Breastfeeding is an essential complement to vaccination

Aim:  This article explores the role of breastfeeding in different aspects of vaccination in the first 6 months when infants are still developing: (1) pain management; (2) immunomodulation of infants' vaccine responses; (3)metabolism of thimerosal.
Methods:  Major databases were searched for studies that addressed outcomes of related issues.
Results:  Studies reveal that breastfeeding can: (1) help mothers and infants to cope with the stressful situations that accompany parenteral vaccines; (2) improve response to vaccines in the still maturing immunologic and enterohepatic systems of infants; (3) influence physiologic parameters that can change metabolism of ethylmercury derived from some vaccines.
Conclusion: Health promotion that supports vaccinations should also emphasize early initiation and maintenance of exclusive breastfeeding up until 6 months for maximum protection of the infants with a possible beneficial effect on the vaccine response. Paediatric professionals should inform mothers of the proven benefits of breastfeeding and its importance in complementing vaccination and lowering stress and the risk of untoward reactions on susceptible infants.     

Editorial: Prevention is the best cure

In this issue of Journal of Child Psychology and Psychiatry, many interesting research findings converge to suggest that prevention and early intervention strategies can be the key to building healthier societies with happier people. Across different societies, we observe that scientific attention and practice is becoming more evenly divided between the traditionally dominant focus on clinical disorders and residential treatments on the one hand and a burgeoning focus on prevention and resilience in ambulant settings and younger populations on the other hand.     

Breastfeeding is associated with the intelligence of school-age children in Mexico

Breastfeeding has been consistently associated with higher intelligence since childhood. However, this relation could be confounded due to maternal selection bias. We estimated the association between predominant breastfeeding and intelligence in school-age children considering potential selection bias and we simulated the intelligence gap reduction between low versus higher socioeconomic status children by increasing breastfeeding. We analysed predominant breastfeeding practices (breastmilk and water-based liquids) of children 0–3 years included in the Mexican Family Life Survey (MxFLS-1). Intelligence was estimated as the z-score of the abbreviated Raven score, measured at 6–12 years in the MxFLS-2 or MxFLS-3. We predicted breastfeeding duration among children with censored data with a Poisson model. We used the Heckman selection model to assess the association between breastfeeding and intelligence, correcting for selection bias and stratified by socioeconomic status. Results show after controlling for selection bias, a 1-month increase in predominant breastfeeding duration was associated with a 0.02 SD increase in the Raven z-score (p < 0.05). The children who were predominantly breastfed for 4–6 months versus <1 month had 0.16 SD higher Raven z-score (p < 0.05). No associations were found using multiple linear regression models. Among low socioeconomic status children, increasing predominantly breastfeeding duration to 6 months would increase their mean Raven z-score from −0.14 to −0.07 SD and reduce by 12.5% the intelligence gap with high socioeconomic status children. In conclusion, predominant breastfeeding duration was significantly associated with childhood intelligence after controlling for maternal selection bias. Increased breastfeeding duration may reduce poverty-driven intelligence inequities.     

Breastfeeding

The benefits of breastfeeding for the infant and nursing mother are well established. The World Health Organisation (WHO) recommends exclusive breastfeeding up to 6 mo and continued breastfeeding up to 2 y. Exclusive breastfeeding is the most effective intervention to reduce infant mortality and is estimated to prevent 13 % of under 5 child mortality in low income countries. However, rate of exclusive breastfeeding is alarmingly low in our country. Mothers who face problems in breastfeeding immediately resort to top feeds. It is the responsibility of the health professionals to identify and manage breastfeeding problems appropriately. UNICEF/World Health Organisation, through Baby Friendly Hospital Initiative (BFHI), have recommended good health care practices that support breastfeeding and increase likelihood of optimum breastfeeding. This paper briefly discusses breastfeeding and related feeding problems seen in clinical practice.     

Fetal intestinal graft is the best source for intestinal transplantation

Adult intestinal allografts have demonstrated high immunogenicity in human transplantation, making the search for new and more favorable grafts an actual problem. Accepting that fetal and newborn immune systems are relatively immature, their intestines could be ideal sources for organ donation. The purpose of this study was to compare the immunogenicity of fetal, newborn, and adult intestine for selection of the least antigenic. Using a bidirectional rat model for immunologic responses, 116 small-bowel transplantations were done: 36 fetal, 40 newborn, and 40 adult grafts. Two histocompatibility barriers and different immunosuppression regimes were used. For fetal and newborn intestines, free grafts into the omentum of adult recipients were done; for adult intestines, accessory grafts in adult recipients of the same age, using vascular anastomoses. The diagnosis of graft rejection and graft-versus-host disease (GVHD) was based on histology of hematoxylin and eosin-stained biopsies from target organs. Recipients of fetal and newborn grafts did not show signs of GVHD, while 12% of the adult group did (P < 0.05). Rejection was less severe in fetal and adult (P > 0.05) than in newborn (P < 0.05) intestinal transplantation. Treatment with 10 mg/kg per day cyclosporine prevented rejection in 70% of fetal and 75% of adult grafts, while all newborn grafts were rejected. Under no immunosuppression, or with low doses of cyclosporine (2 mg/kg per day), all groups showed histologic signs of rejection in almost all cases, the fetal intestine being the least affected. Concerning histocompatibility barriers, grafts were usually less damaged in the weaker transplantation subgroups. Our data indicate that fetal intestine is the least immunogenic of the three grafts studied, suggesting that it will be the most suitable tissue for organ donation. Accepted: 8 November 1999     

What is the best way to measure waist circumference?

Waist circumference is a measure of potential value in paediatrics, given its relation to cardiovascular risk in adults. However, three different methods of measurement are currently in use, giving potential for confusion. This study was undertaken to assess consistency across the measures in a population of overweight and normal weight children. We found that when expressed as standard deviation score (SDS) on the British 1990 reference, all three methods correlated highly with body mass index standard deviation score (BMI SDS); however, there was bias and variability between the measures. Based on ease of measurement, the site 4 cm above the umbilicus was the most convenient. This method was also endorsed by children's views. We therefore recommend that 4 cm above the umbilicus is adopted for clinical use until such time as the methods are verified against the gold standard of visceral fat, as measured by magnetic resonance imaging scan.     

Breastfeeding in the workplace

More than 50% of women of reproductive age are employed, and most return to work post partum at a time when exclusive breastfeeding is the ideal. Public health efforts target a goal of increased breastfeeding initiation and duration rates. To be successful at integrating the roles of breastfeeding mother and employee, women need practical advice, the encouragement and support of health care providers, and societal and workplace support. This article discusses the current state of employed breastfeeding women and provides practical guidelines for assisting women to be successful at meeting breastfeeding goals.