Considerable advances have occurred in recent years in the scientific knowledge of the benefits of breastfeeding, the mechanisms underlying these benefits, and in the clinical management of breastfeeding. This policy statement on breastfeeding replaces the 1997 policy statement of the American Academy of Pediatrics and reflects this newer knowledge and the supporting publications. The benefits of breastfeeding for the infant, the mother, and the community are summarized, and recommendations to guide the pediatrician and other health care professionals in assisting mothers in the initiation and maintenance of breastfeeding for healthy term infants and high-risk infants are presented. The policy statement delineates various ways in which pediatricians can promote, protect, and support breastfeeding not only in their individual practices but also in the hospital, medical school, community, and nation.

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Breastfeeding and the Use of Human Milk

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(99)01101-0.pdf

Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study

Human immunodeficiency virus (HIV) type 1 load in breast milk and mastitis were examined as risk factors for vertical transmission of HIV-1. Six weeks after delivery, HIV-1 load and sodium (an indicator of mastitis) were measured in breast milk from 334 HIV-1-infected women in Malawi. Median breast milk HIV-1 load was 700 copies/mL among women with HIV-1-infected infants versus undetectable (<200 copies/mL) among those with uninfected infants, respectively (P<. 0001). Elevated breast milk sodium levels consistent with mastitis occurred in 16.4% of HIV-1-infected women and were associated with increased vertical transmission of HIV-1 (P<.0001). Median breast milk HIV-1 load was 920 copies/mL among women with versus undetectable among those without elevated breast milk sodium levels, respectively (P<.0001). Mastitis and breast milk HIV-1 load may increase the risk of vertical transmission of HIV-1 through breast-feeding.

Human Immunodeficiency Virus Load in Breast Milk, Mastitis, and Mother-to-Child Transmission of Human Immunodeficiency Virus Type 1

ContextUnderstanding the risk of human immunodeficiency virus (HIV) transmission
through breastfeeding is essential for advising HIV-infected mothers and formulating
public health policy recommendations.ObjectiveTo measure the frequency, timing, and risk factors of HIV transmission
through breast milk.DesignProspective cohort study conducted between 1994 and 1997, with follow-up
of infants through 24 months of age.SettingPostnatal clinic of tertiary care hospital, Blantyre, Malawi.ParticipantsA total of 672 infants (HIV-negative at birth) born to HIV-infected
women who had not received antiretroviral drugs during or after pregnancy.Main Outcome MeasureIncidence of HIV in breastfed infants by age and maternal and infant
risk factors for HIV transmission, using proportional hazard models to derive
risk ratios (RRs) and 95% confidence intervals (CIs).ResultsForty-seven children became HIV-infected while breastfeeding but none
after breastfeeding had stopped. The cumulative infection rate while breastfeeding,
from month 1 to the end of months 5, 11, 17, and 23, was 3.5%, 7.0%, 8.9%,
and 10.3%, respectively. Incidence per month was 0.7% during age 1 to 5 months,
0.6% during age 6 to 11 months, and 0.3% during age 12 to 17 months (P=.01 for trend). The only factors significantly associated
with low risk of postnatal HIV transmission in a multivariate model were high
maternal parity (RR, 0.23; 95% CI, 0.09-0.56) and older maternal age (RR,
0.44; 95% CI, 0.23-0.84).ConclusionsOur data suggest that the risk of HIV infection is highest in the early
months of breastfeeding, which should be considered in formulating breastfeeding
policy recommendations.

https://jamanetwork.com/journals/jama/articlepdf/191323/joc81538.pdf

HIV transmission through breastfeeding: a study in Malawi.

Fat in human milk is extremely variable and can represent up to 50 % of infant energy intake. To accurately determine milk composition and infant intake at 1 (n 17), 2 (n 17), 4 (n 17), 6 (n 15), 9 (n 6) and 12 (n 5) months of lactation, samples of fore- and hind-milk were collected from each breast at each feed over 24 h periods from an initial group of seventeen women. The content of fat in milk varied over 24 h, with a mean CV of 47·6 (SE 2·1) % (n 76) and 46·7 (SE 1·7) % (n 76) for left and right breasts respectively. The 24 h amounts of fat, lactose and protein in milk differed between women (Pa0·0001), but were consistent between left and right breasts. Daily milk production differed between breasts (Pa0·0001) and women (Pa 0·0001). Accordingly, amounts of fat (Pa0·0008), lactose (Pa0·0385) and protein (Pa0·0173) delivered to the infant over 24 h also differed between breasts and women (Pa0·0001). The energy content of milk and the amount of energy delivered to the infant over 24 h were the same between breasts, but differed between women (Pa 0·0001). The growth rate of a group of only six infants in the present study was not related to either the concentrations or amounts of fat, lactose, protein and energy in milk over the first 6 months of life. These results show the individuality of milk composition and suggest that only a rigorous sampling routine that takes into account all levels of variation will allow the accurate determination of infant intake of fat, lactose, protein and energy. Milk fat: Infant intake: Sampling routine: Human lactation

/pdf/variation-in-fat-lactose-and-protein-in-human-milk-over-24-h-kxrhfe5w8g.pdf

Natalie P. LeVasseur

Papers

Breastfeeding: A Guide for the Medical Profession

Diary Of A Baby: What Your Child Sees, Feels, And Experiences:

Wet Nursing: A History from Antiquity to the Present