk soundbite that goes like this:

“…In a world as complex and interconnected as the one we live in, the idea that one person has the answer is ludicrous. It’s not only ineffective, it’s dangerous because it leads us to believe that it’s been solved by that hero, and we have no role. We don’t need heroes. We need radical interdependence, which is just another way of saying we need each other.”

It’s a similar lesson Kimberly Seals Allers spoke to during a Milkshake Mondays Facebook Live session where she comments on the New York Times piece Climate Change Tied to Pregnancy Risks, Affecting Black Mothers Most and a laboratory creation intended to replicate human milk which just raised $3.5 million from Bill Gates’ investment firm.

In reference to the despicable maternal child health outcomes for birthing and lactating Black Indigenous People of Color (BIPOC), Seals Allers implores us to stop having “this very individualized conversation about what is happening to Black women.”

“There is so much involved,” she says. “There is no single solution, and there never was a single source of the problem.”

The ideas of interconnectedness and multi-dimensional challenges apply perfectly to this year’s World Breastfeeding Week’s (WBW) theme Support Breastfeeding for a Healthier Planet. Environmental and human health are intricately intertwined.

It’s a tangle that calls for more than reduction, reusing and recycling.

Through an equity lens, Seals Allers uses Bruce Bekkar’s, MD, et al research to ask questions like “Why are there factories mostly in Black and Brown neighborhoods? Why were Black and Brown people driven to heavily populated urban areas?”

The association between air pollution and heat exposure with preterm birth, low birth weight, and stillbirth in the U.S., demonstrated in Bekkar’s research, is heavily influenced by systemic racism.

“Compounding the added risks from warming and pollution, Dr. Basu said, research has shown that minority communities tend to have less access to medical help and that minority patients tend not to receive equal levels of treatment,” Christopher Flavelle writes in the NYT piece.

Flavelle goes on, “Adrienne Hollis, senior climate justice and health scientist for the Union of Concerned Scientists, said the problems could not be tackled in isolation. ‘We need to look at policies that provide equitable opportunities for communities of color,’ Dr. Hollis said. ‘If you address structural racism, I think you’re going to start getting at some of these issues.’”

Seals Allers echoes: “Stop problematizing Black women; look at the systemic solutions.”

Unsurprisingly, the “solutions” we tend to generate include pouring millions of dollars into synthetic milk instead of investing in breastfeeding and lactating people themselves.

“It’s very disturbing,” Seals Allers comments in her Facebook stream. “The solution is not around empowering women, it’s not about getting women breastfeeding, it’s about finding synthetic solutions. [There’s ] such a disconnect.”

Equally concerning in this case, is that the investment into a proposed solution for poor health outcomes related to not breastfeeding, comes from a climate change investment fund. Human milk is arguably the most sustainable food on our planet; why are sub-optimal, artificial substitutes getting so much funding instead of promoting policies and programs that support direct breastfeeding or pasteurized donor human milk?

*Source: United States Breastfeeding Committee.*

The conundrum goes beyond the years of milk feeding onto complementary foods which offer corporations new opportunities to target families with Ultraprocessed Foods (UPF). Like artificial milk substitutes, UPFs pose environmental threats: processing takes natural resources and generates waste. Moreover, UPFs are often heavily marketed in underserved communities, so poor health outcomes continue to be compounded.

Healthy Children Project’s Cindy Turner Maffei recently attended a webinar sponsored by the Breastfeeding Promotion Network of India (BPNI) and the Nutrition Advocacy in Public Interest (NAPI) on UPFs and their relation to obesity, diabetes, and other health dangers.

“Presenters from India, Brazil, and Australia shared insights on the health impacts of UPFs, about the market and social forces at play, and also what we can do to advocate reduction in use of these engineered foods,” Turner-Maffei reports. “Brazil in specific has incorporated decreasing UPFs into their dietary guidelines and restricted use of government funds to purchase these foods for school food programs.”

BPNI and NAPI offer their document on UPFs here.

BPNI has also created a WBW action folder. The document contains information on the carbon footprint of breastmilk substitutes and offers interventions required to support breastfeeding at four levels: policy makers, civil society and breastfeeding advocates, hospitals and doctors and parents.

Nothing is relevant if we don’t have a hospitable planet. Breastfeeding and appropriate, unprocessed complementary feeding are the roots of a healthy ecosystem that all humans benefit from.

For more on interconnectedness read Breastfeeding and parallel advocacy. Explore more on infant feeding and our environment here and here.

Share this:

Share this:

Share this:

Share this: