What are SSRIs?
Selective serotonin reuptake inhibitors (SSRIs) are among the most common antidepressants. The first drug in this class, fluoxetine, commonly known as Prozac, was released in 1987 followed by Paxil, Zoloft, and others. SSRIs are designed to boost serotonin levels. Serotonin is a hormone produced in the brain that helps transmit signals from one part of the brain to another. Serotonin can affect a wide range of body functions including mood, memory, appetite, temperature, sleep, and social behavior. It is widely believed that serotonin plays a role in depression. People suffering from depression typically have low levels of serotonin. It’s unclear whether low levels of serotonin cause depression or if depression brings about low serotonin levels. Recent data suggest that serotonin may also play a role in milk production.

Do SSRIs affect milk production?
In a study in the Journal of Endocrinology and Metabolism, Aaron Marshall, Laurie Nommsen-Rivers and colleagues at the University of Cincinnati and the University of California at Davis examined the effects of SSRI drugs on lactation using laboratory studies of human and animal cell lines and lactating mice.

Because the breasts’ ability to secrete milk is related to the body’s production and regulation of serotonin, the researchers hypothesized that women taking an SSRI drug might experience a delay in the onset of abundant milk production (a phenomenon referred to as lactogenesis) that typically occurs in the early days after birth.

“I was able to examine this hypothesis using data from an observational study of 431 breastfeeding, first-time mothers. Only eight of the women were taking an SSRI medication, but it is notable that seven of the eight did experience delayed onset of lactogenesis (defined as occurring after 72 hours postpartum) and the eighth woman experienced onset right at 72 hours. Median onset of lactation was 85.8 hours postpartum for the SSRI-treated mothers and 69.1 hours for mothers not treated with SSRI drugs,” said Nommsen-Rivers.

“Perhaps the most alarming finding is the timing of lactogenesis for the entire sample of women (69.1 hours),” said Nommsen-Rivers. “Evidence is mounting that the timing of lactogenesis is occurring much later in mothers here in the U.S. as compared to other countries, and this broader issue deserves our attention.”

Is it safe?
The effect of SSRIs on breastfeeding babies depends on a number of factors such as the gestational and chronological age of the baby, the health of the baby, the dose of the drug, and the drug’s characteristics (bioavailability, molecular weight, half-life etc.) According to Thomas Hale, PhD., author of Medications and Mothers’ Milk, available data suggest that Zoloft (sertraline) and Paxil (paroxetine) are far less likely to transfer into mothers’ milk and therefore babies compared to Prozac (fluoxetine). If women taking Prozac are unable to switch to another SSRI, given the many benefits of breastfeeding, Dr. Hale suggests that these women still be encouraged to breastfeed, mindful to watch their babies for possible side effects such as irritability, excessive crying, colic, and seizures.

Given the small number of SSRI users in the study, these results must be interpreted cautiously. Even though seven of the eight women experienced a delay in the onset of abundant milk production, all went on to breastfeed successfully. More human studies are needed before any type of clinical recommendation can be made regarding the use of SSRI medications. In the meantime, women taking SSRIs should be encouraged to breastfeed, but should be made aware that the onset of abundant milk production may be delayed. Also, health care providers should be prepared to provide additional support if needed.

Women who are pregnant or breastfeeding should check with their doctor or their baby’s doctor before taking any medication, including drugs available over-the-counter. As with all medications, consideration must be given to the benefits and the risks. Although there may be risks associated with taking SSRIs while breastfeeding, untreated depression can be far more dangerous for mothers and babies.

Although I find it slightly ironic that I am writing this on my laptop (equipped with high-speed wireless internet) while listening to a CD (through the TV, which is hooked up to my husband’s Play Station 3, of course), I am still sad to report that daily media usage in 8- to 18-year-olds has become more time-consuming than a full-time job. Add in texting and cell phone conversations, another 14 hours per week on average, and they become workaholics!

Many kids spend upwards of 50 hours each week watching TV, surfing the web, listening to music, or playing video games, while they spend less than 14 hours per week participating in sports or being physically active.

In a nationwide study released last week by the Kaiser Family Foundation, researchers found that current levels of media usage in 8- to 18-year-olds have increased significantly since 2004. Instead of 6 hours and 21 minutes of daily media usage in 2004, most kids now spend an average of 7 hours and 38 minutes using media for entertainment every single day (these totals do not include texting or talking on cell phones). Furthermore, when multitasking was included–surfing the web and listening to music simultaneously, for instance–the total daily exposure time increased from 8 hours and 33 minutes in 2004 to 10 hours and 45 minutes per day in 2009.

Limiting screen time
Short of embracing a full-fledged Luddite worldview, how can parents take control of the amount of time their children spend using media for entertainment–and why should they?

For starters, as time in front of the TV or computer increases, grades decrease, according to the Kaiser study. Children who were heavy media users were also more likely to report often feeling unhappy or bored, and were less likely to get along well with their parents or be happy at school than moderate or light media users.

Parents should also know that the above numbers exclude computer and other media use for academic purposes, which can mean several additional hours of computer or media usage each week. It is almost hard to believe that children have any time to eat dinner, do homework, or help with household chores!

The Kaiser study also reports that, parental limits and ground rules seem at least modestly successful at moderating the amount of time children spend using media. Parents looking for advice on monitoring or reducing their kids’ media time can also look to resources such as the National Institute on Media and the Family for tips on shifting the focus from computers and TV to family relationships and other, more engaging activities.

Why has media use increased?
Besides the fact that the domain of after-school gab sessions has switched from the living room to the chat room and group social games like Pogs and street hockey have given way to computer MMORPGs (massive multiplayer online role-playing games), kids seem to be able to work media into every hour of the day.

Much of the overall increase in media usage over the past five years is likely attributable to increased access; few parental restrictions coupled with a rise in the number of children owning individual or portable media devices has created a window of opportunity for kids to cram even more media into their day than they could five years ago. In 2004, only 18 percent of 8- to 18-year-olds had an iPod or MP3 player, but by 2009 over 75 percent of them owned one.

To add to the accessibility theory, the Kaiser study showed that children with TV in their bedroom (the number of whom have cable or satellite TV growing 12 percent since 2004) have an average of four more hours per day of total media exposure than kids with no bedroom TV. Now that phones and music devices often have multiple media capabilities, kids can sneak a look at video clips on their iPods between classes or play Pac-man on their phones while waiting for the bus.

Although to some extent it could be argued that MP3 players have simply replaced portable CD players and that X-Box merely upstaged the neighborhood arcade, there is no doubt that kids are spending more time with the extensive range of modern media than ever before, leaving precious little time for anything else.

Now that I am old enough to set my own rules for media use, I am grateful that my parents restricted the time I could spend staring at the TV or the computer–it fostered my creativity, gave me a deeper appreciation of reading and board games, opened up my time for developing friendships, and ensured my involvement in many memorable household activities (including chores!). I understand that life has more to offer than pop culture and constant digital entertainment, and unless kids step back from the screen to find this out for themselves, that’s a lesson it may take a long time for them to learn.

Cregan’s discovery of mammary epithelial and immune system stem cells in breast milk demonstrates that adult stem cells are present in expressed human milk. It is unclear whether these cells behave like other adult stem cells, which would mean these cells could be a source for tissue growth and infection-fighting therapies for a variety of health conditions.

Cregan hopes that the presence of stem cells in human milk may further explain some of the many benefits of breastfeeding over formula-feeding. He believes that stem cells may even serve as a guide for muscle, bone, and immune system development after birth.

There has been little research on these exact topics since Cregan’s exploratory study in 2007, and until scientists determine whether the cells in breast milk behave like adult stem cells progress is likely to be slow. If scientists find that the stem cells in human milk behave like adult stem cells, it may be possible to “reprogram” them or force them into becoming specific types of tissues and cells.

Like any stem cell technology, research on breast milk stem cells will be time-consuming and expensive. Another challenge to the rapid advancement of breast milk stem cell research is its relative obscurity; research on other sources of stem cells is more widely practiced and better developed, and thus more frequently funded.

Although the study of breast milk stem cells is in its infancy, the readily available supply of breast milk and the non-invasive technique for collecting it would weigh highly in its favor as a source for stem cells for research if the cells prove to behave like adult stem cells.

Stem cell basics
Stem cells are cells that have the ability to develop into different types of cells. When a stem cell divides, each new cell has the potential either to remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell, or a brain cell.

Multiple therapies using adult stem cell technologies already exist, and many more are in clinical trials. Adult stem cells are different from embryonic stem cells; adult stem cells theoretically have the capacity to turn into any tissue or organ of their original general cell type, while embryonic stem cells theoretically have the capacity to turn into any cell type or tissue in the body, and can even generate an entire new body.

Retrieving embryonic stem cells for research, however, is often considerably more controversial than collecting adult stem cells. Harvesting embryonic stem cells means destroying embryos. Adult stem cells can come from many different sources, such as umbilical cord blood, the heart, and bone marrow.

Because stem cells can generate tissue, and even entire organs, they can be used to repair or replace damaged cells or tissues in the body. The regenerative and healing properties of stem cells demonstrate their effectiveness by performing routine repairs in the body and offer significant potential for treating disorders and illnesses.

Breast milk stem cells
Although there is no evidence to support the idea that maternal stem cells transferred to the baby in breast milk affect the baby’s health, the concept is scientifically plausible. It’s already been demonstrated that some stem cells survive digestion in the baby’s gut and could theoretically be absorbed into the baby’s system. Adult stem cells that are already programmed may, according to Dr. Cregan, help guide a child’s development by promoting healthy growth and improving a baby’s defense systems.

The significance of this research is of the identification of additional components of human milk that are distinct from formula. The exact impact of these stem cells on the baby may eventually be clarified, but until then, breastfeeding women can take pride in the fact that their milk may be biologically designed to promote their child’s healthy transition into adulthood.

Doctors Shefrin and Goldman of British Columbia Children’s Hospital in Vancouver, Canada, reviewed a collection of studies examining the effectiveness of over-the-counter (OTC) cough and cold medications in young children. Surprisingly, although children ages 0 to 5 years are the most common users of these medications, there is little to no evidence indicating the efficacy of the drugs to improve cough and cold symptoms in this population.

There might be significant evidence indicating the opposite: OTC cough and cold medications may put young children at risk for serious health complications and in some cases may be involved in infant or child death.

The facts about kids and cough medicine
Experts suspect that OTC cough syrups and cold medications may be dangerous for young children because of certain ingredients they contain (such as antihistamines, antitussives, and decongestants), some of which have a sedative effect. Even when doses are reduced, such as a half dose for 5- to 12-year-olds and a quarter dose for 2- to 5-year-olds, there still may be risks.

There are no guidelines for using OTC cough and cold medications in children younger than 2 years old. Children under the age of 2, however, were the most likely of any group to have adverse reactions to the medications, despite the fact that 2- to 5-year-olds are the age range with the highest rate of OTC cough and cold medication usage.

In 2004 and 2005, use of OTC cough and cold medicines were the cause of over 7000 emergency room (ER) visits in children under 12. Although the majority of these cases involved unsupervised consumption of the medications, one in four cases involved properly administered medication with unexpected negative outcomes.

OTC cough and cold medication complications were eight times more likely to result in ER visits than problems with other types of medications. Shefrin and Goldman believe that complications with these medications may be underreported, as OTC cough and cold medications are frequently found in toxicology screens when young children are admitted to the hospital for apparent life-threatening events. These medications have been causally implicated in numerous infant deaths, both intentional and accidental.

Recommendations
Because of the scarcity of evidence in favor of safe and effective OTC cough and cold medication use in children, the Food and Drug Administration warns against their use with children under 4 years of age. Taking an even stricter stance, Health Canada recommends against the use of OTC cough and cold medications with children under 6 years of age and advises parents to exercise caution with children older than 6.

If it’s not safe to use cough syrups and OTC cold medications, how should parents ease coughing and cold symptoms in their young children?

The Mayo Clinic has a variety of natural and safe home remedy suggestions for easing coughs and colds in young children and infants. Suggested remedies include suctioning mucus from a baby’s nose, using a home humidifier, and administering a spoonful of honey (for those over the age of 1), or a cup of tea.

While no parent likes a fussy baby, it’s a small price to pay, given the risks associated with OTC cough and cold remedies.

Their findings, published in the Journal of Toxicology, clearly show that women who use marijuana should not breastfeed. According to the French researchers, a combination of animal trials and human data indicates that compounds in marijuana can be easily passed on to the baby during breastfeeding, and may cause significant neurodevelopmental delays.

When a mother uses drugs, so does her baby

Marijuana is the most commonly used illegal substance among women of childbearing age, with some surveys indicating that nearly 50 percent of U.S. teenagers have used the drug at least once. Marijuana use during pregnancy has been demonstrated to have a negative impact on the health of a newborn, causing complications such as low birth weight and neurobiological conditions.

The primary active component of marijuana is TetraHydroCannabinol, commonly known as THC. Responsible for marijuana’s stimulating properties, THC can be found in varying concentrations in marijuana. A small percentage of this compound is passed on to a nursing baby during breastfeeding, and can be excreted in the baby’s urine for up to three weeks after the mother’s drug use.

Multiple studies indicate that THC directly affects the brain in both mother and child, and can negatively impact the newborn’s ability to suckle. Additional research studies have revealed that THC in infants may also affect cognitive development, appetite and weight regulation, and motor control abilities.

Studies show conflicting results regarding long-term effects in both baby animals and newborn humans. In some cases, there was a measurable effect on motor development and growth after having ingested THC through breastfeeding. High levels of THC can build up in human milk, and when ingested by infants can pass on the effects of the drug use to the baby.

According to the French research team, even occasional marijuana users should avoid breastfeeding for at least several hours after consuming the drug. Such infrequent users should consult their physicians for more specific recommendations. Regular or daily users are cautioned to avoid breastfeeding altogether, as it is unclear how long the drug may be excreted in their milk. THC can stay in maternal fat stores and body tissue for weeks to months, and may potentially pass to the baby during this same time period.

In addition to the health and developmental concerns that the transmittal of THC to the baby raises, and because the drug affects each person differently, there is worry that parents who use marijuana or other drugs may not be providing appropriate care and attention to the infant, putting the child at risk for other safety concerns, including Sudden Infant Death Syndrome (SIDS).

Addressing maternal drug use
The American Academy of Pediatrics’ Committee on Drugs and the March of Dimes both recommend that mothers who use marijuana should not breastfeed. Instead, they should receive assistance from health care providers and social counselors to quit using drugs. Depending on the situation, the mother may not be able to care appropriately for her baby before or during recovery. Custodial concerns due to drug use should be examined on a case-by-case basis.

More research is needed to determine whether any amount of THC in milk is safe, and whether any significant long-term effects can be reasonably attributed to marijuana use during breastfeeding. In the meantime, women should refrain from illicit drug use while pregnant or breastfeeding.

Finally, using formula does not give mothers the green light for marijuana or other illegal drug use, as maternal awareness is still needed if a mother is to provide appropriate care for her infant. In addition, the newborn may still be exposed to the drug via secondhand smoke or drug residue. Immediate actions to protect the health and wellbeing of the child should be taken, and assistance given to the mother to facilitate rehabilitation.

Results published in Nutritional Neuroscience showed that breast milk produced during the evening and at night contained more sleep-inducing nucleotides than milk produced during daylight hours.  Researchers also found that certain nucleotides, including some that have been shown to induce sleep, demonstrated a circadium rhythm, increasing with the onset of darkness.

It is widely accepted that the composition of breast milk changes over time, but how those changes affect infants are less clear.  There is speculation that these changes may occur in response to the changing developmental needs of infants as they transition from more frequent feedings and shorter sleep intervals to less frequent feedings and longer periods of sleep. The researchers also theorized that the cyclical variation in the concentration of nucleotides may explain the calming, sedating effect breastfeeding can have on babies, particularly at night.

Breastfeed at night
Although the study’s researchers have suggested that it would be a “mistake” to feed a baby expressed milk collected at a different time of day, the recommendation needs to be put in perspective.  Regardless of the potential variations in sleep-inducing nucleotides found in breast milk, the other benefits that breast milk confers when compared to artificial formula still make human milk the optimal source of nutrition for infants. In addition, the direct effect of specific nucleotides on the development of an infant’s sleep cycle and his or her adjustment to a circadian rhythm is as yet unclear.

While it might prove to be ideal to feed babies expressed milk at the same time of day that it was expressed, in practical terms doing so may not be easy. Many mothers express small amounts of breast milk throughout the day to complete a single feeding. While others express whenever time permits and not necessarily on a fixed schedule. What’s most important is that babies be breastfed or be given breast milk feedings whenever possible.

If further data show that the circadian rhythm in nucleotides significantly impacts the development of healthy sleep patterns, perhaps women will make more of an effort to offer expressed milk at the same time of day it was expressed.

Human milk has already demonstrated its capacity to cater to an infant’s needs, even from hour to hour. The fact that a mother’s milk is tailored to the nutritional needs and even the sleep patterns of the baby supports the growing body of evidence in favor of breastfeeding.

Until a connection is demonstrated between nucleotide circadian rhythms and the health of the baby, mothers who pump breast milk and later bottle-feed their infants should not worry about feeding milk pumped at a different time of day. Rather, mothers can take comfort in knowing that by breastfeeding at night, they are lulling their babies to sleep naturally and safely.

The researchers compared the effect of different types of milk smells on the distress exhibited by 48 infants during a routine heel stick (a procedure used to get a small blood sample in newborns). Distress was measured by the infant’s crying, grimacing, and motor activities as well as by the concentration of salivary cortisol, a hormone present in saliva during times of stress or pain. Infants were assigned to one of the following groups of odors: their own mother’s breast milk, another mother’s breast milk, a milk-based formula, or the control (no milk odor present).

Both behavioral and chemical measurements of distress were lower among infants who were able to smell their own mother’s milk; they cried and made physical signs of pain less frequently than the infants in other categories, and they had less concentrated levels of cortisol in their saliva than their non-maternal breast milk counterparts.

Not only did infants react with less behavioral and chemical indications of pain if they could smell their own mother’s breast milk, but there was also no indication that the smell of another mother’s breast milk or the odor of formula made any significant difference over the smell of nothing at all.

Although researchers have previously demonstrated the soothing effect the smell of a mother’s breast milk can have on her child during painful procedures, there was little to suggest that the infant’s own mother’s milk would have more of a calming effect than that of another mother or of formula—until this study.

Will maternal breast milk become an analgesic for newborns?
Because there was no significant change in the reaction of the newborns to the heel stick between the control group and the non-maternal milk or formula groups, there may be a particular component to a mother’s milk that her baby recognizes and responds to. If smelling the milk relieves pain and calms the infant, it is reasonable to assume that this research may have clinical applications.

It is possible that this calming effect comes from the infant’s recognition of the individual smell of the breast milk, as the infants involved in the study were only breastfed babies. The researchers suggest, however, that the infants may be calmed by the presence of certain (major histocompatibility complex) genes in the milk that are familiar and comforting to them, and that another mother’s milk with similar genes may have a similar calming effect.

Because it is unclear as to why the maternal breast milk reduces distress in newborns, there are few immediate direct clinical implications of this research; additional research on the topic may clarify whether maternal breast milk is more calming than amniotic fluid or other familiar smells, for instance, and whether the same calming effect can be demonstrated in formula-fed infants or infants at different ages (the study participants were 5 days old).

Regardless of whether maternal breast milk odor becomes a commonplace analgesic for newborns, the calming properties of a mother’s milk only serve to bolster the reputation that breastfeeding has earned for its ability to bond mother and baby and protect infant health.

The researchers monitored over 7,200 mother-infant pairs in Australia for a 15-year period, tracking the duration of breastfeeding and any substantiated incidences of child abuse (physical or emotional) or neglect.

Approximately 4.3 percent of the children experienced documented abuse or neglect at the hands of their mothers. Sadly, according to the U.S. Department of Health and Human Services, the infant or child’s mother is a perpetrator in nearly 60 percent of substantiated reports of abuse or neglect.

Even after adjusting for confounders such as sociodemographics, substance abuse during pregnancy, postpartum employment status, maternal attitudes about infant caregiving, and symptoms of anxiety or depression, the Australia-based study revealed a significant relationship between the duration of breastfeeding and the likelihood of maternal maltreatment.

In fact, non-breastfed infants were 2.6 times more likely to be abused or neglected by their mothers than were breastfed infants. In addition, the longer a baby was breastfed, the less likely the child was to suffer from maternal neglect.

The study also showed that the length of time spent breastfeeding could not be significantly associated with substantiated reports of maltreatment from people other than the mother.

Why does breastfeeding reduce the likelihood of maternal maltreatment?
Many factors contribute to the possibility that a child will suffer from abuse. Researchers have observed a connection, however, between breastfeeding and the production of oxytocin, a natural compound in the body that improves a mother’s mood and her attachment to her baby. Although oxytocin can be present in women who bottle-feed, it is higher among women who breastfeed.

The connection between oxytocin and breastfeeding is one reason the researchers give for the relationship between prolonged breastfeeding (at least four months) and lower rates of maternal abuse. Oxytocin can also act to relieve or dull a mother’s feelings of stress and anxiety, potentially reducing the likelihood of the mother to respond aggressively or negatively to difficult childrearing situations.

The increased presence of oxytocin is unlikely to be the only reason behind the protective function of breastfeeding. The researchers also suggest that the type of women who chose to breastfeed might have been less likely to abuse her children in the first place. Factors commonly connected to subsequent child abuse and neglect, such as maternal drug use, poverty, and the mother’s own abuse experiences, may make a mother less likely to breastfeed, strengthening the association between feeding method and maltreatment.

Regardless of the potential causes for the difference in maltreatment rates between breastfed and non-breastfed babies, it is clear that breastfeeding seems to have a protective effect.

Although more research is needed to explore the exact mechanisms at work behind the connection, researchers and health professionals alike see the results of this study as yet another reason to promote breastfeeding. Widespread encouragement for mothers to breastfeed may turn out to be a simple and cost-effective way to reduce the frequency of child abuse and neglect both in the United States and abroad.