Thursday, September 1, 2011

Fat Babies: Beginning Prevention Early

From Medscape Pediatrics Alan Greene, MD 08/25/2011 Commentary The earlier edition of the breast-feeding guide was a million-plus bestseller and a major influence on breast-feeding in the 21st century. Launched to coincide with the World Health Organization's (WHO) World Breastfeeding Week, the new edition features a decade of the latest research, including new research on ways that breast-feeding can reduce childhood allergies and childhood obesity, 2 pressing concerns for today's parents and clinicians. Perhaps most useful for parents and clinicians alike are the numerous question and answer sidebars with practical mom-tested solutions to common and not-so-common breast-feeding issues. Consider 3 important facts: Between 2002 and 2009 the C-section rate in the United States rose to an all-time high of 34%, according to a HealthGrades report released earlier this summer. The US Centers for Disease Control and Prevention (CDC) and March of Dimes report that the rate of babies born prematurely is dropping slightly but remains above 12%. In a report published in August 2011, the CDC noted that only a very small minority -- 3.5% -- of hospitals implemented 9 of 10 steps recommended in the WHO/UNICEF Ten Steps of Successful Breastfeeding. More than 40% of babies born in the United States are born in ways that produce special challenges -- and solutions -- to establishing breast-feeding. The odds of these mothers and infants being appropriately supported from the time of delivery are slim. The AAP's updated guide provides much-needed expert advice on best handling this sizeable minority of babies. However, providing a recommendation to purchase a book does not then give the clinician permission to just move on. For women with lower literacy, fewer resources, or just not enough time or inclination to read a book, there are many other resources. The Table provides a number of helpful Websites for both professionals and families. Many of the professional sites offer brochures in English and Spanish that are available for download and perfect for displaying in a waiting room or using for breast-feeding classes. Table: Breast-feeding Resources For Healthcare Professionals For Families Hospital Support for Breastfeeding This is part of the CDC Vital Signs program and provides important data to assist clinicians and hospital administrators in creating a baby-friendly hospital Your Guide to Breastfeeding This is available from the US Department of Health & Human Services (DHHS). This full-color downloadable pdf is available in English, Spanish, and Chinese. Breastfeeding Report Card -- United States, 2011 This report provides a wealth of information including process and outcomes indicators of change. Breastfeeding Answers from La Leche League This guide provides information in 11 languages, includes mother-to-mother forums, and provides online support. AAP Breastfeeding Initiatives This Web site includes breast-feeding guidelines, advocacy materials, and links to other resources. Breastfeeding Hotline This Website includes numerous fact sheets, breast-feeding videos, and links to a helpline with English and Spanish counselors. Although breast-feeding for the first 12 months of life is the best obesity prevention strategy, this is not the reality for many women and infants. With a plethora of preparations on the market, formula-feeding decisions are not as simple as they used to be. The United States Department of Agriculture (USDA) provides information about Infant Formula Feeding as part of their online publication, Infant Nutrition and Feeding: A Guide for Use in the WIC and CSF Programs. The timing and choice of solid food introduction is another important factor. A 2011 study found that starting solids before age 4 months (as is the case with a quarter of infants in the United States) is associated with 6 times the risk for obesity at age 3 years. Beyond this, for decades the top source of solid food calories in the first year has been processed white flour that we call rice cereal. Many parents have been advised to make this a first food for babies despite a lack of scientific evidence for this recommendation.

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