5: BREAST IS BEST!

"A pair of substantial mammary glands have the advantage over the two hemispheres of the most learned professor's brain in the art of compounding a nutritive fluid for infants."

--CHIEF JUSTICE OLIVER WENDELL HOLMES (1809-1894)

Throughout this century, the debate over breast-feeding versus bottle feeding has raged without a conclusion. Does breast-feeding mean reverting back to nature? Has the modern world changed the value of this natural nutrition? What are the advantages and disadvantages of human breast milk? These are some of the questions examined in this chapter.Human milk has everything necessary to promote growth and provide good nutrition to a newborn during the first six months. After six months, breast milk does not provide enough nutrition to support infant growth.

The quality of breast milk depends on the nourishment of the mother throughout the pregnancy and during the nursing period (appendix 5.1). Poorly nourished mothers produce milk inadequate in fat, vitamins, calcium and protein, even if the volume of milk produced is normal. Poor milk quality can be obviated by improving the diet of the mother. "Feed the mother; thereby the infant," said Dr. R. Sosa. Today, in the West, most mothers receive proper nutrition making nutritional considerations less important than the psychologic factors such as maternal stress in determining the quality and quantity of lactation.Human milk provides more than just nutrition. Listed are some of the advantages of breast-feeding (elaborated on in later chapters) compared with other sources of nutrition:

. easy digestion (due to fine curdling);

. special brain-development components;

. special growth-development factors;

. improves absorption of iron, calcium and zinc;

. special supplementation of hormones;

. enhances absorption of nutritional elements;

. reduces electrolyte load on kidneys;

. reduces water retention in body;

. appropriate combination of vitamins and minerals;

. optimal ash level to keep kidney loads light;

. passive immunity system: less infections;

. favores growth of "good" intestinal bacteria;

. reduces incidence of food allergies;

. natural contraception;

. accelerates rejuvenation of mother;

. weight loss in mothers;

. prevents breast-cancer;

. reduces incidence of sudden infant death syndrome;

. improves maternal-child bonding;

. reduces over-feeding and infant obesity;

. instills pleasure and confidence in mother.

The role of human milk in Sudden Infant Death Syndrome (SIDS) needs further examination. SIDS or Crib Death claims the life of two to three out of every thousand annually. Almost 70 percent of these deaths occur between the ages of one and four months. Deaths due to SIDS during this age period outnumber the deaths from all other reasons combined. SIDS also occurs in other mammalian species such as calves and piglets.

The causes of SIDS are not clearly known but low or high birth weight, social status of parents, family income, suffocation, infection, allergy and developmental maladjustments are some of the possible causes. However, one factor clearly associated with SIDS is breast-feeding. Babies breast-fed show much less incidence of SIDS than those fed on the formula or cow's milk.

Breast-fed infant takes night-time feeding several times while formula-fed children take lesser feedings allowing more time in between when breathing abnormalities can go undetected.

Perhaps the most convincing causes of SIDS are infections and endotoxemia. By the age of three infants lose almost 70 percent of the immunity gained from mother. This encourages infections since the active immunity system of the body is not yet fully developed. Infections of the respiratory tract are more common in bottle-fed infants especially in poor hygiene circumstances. Deficient immune function also causes hypersensitivity in SIDS patients. Endotoxemia occurs when hostile bacteria start growing in the intestine and the breeding of the friendly bacteria stops resulting in production of toxins.

According to an Australian theory, reduced level of biotin (a B vitamin) in mother's milk cause SIDS. Maternal stress reduces levels of biotin in breast milk.How breast-feeding assists in emotional adjustment is quite remarkable. The human brain is highly immature and vulnerable at birth and its sensory stimulation is as important as the biologic nutrition. Studies show that breast-fed infants grow up to be less aggressive and violent than those bottle-fed. Child abuse is less common in societies and in communities where breast-feeding is common. Some researchers go as far as holding bottle-feeding responsible for most of today's ills of the society, whether of social, psychological or economic nature.

The economic consequences of bottle feeding may not be as significant in Western society but certainly they are of consequence in the poorer countries who have almost always followed the pattern of the developed Western societies whether they could afford it or not. The breast milk is the cheapest source of nutrition for the infant and as such presents an ideal economic venue to raise families in the developing countries.The most dramatic evidence of human milk's utility is the change in infant death rates recorded during the Industrial Revolution. With declining breast-feeding there was a gradual rise in infant mortality. In early 1900s, in Derby, England, only seven percent of breast-fed infants died before the age of three, compared to over 40 percent of those who were not breast-fed. The role of human milk in preventing infections is remarkable. For example, in the 1930s a study of over 20,000 infants in Chicago showed that the overall death rate of the babies raised on human milk was 1.5 per 1,000 as opposed to 84.7 per 1,000 for infants fed cow's milk during the first nine months of life. The death rate in bottle-fed infants was 40 times higher from gastrointestinal infections and 120 times higher from respiratory infections. This is an important study to quote since at that time antibiotics were not available and hence the "unadulterated" data it presents would not be possible to collect today.

The milk of each species protects the newborn from various infections by several mechanisms:

. antibodies to specific diseases;

. bifidus factor in promoting "good" bacteria;

. lactoferrin factor in reducing pathogenic bacteria;

. communication with mother on infant infections.

When a calf or piglet does not receive milk from the cow or sow during the first 24 hours of life, the animal frequently develops gastrointestinal infections and dies. Cross feeding of milk does not work. Colostrum, the breast secretion which precedes the milk flow, has long been the subject of myths and taboos. Much of the developing world considers it a poison. Some African tribes believe that one breast yields wholesome milk while the other gives bad milk.

We now have scientific evidence, however, that colostrum is full of antibodies and is essential in developing resistance to milk allergies. The concentration of antibodies in colostrum is often three to 10 times higher than in milk.

Colostrum also helps prevent infections which can result from the contamination of infants during delivery.

Human milk itself contains thousands of bacteria which come from the mother. These bacteria do not proliferate due to the antiseptic properties of milk and since breast-feeding involves no storing of milk.The embryo receives antibodies and vitamins from the mother through placenta to help boost the immune defense system of the infant. The breast has the ability to concentrate these important protective chemicals and when transferred to the infant, the concentration is much higher than in the mother's blood.

After birth the still immature defense system of an infant also receives support from the nursing mother through an elaborate system of communication between the mother and the infant. When the infant develops infection, the mother's defense system learns about it as soon as the infant starts to suckle and that triggers the mother's immune system to produce antibodies to fight off these infections. These antibodies concentrate in the mother's milk and reach the infant in subsequent feedings. This is perhaps nature's most elaborate and highly sophisticated mechanism of protecting infants from infections. Similarly, vaccination of the mother also immunizes her infant through breast-feeding.The bifidus factor, a carbohydrate identified in 1953 is 40 times more concentrated in human milk than in cow's milk. The bifidus factor promotes the growth of good bacteria which act as "intestinal guardians," checking the growth of undesirable and possibly harmful bacteria such as E. coli. Bacteria found in the intestines of infants who drink only cow's milk are quite different from those in the intestines of breast-fed babies. The former are more susceptible to intestinal infections.

Lactoferrin, another unique component of human milk is also a powerful inhibitor of bacterial growth. A protein, lactoferrin acts by binding the iron in the intestine which the bacteria need to grow. It also helps prevent bacterial diarrhea. Iron supplements are, therefore, not recommended for breast-fed infants to maintain the action of lactoferrin. However, the iron-binding property of lactoferrin also causes anemia in breast-fed infants. Thus treatment of anemia in breast-fed infants requires large doses of iron to compensate for loss through binding with with lactoferrin.

Realization of the value of human milk in averting infections, allergies, asthma, eczema, diabetes, etc, has mostly come from anecdotal observations for many practical reasons. It is almost impossible to find a group of children who are only breast-fed and compare them with those who are only bottle-fed. Almost invariably, at least in our modern society, children receive both, making a controlled study impossible. However, the evidence supporting the value of breast milk in affording immunity and preventing specific disease is overwhelming in societies where breast-feeding is prevalent. Milk and colostrum prevent many bacterial, viral, fungal infections causing such dread diseases as diptheria, cholera, typhoid, bacterial dysentery, polio, herpes, rubella, etc. (appendix 5.2).Since antiquity, milk has been acclaimed for its curative properties as well as for its food value. Anecdotal tales abound of medicinal cures using milk. Hippocrates prescribed it for the treatment of tuberculosis. Dr. S. Wier Mitchell of this century accomplished wonders in his medical practice using milk as a therapeutic agent.

Modern studies on the composition of milk lend some credibility to these anecdotal claims. For example, we now know that the various antibodies found in milk can protect against infections and the hormonal and exorphin factors can alter the course of many body functions.

Dr. Charles S. Porter has successfully treated thousands of patients suffering from exhaustion of adrenal glands with a milk-diet cure. He describes the subjective response of the diet:

Within two hours after commencing the diet, the action of the heart will be accelerated and within 12 to 24 hours there will be a gain of six beats to the minute. Within two or three days there will be an increase of about twelve beats to the minute; the pulse will be full and pounding; the skin flushed and moist; the capillary circulation quick and active...There is an increase in the general warmth of the body...The stimulation of a full milk diet is very much similar to the effects of alcoholic stimulation on the circulation, but the after effects are entirely different...The voluntary muscles of the body become firm and solid, almost like an athlete's limbs...There is an increased power of the intestinal muscles, resulting in several copious bowel movements per day.

Breast milk is often rightly called a "patented" medicine by many. For example, according to a study reported in 1972, a one-half teaspoon of breast milk per pound of body weight per day reduced the incidence of diarrhea in children eight-fold. The report calls the milk the "white blood." In some cultures, fresh breast milk treats eye infections.

Dr. Henry G. Bieler, who died in 1975, was one of the strongest proponents of the milk-diet and other natural foods for treating human diseases. His book, "Food is Your Best Medicine," published in 1966, lists many case studies of treating diseases with foods including milk-diets.

Many, including Dr. Bieler, believe raw milk to be superior to pasteurized and homogenized milk since the processing of milk destroys many of its protective ingredients. Nature takes great pains in assuring the freshness of milk by the "nipple to mouth" system. The chemical instability of raw milk makes is more easily digested. Old Testament writers knew about this ease of digestion and exceptional nutritional qualities of milk when they said: "Such as have need of milk, and not of strong meat" (Hebrews V:12).

According to Dr. Bieler, pasteurized milk putrefies in the intestine whereas raw milk ferments. Observing changes in both types of milk at room temperature proves his point.How pasteurization makes milk hazardous to health is a matter of guess. In an interesting experiment, calves "bucket-fed" grew abnormally when compared to "udder-fed" calves. Pasteurized milk given to calves caused death within 60 days according to Dr. John Thompson of Edinburgh.

Populations which consume raw milk, such as the Swiss or Masai (who also drink cow blood), enjoy good health. However, raw milk is also a good source of infections. Many countries and most states in the U.S. have banned the sale of raw milk.The calories taken in the early years of life determines the number of "fat cells" formed in the body. In later years, these cells only expand or contract. So, the stage to curb obesity is in infancy. Problems arise when infant formula is used in conjunction with mother`s milk. It is relatively easy to over-feed the infant, if for no other reason, than to satisfy the young mother and overcome her guilt of inadequate lactation.

The composition of human milk changes continuously during any one feeding. It is lighter as the baby begins to suckle and becomes richer in fats towards the end of the feeding cycle. This high concentration of fat gives infants a feeling of fullness and keeps them from over feeding. Cow's milk or milk formulas, on the other hand, have uniform composition and often blamed for obesity in children, because most infants take more than they need.

Mothers often take blame for their obese children. Some clinicians believe such children were over-fed, given solids at an early age, more likely not breast-fed and over indulged. A recent study from the Department of Nutrition and Food Sciences of the University of Toronto absolves mothers once and for all. There was no difference found in the feeding patterns of a group of about 100 children, half of whom were obese and the other half of normal weight. Certainly breast-feeding of itself does not control infant weight. The human brain develops mainly during the last term of the pregnancy and during the first few weeks of birth. The brain cells are quite capable of synthesizing or otherwise extracting what they need from the nutrition in the blood. It is fallacious to assume that breast-feeding mothers must adopt certain special diets to promote intelligence in their offspring. Survival of the human race over the millennia of adverse conditions points to the adaptability of all of its organs, the brain being no exception. As long as there is proper nutrition given infants, there is no need for any concern.

Recent studies, however, show that infants do need some supply of a fatty acid, DHA, found in the mother's milk but not in formulas or cows milk. Milk-formula producers should include this component to milk substitutes to bring them a step closer to the real milk.

Fish has abundant DHA. Whether fish-eating communities produce more intelligent off-springs is a matter of conjecture. Breast-feeding, an emotionally satisfying experience for the mother, also promotes the emotional attachment between her and the child. However, it is wrong to assume that mothers who do not breast-feed are less emotionally bonded to their children. To an infant, hunger is a natural response demanding food, not necessarily the breast. It is the intimate physical contact as the mother holds the child during feeding that helps strengthen their bond, not breast-feeding. Unfortunately, many studies based on animal models have concluded otherwise without considering the differences between animal and human behavior. These concepts only give a guilt complex to mothers who can not or will not breast-feed.

However, the biggest problem for the Western woman who wants to breast-feed her baby comes from the abundant availability of various infant foods which decrease the appetite and the suckling reflex. Not understanding this connection, the young mother becomes anxious, associating the infant's lack of appetite to her inadequacy in milk production. The anxiety leads to an actual drop in milk yield and the vicious cycle continues. Mixing bottle with breast-feeding also confuses the baby since the sucking mechanisms are different in the two.

Nowhere is the process of evolution more vividly expressed than in the changes in a mother's health when breast-feeding. Breast-feeding produces several important chances in mothers:

. reduced weight to pre-pregnancy level;

. reduced engorgement of breasts and reduced cracking of nipples;

. reduced incidence of breast infection;

. controlled ovulation (contraception);

. quick involution and contraction of uterus;

. psychological satisfaction;

. conservation of body water.

Pregnancy causes considerable strain, both emotional and physical, on women's health. Delivery of the child does not bring this "trauma" to an end; in most cases, it worsens it, despite the reduced physical constraints. Nature has designed, through millions of years of evolutionary development, an elaborate mechanism to put the whole body apparatus back into its original condition as quickly as possible. Breast-feeding accelerates this process.

During pregnancy, women gain anywhere from 20-25 pounds, about half of it due to added fat, to serve as the store of calories for feeding the infant. Women who opt not to breast-feed must burn these calories otherwise to lose weight.

Many of the effects of breast-feeding are due to a hormone, prolactin. The levels of prolactin are much higher in breast-feeding women than non-breast-feeding women. The prolactin levels are also dependent on the number of feedings in a 24 hour period, the duration and the vigor of the baby's sucking. Strong and prolonged suckling increases prolactin levels in the body. Breast-feeding also acts as contraceptive. There is a delay in menstruation and ovulation during breast-feeding, a connection highly appreciated in the Third World countries, where breast-feeding is more popular as a means of birth control. The pregnancy-spacing effect of breast-feeding is due to the increased secretion of prolactin. However, partial breast-feeding or the use of pacifier decrease prolactin concentration in the mother and thus its contraceptive effect.

Infertility during the lactation period is a nature's way of allowing a mother to give exclusive attention to her newborn. Lactation is, therefore, nature's prescription for health care of the newborn and the mother alike.

Maternal malnutrition also delays menstruation as seen in famines and during vigorous weight-reduction programs often followed by teenage girls. However, the ovulation cycles become normal as the nutritional status improves.

In poorly fed communities where breast-feeding is prolonged, menstruation begins late after delivery. For example, in Bangladesh, menstruation most often begins again between November and March, coinciding with the rice harvesting season when nursing mothers receive better nutrition.

The longest recorded period of delayed menstruation in the U.S. is 15 months in a well-fed woman practicing natural breast-feeding. On an average, in non-breast-feeding women menstruation begins within four months of delivery compared to about 10 months for breast-feeding women.

However, delayed menstruation does not represent complete loss of ovulation and 3-15 percent of pregnancies occur without menstruation ever having begun since the previous birth.

Breast-feeding is not a guaranteed method of birth control once menstruation begins and half of all breast-feeding women become pregnant in late breast-feeding, which can be arduous for a woman still nursing an infant.

The effect of breast-feeding on birth spacing yields the theoretical maximum of 10 babies in 30 years of fertility compared with 30 babies in non-breast-feeding women. Some mammals have mating seasons which serve the same function as lactation and delayed menstruation in humans.

Birth control pills also alter lactation. The mixed pills, which contain both estrogens and progestogens, reduce the production of human milk by as much as 80 percent and also cause significant changes in its composition. The use of single-component progesterone pills for contraception has little effect on milk production. In some cases these pills may even increase the production of milk. Also, there is no evidence that progesterone pills during breast-feeding cause any feminization of the infant. Some newborns show secretions of colostrum-like "bitch's milk" which is a result of some remaining maternal hormones of pregnancy. This lasts only for a few days.Some recent reports show reduced breast cancer incidence in less developed countries where early and frequent pregnancies and prolonged breast-feeding are common. These observations are attributed to several factors, including prolactin levels and the diet of mothers.

Since we are routinely exposed to many carcinogens, it is logical to explore all means of counteracting them. Although not conclusive, the cancer prevention effect of breast-feeding is worth considering. Human milk contains many components which make it uniquef: anti-infective interferon; lysozyme and lactoferrin; antitoxins to detoxify infections; bifidus factor, discussed earlier, which promotes growth of "good" bacteria; essential fatty acids and taurine required for body growth; immunity inducing agents such as eicosanoids; lipase enzyme to help improve absorption of fats; and nucleotides and DHA for rapid brain development. Many of the special components of milk are synthesized in the mother's milk only when they are needed by the infant. For example, lysozyme appears in human milk in a wide range of concentrations but even at its lowest concentration it is 5000 times higher than in cow's milk. This compound not only protects against some of the bacteria but also against viruses such as herpes. A unique chemical in human milk is taurine, which promotes the function of skeletal muscles, heart, retina, bile metabolism and the central nervous system. Cow's milk and formulas derived from it have only traces of taurine. Cow's milk immediately after calving contains taurine but by the time they are milked for human consumption, the concentration of taurine declines to trace levels.

Several other mammals including the gerbil, cat, and rat also produce taurine. In cats, lack of taurine leads to blindness. Taurine deprivation does not cause any disease in humans or at least we do not know that yet. There are indications that it helps in mental growth. What suggests an important role is its high concentration which changes as the infant grows. Human milk also contains a group of chemicals called eicosanoids, synthesized from the essential fatty acids in our body. Eicosanoids regulate blood clotting, blood pressure and resistance to diseases of the heart and of the body's immune system. These include atherosclerosis, hypertension, asthma, diabetes, multiple sclerosis, migraine, cancer, allergies, asthma and scores of other diseases. Eicosanoids help infants adapt to life outside of the womb by providing resistance to diseases. Milk from mothers of premature babies has a different composition from that of mothers whose babies are full term. It is specifically designed to meet the needs of the "preemie." As a result, many scientist criticize the pooling of human milk. Many components of milk described above stimulate body and brain growth of infants. This explains how, despite low caloric value and vitamin and mineral value, human milk promotes normal growth. The growth regulators are: Nutrients (amino acids, lipids, minerals, vitamins); Hormones (insulin, prolactin, endorphin, thyroliberin); Specific growth chemicals (nerve, skin); Attachment factors (fibronectin); Binding proteins (lactalbumin, transferrin, casein); Polyamines (spermine, spermidines, putrescine); Cells (lymphocytes, macrophages, epithelial); Enzymes (lipase); Interferons. However, despite all the pluses, there are some disadvantages to breast-feeding, both socioeconomic or medical:

. conflicts in working schedules;

. pre-delivery medication exposure of the infant;

. physical problems of breast;

. infecting infant with mother's infections;

. transfer of environmental pollutants;

. lower potential than formula to maximize growth rate;

. staph and viral infections;

. not adequate nutrition for premature and low-birth-weight infants;

. inconsistency in nutritional content;

. increased incidence of jaundice (absorption of bilirubin) in newborns;

. adverse reactions to various foods and drugs taken by the mother (allergies, irritation due to spices and enzyme deficiencies due to fava beans and oxidant drugs);

.allergic reaction due to transfer of unchanged proteins;

.possible transfer of acquired immune deficiency syndrome (AIDS).

Problems due to exposure of the infant to the chemicals and drugs in mother's milk are serious. Chemical exposure of infants to chemicals can be especially damaging since their detoxification mechanism has not yet developed. As a result, these chemicals persist in the body for a long time and cause serious damage to the brain and affect the growth of other body organs.We have all heard horror stories about babies addicted to heroin due to their mother's addiction. However, it is important to note that all drugs taken by a woman show up in her milk and in view of the immature detoxification system of infants, any drug exposure is too much for them.

Tetracycline antibiotics, for example, create problems in the intestine of infants upsetting the good bacterial environment of the intestine. Tetracycline when absorbed in infants causes discoloration of teeth on a permanent basis. Infant drops of tetracycline were withdrawn from the market in the U.S. in 1978.

Hormones in mother's milk, whether natural or taken as drugs, affect the body growth, especially the breasts in male infants.

The advice to mothers is to forego all but the most essential drugs, and even then to take them only when needed and under the supervision of a physician. Nursing mothers should also avoid foods which contain some active drugs such as medicinal herbs and some spices.

Effective December 26, 1979 all manufacturers of drugs in the U.S. are required to display a warning on the label for pregnant and nursing mothers regarding any side effects of drugs on infants. Your family pharmacist in this regard can be very helpful. Appendix 5.3 lists drugs to avoid while breast-feeding.

Pesticides found in human milk are traceable to such sources as vegetables, dairy products, smoking and use of insecticides in the home and environment. Studies from Israel show DDT in colostrum present at 5-7 parts per million (ppm) level in some women. The maximum allowed levels are 0.1 ppm. In all those countries where DDT and other similar pesticides are prohibited, their concentration in milk is decreasing rapidly. Women of the U.S, Canada, Sweden and Japan show only a small quantity of pesticides in their milk.

Other environmental contaminants of concern are heavy metals such as arsenic, lead, mercury, fungal toxins such as aflatoxins and PCBs or other related chemicals. Fluoride in drinking water does not affect the level of fluoride in human milk. However, the exposure of a mother to lead does raise the lead content of her milk.

Cigarettes, caffeine, and alcohol consumption offer additional hazards in breast-feeding. Smoking mothers invariably poison their infants with nicotine. It is not uncommon for infants to refuse feeding, become apathetic, vomit and retain urine and feces if the mother smokes. The effects of marijuana smoking are even worse. The new warnings on cigarette packs include these contraindications to mothers.

Caffeine causes birth defects in animals, the results in humans are not conclusive. However, nursing mothers who consume large volumes of coffee or tea often have infants that are wakeful and irritable.

Artificial sweetener cyclamates, now banned in the U.S., but not in many other countries, reach the infant through its mother's milk very quickly. The newly-introduced sweetener aspartame (Nutra SweetR) is also suspect with some indication that it affects the brain although conclusive data are not available yet. Breast feeding is often associated with jaundice in the new-born. Human milk contains factors which inhibit absorption of bilirubin, the jaundice-causing chemical. Inadequacy of this factor increases absorption of bilirubin and thus the incidence of jaundice. Use of milk from another mother or formula readily resolves this situation. Human milk, like cow's milk, is a good carrier for several infectious bacteria, most commonly the staph organisms, which abound in the human body and its environment. Unfortunately, effects of staph infections in a woman's breast appear only after the infection starts affecting the infant. Studies from Poland show that several disorders, including those of the intestines, in infants on breast-feeding are a result of the toxins produced by staph organisms in the mother's breast.

A report presented at the 1981 meeting of the American Society of Microbiology also implicated staph organism in the disease called toxic shock syndrome. At first the disease was found only in women who used tampons. Now reports confirm cases in women who do not use tampons and also in males. The toxin associated with the disease has also been found in breast milk of afflicted women. Whether infants receive this infection through milk is not certain.

Cow's milk is now considered a major source of salmonella infection coming directly from cows and not through processing of milk. Investigations of the Center for Disease Control on several salmonella outbreaks in California in 1985 and 1986 led to cows treated with chloramphenicol. This yielded new strains of salmonella which were resistant to chloramphenicol, a drug of choice treatment against salmonella in humans.There is a large variation in the quality of human milk not only between mothers but also in the same mother under different circumstances. This is attributed to various diet and health factors but also to mental status. The following case related by a Dr. Von Ammon, physician to the king of Saxony (circa 5th century A.D.), is chilling:

A carpenter quarreled with a soldier billeted in his house, and was set upon by the latter with his drawn sword. The wife of the carpenter at first trembled from fear and terror, and then suddenly threw herself furiously between the combatants, wrested the sword from the soldier's hand, broke it in pieces, and threw it away. During the tumult, some neighbors came in and separated the men. While in the state of strong excitement, the mother took up her child from the cradle, where it lay playing and in most perfect health, never having had a moment's illness; she gave it the breast, and in so doing sealed its fate. In a few minutes the infant left off, became restless, panted, and sank dead on its mother's bosom. The physician who was instantly called in found the child lying in the cradle as if asleep, and with its features undisturbed; but all his resources were fruitless. It was irrecoverably gone. (Die erste Mutterpflichten und erste Kindesplfege, P. 102, 3d Ed. Leipsig, 1839).

Breast-feeding or bottle-feeding both have their advantages and disadvantages. However, many of the disadvantages of breast-feeding are creations of modern life and avoidable. There is no question that, despite these disadvantages, breast-feeding remains the only logical way to feed the newborn. However, in modern times it is sometimes hard to justify relying on breast-feeding alone.

The choice of substitutes to mother's milk is, however, not an easy one to make. There really is no true substitute to human milk. Improvisations with cow's milk or formula are possible and if we must choose the lesser evil of the two we should opt for the formula. Nature has always been more casual in its offerings than we are lead to believe. The human infant is much more robust in his ability to extract out of formula what he needs even though it may not be complete. The problem with cow's milk is that it exposes the newborn to serious hazards which are totally unnecessary.

APPENDIX 5.1DIETARY NEEDS OF WOMEN

*: needs nondietary supplementation.After: Packard, V. S., Human Milk and Infant Formula, Academic Press, New York, N. Y. 1982, pp. 242

APPENDIX 5.2 INFECTIONS PREVENTED BY HUMAN COLOSTRUM AND MILK

Bacterial: Enterobacteriaceae, E. Coli, Clostridium tetani, Diptheria, Streptococcus pneumonia, Staphlococcus aureus, Vibrio cholerae

Viral: Enteroviruses, polio 1,2,3, coxsackie A, B, echo 6, 9, Rotavirus, Herpes simplex, Influenza, Aboviruses, Simliki Forest, Ross Rover, Japanese B, Dengue, Rubella, Respiratory syncytial

Fungal: Candida

APPENDIX 5.3

DRUG TO BE AVOIDED BY NURSING MOTHERS

Anticoagulants: ethyl biscoumacetate, phenindione

Anticonvulsants: mysoline, phenobarbital, phenytoin, carbamezapine

Antidepressants: lithium

Antihypertensives: reserpine

Antimetabolite: cyclophosphamide, methotrexate

Antimicrobial: chloramphenicol, metrondiazole, nalidixic acid, nitrofurantoin, sulfonamides

Antithyroid: iodide, thiouracil, radioactive iodine

Autonomic: atropine

Laxatives: anthraquinones, aloe, calomel, cascara, danthron

Narcotics: heroin, methadone, cocaine

Oral contraceptives

Analgesics: propoxyphene

Sedatives: barbiturates, bromides, chloral hydrate, diazepam

Steroids

Other: ergot, gold, etc.