Every tool can carry risk when not used properly. The story about breast pumps and infection risk in the media recently is no exception. Attention all breast feeding & pumping mamas out there (and all the lovely people who support moms who pump milk): The Centers For Disease Control (CDC) has issued new guidelines for properly cleaning your breast pump & parts. The new recommendations come in the wake of a devastating story of a premature baby girl who showed signs of sepsis (bloodstream infection) at age 21 days due to an unusual bacterial infection. She developed spastic cerebral palsy, developmental delays and later passed away. This case is an outlier, for sure, but did prompt learning that the CDC felt the public should know.
After a full investigation, the CDC traced the infection source back to the breast pump and parts. The way the breast pump equipment was cared for may have allowed bacteria to grow. The CDC reported that the girl’s mother typically soaked the collection kit from her personal breast pump in soapy water in a wash basin for ≤5 hours without scrubbing or sanitizing. She then rinsed, air-dried, and stored the kit in a plastic zip-top bag until the next use. It’s possible how she cared for the pump allowed for bacteria to grow and be transferred to the baby. Because the baby was young and born prematurely, the baby was at greater risk for infection that most full-term older infants.
In response to the investigation, we reviewed existing resources for women about how to pump breast milk safely, but found little guidance that was detailed and based on the best available science,” Dr. Anna Bowen, a CDC medical officer, told Parents. “As a result, CDC developed its own guidance.”
New CDC Breast Pump Cleaning Guidelines:
Clean your pump parts after every use. Don’t skip a single feeding. I know it’s yet another step in the long process of breastfeeding and pumping, but it’s crucial. Annoying add but the recommendations are based in experts evaluating risks.
Wash your hands before touching your pump parts or pumped milk.
Key: keep a separate wash basin for the parts, the CDC doesn’t recommend you use the kitchen sink to clean pump supplies as the sink may house germs and bacteria from other food prep.
Have a dedicated cleaning brush for your pump and parts. Clean that brush every few days. Don’t re-use the sponge you use to scrub food off your plates and dishes.
Use running water and soap to clean breast pump parts that come in contact with breast milk.
Then let each piece and part air dry.
For extra cleanliness you can boil or steam the parts to sanitize in either a microwavable steamer or use the sanitize cycle in the dishwasher (HOT water). You can use the sanitizing bags that you use in the microwave or you can bring a pot of water to a boil and boil parts in the bubbling water for 5 minutes.
Bottom Line: this news isn’t meant to scare or drive moms away from breastfeeding and pumping. We know the many benefits of breastfeeding for both mom and baby (see below). This is just a reminder to be diligent when cleaning and sanitizing your breast pump. Read More »
Tongue-tie is a condition in which an unusually short, thick or tight band of tissue (frenulum) tethers the bottom of the tongue’s tip to the floor of the mouth. Often it goes unnoticed and causes no problems in life but rarely it can affect how a child eats and how they sound when they speak, and can sometimes interfere with breastfeeding because baby’s tongue may not have enough range of motion to attach to the breast, suck and swallow effectively. Sometimes tongue-tied babies can’t maintain a latch for long enough to take in a full feeding, and others remain attached to the breast for long periods of time without taking in enough milk. Sometimes babies with tight frenulums make it miserable for mom to feed because of the way they attach and latch. When a newborn has a tight frenulum breastfeeding moms may have nipple pain, mom may hear clicking sound while the baby feeds, or mom may feel it’s inefficient. Sometimes a parent will notice a heart shape to the tip of the tongue as the band of tissue pulls on the tongue where it’s attached.
What to do about tongue-tie can be controversial. Not all pediatricians, Ear, Nose and Throat surgeons, lactation consultants and occupational therapists always agree. However, every baby deserves the chance to be evaluated by both a physician and a board certified lactation consultant if there is concern! Awareness about a newborn’s challenges with breastfeeding increases diagnosis in the newborn period but decisions to clip a tongue-tie come about from a variety of factors. The American Academy of Pediatrics states: “surgery, called frenotomy, should be considered if the tongue-tie appears to restrict tongue movement, such as inability to latch on with breastfeeding. It is a simple, safe, and effective procedure—general anesthesia is not required.” It takes only a few seconds and many pediatricians can perform the clip in their office.
A new study out confirms something that almost every working mom and dad already suspected — it can be a challenge to maintain breastfeeding goals when you return to work after only a few months with your newborn, especially when asked to return to working full time. The study out this week found that moms who worked about 1/2 time (19 hours or less) were able to continue breastfeeding similarly to those women who didn’t work.
Logical: the more hours a new mom works, the tougher it is for her to continue breast feeding. The amount of time we work may be more influential than the timing of our return to work. In this study, conducted in Australia, women who worked 19 or less hours in a week were much more likely to maintain breast feeding until their baby turned 6 months old, compared to moms who had returned to full-time employment. Additionally, women who work 19 hours or less only faced a 10% chance that they quit breast feeding altogether by the time their baby turned 6 months old. Your level of work place seniority will also affect your ability to continue breast feeding at 6 months, meaning those in managerial-type roles will have more success. Other factors that made it easier? Unsurprising it’s being older, higher education, better physical and mental health and being self-employed.
If we want moms to be successful with the recommended breastfeeding guidelines through infancy we should think on how we prime them for success. And how we support them.
It’s inconvenient but potentially important to acknowledge that it’s simply harder for moms to go back to the workforce, especially those who breastfeed, than it is for dads to newborns. In the first few months of life, the time it takes to nurse a baby is equivalent to a 8-9 hour work day for most women. Most babies will drain a breast in about 12-15 minutes if they are eager and actively feeding but babies often stay on the breast for up to 20 minutes or even 30 minutes at a time. Therefore, if you sit down, feed your baby on the right, feed you baby on the left, burp the baby and then change the inevitable diaper: poof, one hour. And, most newborns feed up to 8-10 times daily. 1+1+1+1+1+1+1+1+1. Math is easy when you do it this way. Breastfeeding alone is a full time job for the first few months. The time spent with a baby nursing diminishes as the months unfold but it can still be a significant number of hours spent every day.
The take home for me here is that we may be more successful, culturally, supporting moms to return to work during the 1st 6 months after a baby is born if we give them options for part-time work. Especially if breastfeeding past 6 months is a goal. Read More »
New research out today confirms that buying breast milk on the Internet via milk-sharing sites may not be safe. Although breast milk purchased from online sites may be free or as cheap as $1-$2 an ounce, it may carry significant risk for babies. Clearly the benefits of breast milk are vast; pediatricians and health experts recommend exclusive breast feeding until 6 months of age. However, simply put, breast milk obtained from unknown (or known) individuals online may carry contamination from medications/drugs excreted in the breast milk, bacterial, or viral contamination. If a mother isn’t able to provide enough breast milk for her newborn or infant, parents must know that milk from online sellers can be contaminated at the time of collection and/or during transport, dangerous especially for babies born prematurely. If buying human breast milk parents should look for a certified milk bank.
Back in 2010 the FDA spoke out against the practice of buying breast milk online, warning parents of potential risks due to bacteria or viral contamination, exposure to chemicals, medications, and drugs. The research out today confirmed these hesitations: nearly 3/4 of the breast milk obtained by researchers online had bacterial contamination and 20% of the samples tested positive for a virus called CMV.
It should be noted that breast milk bacteria (or virus) counts aren’t deterministic for infection, meaning that just having bacteria in a breast milk sample doesn’t mean a baby will get sick from it. How old a baby is, the amount of bacteria in the sample, and the immune status of an infant all also play a part. However, there are reports of premature babies and babies with immune dysfunction becoming seriously ill from donated unpasteurized breast milk so caution is necessary.
To be very clear the breast milk obtained and studied in the new research was NOT from a milk bank. Human Milk Banking of North America (HMBANA) breast milk banks screen donors for infections (like HIV) and pasteurize the breast milk to ensure improved safety protection. The trouble for many families unable to make enough breast milk with using these banks can be very costly secondary to the handling, screening, and pasteurization. Milk can be several dollars an ounce! Read More »
When we have children, many of us slip in the self-care department. We may not eat as well, not exercise like we did “pre-baby,” and don’t have time to go and see our own doctors. Simply put, our own care doesn’t come first. Parenthood immediately demotes our status…
All fine in some ways. It’s astonishingly wonderful to care so deeply about our children. That devotion still catches me off guard.
But we have to keep on top of our preventative screening. No reason not to when it may allow us a longer time to parent our children! So that’s where I come to breast cancer screening. As women, breast cancer will affect about 1 in 8 of us during our lifetime, the most common cancer in women after non-melanoma skin cancer. It can be highly curable if detected and treated early. Most women diagnosed with breast cancer are over age 50, but many are younger and some are new moms. There are some risks we need to know and scientific evidence that can help us do a better job caring for ourselves.
Share this widely, please.
Yesterday I teamed up with Dr Julie Gralow, the head of breast cancer oncology at the Seattle Cancer Care Alliance (SCCA) and the UW on Twitter for a 1 hour conversation about moms and breast cancer— lifestyle choices, genetic risks, screening, & coping with breast cancer. I learned a ton preparing for the chat and have already tried to think about changes I’ll make in my own life. When I finished the fast-paced hour conversation I sent a note to a friend on Twitter that I now had to head out for a run, pour out the wine in the house, call my friends to schedule mammography, and ask about a breast MRI. You’ll see why:
Girls in the news…It just has to get better than this. I’m a bit deflated with the amount of time and energy going into three stories this past week or so.
Last week it was the push-up-padded-bra bikini marketed to young girls (age 8 years) from a big retailer in the US. The company has a bad track record and nonetheless, outrage ensued about early sexual images, contorting body image, and simply pushing girls to “grow up too fast.” This month, I started to hear murmurs about a group of 8 year-old girls in a national dance competition, dressed in bikinis dancing to a Beyonce song with controversial choreography. The dance hit sparked thousands of comments on media Facebook pages and the blogosphere lit up like a sunbeam. And then this week it’s about a breast-feeding baby doll that mechanically sucks on nipples (via a bib worn by the doll’s owner). Concern about young girls being asked to act like grown women, perversion by the doll’s manufacturers, and a too-soon anatomic education about physiologic breast function before kindergarten…
But wait a second. What is this really about? We get so lost when this chatter fills our water-cooler moments we remember all the wrong things: Read More »
Here’s a response to some of the comments about the post I wrote earlier this week. As I’ve said before, I support parents feeding with breast milk and with formula. Studies like this aren’t designed to alienate parents who feed with formula. Take a listen. Here’s a post I wrote about the juggle/struggle to breastfeed while working. Ultimately, the goal of the Pediatrics study on timing of solids was to illuminate ways to improve obesity prevention. Not divide us or cause us to doubt ourselves.
Loved a study published today in Pediatrics. Researchers sought to determine if mothers who breastfed slept less than those who formula fed their babies. I hear lots of talk (at birthday parties to office visits) about how formula or rice cereal creates better infant sleepers. So far, science doesn’t back up these claims. But as every new mom (and dad) knows, sleep is the major commodity during your infant’s first 6-12 months. We really want our babies to sleep through the night. Desperately. Six weeks in, crying is at a peak for infants and mothers are utterly exhausted after a pregnancy, a labor/delivery, and a month or so of very fragmented and dwindling sleep. Not only are we at peace when our babies sleep, we often rest, too. Maternal rest is essential for familial functioning, enjoyment of a baby’s infancy, and simple recovery. Sleep is not just about feeling rested or perceiving that you get more (or less) sleep than the other baby’s mothers on the block. It is about wellness, too. The study asserts that, “a growing body of evidence shows that mothers may not, in fact, do fine with less sleep.” Maternal sleep may affect rates of postpartum depression and an infant’s emotional and cognitive outcome. Getting rest is something we actually CRAVE in the first few months of our baby’s lives. Sleep, at some point, has to be a priority.
Researchers in West Virginia wanted to figure out if mothers of formula fed babies got a better night of sleep compared to those who breast fed or partially breast fed. The motivation behind the study was to dispel any perceived disadvantage of breastfeeding. Before you get up in arms about how bad your night sleep was while breast feeding compared to baby Jane next door who was chugging formula, look at what they did. Sometimes understanding how a study was performed helps you interpret how much weight you put into the results. Read More »
A study in Pediatrics highlighting the importance of breastfeeding and the challenges for working moms was published earlier in 2009. Today, it circulated through a business journal and got some more attention.
I read the study today for the first time. Then I re-read it a number of times. I talk about breastfeeding with moms and parents in clinic on a daily basis. I certainly know the challenges of trying to breastfeed through a transition back to work. I also know how hard it is not to be able to do what you set out to do.
I had my go. With my first son, I saw about 9 lactation consultants in the first week. I am not exaggerating. Me with those women hovering over me trying to help while my little man screamed his head off. The beginnings of motherhood. I breast fed, finger fed, pumped breast milk, finger fed, breast fed, then pumped my way into a sleepless oblivion. Read More »
The MMR vaccine is safe and effective. If you’ve hesitated or declined the vaccine in the past, please reconsider the science and risk to your child and their community now.
I haven’t written much about measles since 2015, but an outbreak in Washington State has prompted me to send out a few reminders. The first thing to know, which I know I already said, is that the MMR vaccine (protects children and adults against measles, mumps, and rubella) is safe & highly effective. If your children are immunized there is very little to worry about during a measles outbreak. The 1st dose (and 2nd dose for those infants and children who didn’t respond to the first) of the vaccine work to trigger lifelong immunity. Typically after the 1st dose (at 12 months old), 95% of people are protected for life. The 2nd dose (age 4) protects those not protected from the 1st dose and brings protection to 97-99%. If your child hasn’t had a 2nd dose of the MMR vaccine and you live where widespread measles infections are being reported, you can get the 2nd dose of MMR now as long as it’s been 1 month since the 1st dose. Call your pediatrician to inquire if you’re interested. The bottom line: immunized children can play and go to school and go to assemblies and even visit a clinic safely during an outbreak because the vaccine is so effective. Hurrah for science!
What To Know About Babies Too Young To Be Immunized For Measles(MMR):
I hate that I can’t completely say infants are perfectly safe during an outbreak. Infants are a vulnerable population during a measles outbreak. Measles is wildly contagious and during an outbreak, it can spread, especially to older infants who aren’t vaccinated yet. The good news is that risk of exposure outside of areas during an outbreak is low (more than 90% of us won’t get measles because we’re vaccinated so we also won’t spread it to your baby). Here’s an even more comprehensive post I wrote about this from 2015.
For Babies Under 6 Months of Age: If a baby’s mother has had her MMR shots and/or had measles infection in her life she passed antibodies to her baby during fetal development while in-utero and continues to pass them passively while breastfeeding. Those antibodies provide protection for young infants and typically are thought to protect infants for up to 6 months or more. However, exactly how long for each baby is not ever known. Immunity wanes for these babies as they age and the mom’s antibodies fail to persist. The reason babies don’t get the MMR shot sooner than a year of age is because of the persistence of these maternal antibodies — if you put a vaccine in while maternal antibodies are still around the vaccine won’t stimulate the baby’s own immune system to respond, it will just get soaked up by the maternal antibodies doing their job.
Okay To Go To The Grocery Or Have A Playdate With Your Infant? Yes! With a few caveats, of course. If you’re in a county where multiple cases of active measles have been recently reported (Clark County reporting 72 cases) you may take more caution disallowing strangers to hold your baby and/or steering clear of anyone with a cough. Measles is infectious on surfaces and in the air for 2 hours after an infected individual has been in the space so it’s tricky to provide solid guidelines of how to avoid it if it’s around. If ever ANY concern for exposure, call your pediatrician to discuss a visit. Like everything in life we balance risk with benefit and being out and about in the world. If planning on visiting with guests or sharing in on a playdate, why not ask parents to children involved, “Is everyone here immunized against measles that can be? If you or your family live in Vancouver, Washington area or Portland area, look at the clinics and multiple schools that have had exposures. I would recommend being clear about how you access a clinic with an infant in these counties during this outbreak.
Is my child’s school protected against a measles outbreak? In many states, you can track vaccination status for your child’s school because exemptions (those opting out of immunizations for medical or philosophical reasons) are tracked. In Washington State, parents can check to see what percent of children are up to date on immunizations in kindergarten by searching SchoolDigger. Because vaccination status is tracked at the state level, many other states provide this service (some are up on School Digger). To find your data, start at school digger or try a search on the state’s Department of Health website for more. If you’ve run into a roadblock or can’t find the information, it’s always your right to request the numbers from school administration or the school nurse. Outbreaks like this are one of the reasons California discontinued allowing children to attend school without up-to-date immunizations. Their non-protection puts other children at risk.
As a parent, do I need another MMR shot? What if I’m pregnant? It’s unlikely you need more MMR shots if you were born after 1957 when vaccination was universal, most of us all got the shot as children. In 1989 we also started to do a 2nd dose of MMR to get more people protected (closer to 100% of the population). Only adults working with vulnerable populations and in health care need to go and get 2nd dose now. If you have ZERO written documentation anywhere that you’ve had MMR shot, talk with your doctor. In addition, if you’re pregnant now, no MMR shot until after the baby’s born. You can get an MMR shot safely while breastfeeding.
Traveling internationally with infants: If you’re planning to travel abroad with your infant and they are between 6-12 months of age, it’s recommended they get an MMR shot before travel to protect against measles. They’ll need to repeat that MMR dose at 1 year of age, and the last shot at age 4 years, but they will be better protected during travel to higher-risk areas while still an infant.
What To Know For Children During A Measles Outbreak:
If your child is up-to-date on MMR vaccination they can play and go to school and live life as they normally would during an outbreak! The MMR vaccine provides lifelong immunity for almost all who get it.
If your child has had the 1st dose of the vaccination (usually given at age 1) and they haven’t yet had their 2nd dose, if you want to get the 2nd dose before age 4 years, especially if you live in or near areas of widespread outbreak or you’re planning travel, call your pediatrician or family practice office. The MMR dosing interval is 28 days meaning you can get the 2nd dose at any age as long as it’s been 4 weeks since the first.
Washington State Outbreak Information January 2019:
As of March 13, 2019, Clark County reports 72 confirmed cases of measles in the state of Washington. 1 confirmed case now in King County. The 72 confirmed cases include two cases who traveled to Hawaii and another case who traveled to Bend, Ore.
1 to 10 years: 53 cases
11 to 18 years: 15 cases
19 to 29 years: one case
30 to 39 years: three cases
Unverified: 7 cases
Unimmunized: 63 cases — the data here is proof that it’s those without the vaccine that are most susceptible!
1 MMR vaccine: 2 cases
In Clark County, 7.9% of children entering kindergarten had vaccine exemptions during the 2017-18 school year, according to the Washington State Department of Health. During the same school year, 7.5% of children in all grades in the county had vaccine exemptions. The county is working with teachers and families to ensure children at risk do not attend until they are immunized and/or this outbreak is under control.
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