Breastfeeding and breast milk

The breast
Breastfeeding and
breast milk
Vital for our species
By Monica Hogan
Breast milk contains all the nutrients, antibodies, hormones, immune
RN RM IBCLC

factors, and antioxidants that an infant needs to thrive during the first six
months of life.
By Louise Duursma
Breast milk continues to
Currently, its principles are being extended to cover the work of
RN IBCLC ABA Counsellor
provide the basis for normal community health care services in the Seven Point Plan for the

growth, development and
Promotion, Protection and Support of Breastfeeding in Community
By Dale Hansson
immunological protection
Healthcare Settings. Following on from the community health steps
RN IBCLC ABA Counsellor
and is recommended for at
will be the steps for paediatric units. In Australia, it is now called the
least two years and beyond.
Baby Friendly Health Initiative (BFHI) to acknowledge this expansion.
The long-term health
and psychological benefits of being breastfed for this minimum
The BFHI is an international project that aims to give every baby the

recommendation should be considered as the norm. The risks
best start in life by creating a health care environment where:
associated with not breastfeeding are well-known to both health
professionals and the public to enable real, informed choices.
• Breastfeeding is the norm;
• Practices known to promote the health and wellbeing of all
The lack of understanding of the risks of artificial feeding combined
babies and their mothers are followed; and
with the lack of skilled support and inappropriate marketing of
• Those who are unable to breastfeed or who choose not to are
breast milk substitutes, contribute to women in Australia weaning
provided with individual support for safe infant feeding.
prematurely when they have made the choice to breastfeed.
Being born in a hospital which holds the award increases the
The Baby Friendly Hospital Initiative (BFHI) Ten Steps to Successful
chance of being breastfed.
Breastfeeding are the global standard by which health services
are assessed and accredited. A Baby Friendly health service is
‘Breastfeeding is both a vital and
one where mothers’ informed choice to breastfeed is supported,
respected and encouraged. BFHI was developed jointly by the
integral part of short and long-term
World Health Organisation (WHO) and uNICEF. It was launched in
1992 to encourage maternity hospitals to implement the Ten Steps
health outcomes.’
to Successful Breastfeeding and to practise in accordance with the
International Code of Marketing of Breast Milk Substitutes.
Health benefits of breastfeeding
There is a plethora of evidence supporting the major short and
long-term health risks of a child not being breastfed. WHO

recommends exclusive breastfeeding for six months and continued
feeding with appropriate family foods until beyond the second year
of life. The benefits continue into adulthood.
Risks for the child
Necrotising enterocolitis (NEC)
Babies who are fed artificial baby milks (infant formula) are at
500-1000 per cent increased risk of developing NEC and babies
fed a mixture of breast milk and artificial baby milk are at a 200
per cent increased risk of developing NEC1,2. It is thought that

components of human milk assist in the maintenance of intestinal
health in premature babies and prevent the development of NEC1.
A recent retrospective study suggested a reduction in death from
NEC after the first two weeks may be dose-related to the amount of
human milk given.2
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The breast
Obesity
Leukaemia and lymphoma
Research has consistently found that children who are not breastfed
The incidence of these diseases is much less for breastfed children,
are more likely to be overweight in childhood and adolescence. The
with the risk reduction being dose-related. According to Dr Mark
relationship appears to be dose-dependent. A recent meta-analysis
Cregan (School of Biomedical, Biomolecular and Chemical
of research found that children breastfed for less than one month
Sciences, Faculty of Life and Physical Sciences, The university of
have a 32 per cent increased risk of being overweight as compared
Western Australia), lymphoma is six times more likely if the child
to children breastfed for four to six months. Children breastfed for
has been artificially fed. 19,20
less than one month have a 47 per cent increased risk of being

overweight as compared to children breastfed for more than nine
Mental health morbidity
months.3
Recent research found that children breastfed for less than six
months had an increased risk of mental health morbidity at ages
Diabetes
two, five, eight and ten, regardless of maternal socio-economic,
There is evidence that the likelihood of developing Type 1 Diabetes
demographic or psychological factors.21
may be related to early nutrition. It is thought that sensitisation and
development of antibodies to a cow’s milk protein may be the initial
Dental problems and malocclusion
step in the aetiology of Type 1 Diabetes.4 A relationship between
Research suggests that the use of a teat causes malformation of
diarrheal disease due to rotavirus infection and Type 1 Diabetes has
the palate and an increased need for extensive dental work in later
also been identified.5
life. Increased pressure from the process of bottle feeding causes
the palate to narrow and heighten. This has the potential to cause
Asthma
upper airway disturbances such as snoring and sleep apnoea,
In a specifically Australian context, research has found that
which are related to serious health consequences.22

introduction of milks other than human milk before four months
of age results in a 25 per cent increased risk of asthma, an earlier
Risks for the Mother
diagnosis of asthma, a 31 per cent increase in wheezing and earlier
onset of wheezing.6
Breast cancer
Breastfeeding reduces the risk of a woman developing breast
Allergy
cancer in a very strong dose dependent relationship. It has been
Infants fed infant formula (cow’s milk-based or soy) have a higher
estimated that each 12 months of breastfeeding reduces the risk of
incidence of allergy than babies who are breastfed.7,8
breast cancer development by 4.3 per cent23 and that the impact

of breastfeeding on breast cancer reduction increases with
Gastroenteritis
long-term breastfeeding such that women who breastfeed each
Children who are not breastfed have been found to be three times
of their children for two years or more may halve their risk of
more likely to contract rotavirus infection9 and children who are not

developing breast cancer.24
breastfed will also be sicker than breastfed children who contract

rotavirus.10 One study found that babies who were not breastfed
Ovarian cancer
had an 800 per cent increased risk of being sick enough with
Research has found that breastfeeding for two to seven months
rotavirus to require a doctor’s visit.11 Other research has found
results in an average 20 per cent reduction in incidence of ovarian
that babies who are not breastfed have a 200-500 per cent risk of
cancer (studies have found up to a 50 per cent reduction with the
developing gastroenteritis caused by non-viral pathogens.12
relationship being dose dependent).25
Respiratory infection
Diabetes
Australian research has identified that in the first year of life
A recent study found that each year of breastfeeding reduces the

babies not exclusively breastfed for two months or at least partially
risk of developing Type 2 Diabetes by 15 per cent in young and

breastfed for six months are four times more likely to have four or
middle aged women even when BMI and other risk factors are
more hospital or doctors visits because of upper respiratory tract
controlled. It is thought that this may be because breastfeeding
infections.13 Babies not exclusively breastfed for six months are two
improves the stability of glucose levels in women.26
times more likely to have two or more hospital or doctors visits and
are 2.6 times more likely to be hospitalised for wheezing lower
Osteoporosis
respiratory illness (bronchiolitis or asthma).12
Breastfeeding improves bone mineralisation leading to decreased
risk of post-menopausal hip fracture.27
Otitis media
Children not breastfed have between 60 and 100 per cent

increased risk of developing otitis media14,15,16 and are at double
Lactation consultants who operate privately in the community can
the risk of suffering from recurrent otitis media.17
provide immediate skilled support for breastfeeding mothers. A

medicare rebate for this service would mean this was accessible to
urinary tract infections
all mothers and would strengthen the effectiveness of those services
Babies who are not breastfed are five times more likely to suffer
already in place which do not have the resources to get to all the
from urinary tract infection in infancy than children who are
mothers in need quickly enough.

breastfed.18 They are also more likely to suffer from urinary tract

infections up until at least six years of age.
There is a professional standard for International Board Certified
Lactation Consultants (IBCLC). They must have extensive

experience working with breastfeeding mothers and babies to
be eligible to sit the six hour international exam. Once they
Vol 9 No 3 Spring 2007 39

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The breast
The breast
have gained the IBCLC qualification, they must show evidence
in 6 year old children: findings of a prospective birth cohort study.
of continuing education and research (CERPS) to maintain this
British Medical Journal 319: 815-819.

qualification. Every ten years they must re-sit the international
7. Friedman NJ, Zeiger RS (2005). The role of breast-feeding in the
exam. These consultants are specialists in the management of
development of allergies and asthma. Journal of Allergy and Clinical

breastfeeding and lactation issues and are very valuable members
Immunology 115: 1238-1248.
8. Oddy WH, Peat Jk (2003). Breastfeeding, asthma, and atopic disease:
of the healthcare team.
an epidemiological review of the literature. Journal of Human Lactation
19: 250-261.
Growth charts and standards
9. Gianino P, Mastretta E, Longo P, Laccisaglia A, Sartore M, Russo R,
Mazzaccara A (2002). Incidence of nosocomial rotavirus infections,
symptomatic and asymptomatic, in breast-fed and non-breast-fed
The growth charts in circulation do not represent the normal growth
infants. Journal of Hospital Infection 50: 13-17.
patterns of exclusively breastfed infants. This fact, combined with
10. Duffy LC, Byers TE, Riepenhoff-Talty M, La Scolea LJ, Zielezny M, Ogra
the use of weight alone as an indicator of wellbeing means that
PL (1986). The effects of infant feeding on rotavirus-induced
many babies who are thriving on breastmilk are weaned so they
gastroenteritis: a prospective study. American Journal of Public Health
can attain an unhealthy rate of growth. The Multicentre Growth
76: 259-263.
and Reference Study was commissioned by the WHO from 1997
11. Sethi D, Cumberland P, Hudson MJ, Rodrigues LC, Wheeler JG, Roberts
to 2003 in six carefully selected countries across the world. It is a
JA, Tompkins DS, Cowden JM, Roderick PJ (2001). A study of infectious
intestinal disease in England: risk factors associated with group A rot
planned international standard showing how children should grow.
virus in England 126: 63-70.
Australia needs national adoption of WHO growth standards as the
12. Golding J, Emmett PM, Rogers IS (1997). Does breast feeding protect
only valid assessment tool of infant growth and development.28
against non-gastric infections? Early Human Development 49: S105
S120.
Human milk banking
13. Oddy WH, Sly PD, de klerk NH, Landau LI, kendall GE, Holt PG,
Stanley FJ (2003). Breast feeding and respiratory morbidity in infancy”
a birth cohort study. Archives of Diseases in Childhood 88: 224-228.14
WHO and uNICEF support the use of donor breast milk as the best
14. Duffy LC, Faden H, Wasielewski R, Wolf J, krystofik D (1997). Exclusive
alternative when mother’s own milk is not available. Many countries
breastfeeding protects against bacterial colonization and day care
use donor human milk but Australia is one of only a few nations that exposure to otitis media. Pediatrics 100: e7.
15. Duncan B, Ey J, Holberg CJ, Wright AL, Martinez FD, Taussig LM
do not have a donor human milk service.
(1993). Exclusive breast-feeding for at least 4 months protects against
otitis media. Pediatrics 91: 867-872.
Milk banks collect breast milk from healthy screened mothers who
16. Teele DW, klein JO, Rosner B (1989). Epidemiology of otitis media
have a plentiful supply and give donor breast milk to babies when
during the first seven years of life of children in greater Boston: a
mother’s own milk is not available. All milk is tested and heat
prospective cohort study. Journal of Infectious Diseases 160: 8-94
17. Fosarelli PD, Deangelis C, Winkelstein J, Mellits ED (1985). Infectious
treated prior to use. The donor milk is also fed to sick babies whose
illnesses in the first two years of life. Pediatric Infectious Diseases 4:
mothers cannot provide sufficient breast milk of their own.29
153-159.

18. Pisacane A, Graziano L, Mazzarella G, Scarpellino B, Zona G (1992).
In 1999 and 2000, Brazil had a network of some 150 human milk
Breast-feeding and urinary tract infection. Journal of Pediatrics 120:
banks that delivered 215,000 litres of human milk to 300,000
87-89.

preterm and low birth weight infants. By 2006, Brazil’s national
19. Collaborative Group on Hormonal Factors in Breast Cancer (2002).
network of milk banks had expanded to approximately 300.
Breast cancer and breastfeeding: collaborative reanalysis of individual

Pasteurised donor milk is used around the world for infants with
data from 47 epidemiological studies in 30 countries, including 50 302
women with breast cancer and 96 973 women without the disease. The
failure to thrive.
Lancet 360: 187-195.

20. Zheng T, Duan L, Liu Y, Zhang B, Wang Y, Chen Y, Zhang Y, Owens PH
Conclusion
(2000). Lactation reduces breast cancer risk in Shandong Province,
China. American Journal of Epidemiology 152: 1129-1135.
21. Oddy WH, kendall GE, Silburn SR, Zubrick SR, de klerk NH, Li J,
Breastfeeding is both a vital and integral part of short and
Robinson M, Stanley FJ Breastfeeding and Child mental health: A
long-term health outcomes. Improvements in breastfeeding rates
Pregnancy Cohort Study to 10 Years.Telethon Institute for Child Health
are essential to the long term health of Australians. The BFHI is a
Research, Centre for Child Health Research, Perth WA, School of Public
strategy underpinned by evidence and designed to help improve
Health, Curtin university of Technology, Perth WA, School of Nursing

breastfeeding support and the provision of care for all mothers and
and Midwifery, Curtin university of Technology, Perth WA, Australia.
babies. Most importantly, it creates an environment that supports
22. Palmer B (1998). The influence of breastfeeding on the development of
breastfeeding as the norm which then gives all babies the best start
the oral cavity: a commentary. Journal of Human Lactation 1493-98.
in life.
23. Collaborative Group on Hormonal Factors in Breast Cancer (2002).
Breast cancer and breastfeeding: collaborative reanalysis of individual
data from 47 epidemiological studies in 30 countries, including 50 302
women with breast cancer and 96 973 women without the disease. The
References
Lancet 360: 187-195.
24. Zheng T, Duan L, Liu Y, Zhang B, Wang Y, Chen Y, Zhang Y, Owens PH
1. Lucas A, Cole TJ (1990). Breastmilk and neonatal necrotising
(2000). Lactation reduces breast cancer risk in Shandong Province,
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2. Meinzen-Derr J, Poindexter B, Donovan E, Stoll B, Morrow AL, Wrage L,
25. Labbok MH (2001). The evidence for breastfeeding: effects of breas
for the NICHD Neonatal Research Network. “Role of Human Milk in
feeding on the mother. Pediatric Clinics of North America 48: 143-158.
ELBW Risk of NEC or Death” J Hum Lact 23(1),2007 p.94
26. Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels kB
3. Harder T, Bergmann R, kallischnigg G, Plagemann A (2005). Duration
(2005). Duration of lactation and incidence of type 2 diabetes. Journal
of breastfeeding and risk of overweight: a meta-analysis. American
of the American Medical Association 294: 2601-2610.
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27. Binns CW (2003). Dietary Guidelines for Children and Adolescents in
4. Villalpando and Hamosh 1998 Villalpando S, Hamosh M (1998). Early
Australia. Commonwealth of Australia. pp. 1-19.
and late effects of breast-feeding: does breast-feeding really matter.
28. WHO Child Growth Standards based on length/height, weight and
Biology of the Neonate 74: 177-190.
age. WHO Multicentre Growth reference Study Group. Department of
5. Couper JJ (2001). Environmental triggers of type 1 diabetes. Journal of
Nutrition, World health organisation, Geneva, Switzerland and
Paediatrics and Child Health 37: 218-220.
members of he WHO Multicentre Growth reference Study Group. Acta
6. Oddy WH, Holt PG, Sly PD, Read AW, Landau LI, Stanley FJ, kendall
Paediatrica, 2006; 450: 76 - 85
GE, Burton PR (1999). Association between breast feeding and asthma
29. ukAMB (united kingdom Association of Milk Banking) www.ukamb.
org/about.htm
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