Albow is not alone in his criticism. TODAY Moms invited comments on the cover photo from its readers by posing the question, “We know you have opinions about the cover. Sure, it got everyone’s attention, but does it ultimately hurt or help the perception of breast-feeding?” Most of the 3,126 comments were critical of the cover: “I have cancelled my subscription.” “An infant OK, a kid that age NO.” “I consider this picture child abuse.” Sadly, I had to dig deep to find a positive comment: “This is a good thing, and the more mothers do it the better.”

Calculated or misguided?
“It’s [extended breastfeeding] not socially normal. The more people see it, the more it’ll become normal in our culture. That’s what I’m hoping. I want people to see it,” Grumet tells Kate Pickert, author of The Man Who Remade Motherhood, the TIME magazine article marking the 20^th anniversary of attachment parenting.

Whether TIME’s choice of cover photo was calculated or misguided, it’s clear that Grumet’s photo (along with the photos inside the magazine) has reignited the Attachment Parenting debate (a parenting approach largely characterized by babywearing, co-sleeping, and child-led weaning). Lost in the debate, however, is the fact that attachment parenting is more than the sum of its parts. It is a parenting method designed to make children confident and compassionate by responding to their needs, nurturing strong physical and emotional connections, and modeling appropriate social behavior.

Sound familiar? It should. Because it’s a parenting method that every parent embraces—keep your child warm, well nourished, and safe; stimulate their senses; calm their fears; and behave in a way that says to your child, “Do as I say and as I do.”

Is the cover photo good for breastfeeding?
“Time” will tell whether negative media is better than no media. However, when only 1 in 10 U.S. babies breastfeed exclusively for six months perhaps it’s time to tone down the rhetoric and stop arguing about the small number of mothers who breastfeed three, four, or more years, and focus instead on the many mothers who try to breastfeed but can’t. Perhaps it’s time to acknowledge that how long a mother breastfeeds—six days, six weeks, six months, six years, or not at all—was never meant to be a measure of motherhood.

Until recently, foremilk was thought to contain less fat and fewer calories than hindmilk. Consequently, foremilk was described as thin and runny, and hindmilk was described as thick and creamy.

When you compare samples of foremilk and hindmilk expressed during the same feeding, it’s true that the foremilk usually has less fat and fewer calories than the hindmilk. However, if you compare a sample of foremilk expressed at one feeding with a sample of hindmilk expressed at another feeding, the foremilk may actually contain more fat than the hindmilk. Confused? You’re not alone!

Fat content varies with milk volume—the smaller the milk volume, the higher the fat content. Feeding patterns determine milk volume. The longer the period of time between feedings, the greater the milk volume and the lower the fat content. When the time between feedings is short (1–2 hours), babies get smaller amounts of high fat milk. More time between feedings (3 or more hours) causes babies to get larger amounts of low fat milk. Most babies get the nutrients they need to grow by following their own unique pattern.

Breast fullness is a measure of fat content. The fuller the breast, the lower the fat content of the milk and the greater the difference in fat content between the milk obtained first and the milk obtained last. The emptier the breast, the higher the fat content and the lesser the difference between the milk obtained at the start of the feeding and the milk obtained at the end.

One of the amazing things about human milk is its ability to change from month-to- month, week-to-week, day-to-day, feeding-to-feeding, and from start to finish during a single feeding. To ensure that your baby gets all the fat and calories she needs to grow, breastfeed at the first sign of hunger and continue to breastfeed until your baby is full. Remember, it is important to always watch your baby, not the clock, for signs of hunger and fullness.

1. Mammals are the only animals that produce a unique and complex fluid that protects and nourishes their young. Infant formulas nourish but do not protect.
2. The human breast contains hundreds of milk-producing cells ensuring an ample supply of milk for one, two, or more babies! Instances of insufficient milk are rare and are usually due to lack of knowledge or lack of support.
3. Aristotle was among those who wrongly thought milk produced in the first days after birth (colostrum) was unsuitable to drink. So much for genius!
4. There are over 200 known ingredients in human milk and they are all free! Mothers that breastfeed save as much as $2,500 the first year alone in bottles, nipples, and formula.
5. Babies are born with reflexes such as rooting, sucking, and swallowing that make learning to breastfeed easier. But it takes patience, persistence, and practice to become proficient.
6. Babies who must cry in order to be fed often have difficulty latching on. Crying also triggers the release of hormones that affect brain development and personality. Keeping your baby close—day and night—during the early weeks, will ensure that you see your baby’s hunger cues long before you hear his cry.
7. Breastfeeding can be painful at first. But the pain should only last a few seconds. If the pain persists, it can be a sign that your baby is poorly latched. Break the suction, remove your baby from the breast, and try again. Still hurts? Get help from someone trained to help moms breastfeed.
8. Breastfeeding a child beyond their first year is normal. Mammals most like humans—chimpanzees, orangutans, and gorillas—nurse their young for 4–6 years.
9. The portions of the brain associated with maternal sensitivity are more active in breastfeeding mothers compared to formula-feeding mothers. The significance of this and similar findings are yet to be gleaned.
10. In 2010, a group of Swedish scientists discovered a substance in human milk that kills cancer cells but spares healthy cells. Dubbed HAMLET—human alpha-lactalbumin made lethal to tumor cells—these cells serve as a reminder of how little we know about human milk and why artificial formula will never compare.

Human milk is a marvel of evolution—six million years in the making—with a delivery system that has truly endured the test of time!

While breastfeeding may not seem the right choice for every mother, it is the best choice for every baby.

The incidence of allergic disease has increased dramatically in recent years. Although genes play an important role, the reasons for the increase are unclear. If the mother has a strong family history of allergic disease, she might be encouraged to follow certain guidelines in an effort to limit the onset and reduce the severity of allergic symptoms in her baby.

The importance of breastfeeding for all moms and babies cannot be overstated. Admittedly, breastfeeding will not prevent the occurrence of allergic disease in babies with a strong family history of allergy, but exclusive breastfeeding for the first six months and continued breastfeeding for at least the first year may delay the onset of allergic symptoms (gas, diarrhea, vomiting, fussiness, and skin rashes) and reduce their severity.

Research shows that food proteins can appear in human milk in small amounts. In extremely sensitive babies, the amount of protein can be large enough to cause allergic symptoms. Parents of high-risk babies have long been cautioned not to introduce solid foods too soon. However, recent studies suggest that delaying the introduction of foods other than human milk beyond six months may actually increase the risk for allergic disease. It appears that when the immune system is exposed to foreign proteins (antigens) during a specific time period (not too early, not too late), a tolerance to the antigens rather than sensitivity may actually develop.

Because our understanding of allergic disease is constantly changing, mothers of high-risk babies (especially those with a family history of peanut sensitivity) should be advised to talk with their baby’s doctor before introducing any foods other than human milk.

Rodale begins with the customary compliment, “…breastfeeding is better for Baby and Mother,” and follows with the inevitable, but, which in this case is however. Which effectively makes everything before the but (however) irrelevant. Or as my Dad would indelicately say, “It makes everything before the but, bullshit.”

“…breastfeeding is better for Baby and Mother… However, having done it three times, I think it’s time to tell the truth about it so moms know what they are getting into,” says Rodale.

She then goes on to list 11 “unvarnished, unfiltered truths about breastfeeding.” While I agree with many of the items on Rodale’s list—and applaud her efforts to give mothers realistic expectations—several of her truths (#s 1, 2, 3, 4, and 11) are short on facts.

#1 “Your milk will not “come in” for two to four days after the baby is born.”
Fact: Mothers begin to produce milk around the 20th week of pregnancy. The fact that small amounts of milk are produced in the first days after birth reflects the physiologic needs of newborns as they adapt to life outside the uterus. No one consumes a five-course meal after running a marathon. Athletes choose small, frequent meals instead. The same is true of newborns. Small, frequent feedings will ensure that newborns get the nutrients they need in the first days after birth, and reduce the risk of babies getting formula supplements. Rodale cautions mothers not to “let the baby over-suck.” What she fails to recognize is that nipple damage occurs when babies are poorly latched, regardless of how often they breastfeed. Mothers are urged to keep their babies close at hand, and to respond to every request to breastfeed. This is your chance to practice while there is expert help available.

#2 “Be careful what you wish for because when your milk finally does “come in,” it will come in with a vengeance, and it will hurt like hell for two to three days and your boobs will feel like giant rocks and you may even want to cry.”
Fact: Milk production will increase dramatically around day 2–4. Milk removal is key to preventing engorgement (rock-like boobs). Responding to your baby’s every request to breastfeed will ensure that your baby breastfeeds at least 8 times in each 24 hours, and that your breasts remain soft, albeit full. Cool compresses (bags of frozen peas covered with a wet cloth) will reduce the swelling so that your baby can latch on well. While the supportive bra recommended by Rodale may be helpful, the bra should be removed for several feedings during the day and at night, so that milk can be removed from all parts of the breast.

#3 “You will start to leak. And you will leak for months, or maybe even years…”
Fact: Leaking is cause for celebration. Yes, I’ve got milk! Now the only challenge is getting the milk out of your breast and into your baby. Once your baby settles into a routine (around 6–12 weeks) and your breasts know how much milk to make and when to make it, leaking will become less of an issue. Leaking rarely lasts more than 3–6 months. Breast pads can be used to protect your clothing. Some pads are meant to be used only once, while others can be washed and used over and over. Remember to change pads frequently, and avoid pads with waterproof liners that trap moisture against the skin.

#4 “Your nipples will probably hurt. A LOT. For a good two to three weeks.”
Fact: During the first week or two of breastfeeding, you may feel pain at the start of a feeding, when your baby first latches on to your breast. If your baby is positioned well, the pain should stop after a few seconds. If the pain persists, slide your finger into your baby’s mouth, release the latch, remove your baby from the breast, and try again. If your baby is positioned poorly and continues to breastfeed, you can damage your nipples. Don’t ignore breast or nipple pain.

#11 “Finally, one day your boobs will return to normal size, and even though the shape might have changed and they might sag a bit more, they will still be beautiful and loved by all the people in your life who loved your breasts to begin with.”
Fact: Breasts may change shape, but before you assign breastfeeding as the culprit, know that breast changes occur in women who bottle-feed as well. Why? It’s a result of weight gain and weight loss—something every pregnant woman, and many never pregnant women, experience.

As for the remaining six items on Rodale’s list, my favorites are #10 “Breastfeeding is free” in which she dispels the myth that breastfeeding moms need to follow a special diet, and reminds readers that even in a toxic world, a mother’s own milk is still a better choice “than whatever mystery is in formula.” And #6 “Once the pain goes away, it is totally easier,”—although I would downplay the pain and emphasize the convenience. But I particularly like Rodale’s use of the word “easier,” because the fact is breastfeeding isn’t always easy. Like any new skill, it often requires patience, persistence, and practice. But it does get easier. Plus, as Rodale aptly states, in the end, “It’s worth it!”

Unfortunately, weight loss studies, including those in this systematic review, are rife with limitations:

• Day of birth is often counted as either day zero or day one.
• Weight measurements on days 1–14 are often incomplete.
• There is no clear definition of “exclusive breastfeeding.”
• There is no clear indication of when slow gaining infants were supplemented with formula.
• Convenience samples are used rather than random samples.
• Only one study followed the infants for a full 14 days.

What remains unclear is whether any amount of weight loss in exclusively breastfed babies is “normal” or an unintended outcome—the consequence of a myriad of policies, procedures, and practices, which have been shown to be unsupportive of breastfeeding.

Until more data is available, parents should expect their baby to lose about 3­–7 percent of their birth weight during the first five days after birth. They should expect their baby to return to her birth weight during the next five days; and to gain ½–1 ounce (15–30 grams) each day until 3 months of age. Babies typically gain weight more slowly during the remaining months of their first year.

• Babies with galactosemia. Galactosemia is a rare genetic disease. Babies with galactosemia are unable to digest galactose, a sugar found in breast milk, and must be fed galactose-free formula. Knowing that early diagnosis leads to early treatment, babies are screened for galactosemia at birth. Although galactosemia is a permanent condition, it is easily managed with a galactose-free diet.

• Babies with phenylketonuria. Phenylketonuria (PKU) is a metabolic disease similar to galactosemia. Babies with PKU cannot digest the amino acid, phenylalanine, and must be fed phenylalanine-free formula. Unlike babies with galactosemia who must be formula-fed, babies with certain types of PKU can partially breastfeed. However, the amount of phenylalanine in the baby’s blood must be periodically measured to ensure that it is below a certain level.

• Mothers with active, untreated tuberculosis. Tuberculosis (TB) is a disease caused by bacteria. It usually infects the lungs (pulmonary tuberculosis), but can infect other body parts as well, including the breast. When a mother with pulmonary tuberculosis sneezes or coughs, the bacteria can spread to her baby. Keeping babies disease free is a top priority. In the past, mothers with active, untreated TB were routinely separated from their babies until the mother was no longer contagious (about two weeks after the start of treatment). Today, every effort is made to keep mothers and babies together while being treated. But given the many different scenarios, each case must be evaluated individually. If both mother and baby are infected, they can be isolated together and continue to breastfeed while both are treated. If only the mother is infected, the mother and baby may be separated until treatment is started or longer (up to two weeks after the start of treatment) if the mother is highly contagious. The bacteria that cause TB do not transfer into breast milk, so a mother with active TB who is separated from her baby can express her milk and have it fed to her baby until she is able to resume breastfeeding.
• HIV-positive mothers. HIV-positive mothers living in developed countries are advised not to breastfeed. In contrast, those living in developing countries where sanitation, clean water, and adequate supplies of breast milk substitutes are unavailable or limited are urged to breastfeed exclusively, since the risk of babies dying from infectious disease is greater than the risk of HIV infection. The use of antiretroviral drugs has reduced the risk of mother-to-child HIV transmission during pregnancy and while breastfeeding. Nonetheless, HIV-positive mothers living in developed countries are urged to talk with their health care provider about the benefits and the risks before deciding to breastfeed.

• Mothers with HTLV type I or II infection. Human T-cell leukemia virus type 1 (HTLV-1) is spread through sexual contact, bodily fluids, blood transfusions, breastfeeding, and from mother to fetus during pregnancy. Many people infected with HTLV-1 develop T-cell leukemia and lymphoma as adults. Studies comparing transmission rates based on infant feeding type show that 30 percent of exclusively breastfeeding babies born to mothers infected with HTLV-1 become infected, as opposed to only 10 percent of mixed-feeding infants. No formula-fed infants developed the disease. Because only 1–5 percent of those infected with HTLV-1 develop leukemia, mothers with this disease are urged to discuss infant feeding options with their health care providers. Similar to HIV recommendations, HTLV-infected mothers who live in developing countries, where the risk of not breastfeeding may be greater than the risk of breastfeeding with the disease, are often urged to breastfeed their infants.
• Mothers using or dependent on illegal drugs. The risks of breastfeeding by mothers using illegal drugs are twofold: whether the drugs will negatively affect the infant, and whether the drugs will impair the mother’s ability to adequately care for her baby. Drugs such as cocaine, LSD (and other hallucinogenic drugs), heroin, marijuana, and amphetamines (taken in larger than prescribed doses) are all contraindicated while breastfeeding because of the effects on the baby’s developing nervous system. Mothers participating in methadone treatment programs can breastfeed, but their babies should be carefully observed for adverse effects. The Academy of Breastfeeding Medicine’s protocol on Breastfeeding and the Drug-Dependent Woman lists criteria for when breastfeeding should or should not be supported.

• Mothers receiving cancer chemotherapy. Chemotherapy drugs are designed to kill rapidly producing cells such as cancer cells. Since babies are one big bundle of rapidly producing cells, chemotherapy drugs are not compatible with breastfeeding. The length of time these drugs remain in the mother’s system (and her milk) varies from drug to drug. Mothers who would like to resume breastfeeding after their cancer treatment ends, should talk with their cancer doctor as well as their baby’s doctor to ensure that it is safe to breastfeed. (Read one woman’s amazing story here.)

• Mothers receiving radiologic tests and treatments. Only a small amount (less than 1 percent) of the contrast material used for radiologic tests passes into a mother’s milk. The baby absorbs even less, so there is no need to interrupt breastfeeding. While contrast agents used for testing are considered safe, those used for treatment purposes, such as radioactive iodine (RAI), can be extremely toxic. Because RAI concentrates in breast milk, mothers receiving RAI are cautioned to wean several weeks prior to treatment to limit breast exposure. Exposing the breasts to RAI increases a mother’s risk for breast cancer. X-ray treatment, even for breast cancer, is not considered a contraindication to breastfeeding. Mothers can continue to breastfeed on the non-radiated breast, as long as they are not receiving chemotherapy. Because the safety of radiologic tests and treatments varies with the contrast agent used, it’s essential that mothers talk with their health care provider as well as their baby’s health care provider before making a decision about breastfeeding.

The importance of human milk for human babies is illustrated by the fact that there are very few conditions that preclude breastfeeding. Babies breastfed exclusively for 6 months are healthier, not just in infancy, but for many years to come compared to formula-fed babies or babies fed a combination of formula and breast milk. Fortunately the breastfeeding challenges many mothers experience in the early weeks, such as nipple pain and breast engorgement, are short-lived and easily managed. Mothers who are unable to breastfeed for any reason can still bond with their babies by holding them skin-to-skin during feedings.

Additional reporting by Melissa Clark Vickers

Sounds simple enough. But a recent New York Times article suggests that good intentions may have unintended consequences. Since the no aspirin policy was implemented, cases of Reye’s syndrome have decreased but asthma rates have risen.

Dr. Arthur Varner was the first to suggest a possible link between acetaminophen and asthma in an article published in 1998 in The Annals of Allergy and Asthma Immunology. Since then, numerous studies have shown similar results, including a large analysis of data on more than 200,000 children that found an increased risk of asthma among children who had taken acetaminophen.

Most recently, Dr. John T. McBride, a pediatrician at Akron Children’s Hospital in Ohio, in an article published in the December 2011 issue of Pediatrics suggests that there is enough evidence for doctors to recommend not giving acetaminophen (using ibuprofen instead) to children with asthma or those at risk for developing the disease.

However, Dr. Mahyar Etminan, a pharmocoepidemiologist at the University of British Columbia and lead author of a meta-analysis on acetaminophen use and asthma published in 2009 urges caution. Despite evidence showing an increase in the risk of asthma and wheezing in children and adults exposed to acetaminophen, it’s unclear whether acetaminophen is responsible for the increase or whether the viral infection that prompted the use of acetaminophen is the cause. Parents of study children were asked to remember how much acetaminophen they gave their child and how often. Because parents of children with asthma are more attune to events leading up to an attack, they may be more likely to recall giving their child acetaminophen.

Until more data is available (several trials are currently underway), parents are urged to talk with their child’s health care provider about treatment options for fever. Given that both acetaminophen and ibuprofen have been linked to asthma and aspirin to Reye’s syndrome, perhaps using anti-fever medications sparingly is the best course of action for parents.

Click here to read more about treating fevers.

Human milk is manufactured in the alveoli—grapelike clusters of cells scattered throughout the breast. Only small amounts of milk are produced at first, starting around the fifth or sixth month of pregnancy. This early milk is called colostrum.

The placenta or afterbirth produces two hormones, estrogen and progesterone. These hormones keep milk production low during pregnancy by suppressing the release of prolactin, the hormone that causes milk production.

During pregnancy, the placenta transfers nutrients from mother to baby and removes waste products. After the baby is born, uterine contractions push out the placenta. Once the placenta is gone, estrogen and progesterone levels fall and prolactin levels rise.

The pituitary gland located at the base of the brain acts as the control center. When a baby breastfeeds a message is sent to the brain. The brain receives the message and responds by releasing two hormones, prolactin and oxytocin. Prolactin stimulates milk production. Oxytocin causes milk release.

Estrogen and progesterone control milk production during pregnancy and after birth. But once a mother’s milk supply is well established (several weeks after birth), hormones play a minor role and milk removal (through breastfeeding or breast expression if a baby is unable to breastfeed) serves as the stimulus for milk production. The more milk a baby removes from the breasts through breastfeeding the more milk a mother makes!

The first two weeks of breastfeeding set the stage for future milk production. Prolactin and oxytocin work hand-in-hand with the breastfeeding baby to ensure that mothers have an ample supply of milk.