April News Letter: Breast Feeding

As always the subject of breast feeding is topical.

I have set out below a quasi historical perspective.

Breast feeding

My views about breast feeding have for years been non mainstream.

Many years ago after reports that the early unmodified bottle milks could cause problems with excessive sodium load contain the wrong sort of constituent fats  they were modified and these problems eased .

Certainly in countries where a safe supply of water is not readily available then use of powdered formula milks can increase the risk of infection. This is not a problem with preprepared  bottled milks but these are too expensive for general use in poor countries

It may be that the composition of iron in breast milk ( lactoferrin ) is less available to bacteria and better absorbed by the infant.

There is also some evidence that the infants ability to fight infection may be helped by immunoglobulin  present in breast but not bottled milk.

All these advantages of breast feeding are real and hugely important on a world population level.

But like so many edicts they are not so relevant for many.

Why do mothers I see choose to breast feed second and third children children less often.than their first borne – surely if the experience of breast feeding is so inspiring then the opposite would be true.?

 Clearly there are lots of possible reasons but here are a few - Because it is harder work than bottle feeding, can only be done by them and leads to sleepless nights. It limits their ability to look after their other children, to socialise outside of the home  and to go back to work

 A pre-programmed NHS midwife or health visitor at this point  would interject  that the “ welfare of the infant is paramount”

Whereas I would in no way wish to disagree with this excellent sentiment I would suggest that the physical and mental health and well being of the mother might also be relevant. It should certainly not be proffered in a manner that is likely to  make the mother  feel guilty because she wants a life.

The recent news that biological tweeking has enabled  cow’s to produce milk that is in all intents identical to  human breast milk I see as a great step forward in human health rather than has been interpreted as a lamentable reduction in cow’s because they may be more prone to mastitis.  

I guess  the take home message is that that al is not as black and white as might be suggested.

March 2011 News letter

Safety Helmets for skiers and snowboarders.

Following the recent death of 2 well know personalities from head injury in skiing accidents a lot of media attention has been drawn to this subject.

My view is that:

Helmets should be worn by all children and adults.

There is good evidence that this reduces the risk of head injury in all age groups.

In Austria is compulsory for children under 16 years.

Was said that because of their relatively large heads children at greater risk of cervical injury with helmet – not true.

There is some evidence that they can block out high frequency sound such as produced by skis or boards on snow but they don’t cut out human voice.

Goggles but not helmets limit peripheral vision.

They should certainly be worn in paraponting where I recently was advised by my instructor that a safety not crash helmet.

When to stop breast feeding ?

A recent study has challenged the recent edict that breast feeding should continue after 4 to 6 months citing iron deficiency anemia as a common result..

On an international level where there may not be availability of clean water or suitable nutritional alternative I think this may well not be true -  the risk of infection being much greater in bottle dd babies.

In developed societies where there is ready access to clean water and adjusted formula feeds I am not so sure.

One thing that is vital is that mothers who decide to not breast feed their child should not be made to feel guilty by members of the caring professions. Unfortunately in my experience this often happens.

Gardesil for protection against venereal warts and cervical cancer.

I have always used Gardesil, rather than Cevarix ( which is the one used in the UK) in my patients – both boys ( the vectors)and girls because unlike Cevarix it protects against the viruses that can cause venereal warts as well as cervical cancer ( cervical screening should still continue) .

Immunisation against the human papilloma virus is now being undertaken in developing countries as well.

Gardesil can be given from the age of 9 years.There is evidence that it can be protective against cervical cancer even in women who have been exposed to the human papilloma virus.

Hepatis A/B vaccine

I recommend this vaccine from the age of 2 years in all children.

Pre School Age DPT booster

This should be given to all children from the age of 3 years.

Diptheria Pertussis ( whooping cough) Tetanus and polio.

School Age booster 

This should be given to all children aged 9 and above.

Contains the same as the preschool booster but no pertussis ( whooping cough).

If you child has not received any of these vaccines please make an appointment and I will administer them. During the half hour consultation we can discuss any other issues that may be causing concern.