Medications and More
Volume 35 • October, 2008
Melamine and Breastfeeding
Notes from Dr. Hale by Thomas W. Hale, PhD
Notes from the Editor Melamine contamination of infant formulas is of great
Affiliate Program interest today, following the report of thousands of
PubMed Section Chinese infants who have fallen ill with exposure to
Breastfeeding in the News this product in formula. I was recently asked about
What’s New melamine exposure in the mother and how much
Book Shelf melamine would transfer into human milk.
Hartmann/Hale Human Lactation
Research Conference Melamine is a small organic base used in the
synthesis of plastics. Because it appears in tests to act
like protein, it has been used illicitly to increase the
protein content of foods. In China, it was added to
milk to increase the test results for protein, even
though it is not a protein. It has a molecular weight of
126 Daltons and is quite polar or water soluble.
Although we have no data on its transfer into human
milk, just chemical characteristics alone would suggest
that milk levels are probably going to be quite low. It
has a pKa of 5.66 and LogP (pH 7.0) of -1.37. When
ingested, it is primarily retained in body water, failing
to enter most compartments due to a very poor lipid
Using a mathematical formula to estimate milk
levels, Dr. Ken Ilett has estimated that the Milk/
Plasma ratio will range from 0.15 to 0.86, depending
on protein binding (which we don’t know). From its
chemistry alone, we can estimate that the protein
binding will be less than 50%. In addition, rodent
studies suggest that its plasma half-life is brief, with
90% excreted in 24 hours.
At this time we cannot really estimate an accurate
dose that is transferred into human milk because we
Notes from the Editor: simply do not have data on human plasma levels, nor
protein binding following exposure. However, a
October 1-3 - ILCA - A Worldwide View on good guess is that the relative infant dose of melamine
Breastfeeding - Vienna Austria in human milk is likely to be quite small, and any risk
October 11 - Breastfeeding Challenge to the breastfeeding infant is low.
Editor: Janet Rourke
Medications and More Newsletter is a free monthly
e-newsletter publication of Hale Publishing LP, Amarillo, TX.
Guest Author With commercial discharge bags being distributed
through approximately 90% of US birthing hospitals, the
hospital itself has morphed into the marketing arm of the
infant formula industry. Merewood and colleagues (2008)
Formula Company Discharge Bags: describe the pervasiveness of formula gift bag distribution,
The Wolf in Sheep’s Clothing noting that 94% of hospitals in 21 eastern states and the
District of Columbia dispense these bags. This is in spite of
by Marsha Walker RN, IBCLC
the condemnation of this practice by the US Office on
Women’s Health, the Centers for Disease Control and
What could be happier than the birth of a baby? Prevention, the American Academy of Pediatrics, the
Unfortunately, that cute little infant and his mother American College of Obstetricians and Gynecologists, and
are viewed as marketing targets by the infant the Government Accountability Office.
Hospitals do not distribute these bags as a charitable
Stalked throughout her pregnancy, a mother is endeavor. They are paid (bribed) to do so by formula
the recipient of cans of formula, coupons, emails, companies who addict hospitals with gifts of cash, supplies,
and invitations to join baby formula clubs. This equipment, and continuing education for staff, until the
crushing commercial pressure to feed her baby hospital becomes so dependent on this influx of “good will”
formula continues after the birth of her baby with that it turns a blind eye to the conflict of interest it is
the formula company discharge bag given to her engaged in.
when she leaves the hospital.
The bags are not free, nor are any other items provided
Research has demonstrated that the receipt of to the hospital or staff. Mothers who purchase these
commercial formula company discharge bags results premium formula brands pay for the marketing tricks.
in shorter durations of breastfeeding, especially Fancy dinners in expensive restaurants are provided to
exclusive breastfeeding. This, of course, is precisely physicians and nurses as a lure to listen to marketing
the outcome desired by the industry from this form packaged as “education.” Most of the mothers who purchase
of sampling. In order to sell more formula, they the high-priced formula cannot afford the meals that their
need to “sell” less breastmilk. health providers are lavished with in an attempt to buy
Rosenberg, Eastham, Kasehagen, and Sandoval goodwill and recommendation of the company’s product.
(2008) demonstrated, yet again, the association Clinicians may enjoy the gifts and attention paid to
between commercial discharge bags and the them by formula company salespeople, but serve only as a
decreased amount of exclusive breastfeeding seen in means to an end. An old Ross Laboratories’ training manual
the presence of these bags. Mothers think they are emphasizes the importance of hospital staff:
receiving a free gift, one that is safe and sanctioned
Ross Hospital Feeding System is designed to provide
by the hospital. A mother believes that her
an early and convenient means of getting infants
healthcare providers have her and her baby’s best
started on Similac…and ultimately sent home with
interest in mind, not realizing that these bags will
instructions that they continue to use Similac.
diminish her chances of breastfeeding exclusively.
The giving of this bag is actually a form of “Never underestimate the importance of nurses. If they
marketing, defined as such by Health Information are sold and serviced properly, they can be strong allies. A
Privacy and Protection Act (HIPPA), and so nurse who supports Ross is like an extra salesperson”.
effective that it is used as an example in marketing While infant formula marketing preys upon consumer
textbooks. Market research has shown that mothers vulnerability, healthcare professionals are inundated with
almost always purchase the same formula that was food and gifts by formula company salespeople. Food and
used in the hospital. Sampling gets the product into gifts, under the guise of friendship are designed to remove
the hands of the consumer, provides for its easy use professional barriers between salespeople and clinicians
at the first sign of breastfeeding roadblocks, and with the expectation of reciprocity in the form of looking
starts the process of early weaning—the perfect set- favorably upon the formula company’s product. There is a
up for creating a market where none existed before. tendency for people to be much more receptive to
information when it is presented while eating enjoyable
food. This is why formula salespeople offer food at every
opportunity. When salespeople combine food with flattery,
recipients tend to like them more, regardless of what it is
they have to say. The positive feelings associated with good
food are projected onto the people providing it as well as the Merewood A, Fonrose R, Singleton M, Grossman X,
messages being presented while eating. Navidi T, Cook JT, Pomales T. From Maine to
The bags are not only a hazard to breastfeeding but pose Mississippi: Hospital distribution of formula sample
packs among the eastern seaboard. Arch Pediatr
other risks as well. Powdered infant formula is not sterile
Adolesc Med. 2008;162:823-827.
and if included in the bag, increases the risk of an infant
being fed a contaminated product. The formula in these Rosenberg KD, Eastham CA, Kasehagen LJ, Sandoval
AP. Marketing infant formula through hospitals:
bags can--and has--sickened infants. Since most hospitals
the impact of commercial hospital discharge packs
lack any stock control procedures, there is no way to inform on breastfeeding. Am J Public Health. 2008;98:290-
mothers when there is a recall of the formula in the bags 295.
such as happened in 2006. Many Risk Management
departments in hospitals have been unwilling to accept such
liability and have requested that their respective hospital
cease doling out these bags. Marsha Walker is a registered nurse and IBCLC. She is
a published author, international speaker, a current
Following an unsuccessful attempt at removing the bags member of the board of directors of the Massachusetts
through mandates in the Massachusetts state perinatal Breastfeeding Coalition and Baby Friendly USA, and
regulations, the Massachusetts Breastfeeding Coalition past president of ILCA. Watch for her newest
created the Ban the Bags campaign. Help is available at the monograph from Hale Publishing, Breastfeeding the
campaign’s website at www.banthebags.org. Despite the Preterm Infant, available Summer, 2009.
odds of eliminating the bags, there are more than 300
birthing hospitals that have done so. If your hospital has rid
itself of commercial gift bags, be sure to report it on the
website so we can keep track of hospitals that have made an
ethical commitment to breastfeeding. When a hospital has
eliminated the discharge bags, we have seen a tendency for
formula gift packs to show up in the special care nursery or
NICU, in physician offices, and in clinics. Make sure to
check on other portals of entry for formula marketing and
ask that these be discontinued so that your breastfeeding
promotion and support efforts are not sabotaged. While
there are often objections to eliminating the bags, mostly
from nurses, we have never seen mothers leaving one
hospital for another because they cannot get their free
formula bag. Mothers and infants deserve our
unbiased support for breastfeeding and the ethical
practice of our respective professions. Healthcare
providers should not be in the business of promoting
pricey products. The health and lives of our most
precious assets depend on this. As the tag line for the Ban
the Bags campaign says, “Give the bags the boot!”
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See you in print!
Approach to milk protein allergy in infants.
Breastfeeding and allergies: time for a change in paradigm?
Breastfeeding and prevalence of allergic diseases in Japanese Getting bone health right from the start!
Pregnancy, lactation and weaning.
Maternal tolerance achieved during pregnancy is transferred Growth pattern of exclusively breastfed infants in
to the offspring via breast milk and persistently protects the first six months of life: a study of babies
the offspring from allergic asthma. delivered at the University of Port Harcourt
Teaching Hospital, Rivers State, Nigeria.
Infant feeding and weight in the first year of life
BiochemicAl in babies of women with eating disorders.
Identification of N-linked glycoproteins in human milk by Infant growth and child cognition at 3 years of
hydrophilic interaction liquid chromatography and mass
Minerals and trace elements in commercial infant
IgA1 levels in milk and serum samples from intestinal food.
parasite-infected or normal puerperae.
Neonatal jaundice: a critical review of the role and
Using interphase fluorescence in situ hybridization (i-fish) practice of bilirubin analysis.
to detect the transfer of infant cells during
Staphylococcus epidermidis: a differential trait of
the fecal microbiota of breast-fed infants.
Treatment of neonatal hypoglycaemia: more
hiV/AiDs frequent latching onto the breast versus
A feeding education program to prevent mother-to-child supplementary feeding with formula;
transmission of HIV in Haiti. retrospective study of patient files
Feeding and nutritional characteristics of infants on pmtct
programs. mAternAl issues
Maternal immune status influences HIV-specific immune Changes in breast hemodynamics in breastfeeding
responses in pups after DNA prime protein boost using mothers.
Exposure assessment of French women and their
newborns to tetrabromobisphenol-A:
infAnt/chilD issues Occurrence measurements in maternal
[A case of hypernatremic dehydration due to breast- adipose tissue, serum, breast milk and cord
Associations of maternal fish intake during pregnancy and Gestational diabetes mellitus: postpartum
breastfeeding duration with attainment of opportunities for the diagnosis and prevention
developmental milestones in early childhood: a study of type 2 diabetes mellitus.
from the Danish National Birth Cohort. Influence of oxytocin or epidural analgesia on
Breastfeeding or oral sucrose solution in term neonates personality profile in breastfeeding women: a
receiving heel lance: a randomized, controlled trial. comparative study.
Case definition, aetiology and risk assessment of early Management of postpartum loss of libido.
childhood caries (ecc): a revisited review. Occurrence of lactational mastitis and medical
Clinical approach of ankyloglossia in babies: report of two management: A prospective cohort study in
Cytomegalovirus seroprevalence and childhood sources of Offspring-exposure reduces depressive-like
infection: A population-based study among pre- behaviour in the parturient female rat.
adolescents in the United States. Research summaries for normal birth.
PubMed Determinants of infant-feeding choice among young
women in Hilo, Hawaii.
Factors Associated With Exclusive Breastfeeding at 3
Months Postpartum in Valdivia, Chile.
The influence of psychological factors on Health professionals’ advice for breastfeeding problems:
breastfeeding duration. Not good enough!
Incorrect advice: the most significant negative determinant
meDicAtion on breast feeding in Malta.
Azathioprine treatment during lactation. Inclusion of Fathers in an Intervention to Promote
Breastfeeding: Impact on Breastfeeding Rates.
Breastfeeding and drug management in connective
tissue and rheumatic diseases. Infant feeding in Sweden: socio-demographic determinants
and associations with adiposity in childhood and
GF120918 as a chemical Abcg2 knockout model to
study nitrofurantoin transfer into milk.
Make or break. Mothers’ experiences of returning to paid
Olanzapine and breast-feeding: changes of plasma
employment and breastfeeding: a New Zealand study.
concentrations of olanzapine in a breast-fed
infant over a period of 5 months. Misperceptions and misuse of Bear Brand coffee creamer
as infant food: national cross sectional survey of
Pharmacogenetic insights into codeine analgesia:
consumers and paediatricians in Laos.
implications to pediatric codeine use.
Prenatal breastfeeding education and breastfeeding
Pharmacological management of panic disorder.
Providing responsive nursing care to new mothers with
oBesity high and low confidence.
Alternative regression models to assess increase in Socioeconomic status and rates of breastfeeding in
childhood BMI. Australia: evidence from three recent national health
An ecological systems approach to examining risk surveys.
factors for early childhood overweight: findings Understanding maternal breastfeeding confidence: a
from the UK Millennium Cohort Study. Gadamerian hermeneutic analysis of women’s stories.
Do Differences in Childhood Diet Explain the Who supports breastfeeding?
Reduced Overweight Risk in Breastfed
Survey of Mothers’ Sleep & Fatigue
Dr. Thomas Hale and Dr. Kathleen Kendall-
Promotion Tackett are conducting an on-line survey of
Attempted breastfeeding before hospital discharge mothers’ sleep and fatigue.
on both sides of the US-Mexico border, 2005: Your help is needed in referring new mothers
the Brownsville-Matamoros Sister City Project to complete this survey! Please tell the mothers
for Women’s Health. you work with about the study and encourage them
Breastfeeding: factors that cause early weaning. to participate. The more mothers who complete
Breastfeeding duration in families with type 1 the survey, the more valid the findings will be.
diabetes compared to non-affected families: The survey takes 20 to 30 minutes to complete
results from BABYDIAB and DONALD and is confidential. It has been approved by the
studies in Germany. Institutional Review Board at Texas Tech
Breastfeeding duration related to practised University Health Sciences Center, Amarillo,
contraception in the Netherlands. Texas.
Breastfeeding Practices in Duzce, Turkey. The link for the survey is:
September 21, 2008 – GMANews.TV reports that the
BF in the NEWS
Manila, Philippines Department of Health is encouraging
mothers to “go back” to breastfeeding in response to the
Chinese melamine-contaminated baby milk products
September 11, 2008 – Red Orbit reports on an
article in the Israeli Journal of Psychiatry and
September 21, 2008 – Shanghaiist reports that an Related Sciences that found that 30% of newborn
enterprising Chengdu mother has offered her breastfeeding infants exposed to SSRIs during pregnancy may
services for the reportedly princely sum of RMB300 per present with neonatal abstinence syndrome (NAS)
day to moms worried about giving their babies Chinese during the first days after birth. NAS includes a
formula. The mother is breastfeeding a 3-month-old son. wide spectrum of symptoms divided into 4
She says she has so much extra milk she could easily categories: central nervous system, gastrointestinal,
breastfeed up to two additional babies. autonomie, and respiratory. SSRI-exposed
newborns should be monitored for NAS
September 20, 2008 – The Peterborough Examiner symptoms. Commonly seen symptoms include:
reports that WHO has designated the Peterborough irritability, jitteriness, abnormal crying, altered
County-City Health Unit as a “baby-friendly community behavior, sleep abnormalities, poor feeding,
health service” for its efforts to promote breastfeeding in vomiting, hypotonia, hypertonia, respiratory
the community. distress, and increased reflexes.
September 17, 2008 – OneNews reports that new September 10, 2008 – Medical News Today
research from the University of Georgia in Athens found reports that a Danish study linked higher fish
that mothers who exclusively breastfed lost more weight consumption and longer breastfeeding
than their mixed feeding counterparts. Researchers (independently beneficial) to better physical and
followed 24 new mothers, 17 exclusively breastfeeding and cognitive development in infants. The article
9 mixed feedings their infants, for 12 weeks after delivery. appears in the September issue of the American
When the researchers compared post-pregnancy weight Journal of Clinical Nutrition. These findings
loss to pre-pregnancy weight, exclusively breastfeeding provide additional proof that the omega-3s found
mothers lost more weight from 2-12 weeks than mixed in fish and breastmilk are beneficial to infant
feeding mothers . The trend in percent body fat loss was development.
statistically significant among the exclusively breastfeeding
mothers. These findings were reported in the International September 9, 2008 – MedicineNet.com reports
Breastfeeding Journal. on a new study published in the September issue
of the Archives of Pediatrics & Adolescent Medicine.
September 17, 2008 – The Huffington Post reports that Researchers surveyed 1,295 hospitals in 21
Professor Sarah Rubenstein-Gillis surveyed 150 films from Eastern states and the District of Columbia. They
the last few decades that contain scenes of nursing mothers found that 1,215 hospitals still distribute formula
or plot lines that refer to nursing. She found that sample packs to at least some new mothers. Out
Hollywood reflects much of the ambivalence about nursing of the 80 hospitals that were sample-free, 20
found in society today. In an article published in the eliminated the practice before 2000 and 60 have
October issue of Mothering magazine, Rubenstein-Gillis eliminated the practice since 2000, indicating this
suggests that moviemakers should consider taking a public practice is changing significantly.
health stand by being more mindful of how they portray
Textbook of Human Lactation
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The Histology and Cytology of the Human Mammary
Human Milk Fat Composition - Fat
Hormonal Control of the Lactation Cycle
Mammary Gland: Past, Present, and Future
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Human Milk Composition - Carbohydrates
Molecular Aspects of Mammary Gland Development
Oxytocin: Milk Ejection and Maternal-Infant Well-
The Role of Breastfeeding in the Defense of the Infant
Human Milk and Infectious Diseases
Human Milk, Breastfeeding, and the Preterm Infant
Hyperbilirubinemia and Breastfeeding
Breastfeeding, Birth Spacing, and Family Planning
Reproductive Bioenergetics, Infertility, and Ovulation
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Management of Lactation in the Puerperium
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