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.

Some babies will breastfeed every 2–3 hours, day and night, while others will “cluster-feed,” breastfeeding every hour for three to five feedings and sleeping 3–4 hours between clusters. Some babies will breastfeed for 10–15 minutes on each breast, some will breastfeed for 15–30 minutes on each breast, and others will breastfeed for 15–30 minutes on one breast only. Every baby is different. Although some babies will “graze” while others “chow down,” you will know your baby is full when she no longer swallows.

What’s most important is that you breastfeed your baby whenever she seems fussy or hungry. Early signs of hunger include: squirming, wiggling, sucking on fingers or fists, yawning, and stretching.

If you wait for your baby to cry (a late sign of hunger), it will be harder for her to latch on well. Instead, learn her hunger cues and feed on request.

During breastfeeding, the tongue extends over the gum line and protects the breast against the bony jaw below. If movement of the tongue is restricted, the baby won’t be able to form a tight seal, create positive pressure, and maintain a proper latch.  Without a proper latch, the baby can’t remove milk from the breast, and breastfeeding will be painful for mom.

It’s estimated that tongue-tie occurs in 1 in 250 babies. In the majority of cases, no treatment is required. Occasionally, the frenulum needs to be cut. This simple procedure, known as a frenulotomy, can often be performed by your baby’s doctor or dentist. In most cases, the procedure gives immediate relief—babies are able to latch on well and breastfeeding is no longer painful. Occasionally, the baby has to be taught to latch on properly using this new tool—a tongue that moves in and out and up and down. It may take several days for your baby to learn to a new latch. In the meantime, continue to offer the breast and supplement, if necessary with expressed breast milk given by teaspoon or cup.

Despite years of debate, there is still no consensus in the medical community over the diagnosis and treatment of ankyloglossia. Since there are no obvious symptoms, and most babies with short frenulums adapt over time, health care providers are often reluctant to intervene. Plus, lots of moms experience nipple pain and, in most cases, it resolves after a several days or weeks. This makes it even more difficult for mothers of babies with severe tongue-tie, persistent nipple pain, and slow (or no) weight gain to get the care they need.

If you are concerned that your baby may be tongue-tied (persistent nipple pain despite a good latch) talk with your health care provider or lactation consultant—and don’t be “tongue-tied” about your concerns.

Read more about tongue-tie here.

Since the release of a 1998 study suggesting a link between autism and the measles-mumps-rubella (MMR) vaccine, parents have questioned the safety of vaccines. Even though the study was discredited and the results were shown to be false, restoring parents’ trust in vaccines has been difficult. Despite assurances from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) that vaccines are safe, a growing number of children are unvaccinated or partially vaccinated. Some parents are refusing to vaccinate their children altogether; others are giving their children some but not all vaccinations; and still others are spacing out their child’s vaccinations over a longer time period than is recommended by the AAP. The result is a greater risk that these children and others will develop a vaccine-preventable disease.

Current outbreaks of measles, mumps, Haemophilus influenza (H-flu), and pertussis (whooping cough) have been reported. More cases of measles were reported in the U.S. in 2008 than in any of the previous 11 years. Ninety percent of those infected had not been vaccinated or their vaccination status was unknown. In 2010, six California babies died in the worst pertussis epidemic in 50 years. All of the babies were less than 3 months old—too young to receive the pertussis vaccine, prompting state health officials to urge anyone who comes into contact with babies to be vaccinated against pertussis.

Due to scientific advances, there are more vaccines available today than ever before—a total of 14 different vaccines. Even though some vaccines are combined together in a single shot, children still receive 26 different doses (some vaccines require more than one dose) by 2 years of age. Studies show that healthy children—even babies—can handle the number of vaccines given. Continuous monitoring by the CDC’s Immunization Safety Office further ensures the safety of vaccines.

For vaccines to be effective, an estimated 85–95 percent of the population must be immunized—that’s 9 out of every 10 individuals. Each parent must decide what is in the best interest of their child but in doing so are urged to consider not only the unproven risks but the known benefits.

Click here to learn more about each childhood vaccine.