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Cautions About Breast-Feeding

Despite the benefits, not every mother is able to breast-feed or chooses to do so. In rare cases, a mother's health may prevent her from breast-feeding. Women who test positive for HIV and AIDS or who have human T-cell leukemia virus type 1 (HTLV-1) should not breast-feed or provide their breast milk for the nutrition of their own or other infants because of the risk of transmission to the child.

Under certain conditions, a case-by-case assessment should be made about whether or not breast-feeding is advisable or should be temporarily stopped. According to the Blueprint, some of these conditions include:

• Exposures to environmental chemicals, such as DDT, dioxin, and methyl mercury
• Hepatitis C
• Illicit drug use, such as amphetamines, cocaine, heroin, and marijuana
• Implants and breast surgery
• Metabolic disorders such as galactosemia, a condition in which the infant cannot metabolize lactose, a sugar found in all mammalian milk
• Tobacco and alcohol use, since alcohol and nicotine are present in breast milk. However, for women who cannot or will not stop smoking, breast-feeding is still advised, since the benefits of breast milk outweigh the risks from nicotine exposure
• Use of drugs such as cyclosporin, doxorubicin, ergotamine, methotrexate, and radioactive isotopes, as well as anti-anxiety, anti-depressant, and anti-psychotic agents. For most prescribed and over-the-counter medications taken by women, the risk to the nursing infant is unknown.

Mothers should always ask their physicians before continuing or taking new medications while nursing.

The American Academy of Pediatrics (AAP) first issued a statement on the transfer of drugs and chemicals into human milk in 1983, revising its lists in 1989 and 1994. Information continues to become available. The current statement, which can be found on the AAP's Web site (www.aap.org/policy/0063.html), is intended to assist physicians in counseling a nursing mother regarding breast-feeding when the mother has a condition for which a drug is medically indicated.

Susan F. Wood, Ph.D., director of the FDA's Office of Women's Health (OWH) says, "The FDA's Center for Drug Evaluation and Research and the OWH are working to improve the current label on products so that it is more helpful to both mothers and prescribing physicians. However, more research is needed in order for good information to show up in the label, and FDA is also working to encourage such research."

Infant Formulas

For women who are unable to breast-feed, the FDA recommends using only commercially prepared formulas as an alternative to breast milk. These formulas contain the complex combination of proteins, sugars, fats, minerals, and vitamins needed to support growth in infants. The composition of commercial formulas is carefully controlled, and the FDA requires that these products meet very strict standards.

The safety of commercially prepared formula is ensured by the agency's nutrient requirements and by strict manufacturing quality control procedures. These procedures require manufacturers to analyze each batch of formula for required nutrients, test samples for stability during the shelf life of the product, code containers to identify the batch, and make all records available to FDA investigators.

But, while formulas try to imitate the ingredients in human milk, the exact composition of breast milk cannot be duplicated. Human milk contains living cells, hormones, active enzymes, and immunoglobulins that cannot be replicated in infant formula. It also has carbohydrates, easily digestible proteins, and fat, plus antibodies that can protect the baby from infection. Therefore, performance of infant formulas is measured by the infant's growth, absorption of nutrients, and gastrointestinal tolerance.

Tags: Breastfeeding

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.