Risks of Breastfeeding

Iron deficiency is approximately twice as common in breastfed infants up to 30 percent have iron deficiency anemia, and more than 60 percent of the anemic infants are also iron deficient at 12 months of age (Pisacane et al., 1995), although the etiology is unclear. The iron content of human milk is low 0.5 mg/L compared with 10 to 12 mg/L in supplemented cow-milk formulas. The absorption rate, however, is considerably higher. Breastfed infants absorb up to 50 percent of consumed iron, compared with a 7- to 12-percent absorption rate for formula-fed infants (Fomon et al., 1993). The risk of iron deficiency increases after 4 months of age since most full-term infants are born with adequate iron stores to support hemoglobin synthesis through the first 4 months after birth. 

There have been increasing reports of nutritional rickets in breastfed infants, particularly in northern climates (Kreiter et al., 2000). This is likely due to lack of sunlight exposure, which is increasingly common with the use of sunscreens and the tendency to cover infants for health or cultural reasons. Human milk, like cow milk, is very low in vitamin D, with average concentrations of 24 to 68 lU/L. Since infants consume less than 0.5 L of milk/ day in the first months of life, breastfed infants have vitamin D intake well below the Adequate Intake of 200 lU/day. With sun exposure this is not likely to be a problem. However infants born to mothers with vitamin D deficiency are at increased risk for rickets, as are those who are not exposed to the sun. The American Academy of Pediatrics and the Canadian Paediatric Society recently recommended supplementing all breastfed infants with 200 lU of vitamin D by 2 months of age (AAP, 2003 Canadian Paediatric Society, 1998). 

From a research standpoint, clinical studies that assess the effects of new ingredients will be difficult to design because infants cannot be randomized to be formula fed or breastfed. Furthermore, there may be significant non-nutritional confounding variables between the groups, including, but not limited to, factors related to which mothers breastfeed. Finally, human-milk composition varies considerably among individuals and within individuals over time, while infant formula content remains constant. 

The committee anticipates that manufacturers will wish to add both ingredients that are currently contained in human milk, but not in formulas (e.g., LC-PUFAs), and those not found in human milk (e.g., prebiotics) to enhance the performance of formulas to a level at or nearer to human milk. Thus a breastfed control group should be part of experimental designs to assess the addition of ingredients new to infant formulas in order to provide a performance standard. 

AAFP (American Academy of Family Physicians). 2003. Breastfeeding (Position Paper). Online. Available at http //www.aafp.org/x6633.xml printxml. Accessed February 5, 2003. 

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Lactation — The moderate protein-binding profile of FLB suggests that the infant may have measurable plasma concentrations if breast-fed. In addition, safety issues regarding rare aplastic anemia associated with FLB in patients with epilepsy may increase the theoretical risks of breastfeeding. 

My question concerns the risk of breastfeeding in the event of a nuclear accident. ERMANS (Brussels)... 

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