Professional breastfeeding education and support. Breastfeeding, childbirth and baby care issues.
Wednesday, December 11, 2013
Tongue-ties interfere with successful breastfeeding
Low-risk snip may help tongue-tied infants breastfeed
Is this baby tongue-tied? Few doctors agree on how best to find out, say breastfeeding experts.
Is this baby tongue-tied? Few doctors agree on how best to find out, say breastfeeding experts.
Photo Credit: © 2013 Thinkstock
Lack of training remains an obstacle to treatment of a relatively common cause of breastfeeding problems, warn experts.
An estimated 4-10% of babies have "tongue-tie," or excess tissue anchoring the tongue to the floor of the mouth. Also known as ankyloglossia, the condition can make it difficult for some infants to breastfeed, resulting in slow weight gain, colic and early weaning. It's also linked to poor milk supply, nipple trauma and infections in nursing moms.
But the simple fix — a quick snip of the offending tissue with surgical scissors or a zap with a laser to release the tongue — seldom features in pediatric literature or training.
Called a frenotomy, the voluntary procedure has almost "no risk if done correctly" and often results in immediate improvements in both the ease and comfort of feeding, says Lawrence Kotlow, a pediatric dentist from Albany, New York. He performs the surgery six to eight times a day.
"It doesn't require anesthesia or stitching, it takes maybe 20 seconds to do, the baby is put on the breast immediately afterwards and most parents find a significant difference because now the baby can have a deeper latch."
Even so, it can be difficult to find a physician to perform the procedure, as both diagnosis and treatment of tongue-tie remain a longstanding source of controversy in the medical community.
The Canadian Paediatric Society hedges that the procedure "cannot be recommended," except in cases where "the association between significant tongue-tie and major breastfeeding problems is clearly identified and surgical intervention is deemed necessary."
Similarly, a recent CMAJ Practice article suggests reserving the procedure for newborns with feeding difficulties caused by "severe" tongue-tie.
A systematic review of 17 studies suggested that "frenotomy is a safe procedure that may facilitate breastfeeding in women who may otherwise have given up," but acknowledged that most studies were not randomized and therefore not a good indication of "any true benefit" (Arch Dis Child 2011;96:A62-3).
One such trial recently showed that frenotomy for infants with mild or moderate tongue-tie "did not result in an objective improvement in breastfeeding" at the end of a five-day period.
However, the study's authors noted that 17% of those randomized to "usual care" did not last five days before the mothers demanded a frenotomy, and 15% switched to bottle feeding. After the five days, most women in the comparison group opted for a frenotomy for their infant.
According to the authors, it's unclear "how many women would have given up breastfeeding if frenotomy had not been available in a few days' time."
In the absence of clear cut evidence, few doctors outside of specialty breastfeeding clinics even assess for tongue-tie, says Dr. Howard Mitnick, a breastfeeding management expert at the Goldfarb Breastfeeding Clinic at Jewish General Hospital in Montréal, Quebec. His clinic is "overwhelmed" with frenotomy referrals from across the province. "There are major chunks of Canada where no one's doing them … because you don't look for something you can't deal with."
Adding to the confusion, there's no standard way in which physicians diagnose the condition. Some doctors identify tongue-tie based solely on anatomical criteria, such as the degree of fusion between the tongue and the floor of the mouth. Others look for signs of limited function, such as an inability to raise or stick out the tongue.
In both cases, it's hard to attribute feeding problems to tongue-tie without a "baseline expertise" to rule out other possible causes, says Mitnick. "Lots of the women I see are struggling with breastfeeding, and the baby has the anatomy of a tongue-tie, but it's not a tongue-tie problem; it's a confidence, knowledge or positioning problem."
According to Dr. Jack Newman, founder of the International Breastfeeding Centre in Toronto, Ontario, "most physicians have no idea how to diagnose a tongue tie, at least the more subtle ones."
"We see babies in our clinic who have very significant tongue ties, yet the parents were told by the doctor that there was no tongue-tie," he wrote in an email. "And most physicians will not release a tongue tie because they don't know how."
The fact that dentists and lactation consultants often know more about the condition than physicians can further complicate the issue.
"If the family doctor doesn't recognize it, and a nonphysician says it's there, you run into a conflict," says Kotlow.
Ultimately, the losers in these scuffles are the babies and parents, who may spend months bouncing from one provider to another in search of a solution.
Mitnick argues that the wait-and-see attitude adopted by many physicians puts mothers at unnecessary risk of having to supplement poor milk supply with formula or giving up breastfeeding entirely. "We know very well that if babies are not exclusively breastfed there are genuine medical concerns, so if the alternative is frenotomy, it should be seriously considered, especially when the risks of the procedure are so low."
DOI:10.1503/cmaj.109-4675
— Lauren Vogel, CMAJ
Copyright 1995-2013, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
Friday, December 6, 2013
Monday, December 2, 2013
The co$t of infant formula
Budgeting for Baby: The Cost-Saving Benefits of Breastfeeding
September 3, 2013
Budgeting for Baby: The Cost-Saving Benefits of Breastfeeding
Of course, there are many benefits of breastfeeding to consider for both mom and baby, but what about cost? We all know that starting a family means a significant financial commitment – in other words, babies are expensive. No matter what your budget is like, it’s important to plan ahead and prepare for the lifestyle change that a new baby brings.
Whether you’re about to welcome a little one into the world or thinking about your current breastfeeding journey, you might be wondering how much breastfeeding costs. But first, take a look at the cost of not breastfeeding:
Powdered formula, the least expensive type of formula, usually costs between $20 and $30 per large can and formula-fed babies will likely need about 1-1.5 cans of formula per week. Feeding formula means spending $80-$150 or even upwards of $250 per month if your baby requires special formula due to allergies or other special nutritional needs. This means that in one year, your family could spend $960 (low end) to $3,000 (high end) on formula.
Compare that to breastmilk – perfect, complete nutrition without having to mix bottles or carry extra feeding gear – which is totally free. The Surgeon General of the United States notes that following optimal breastfeeding practices can save $1,200–$1,500 in the first year of your baby’s life when compared to buying formula. With that in mind, even spending a couple hundred dollars on a breastpump and supplies winds up costing considerably less than purchasing formula for your baby. We all know about the health benefits of breastfeeding, but don’t forget that healthier infants can also require fewer doctor visits, which lowers healthcare costs (and less time out of work for mom + dad). You can find more of the Surgeon General’s cost-saving benefits of breastfeeding here.
We can also take a look at the big picture. A study published in the Official Journal of the American Academy of Pediatrics found that the United States could save $13 billion per year (in direct and indirect health costs) and prevent almost 1,000 infant deaths if 90% of families chose to breastfeed their babies exclusively for 6 months.
Breastfeeding saves money (and lives) while creating a lifelong bond between you and your little one.
What made the biggest impact on your decision to breastfeed?
Saturday, November 23, 2013
Thursday, November 14, 2013
Rethinking Rice Cereal with Babies
Rethinking Rice Cereal
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by Deborah Pike Olsen
November 09, 2013
When it’s time for babies to eat food other than breast milk or formula, many parents reach for baby cereal—particularly rice cereal. For years, pediatricians have recommended that babies’ first food be iron-fortified cereal, particularly rice, which has a low risk for allergic reaction.
Recently, concerns have been raised about the levels of arsenic in rice and rice-based products, including baby cereal. New research on the topic from the U.S. Food and Drug Administration (FDA) has led that agency and others, including the American Academy of Pediatrics (AAP), to take a closer look at rice cereal and offer more recommendations on introducing solids to your baby.
What is arsenic?
Arsenic is a chemical element in the earth’s crust, present all around us, in both organic (naturally occurring) and inorganic forms. Both forms can be found in water, air, soil, and foods. Organic forms are released from volcanoes and through erosion of mineral deposits; inorganic arsenic, the more toxic form, is added to the environment through human activities such as burning coal, oil, gasoline, and wood, mining, and the use of arsenic-containing compounds in pesticides, herbicides, and wood preservatives.
The Environmental Protection Agency (EPA) describes inorganic arsenic as a carcinogenic (cancer-causing) agent. Several studies have linked inorganic arsenic with increased risk of skin cancer, as well as cancer of the prostate, liver, bladder, kidney, nasal passages, and lungs. For children, long-term exposure may cause lower IQ scores; exposure in utero and early childhood may increase mortality risk in young adults. Low level exposure can cause nausea, vomiting, stomach pain, circulatory problems, damage to blood vessels, a “pins and needles” feeling in the hands and feet, and redness and swelling of the skin.
Experts currently don’t know what level of arsenic is dangerous to public health. Since 2011, the FDA has analyzed samples of rice and rice products. As FDA Commissioner Margaret A. Hamburg, MD explains, the agency is “committed to ensuring that we understand the extent to which contaminants such as arsenic are present in our foods, what risks they may pose, whether those risks can be minimized, and to sharing what we know.”
Research
The FDA has monitored arsenic levels in food for nearly two decades, with the latest analysis being its most ambitious and far-reaching effort to date. The report provides data on 1,300 samples of rice products, 200 first reported in 2012 and an additional 1,100 tested in 2013. Products included in the analysis ranged from over-the-counter cookies and rice snacks to infant formula and baby cereal, ready-to-eat and hot cereals, rice “milks,” and more.
The FDA measured levels of inorganic arsenic and total arsenic for each product type. The FDA focused on rice because, unlike other crops, rice readily absorbs arsenic from the environment.
Results
FDA researchers found that arsenic levels varied widely from sample to sample within the same product. For the various products, levels ranged from 0.1 to 7.2 micrograms of inorganic arsenic per serving. However, serving sizes also varied.
In the absence of dietary limits, it is hard to know how to interpret these results, but the full text is available online. Readers can consider the relative risks of such products as rice cakes, rice milks, brown rice, and more. (Note that brand details about samples are not provided.)
Recommendations
The Illinois attorney general’s office conducted similar testing in 2012 in conjunction with Consumer Reports. Based on the “troubling” results, Consumer Reports and Illinois Attorney General Lisa Madigan have called on the FDA to set federal maximum levels for arsenic in food, especially baby food, and to caution the public about eating large amounts of rice and feeding it to small children. In fact, the next step in the FDA’s process will be risk assessment.
In the meantime, parents can take the following steps to minimize the risk of arsenic exposure for themselves and their children:
•Choose a different first food for babies. Former chair of the AAP’s nutrition committee Dr. Frank Greer notes that the group has “been trying to move people away from the use of rice cereal for the first weaning food … because it does not really provide that much nutrition.” Some experts suggest starting with meat, poultry, or tofu, which are iron-rich foods. Currently, the AAP’s position on introducing solids is that there is not sufficient evidence to show that introducing solids in any particular order is beneficial. Instead, the organization suggests babies should be offered a wide variety of nutrient-rich foods, including a variety of grains, within the first year to reduce exposure to arsenic from rice. Other good first-food options include sweet potatoes, squash, carrots, avocado, apples, pears, bananas, and peaches.
•For babies with gastroesophageal reflux (GERD) tendencies, consult a pediatrician. While rice cereal has traditionally been recommended as a thickener for these infants, the FDA notes that “wheat, barley and other grain-based infant cereals also readily absorb liquid and are similarly effective for infants with esophageal reflex tendencies.” Parents should talk with their child’s doctor.
•Avoid rice milk for children younger than age 5. Some of the highest levels of arsenic were found in products marketed as “rice milk.”
•Eat a balanced diet, with a variety of grains. Everyone should consume a varied diet. For nutrition guidance, the ChooseMyPlate website can be a good place to start.
•Limit rice consumption. Consumer Reports provides specific recommendations of servings per week for children and adults, noting, “for infants, children, and pregnant women, risks may be heightened.”
Sunday, November 10, 2013
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