Pediatric Nutrition in Practice

94 Michaelsen

hexaenoic acid in human milk. Breastfeeding has
also an effect on growth. Breastfed infants gain
weight faster during the first months of life and
are leaner and slightly shorter than formula-fed
infants at the age of 12 months [ 7 ; Chapter 1.1].
This was the main reason why the WHO devel-
oped a new global growth standard based on
breastfed infants [ 8 , 9 ; Chapter 4.1]. It has been
suggested that the difference in growth pattern
could be one of the reasons why breastfed infants
have a lower risk of some noncommunicable dis-
eases, including obesity, later in life.
Breastfeeding also affects maternal physiolo-
gy and health. From a global perspective, the
most important byproduct is the inhibitory effect
on ovulation, i.e. lactational amenorrhea, which
in populations with low use of contraceptives en-
hances child spacing, and thereby has a positive
effect on infant and young child health. Breast-
feeding also has a positive effect on maternal
health. Breastfeeding induces utilization of ma-
ternal body fat stores and thus can help to de-
crease excessive body fat depots. Cumulative du-
ration of breastfeeding for more than 12 months
is in some studies associated with substantial re-
ductions in the risk of breast and ovarian cancer,
type 2 diabetes and rheumatoid arthritis [2].

Potential Untoward Effects of Breastfeeding

Transmission of HIV
Breastfeeding can cause mother-to-child trans-
mission of HIV. Therefore, breastfeeding by
HIV-positive mothers is not recommended in
high-income countries. In low-income countries
with a high prevalence of infectious diseases and
high infant mortality, mothers are recommended
to breastfeed until 12 months of age if they receive
antiretroviral drugs. In these settings, replace-
ment feeding should only be used if it is accept-
able, feasible, affordable, sustainable and safe.
The UN agency guidelines on HIV and infant
feeding were updated 2010 [10].

Hypernatremic Dehydration

If there are problems with initiation of milk pro-

duction during the first 1–2 weeks after delivery

and no other fluids are given, there is a risk that

the infant develops hypernatremic dehydration.

In severe cases this can cause convulsions and

brain damage, and in rare cases death [11]. This

can be prevented by supervision and support dur-

ing initiation of breastfeeding, monitoring weight

loss and urine production, and provision of other

fluids if there are signs of dehydration.

Environmental Contaminants

The content of environmental contaminants is

higher in breast milk than in cow’s milk or infant

formulae because of the accumulation particular-

ly of lipid-soluble contaminants in maternal tis-

sues [1]. Some studies have shown an association

between high levels of contaminants in the moth-

er’s blood and negative effects on health and de-

velopment of the infant. However, it is difficult to

disentangle intrauterine exposure from exposure

through breast milk. There is general agreement

that the positive effects of breastfeeding are far

more important than the potential negative ef-

fects, but also that it is important to reduce the

level of contaminants in the environment and in

the diet of pregnant and lactating mothers.

Maternal Medication

Most drugs given to a breastfeeding mother are

excreted in her milk. However, there are only a

few drugs with an absolute contraindication. A

mother should not breastfeed if she receives che-

motherapy, ergotamines, amphetamines or

statins [2]. Information on the safety of maternal

medication is given on the LactMed website [12].

Support of Breastfeeding

Many factors influence the initiation and dura-

tion of breastfeeding: cultural patterns, the moth-

er’s perception, and the attitudes of friends and

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 92–96

DOI: 10.1159/000360323