Bottles, Pacifiers and Sippy Cups May Pose Risks

In a Pediatrics article published online yesterday, researchers from The Research Center at Nationwide Children's Hospital in Columbus, Ohio, found that bottles, sippy cups and pacifiers are a significant source of injury in children under 3. Bottles are the most significant source of injury, causing 65.8% of all injuries, followed by pacifiers (19.9%) and then sippy cups (14.3%).   The most common injury was to the mouth, and the most common type of injury was laceration.

The researchers note that both the American Academy of Pediatrics and the American Academy of Pediatric Dentistry have issued recommendations about transitioning to a lidless cup by 12 months of age to prevent dental caries (note that in both referenced articles above, they say 18 months is the upper limit for complete cessation of bottle usage). Furthermore, in this article from the journal of the American Academy of Family Physicians, pacifier use after one year of age is linked to an increased incidence of otitis media (ear infection). 

They also make the point that in 2010, there was a 29.6% decrease in injuries from 1991. They note that, 

"This trend was largely driven by a decrease in bottle-related injuries over time; we speculate that either bottles were involved in fewer or less serious injuries or fewer children used bottles over time (because they transitioned increasingly earlier to a sippy cup or cup or because more children were breastfed or breastfed longer)."

So what does all this have to do with you? Based on the evidence gathered in this retrospective analysis, it  appears that it is very important to teach your child to remain seated when drinking. Allowing a toddler to run around with a bottle or sippy cup isn't a good idea. It is also important to note that babies and toddlers who are breastfeeding instead of using a bottle or sippy cup are not at risk for any of the types of injuries noted in this study.

Some babies really do seem to have a stronger suck need than others. A breastfeeding mother who's baby is nearing the one year mark might decide to continue nursing a little longer to help baby through the many stresses of toddlerhood. An in-tune, attached mother is the real expert on her baby. You are the only one who can make the decision about what your little one needs, so do the research and follow your gut!

Breastfeeding Isn't Just a Lifestyle Choice

The American Academy of Pediatrics has recently taken its strongest stand ever in favor of breastfeeding. In the current issue of Pediatrics, they make this statement: "Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice." This is encouraging news for breastfeeding advocates because it reinforces the message we've been giving mothers for years. It isn't a matter of breast milk being a superior food. The fact is that human milk is the standard food for human babies. Anything else is an inferior substitute.

I will be the first to aggressively defend a mother who, for reasons beyond her control, has had to resort to using some infant formula to help her baby. It's kind of like using medication when you have to. Nobody wants to keep a child on medication unnecessarily, but what a blessing that the medication exists for those babies who need it!

However, I hope that this AAP statement will open the door for more honest dialogue between doctors (both Ob/Gyn's and Pediatricians) and their patients. When a doctor tells a mother that it doesn't really matter how she feeds her baby, it may serve to undermine her confidence and her belief in breastfeeding. With the advent of this new policy statement, any doctor who doesn't actively support and encourage every patient to breastfeed is either unaware of the research contained in this document, or truly doesn't sincerely care that his or her patients might receive substandard immunological protection.

So what has happened over the last ten years to warrant such a strong statement from the AAP? The statement acknowledges that methodological issues have been raised about some of the studies that have been done. However, the data upon which this statement is based comes from the report prepared by the Evidence-based Practice Centers of the Agency for Healthcare Research and Quality (AHRQ) of the US Department of Health Human Services. It clearly shows that babies who are not exclusively breastfed for 6 months have a 77% higher chance of developing ear infections and a 63% greater chance of contracting an upper respiratory infection.

In many public health sectors, there is a growing emphasis on wellness and prevention of illness as opposed to treatment. The illnesses that breastfeeding helps prevent include asthma, RSV, Necrotizing enterocolitis (NEC), Leukemia, Celiac Disease, atopic dermatitis, gastroenteritis and Diabetes (Types 1 and 2), and numerous other conditions. It also reduces the risk of SIDS by 36%.  Another way to look at this data is to see that using infant formula increases an infant's chances of having these conditions.

In this document, the AAP also emphasizes the importance of work-place support for breastfeeding mothers. They cite The Patient Protection and Affordable Care Act passed by Congress in March 2010 which mandates that employers provide “reasonable break time” for nursing mothers and private non-bathroom areas to express breast milk during their workday.

We encourage all mothers to discuss this new AAP statement with your Ob/Gyn and and your pediatrician. Here at A Nurturing Moment, we will do all we can to help you as you nurse your baby, but it makes a big difference if your health care providers offer their support as well. If you have a particularly supportive doctor, please leave a comment so others will know how wonderful he or she is. (Positive comments only, please.)