<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" lang="en" xml:lang="en">
<!--Generated at Wed, 07 Dec 2011 15:49:28 +1100 HEXML processor version: 2642-->
  <head>
    <meta name="author" content="Denise Fisher" />
    <meta name="course" content="ES12" />
    <meta name="topic" content="1.2" />
    <meta http-equiv="content-type" content="text/html; charset=utf-8" />
    <meta name="copyright" content="2011 Health e-Learning" />
    <meta name="robots" content="NONE,NOARCHIVE" />
    <meta name="cache-control" content="NO-CACHE" />
    <link rel="stylesheet" href="design/hexml.pack.css?v=1323233368" type="text/css" />
    <script type="text/javascript" src="design/hexml.pack.js?v=1323233368"></script>
    <title>What information to give</title>
  </head>
  <body>
    <div id="access">
      <a href="#access" accesskey="a">Access Keys</a>
      <a href="#menu" accesskey="m">Skip to Menu</a>
      <a href="#content" accesskey="c">Skip to Content</a>
      <a href="#footer" accesskey="f">Skip to Footer</a>
    </div>
    <div id="content">
      <h1 id="top">1.2 What information to give</h1>
      <table class="callout">
        <thead>
          <tr class="decoRow">
            <td class="topleft" style="width: 10px">
              <img src="design/callout_01.png" width="10" height="10" alt="" />
            </td>
            <td class="topcenter" style="background: repeat-x url(design/callout_02.png);">
              <img src="design/callout_02.png" width="59" height="10" alt="" />
            </td>
            <td class="topright" style="width: 10px">
              <img src="design/callout_03.png" width="10" height="10" alt="" />
            </td>
          </tr>
        </thead>
        <tfoot>
          <tr class="decoRow">
            <td class="topleft" style="width: 10px">
              <img src="design/callout_07.png" width="10" height="10" alt="" />
            </td>
            <td class="topcenter" style="background-image: url(design/callout_08.png);">
              <img src="design/callout_08.png" width="59" height="10" alt="" />
            </td>
            <td class="topright" style="width: 10px">
              <img src="design/callout_09.png" width="10" height="10" alt="" />
            </td>
          </tr>
        </tfoot>
        <tbody>
          <tr>
            <td class="middleleft" style="background: repeat-y url(design/callout_04.png);">
              <img src="design/callout_04.png" width="10" height="80" alt="" />
            </td>
            <td class="body"><img src="images/key_icon.gif" class="icon" alt="" /><h3>Key Points - Case Study A</h3>
		<stage>
		<stage>
		<stage>
		
		
		<p>
			Joanne, aged 32, a regular patient, comes to see you when she is 12 weeks pregnant with her first baby. She has just returned from a trip around Australia and her pregnancy was confirmed by a doctor in the town they were in at the time. She has copies of her baseline blood tests with her and all are normal.
		</p>
	</stage>
		<p>
			Would you discuss breastfeeding at this visit?
		</p>
		<dl><dt><a href="topic_1-1.html"><cite>Topic 1.1: Discussing breastfeeding</cite></a></dt><dd class="topic-paragraph">It is important that doctors discuss infant feeding decisions and breastfeeding with women early in a pregnancy rather than waiting until the third trimester or after the baby is born.</dd></dl>
	</stage>
		<p>
			What information would you give?
		</p>
		<dl><dt><a href="topic_1-2.html"><cite>Topic 1.2: What information to give</cite></a></dt><dd class="topic-paragraph">When discussing infant feeding with mothers it is important to note that alternatives to breastfeeding have many undesirable outcomes.</dd></dl>
	</stage>
	</td>
            <td class="middleright" style="background: repeat-y url(design/callout_06.png);">
              <img src="design/callout_06.png" width="10" height="80" alt="" />
            </td>
          </tr>
        </tbody>
      </table>
      <strong>
        <p>
			What information would you give?
		</p>
      </strong>
      <p>
		Ask whether she has thought about how she will feed her baby, and her views about breastfeeding. Most women say they will "breastfeed if they can" or think they should breastfeed but feel uncertain and anxious. They may see breastfeeding as a superior product, with formula feeding being seen as an adequate and valid alternative method of infant feeding<sup><a href="#note1">1</a></sup> with little understanding of the differences between the two.
	</p>
      <div class="section display-accordion" id="Disadvantages_of_Breast_Milk_Substitutes"><h2>Disadvantages of Breast Milk Substitutes</h2>
	<p>
		When discussing infant feeding with mothers it is important to note that alternatives to breastfeeding:
	</p>
	<p>
		<em>(Please click on any point for further details.)</em>
	</p>
	<ul class="collapse"><li>
			are more expensive for the family and the community<sup><a href="#note2">2</a></sup>
			<ul><li>costs of formula, bottles, teats/artificial nipples, etc and medical costs</li><li>costs to community calculated to be at least $1-2 million in Australian Capital Territory each year<sup><a href="#note3">3</a></sup> and $U.S. 3.6 billion/ year in the USA<sup><a href="#note4">4</a></sup></li></ul>
		</li><li>
			are usually less convenient
			<ul collapse="yes"><li>preparation and storage of alternative feeding products</li><li>being caught out without sufficient formula</li><li>needing to find places and ways of keeping formula sterile and utensils clean when travelling</li></ul>
		</li><li>
			risk contamination during
				<ul><li>the manufacture phase</li><li>the preparation phase<sup><a href="#note5">5</a>,</sup><sup><a href="#note6">6</a></sup></li></ul>
		</li><li>
			lack the same hormonal responses in the mother
				<ul><li>fertility returns immediately</li><li>Breastfeeding encourages attachment and bonding between the mother and her infant.<sup><a href="#note7">7</a>,</sup><sup><a href="#note8">8</a></sup></li></ul>
		</li><li>
			lack the same levels of nutritional components
				<ul collapse="yes"><li>
						ie. essential amino acids and types of proteins, fatty acids and other nutritional components tailored to suit the developing human infant.<sup><a href="#note9">9</a></sup> <span class="aside">(See Case 3 for further information)</span>
					</li></ul>
		</li><li>
			lack immunological components that provide protection from a number of diseases and adverse outcomes in infants and their mothers<sup><a href="#note10">10</a>,</sup><sup><a href="#note11">11</a></sup> such as ...
				<ul collapse="yes"><li>infection (otitis media, gastrointestinal infection, lower respiratory tract infections)</li><li>allergy (atopic dermatitis, asthma) </li><li>chronic disease (Type 1 and Type 2 diabetes, childhood leukaemia, SIDS, coeliac disease)</li><li>necrotising enterocolitis (NEC)</li><li>poorer cognitive development</li><li>maternal type 2 diabetes</li><li>maternal breast and ovarian cancer</li><li>maternal rheumatoid arthritis</li><li>All these effects are evident in developed as well as developing countries. Two extensive reviews<sup><a href="#note10">10</a>,</sup><sup><a href="#note11">11</a></sup> published in 2007 evaluated the methodological rigour of studies comparing the effect of breastfeeding and formula feeding on a number of outcomes. These reviews and other studies published since their data were collected are able to quantify the risk for formula fed infants and their mothers.</li></ul>


		</li><li>
			increase the likelihood of acute otitis media
				<ul collapse="yes"><li>
						Formula fed infants are twice as likely to develop acute otitis media as infants exclusively breastfed for 3-6 months (OR 2)<sup><a href="#note10">10</a></sup> and are more likely to suffer from recurrent otitis media<sup><a href="#note12">12</a></sup>. Additionally, infants breastfed for 4-6 months are nearly twice as likely (OR 1.95) to develop otitis media by the time they are two years old as infants breastfed for more than 6 months<sup><a href="#note13">13</a></sup>.
					</li></ul>

		</li><li>
			increase the likelihood of gastrointestinal infection
				<ul collapse="yes"><li>
						The adjusted odds ratio of formula fed infants developing non-specific gastrointestinal infection is approximately 2.7.<sup><a href="#note10">10</a>,</sup><sup><a href="#note14">14</a></sup> In recent published research from the United Kingdom<sup><a href="#note14">14</a></sup> exclusive breastfeeding could have prevented 53% of hospital admissions for gastrointestinal illness each month in the first eight months of life. The risk of hospital admission doubles for each month after weaning.
					</li></ul>

		</li><li>
			increase the likelihood of lower respiratory tract infections (LRTI)
				<ul collapse="yes"><li>
						In Ips<sup><a href="#note10">10</a></sup> meta-analysis there would have been a reduction of 72% in hospital admissions for LRTI if all infants were exclusively breastfed for 4 months (OR 3.75). The odds ratio for infants contracting pneumonia if breastfed for between four and six months rather than &gt; 6 months was 4.27.<sup><a href="#note13">13</a></sup>
					</li></ul>

		</li><li>
			increase the likelihood of atopic dermatitis
				<ul collapse="yes"><li>
						For children under school age the odds ratio for those formula fed, compared to those exclusively breastfed for 3 months, developing atopic dermatitis was 1.47. This was even more evident for children from atopic families (OR 1.72)<sup><a href="#note10">10</a></sup>. However, the effect does not appear to persist into later childhood or adulthood<sup><a href="#note15">15</a></sup>.
					</li></ul>

		</li><li>
			increase the likelihood of asthma
				<ul collapse="yes"><li>
						Although studies appear to give conflicting reports and are difficult to evaluate, formula feeding appears to increase the incidence of wheezing within the first four years of life (OR 1.43) especially for those with a family history of atopy (OR 1.66)<sup><a href="#note10">10</a>,</sup><sup><a href="#note16">16</a></sup>. Similar to the findings with atopic dermatitis, it is unlikely that the effect persists into adolescence and adulthood<sup><a href="#note10">10</a>,</sup><sup><a href="#note16">16</a></sup>.
					</li></ul>

		</li><li>
			increase the likelihood of Type 1 diabetes
				<ul collapse="yes"><li>
						Formula feeding, compared to breastfeeding for at least 3 months appears to increase the risk of developing Type 1 diabetes (OR 1.23-1.43). However, exclusivity of breastfeeding and other confounders were not always addressed<sup><a href="#note10">10</a>,</sup><sup><a href="#note17">17</a></sup>.
					</li></ul>

		</li><li>
			increase the likelihood of Type 2 diabetes
				<ul collapse="yes"><li>
						Similarly, formula fed infants are more likely to develop Type 2 diabetes than those breastfed (OR 1.64).<sup><a href="#note18">18</a></sup>
					</li></ul>

		</li><li>
			increase the likelihood of childhood leukaemia
				<ul collapse="yes"><li>
						Infants formula fed or breastfed for less than 6 months had a higher incidence of developing Acute Lymphoblastic Leukaemia (ALL) (OR 1.32) and Acute Myeloblastic Leukaemia (AML) (OR 1.18) in childhood<sup><a href="#note10">10</a>,</sup><sup><a href="#note19">19</a></sup>. There is some evidence that other childhood cancers may also be affected<sup><a href="#note20">20</a></sup>.
					</li></ul>

		</li><li>
			increase the likelihood of obesity
				<ul collapse="yes"><li>
						There appears to be a small increase in obesity and overweight in children and adults who were not breastfed as infants (OR 1.32  1.07). This effect seems to be dose related ie the effect increases with increasing duration of breastfeeding<sup><a href="#note11">11</a></sup> with one study finding a reduction of 4% in the risk of overweight for each month of breastfeeding.<sup><a href="#note21">21</a></sup>
					</li></ul>

		</li><li>
			increase the likelihood of SIDS
				<ul collapse="yes"><li>
						A meta-analysis of studies using a precise definition of SIDS and adjusting for known confounders found that formula fed infants were more likely to die of SIDS than infants who had been breastfed at all (OR 1.56)<sup><a href="#note10">10</a></sup>.
					</li></ul>

		</li><li>
			increase the likelihood of coeliac disease
				<ul collapse="yes"><li>
						Being breastfed at the time of the introduction of gluten reduced the incidence of coeliac disease by 52%. Additionally, reducing lengths of breastfeeding increase the risk of the infant developing coeliac disease<sup><a href="#note22">22</a></sup>.
					</li></ul>

		</li><li>
			increase the likelihood of NEC
				<ul collapse="yes"><li>
						The absolute risk difference for developing NEC between premature infants receiving breast milk or formula is 5%. However, any advantage is still clinically important in these fragile infants<sup><a href="#note10">10</a></sup>.
					</li></ul>

		</li><li>
			increase the rate of infant mortality
				<ul collapse="yes"><li>
						The odds ratio of a formula fed infant dying in the first 12 months in the USA compared to an infant who was ever breastfed is 1.27<sup><a href="#note23">23</a></sup>. This equates to approximately 720 post-neonatal deaths in the USA each year.
					</li></ul>

		</li><li>
			affect cognitive development
				<ul collapse="yes"><li>
						Even when many confounding variables have been accounted for, children who had been breastfed as infants have intelligence scores approximately 4.9 points higher than children who had been formula fed<sup><a href="#note11">11</a></sup>. A 2006 paper<sup><a href="#note24">24</a></sup> and subsequent review<sup><a href="#note10">10</a></sup> suggest that this difference is a function of maternal intelligence rather than a function of breast milk or breastfeeding. However, another study, adjusting for maternal cognitive ability and other confounders found a difference of 5.6 and 6.3 points in two different populations. They also found that the association between breastfeeding and cognitive development was modified by a gene involved in fatty-acid metabolism.<sup><a href="#note25">25</a></sup>
					</li></ul>

		</li><li>
			increase the likelihood of maternal Type 2 diabetes
				<ul collapse="yes"><li>
						In women without gestational diabetes a shorter duration of breastfeeding (or no breastfeeding) was related to an increased risk of developing Type 2 diabetes<sup><a href="#note26">26</a></sup>.
					</li></ul>

		</li><li>
			increase the likelihood of breast and ovarian cancer
				<ul collapse="yes"><li>
						For every year a woman breastfeeds she reduces her risk of developing breast cancer by 4.3%<sup><a href="#note10">10</a></sup>. Additionally, women who have breastfed for at least 12 months reduce their risk of ovarian cancer by 28%<sup><a href="#note10">10</a></sup>.
					</li></ul>

		</li><li>
			increase the likelihood of other diseases where there is some data
				<ul collapse="yes"><li>
						<p>
							septicaemia and meningitis, urinary tract infection<sup><a href="#note27">27</a></sup>
						</p>

					</li></ul>

		</li></ul>
	</div>
      <div class="captionBox">
        <img width="460" height="389" src="images/disease_odds_ratio.gif" alt="Odds ratio of disease incidence with breast or formula-feeding" />
        <p>Odds ratio of disease incidence with breast or formula-feeding</p>
      </div>
      <div id="footnotes">
        <h3>Notes</h3>
        <ol>
          <li id="note1"><a href="references.html#wies04" title="See full details">#</a> Wiessinger D (2004) Watch your language</li>
          <li id="note2"><a href="references.html#catt06" title="See full details">#</a> Cattaneo A et al. (2006) Infant feeding and cost of health care: a cohort study</li>
          <li id="note3"><a href="references.html#smit02" title="See full details">#</a> Smith JP et al. (2002) Hospital system costs of artificial infant feeding: estimates for the Australian Capital Territory</li>
          <li id="note4"><a href="references.html#weim01" title="See full details">#</a> Weimer J (2001) The Economic Benefits of Breastfeeding: A Review and Analysis</li>
          <li id="note5"><a href="references.html#walk93" title="See full details">#</a> Walker M (1993) A fresh look at the risks of artificial infant feeding</li>
          <li id="note6"><a href="references.html#giov08" title="See full details">#</a> Giovannini M et al. (2008) Enterobacter sakazakii: an emerging problem in paediatric nutrition.</li>
          <li id="note7"><a href="references.html#kenn98" title="See full details">#</a> Kennell JH et al. (1998) Bonding: Recent observations that alter perinatal care</li>
          <li id="note8"><a href="references.html#klau98" title="See full details">#</a> Klaus MH (1998) Mother and infant: Early emotional ties</li>
          <li id="note9"><a href="references.html#laws07" title="See full details">#</a> Lawson M (2007) Contemporary aspects of infant feeding</li>
          <li id="note10"><a href="references.html#ipsc07" title="See full details">#</a> Ip S et al. (2007) Breastfeeding and maternal and infant health outcomes in developed countries</li>
          <li id="note11"><a href="references.html#hort07" title="See full details">#</a> Horta B et al. (2007) Evidence on the long-term effects of breastfeeding</li>
          <li id="note12"><a href="references.html#lubi06" title="See full details">#</a> Lubianca Neto JF et al. (2006) Systematic literature review of modifiable risk factors for recurrent acute otitis media in childhood</li>
          <li id="note13"><a href="references.html#chan06" title="See full details">#</a> Chantry CJ et al. (2006) Full breastfeeding duration and associated decrease in respiratory tract infection in US children</li>
          <li id="note14"><a href="references.html#quig07" title="See full details">#</a> Quigley MA et al. (2007)  Breastfeeding and hospitalization for diarrheal and respiratory infection in the United Kingdom Millennium Cohort Study</li>
          <li id="note15"><a href="references.html#peso06" title="See full details">#</a> Pesonen M et al. (2006) Prolonged exclusive breastfeeding is associated with increased atopic dermatitis: a prospective follow-up study of unselected healthy newborns from birth to age 20 years</li>
          <li id="note16"><a href="references.html#gree08" title="See full details">#</a> Greer FR et al. (2008) Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas</li>
          <li id="note17"><a href="references.html#rose07" title="See full details">#</a> Rosenbauer J et al. (2007) Early nutrition and risk of Type 1 diabetes mellitus - a nationwide case-control study in preschool children.</li>
          <li id="note18"><a href="references.html#owen06" title="See full details">#</a> Owen CG et al. ( 2006) Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence</li>
          <li id="note19"><a href="references.html#kwan04" title="See full details">#</a> Kwan ML et al. (2004) Breastfeeding and the risk of childhood leukemia: a meta-analysis</li>
          <li id="note20"><a href="references.html#orte08" title="See full details">#</a> Ortega-Garcia JA et al. (2008) Full breastfeeding and paediatric cancer</li>
          <li id="note21"><a href="references.html#hard05" title="See full details">#</a> Harder T et al. (2005) Duration of breastfeeding and risk of overweight: a meta-analysis</li>
          <li id="note22"><a href="references.html#akob06" title="See full details">#</a> Akobeng AK et al. (2006) Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies</li>
          <li id="note23"><a href="references.html#chen04" title="See full details">#</a> Chen A et al. (2004) Breastfeeding and the risk of postnatal death in the United States</li>
          <li id="note24"><a href="references.html#derg06" title="See full details">#</a> Der G et al. (2006) Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis</li>
          <li id="note25"><a href="references.html#casp07" title="See full details">#</a> Caspi A et al. (2007) Moderation of breastfeeding effects on the IQ by genetic variation in fatty acid metabolism</li>
          <li id="note26"><a href="references.html#stue05a" title="See full details">#</a> Stuebe AM et al. (2005) Duration of lactation and incidence of type 2 diabetes</li>
          <li id="note27"><a href="references.html#hans04a" title="See full details">#</a> Hanson LA (2004) Protective effects of breastfeeding against urinary tract infection</li>
        </ol>
      </div>
      <div id="footer"><a href="topic_1-1.html" rel="prev" class="prev">&laquo; Previous</a><a href="topic_1-3.html" rel="next" class="next">Next &raquo;</a><br style="clear: both" /><a href="#top" id="topLink">Back to top</a><a href="javascript: window.print()" id="printLink">Print this page</a><span class="noPrint"> | </span>&copy; 2011 Health e-Learning<p class="printOnly">COPYRIGHT: You are permitted to print ONE (1) copy for your personal use only. No graphics, tables, quizzes, videos, etc, may be used in any form without express written consent. Author: Denise Fisher</p></div>
    </div>
    <div id="menu">
      <h1>Breastfeeding Essentials</h1>
      <ol>
        <li>0.1 <a href="topic_0-1.html">Introduction</a></li>
        <li>1.0 <a href="topic_1-0.html">Case Study A (Joanne)</a><ol><li>1.1 <a href="topic_1-1.html">Discussing breastfeeding</a></li><li class="current">1.2 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_1-2.html">What information to give</a></li><li>1.3 <a href="topic_1-3.html">Effects of Breastfeeding alternatives</a></li><li>1.4 <a href="topic_1-4.html">Common breastfeeding concerns</a></li><li>1.5 <a href="topic_1-5.html">Breast examination</a></li><li>1.6 <a href="topic_1-6.html">Contraindications to breastfeeding</a></li><li>1.7 <a href="topic_1-7.html">Conditions related to lactation outcomes</a></li><li>1.8 <a href="topic_1-8.html">Medications</a></li></ol></li>
        <li>2.0 <a href="topic_2-0.html">Case Study B (Joanne)</a><ol><li>2.1 <a href="topic_2-1.html">Preparation Before Birth</a></li><li>2.2 <a href="topic_2-2.html">Birthing Factors that Affect Breastfeeding</a></li><li>2.3 <a href="topic_2-3.html">Management After Birth</a></li><li>2.4 <a href="topic_2-4.html">Poor Attachment</a></li><li>2.5 <a href="topic_2-5.html">Hypoglycaemia</a></li><li>2.6 <a href="topic_2-6.html">Relationship between Jaundice and Breastfeeding</a></li></ol></li>
        <li>3.0 <a href="topic_3-0.html">Case Study C (Joanne)</a><ol><li>3.1 <a href="topic_3-1.html">Early problems</a></li><li>3.2 <a href="topic_3-2.html">Risk of SIDS</a></li><li>3.3 <a href="topic_3-3.html">Contraception</a></li><li>3.4 <a href="topic_3-4.html">Milk composition</a></li><li>3.5 <a href="topic_3-5.html">Slowing of growth</a></li><li>3.6 <a href="topic_3-6.html">Introducing solids</a></li><li>3.7 <a href="topic_3-7.html">Weaning</a></li></ol></li>
        <li>4.0 <a href="topic_4-0.html">Case Study D (Sally)</a><ol><li>4.1 <a href="topic_4-1.html">Initial assessment</a></li><li>4.2 <a href="topic_4-2.html">Milk production</a></li><li>4.3 <a href="topic_4-3.html">Causes of inadequate infant growth</a></li><li>4.4 <a href="topic_4-4.html">Increasing milk supply</a></li></ol></li>
        <li>5.0 <a href="topic_5-0.html">Case Study E (Anna)</a><ol><li>5.1 <a href="topic_5-1.html">Sore nipples</a></li><li>5.2 <a href="topic_5-2.html">Factors causing nipple damage</a></li><li>5.3 <a href="topic_5-3.html">General treatment for sore nipples</a></li><li>5.4 <a href="topic_5-4.html">Further causes of nipple pain</a></li><li>5.5 <a href="topic_5-5.html">Mastitis – diagnosis</a></li><li>5.6 <a href="topic_5-6.html">Mastitis – treatment and complications</a></li></ol></li>
        <li>6.0 <a href="topic_6-0.html">In conclusion</a><hr /></li>
        <li class="appendix"> <a href="references.html">List of references</a></li>
        <li class="appendix"> <a href="contents.html">Course contents</a></li>
        <li class="appendix"> <a href="full.html">Print version</a></li>
      </ol>
    </div>
  </body>
</html>
    </ol>
    </div>
  </body>
</html>
