Breastfeeding and the use of human milk.

Considerable advances have occurred in recent years in the scientific knowledge of the benefits of breastfeeding, the mechanisms underlying these benefits, and in the clinical management of breastfeeding. This policy statement on breastfeeding replaces the 1997 policy statement of the American Academy of Pediatrics and reflects this newer knowledge and the supporting publications. The benefits of breastfeeding for the infant, the mother, and the community are summarized, and recommendations to guide the pediatrician and other health care professionals in assisting mothers in the initiation and maintenance of breastfeeding for healthy term infants and high-risk infants are presented. The policy statement delineates various ways in which pediatricians can promote, protect, and support breastfeeding not only in their individual practices but also in the hospital, medical school, community, and nation.

Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake.

Rickets in infants attributable to inadequate vitamin D intake and decreased exposure to sunlight continues to be reported in the United States. It is recommended that all infants, including those who are exclusively breastfed, have a minimum intake of 200 IU of vitamin D per day beginning during the first 2 months of life. In addition, it is recommended that an intake of 200 IU of vitamin D per day be continued throughout childhood and adolescence, because adequate sunlight exposure is not easily determined for a given individual. These new vitamin D intake guidelines for healthy infants and children are based on the recommendations of the National Academy of Sciences.

Reporting needs for studies of environmental chemicals in human milk.

Studies of environmental chemicals in human milk have been carried out in many countries, but few have been conducted in the United States. These studies are useful for monitoring population trends in exposure to chemicals, for research into the determinants of environmental chemicals in milk and relationships between the levels found and the health status of the women and their infants, and for risk assessment. This article provides practical advice on data and information reporting for such studies. Participation in these studies comes at a difficult time for the breast-feeding mothers, so it is important that the mothers support the study and its goals. A key goal of any study of environmental chemicals in human milk must be to ensure that the breast-feeding process is not disrupted by unwarranted concerns about harm to the infant from chemicals in human milk. Therefore, it is essential that reporting of information be a two-way process. Information needs to be supplied to participating mothers before, during, and after their participation in the study. Information supplied before participation is necessary to satisfy the ethical requirement for informed consent; information supplied during participation includes advice on expressing, collecting, and storing milk samples, and how to avoid sample contamination; and information supplied to each participant at the end of the study includes a report of their individual results and a summary of study results and outcomes generally. The key instrument for obtaining data from the participants is the study questionnaire. This needs to be prepared in accordance with principles of good questionnaire development, and preferably should be interviewer administered. The questionnaire content will vary according to the objectives of the study. Although studies of environmental chemicals in human milk are logistically complex and demanding, they are practicable and, with careful planning and execution, yield important data.