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The bottom line: The protective effect of breastfeeding on overweight and obesity is small, but real and of significant public health impact. Active promotion and support of the WHO and American Academy of Pediatrics breastfeeding guidelines could substantially reduce the burden of obesity and associated chronic disease in the US.

References

  1. Dewey KG. Is breastfeeding protective against child obesity? J Hum Lact 2003; 19(1):9-18.
  2. Arenz S, Ruckerl R, Koletzko B, von Kries R. Breast-feeding and childhood obesity - a systematic review. Int J Obes Relat Metab Disord. 2004 Oct;28(10):1247-56.
  3. Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of the published evidence. Pediatrics 2005; 115(5):1367-77.
  4. Gillman MW, et al. Risk of overweight in adolescents who had been breastfed as infants. JAMA 2001;285:2461-2467.
  1. Baker JL, Michaelson KF, Rasmussen KM, Sorenson TI. Maternal prepregnant body mass index, duration of breastfeeding, and timing of complementary food introduction are associated with infant weight gain. Am J Clin Nutr 2004; 80(6):1579-88.
  2. Grummer-Strawn LM, Mei Z. Does breastfeeding protect against pediatric overweight? Analysis of longitudinal data from the CDC and Prevention Pediatric Nutrition Surveillance system. Pediatrics 2004; 113:e81-86.
  3. Burke V, Beilin LJ, Simmer K, Oddy WH, Blake KV, Doherty D et al. Breastfeeding and overweight: longitudinal analysis in an Australian birth cohort. J Pediatr 2005; 147(1):56-61.
  4. Li C, Kaur H, Choi WS, Huang TT, Lee RE, Ahlualia JS. Additive interactions of maternal pre-pregnancy BMI and breast-feeding on childhood overweight. Obes Res 2005; 13(2):362-71.
  5. Gillman MW, Rifas-Shiman SL, Berkey CS, Frazier AL, Rockett HR, Camargo CA, Jr. et al. Breast-feeding and overweight in adolescence. Epidemiology 2006; 17(1):112-4.
  6. Harder T, Schellong K, Plagemann A. Differences between meta-analyses on breastfeeding and obesity support causality of the association. Pediatrics 2006; 117(3):987; author reply 987-8.
Valuable New Drugs and Breastfeeding Resource
Philip Anderson PharmD, FASHP, Director, Drug Information Service, Department of Pharmacy, UCSD Medical Center, San Diego, CA has spent the last 2 years creating a database on medication use during breastfeeding for the National Library of Medicine. It is available at: http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT. Bookmark it on your computer and spread the word.
AAP New Mother's Guide to Breastfeeding
Joan Younger Meek, MD, MS, RD, FAAP, IBCLC, Editor in Chief, with Sherill Tippins, AAP 2002; $13.95
Reviewed by: James G. Murphy MD, FAAP

This handbook could easily be called "A New Parent's Guide" as it emphasizes the importance of both parents' involvement in making the decision to breastfeed given the lifestyle accommodations each must be prepared to make to optimize this undertaking. The AAP and WHO policies in support of breastfeeding are clearly stated along with the major benefits to the infant, mother and family in general.

Proper preparation for childbirth and breastfeeding requires detailed planning. Items reviewed include finding an OBGYN and Pediatrician or Family Practitioner who are both knowledgeable and supportive of breastfeeding, a baby friendly hospital, and an experienced lactation consultant to deal with any unexpected difficulties. The components of a home nursery and attendance by both partners at a comprehensive breastfeeding course are also discussed. Child care supportive of breastfeeding may be needed later. Optimal bonding and breastfeeding initiation are achieved when the common stressors have been anticipated in the planning. The Guide assists in the anticipation of normal variations in routines related to the personalities involved including the newest one joining at birth.

The maternal body changes which occur during and after pregnancy are put in perspective regarding breastfeeding readiness and the body's automatic adjustment of breastmilk composition for premature, term and growing infants. Appropriate inclusion of caffeine and alcohol in the maternal diet as well as the importance of obtaining a second opinion regarding the recommendation by a physician not to use a particular medication or to discontinue breastfeeding in order to take the medication are emphasized. Physicians not well trained in supporting breastfeeding often play it "safe," and, rather than research a medication, simply recommend ending breastfeeding. Not mentioned are useful texts for this purpose such as Medication and Mother's Milk by Thomas Hale and Drugs in Pregnancy and Lactation published by Lippincott-Williams and Wilkins, and that the Physician's Desk Reference (PDR) is rarely useful in this regard. Selection of breastfeeding oriented clothing, infant carriers, pillows, etc to make breastfeeding more fun are discussed. Considerable time is devoted to the discussion of "The Perfect Latch".

Going home with baby, monitoring urine and stool output and time and duration of feedings helps the infant's physician determine if all is going well or special assistance is needed. When to consult an expert in breastfeeding is detailed. The old saying that "planning makes perfect" is true and this Guide greatly assists the future breastfeeding mom to anticipate and plan for all essential elements to optimize breastfeeding success and make the experience a joy for the entire family.

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