Why breastfeeding is important | womenshealth.gov

Why breastfeeding is important | womenshealth.gov

Breastfeeding and IQ

Links Tighten Between IQ, Breast-Feeding . Article Comments (32) more in Health & Wellness | Find New $LINKTEXTFIND$ ». smaller Larger facebooktwittergoogle pluslinked ininShare.5EmailPrintSave ↓ More . .Save to ↓ More. Save ↓ More. Saved ↓ More. . Please log in or register for free to use Save This. Log InRegisterLog InRegister What is Save This?Save to+ New CollectionGo to Save & Share »Name your new Collection and click save. SaveCancel Go to Save & Share »Go to Save & Share »smaller Larger By AVERY JOHNSONBreast-feeding longer can make children smarter. That's the conclusion of a study published Monday in JAMA Pediatrics, a journal of the American Medical Association. In many ways, the study won't surprise proponents of breast-feeding, who have long posited a connection between nursing and cognition and now have an additional piece of research to back up their argument. Skeptics could likely stick to the view that what matters most is how smart a baby's mom is, or that social pressure to breast-feed can have its own problems for children's development by creating stressed-out parents. However, the findings are likely to add muscle to public-health advocates' push to increase breast-feeding rates, which start out around 75% but slump to an average of 25% at a baby's first birthday, according to the Centers for Disease Control and Prevention. The JAMA study isn't the first to study a link between nursing and intelligence, but researchers say it is more conclusive because of its size and how it has isolated variables such as the mother's IQ and the child's upbringing. Previous studies have had difficulty adjusting for other factors that might influence a child's IQ, were limited by their small size or didn't account for length of nursing, said Mandy Belfort, the JAMA study's lead author and assistant professor of pediatrics at Harvard Medical School. The latest study examined and rated each child's environment based on factors such as how many books are available, and gave each mother an IQ test. They also asked detailed questions about factors that might influence IQ, such as child care, income and parental education. They then subtracted those factors using a statistical model. Dr. Belfort said she hopes that "what we have left is the true connection" with nursing and IQ. Breast-feeding is hard to study in a randomized trial because it is unethical to put some children in the non- group, Dr. Belfort said, which leaves researchers with observational studies such as the one she conducted. Researchers at Boston Children's hospital followed 1,312 babies and mothers from 1999 to 2010. They found out how many of those children were still consuming their mothers' milk at their first birthday, and then tested the children's intelligence at ages 3 and 7. Intelligence is a strange brew of nature and nurture and isolating one factor is challenging. Breast-feeding in the first place has a lot to do with class and wealth, with richer, better educated women typically opting to make the effort to nurse their babies. Children who were still nursing after a year had higher receptive language scores at age 3, which means they understood what was being said to them better than their formula-fed peers. At age 7, the breast-fed children scored higher on verbal and nonverbal intelligence tests. In 3 year olds, every month of breast-feeding raised cognition scores by an average of .21 point. Each month of breast-feeding was associated with a .35 more verbal IQ point and a .29 more nonverbal point in the 7 year olds. A full year of nursing would boost a child's IQ by about 4 points over a child who didn't nurse, said Dr. Belfort, a significant bump considering that IQs average around 100. That is for children getting some breast milk in their diets; those consuming only breast milk before starting to eat solid foods around six months of age saw even greater advantages. "For an individual person, it would be hard to tell a two or three point difference in IQ, but it would matter a lot for society," said Dr. Belfort. "If we can shift the IQ up, we would have to invest less resources at the low end." Meaning that with improved IQ scores across the board, less funding would have to be spent on remedial education programs. Dr. Amy Tuteur, an obstetrician who writes a blog called skepticalob.com, is unconvinced by a four-point increase in IQ, saying the bump needs to be bigger to prove that it isn't just random variation. "Intelligence is multifactoral and the idea that any one thing can make a big difference right away makes me skeptical," she said. "American IQ has been increasing steadily, it rose when breast-feeding rates were going down and it rose when breast-feeding rates were going up." The possible link between breast milk and brain development is only starting to be teased out. Some theories suggest that it isn't the content of the milk but the bond between mother and child developed while nursing that accounts for some of the boost. Other ideas hinge on nutrients found in breast milk such as DHA and ARA, which are fatty acids linked to brain development. Some formula companies put DHA and ARA in their offerings. "There are nutrients in breast milk that don't really exist anywhere else, and we don't fully know why," says Dimitri Christakis, a pediatrician at Seattle Children's Hospital Research Institute and wasn't involved in the research. He wrote an editorial in JAMA pediatrics on the study and leads an advocacy group called the Global Breast-feeding Initiative. In the editorial he contends the JAMA study should put skepticism to rest about whether breast-feeding is best for brain development and that society should make it easier and more acceptable for moms to nurse. For Amra Chudleigh-Neal of Thousand Oaks, Calif., intelligence is just one more reason for her to breast-feed her 6-week old daughter. She said her older child, now 7, has above average IQ, which Ms. Chudleigh-Neal said could be in part because she exclusively breast-fed until her daughter was 6- months old. "It tends to be a little more of a sacrifice to nurse the second child, you think 'oh my gosh is it really worth it' but looking back with my older child I believe it did make a difference," she said. Ms. Chudleigh-Neal receives extensive support from The Pump Station, a Los Angeles-area nursing resource center that helps with things like connecting moms to lactation professionals. Not everyone can breast-feed successfully, and that needn't make parents worry. "Talk to your baby, hold your baby and read to your baby," Dr. Belfort said. "There are so many different factors in a child's development." One difficulty in studying breast milk is that every feeding can vary based on the mother and what she has eaten. So the Boston researchers also examined a component in mothers' diets that might be responsible for children's brain development: fish, which contains DHA. The authors found that more than two or more servings of fish per week seemed to confer IQ benefits, but that boost in children's cognition wasn't statistically significant. Write to Avery Johnson at avery.johnson@WSJ.com

Postpartum depression screening

The Efficacy of Postpartum Depression Screening By Jane Collingwood How effective is postpartum depression screening? More than one in 10 new mothers is thought to experience significant postpartum depression. The condition has a substantial impact on the whole family, and while effective treatments are available, fewer than half of cases are detected in routine care. Postpartum depression is typically diagnosed a month to a year after childbirth. Women experience a combination of low mood, fatigue, anxiety, irritability, feelings of being unable to cope and difficulty sleeping. It is distinct from the “baby blues,” which is a short-lasting state of low mood suffered by up to 80 percent of mothers within three to four days following birth. Postpartum depression is not recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as being diagnostically distinct from major depression, although the manual does contain a “Postpartum Onset” specifier for patients with an onset within four weeks of giving birth. Formal screening in the U.S. is often carried out using the Edinburgh Postnatal Depression Scale, a 10-item, self-rated instrument also used throughout Europe, New Zealand and Australia. A threshold score of 12.5 was shown in one Australian study to accurately detect major depression. It can be quickly scored, and a woman who meets a threshold score can be assessed in more detail. Dr. Mike Paulden of the University of York, UK, and colleagues recently investigated the utility of the Edinburgh Postnatal Depression Scale for widespread screening of new mothers. They write on the website of the British Medical Journal that widespread screening via questionnaire “has been advocated but is controversial.” Universal screening needs to be balanced against a high rate of false positives, that is, women with an incorrect diagnosis of depression. Although the Edinburgh Postnatal Depression Scale is the most frequently researched, and “performs reasonably well,” the team concludes that it “does not represent value for money for the National Health Service.” Nevertheless, a worrying number of women with postpartum depression are overlooked in primary care clinics. Victoria Hendrick, associate professor at the University of California at Los Angeles, writes, “The mother’s suffering, coupled with the burden that her depression places on the family and the potential detrimental impact on the relationship between mother and child and the child’s cognitive and social development, call for prompt and effective methods of screening for postpartum depression.” She adds, “Postpartum depression is a highly treatable condition. A variety of interventions, including antidepressants and psychotherapy, can be helpful. A principal challenge remains in more effectively screening for and identifying this common diagnosis.” In a study of 214 women who brought their children to a general pediatric clinic, 86 (40 percent) reported high levels of depressive symptoms on the psychiatric symptom index. But only 29 of this group were identified as depressed on a questionnaire given by the pediatricians. The researchers, from Case Western Reserve University in Cleveland conclude that pediatric health care providers did not recognize most mothers with high levels of self-reported depressive symptoms. They suggest that pediatricians may benefit from extra training, and asking directly about maternal wellbeing or using a structured screening tool to identify mothers who are at risk. Postpartum depression risk factors include history of depression, abuse, or mental illness, smoking or alcohol use, fears over child care, anxiety before or during pregnancy, background stress, poor marital relationship, lack of financial resources, the infant’s temperament or health problems such as colic, and lack of social support. C. Neill Epperson, MD, of Yale University School of Medicine, points out that when the onset of postpartum depression is abrupt and symptoms are severe, women are more likely to seek help early in the illness. In cases with a gradual onset, treatment is often delayed, if it is ever sought. Detecting the condition is often complicated by several factors, he adds. For example, most women expect a period of adjustment after having a baby and may not recognize that what they are experiencing is not within the norm. Women may also be reluctant to admit that something is wrong, out of shame and fear. In addition, women may worry that they will be “locked up” or their baby taken away. “Another complicating factor is that women who did not receive their perinatal care from a family physician are often confused about whom to turn to,” says Dr Epperson. “To overcome these significant impediments to the identification of postpartum depression, family physicians should develop formal mechanisms for identifying symptoms.” When a new mother appears to be depressed, he suggests that health care providers “conduct a careful history and physical assessment,” consider her circumstances, and then use a reliable screening questionnaire. References Hendrick, V. Treatment of postnatal depression. The British Medical Journal, Vol. 327, November 1, 2003, pp. 1003-1004. Paulden, M. et al. Screening for postnatal depression in primary care: cost effectiveness analysis. The British Medical Journal, 2010;340:b5203. Postpartum Major Depression: Detection and Treatment Heneghan, A. M. et al. Do pediatricians recognize mothers with depressive symptoms? Pediatrics, Vol. 106, December 2000, pp.

Baby refusing to nurse? Laid back and baby-led breastfeeding may help.

Baby refusing to nurse? Laid back and baby-led breastfeeding may help.

Embarrassed || Spoken Word by Hollie McNish

Press Release from the USLCA

United States Lactation Consultant Association FOR IMMEDIATE RELEASE Celebrity Breastfeeding and the United States Lactation Consultant Association RALEIGH, N.C. --- Somehow it is news that one celebrity is breastfeeding a two-year-old and another "refuses" to breastfeed. The royals are not immune from infant feeding hype as speculation surrounds Kate Middleton. Will she or won't she? That breastfeeding regularly tops tabloid headlines speaks volumes about our cultural conflicts. Breastfeeding is seen as healthy and good...but potentially scandalous if it takes place in public or beyond infancy. Breastfeeding is viewed as good mothering...but may "ruin" the idealized female body. The American Academy of Pediatrics takes the stand that breastfeeding is not a lifestyle choice, but an important public health initiative. It is the desire of the United States Lactation Consultant Association (USLCA) that every woman have the opportunity to be fully informed about breastfeeding so that she may make the best decision for herself and her family. Women need to know that it is not breastfeeding, but rather pregnancy itself that changes breast latitude and longitude. Women need to know that breastfeeding offers significant protection from breast and ovarian cancer and reduces the risk of type 2 diabetes, high blood pressure, and heart disease. And they need to know that breastfeeding offers their children protection from a host of illnesses and chronic diseases such as ear infections, obesity, respiratory infections, sudden infant death syndrome (SIDS), and even some childhood cancers. And once they do make the decision to breastfeed their babies, women need support to do so. A study published in the journal Pediatrics found that only a third of women meet their own breastfeeding goals. A British study recently concluded that breastfeeding may help children climb the social ladder. The child of Prince Charles and Kate Middleton is unlikely to have difficulty with that climb. Children of celebrities have a head start, too. USLCA is concerned for the children whose mothers don't make headlines. We support the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and Michelle Obama in their call for more Baby-Friendly Hospitals so that breastfeeding gets off to a good start. And we urge Congress to continue funding for breastfeeding peer counselors through the Women, Infant, and Children's (WIC) supplemental food program so that the most vulnerable women and children are more likely to benefit from the health, cognitive, emotional, and social perks of breastfeeding. Breastfeeding support comes from employers, businesses, families, and health care providers. Mother-to-mother counseling and encouragement is invaluable. But when designing breastfeeding support policies and programs and when help in overcoming challenges is needed, International Board Certified Lactation Consultants (IBCLC) are the ones to call. In the maze of breastfeeding helpers, only the IBCLC is required to demonstrate completion of specific college-level, health sciences courses, complete ninety hours of education specific to lactation, and spend hundreds if not thousands of hours in clinical practice before sitting for a rigorous international exam. For healthy mothers and babies, for climbing the social ladder, for the health of the nation, breastfeeding is worth the IBCLC. For more information or to find an IBCLC in your area, visit www.uslca.org.