American Academy of Pediatrics Advises Pregnant Women and Children Not to Consume Raw Milk Products

Raw milk and milk products from cows, goats, and sheep can transmit life-threatening bacterial infections, yet sales are still legal in at least 30 states. In a new policy statement, the American Academy of Pediatrics (AAP) advises pregnant women, infants and children to consume only pasteurized milk, cheese and other milk products, and supports a ban on the sale of raw milk in the U.S.

The policy statement, “Consumption of Raw or Unpasteurized Milk and Milk Products by Pregnant Women and Children,” published in the January 2014 Pediatrics (released online Dec. 16), reviews evidence of the risks of consuming unpasteurized milk and milk products in the U.S., especially among pregnant women, infants, and children.

“Given the progress we have made in prevention, there is no reason to risk consuming raw milk in this day and age,” said Jatinder Bhatia, MD, FAAP, a co-author of the policy statement. “Consumption of raw milk products is especially risky for pregnant women, infants, immunocompromised individuals, and the elderly, and the evidence overwhelmingly establishes the benefits of pasteurization on food safety.”

Efforts to limit the sale of raw milk products have been opposed by people who claim there are health benefits from natural factors in milk that are inactivated by pasteurization. However, the benefits of these natural elements have not been clearly demonstrated in scientific research. Numerous data show pasteurized milk provides the same nutritional benefits as raw milk, without the risk of deadly infections including Listeria, Campylobacter, Salmonella, Brucella and E. coli.

“Consumption of raw milk or milk products can result in severe and life-threatening illnesses such as miscarriage and stillbirths in pregnant women, and meningitis and blood-borne infections in both young infants and pregnant women,” said Yvonne Maldonado, MD, FAAP, the lead author of the policy statement. “Before pasteurization of milk began in the United States in the 1920s, consumption of raw dairy products accounted for a significant proportion of foodborne illnesses among Americans, and resulted in hundreds of outbreaks of tuberculosis and other serious infections.”

Today, an estimated 1 percent to 3 percent of all dairy products consumed in the U.S. are not pasteurized. From 1998 to 2009, consumption of raw milk products in the U.S. resulted in 1,837 illnesses, 195 hospitalizations, 93 illness outbreaks, and two deaths. The risks involved with infections due to consuming raw milk are particularly high for pregnant women and their fetuses, as well as for young children.

“Raw milk poses a significant health risk, since the process of obtaining fresh milk from cows and goats can be fraught with risks of contamination both while milking the animals and during storage,” said Mary Glodé, MD, FAAP, a co-author of the policy statement. “Pasteurized milk and milk products are extraordinarily healthy, nutritious and safe for children. We are fortunate to have pasteurized products easily available for our entire population.”

The AAP supports the position of the U.S. Food and Drug Administration and other national and international associations in endorsing the consumption of only pasteurized milk and milk products for pregnant women, infants, and children. The AAP also endorses a ban on the sale of raw or unpasteurized milk or milk products in the U.S., including certain raw milk cheeses. Pediatricians are encouraged to advocate for more restrictive laws regarding the sale and distribution of raw milk and raw dairy products.

Wean Me, Baby, One More Time

weaning baby

Dear Mr. Dad: My wife is breastfeeding our three-month-old baby, but wants to wean the baby and go back to work. I heard somewhere that it’s better for babies to nurse for longer. But does it really matter when she stops? Is there some actual “right” time to introduce solid foods?

A: I teach a class for expectant dads in San Francisco, and that question comes up a lot. The short answer to both of your questions is, ”Yes.” It does matter when your wife weans your baby, and there is a “right time.” The American Academy of Pediatrics (AAP) recommends that, barring any medical reasons to the contrary, babies should have nothing but breast milk for the first six months. Then, gradually introduce solids and phase out the breast milk over the next six months.

However, if you or your wife has—or is at risk of developing—diabetes, that “right time” is more of a window than a hard line: Somewhere between four and five months. Introducing solids too early or too late may cause real problems.

On the too-early end, researchers at the Colorado School of Public Health at the University of Colorado just found that weaning a child before four months doubles the child’s chances of developing type 1 diabetes (which used to be called “juvenile onset” diabetes). So at the very least, you’ll want to encourage your wife to hold off on weaning and keep breastfeeding until four months old.

By the way, extending breastfeeding doesn’t have to interfere with your wife’s return to work. She can pump several bottles of milk at night or in the morning before she goes to work. You or another caregiver can give that milk—and the benefits of breastfeeding—to the baby during the day. Most employers are legally required to provide a place for nursing women to pump (however, that “place” could be a nice lounge or it could just as easily be a stall in the women’s bathroom).

Unfortunately, not enough people follow these guidelines. The Centers for Disease Control and Prevention (CDC) estimates that 40 percent of moms introduce solid food before their baby hits four months. Worse yet, nine percent of moms have given their baby solid food before four weeks.

Okay, let’s talk about the other end of the window. If you’re able to get your wife to breastfeed for four months, see if you can convince her to go all the way to six. Several studies have shown that those two extra months make a huge difference, cutting in half the risk of coming down with an ear infection and/or pneumonia. In addition, for babies with a genetic diabetes risk, the same Colorado study that found that introducing solid foods too soon increases diabetes risk, also found that babies who didn’t get solid foods until after six months had triple the type-1-diabetes risk of those weaned before six months.

“In summary, there appears to be a safe window in which to introduce solid foods between four and five months of age,” wrote Brittni Frederiksen, the study’s lead author. “Solid foods should be introduced while continuing to breastfeed to minimize [type 1 diabetes] risk in genetically susceptible children.”

Remember, introducing solid foods and weaning aren’t always the same thing. In other words, it’s fine to do both at the same time. In fact, the Colorado study found that introducing wheat or barley while continuing to breastfeed actually reduced diabetes risk.

Hopefully, I’ve given you and your wife something to think about. But before you make a final decision about when to wean your baby, make sure to talk with your pediatrician.
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Formula Feeding Your Baby without Fear

[amazon asin=B009S7O084&template=thumbnail&chan=default]Guest 1: Suzanne Barston, author of Bottled Up.

Topic: How the way we feed babies has come to define motherhood–and why it shouldn’t.

Issues: Breastfeeding rates are steadily rising in the US, but by three months after the birth, 64% of women are either supplementing with formula or have ceased to breastfeed completely; giving support and guidance for parents who feed their babies formula.

It’s all fun and games–until someone dies

I’ve been reading about the new middle-school craze–the Choking Game, which involves strangling (one’s self or someone else). The goal is to produce the light-headed feeling that happens when oxygen to the brain is cut off and the “rush” that happens when the choke is released and the oxygen flows back in. As one who, over the course of many years in the martial arts, did plenty of choking (and was choked at least as often), I can say that there is a tiny bit of truth there–you do get a little light-headed before passing out, and you do get a rush when the blood comes back. But I was reminded of two movies that dealt with exactly the same search for a choke-induced high.

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Breastfeeding Dad

Dear Mr. Dad: My baby’s mom and I are separated and I hardly ever get to see my 9-month old son because my ex is breastfeeding. Isn’t there some way I can spend more than just a few hours at a time with him?

A: Feeding your baby is a wonderful way for the two of you to bond with each other. And yes, there are some ways for you to increase your time with him. But before we get to that, it’s important to acknowledge that your ex is doing a fantastic thing for your son.

Current recommendations are that babies should have nothing but breast milk for the first six months of life, then, over the next six months, gradually phase out the milk and phase in solid food. As you may have heard, breastfed babies have stronger immune systems, are less likely to develop ear infections or pneumonia, and may even have higher IQs. Keep in mind, though, that it’s not the act of breastfeeding that gives babies all these advantages; it’s the actual breast milk itself.

Most mothers will express, or pump, their breast milk using a breast pump. The milk can stay in the refrigerator for up to a week or be frozen for several months. Later, when your baby is with you, you’ll give him that milk in a bottle. Using pumped breast milk will allow you to take your son overnight—but you and your ex will have to cooperate. Unfortunately, using a breast pump can make women feel like a cow. And pumps aren’t cheap (they can cost as much as $350). She can rent one, but long term, that will end up costing even more. If your ex won’t provide breast milk, you could give your baby formula—if your pediatrician agrees—until he hits 12 months, which is when he can start drinking cow’s milk. But your wife would still need to pump when the baby’s with you to keep up her milk supply.

If your son has never had a bottle, introducing one might be tricky. Here are some tips:

  • Practice. Don’t wait until you have your son for a full day before trying a bottle. Drinking from a bottle is different than breastfeeding so give your baby a chance to get the hang of it.
  • Offer a bottle a little earlier than his regular feeding time so he’s not starving.
  • Ask your ex to go somewhere else while you’re introducing the bottle. Babies can smell their mothers up to 20 feet away and he may not want to try something new if he can smell her breast
  • Don’t force it. If your son resists, try again a little later. You might also try putting some breast milk on the nipple of the bottle, experimenting with a different type of nipple, or changing positions.
  • If your son flat out refuses to take a bottle, try putting the milk in a sippy cup.

Most babies your son’s age have already started eating at least some solid foods (although “solid” is hardly the right word—“soupy” or “mushy” would be closer). In fact, it’s possible that several of his daytime snacks and feedings in a row consist entirely of baby food (the kind you can buy in the grocery store). This opens up the opportunity for you to take your son for a pretty good stretch. However, to quickly identify allergies, introduce new foods slowly—one at a time every few days. And make sure you and your ex are sharing this information with each other.

What’s Eating You?

Dear Mr. Dad: Our son is only 10, but he is already extremely overweight. He loves food and we don’t want to deny him his favorite dishes, but we’re starting to get worried about his health. What should we do?

A: You’re absolutely right to be concerned. Obesity in this country is a huge problem. And it’s getting bigger by the day. Back in the 1960s, fewer than one in ten kids 6-19 were considered overweight. Today it’s more than one in three. Put a little differently, when you were growing up, the average child drank three glasses of milk for every one of soda. Today, kids are drinking twice as much soda as milk.
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