What is it with doctors and breastfeeding?

[bobthebaby]

My 9 mo ds has bad eczema and allergies to lots of stuff notably milk, egg and peanut. As I am bfing I avoid these too. Today I had to take ds to hospital because his skin got so bad he had to have antibiotics. His paed. gave me a jar of Neocate to wean him onto and the registrar said "I bet you will be glad to wean him" when I told her the things I couldn't eat. I don't want to wean him, in fact I'm not going to. Can anyone point me to studies which show I am helping not harming by continuing to bf him. The doctors seem convinced that if I weaned his eczema would go away, which I think is total rubbish. I think its the only thing that helps the pain and about the only useful thing I can do for him. But then this doubt comes in, because they are doctors and I am just a mum.

[motherinferior]

Sounds bollocks in my totally unqualified opinion. Have they given you any reasons for this slightly bizarre opinion?

[FairyMum]

Time to change your doctor? My DD had exzema and I was advised to bf as long as possible. BF give protection and I would think the exzema will get worse if you stop bf or start weaning too early.

[tiktok]

BTB, it's up to the doctors to show you the studies that what they say is true....I have never heard that eczema is made worse by bf.

There is some work that shows asthma risk may be increased in the bf babies of mothers with asthma - counter to other studies. The inference is that it's exclusive bf that protects against the inherited risk of asthma. In the studies that showed increased risk, the babies were not excl bf....giving formula may disturb the gut enough to allow the babies to be sensitised.

Maybe the docs are seeing some connection with this and eczema, but you'd need to ask them. In any case, I don't think that there's any evidence that continuing bf makes allergic/atopic conditions worse which is what they are telling you. There are very, very rare metabolic conditions when babies cannot cope with any milk, inc human milk, but these babies become very ill shortly after birth.

Anyway, as I say, if they are telling you this, they need to show you evidence it's true!

[Epigirl]

I agree with Fairymum, I'm married to a doctor and he advocates breastfeeding as long as possible. I did come across this attitude in my health visitor though - at dd's 8 month check she asked me when I started her on the bottle. Dh was not impressed!

dd had a bad egg allergy at 10 months and I bf her until she was 1 (and she weened herself). The egg allergy just sorted itself out with time.

I would think that you should trust your instincts and continue to bf. I don't know of any study but everything I've read in dh's BMJ is always pro bf if that helps.

[zebra]

BobtheBaby actually asked for references on eczema & breastfeeding. This appears to be seminal:

Eczema was less common and milder in babies who were breast fed (22%) and whose Mothers were on a restricted diet (48%). In infants fed casein hydrolysate, soymilk or cows milk, 21%, 63%, and 70% respectively, developed atopic eczema.
Chandra R.K.,
"Influence of Maternal Diet During Lactation and the Use of Formula Feed and Development of Atopic Eczema in the High Risk Infants".
Br Med J. 1989

But there are studies which suggest a higher risk for eczema when the mothers didn't limit their diet, such as:

Clinical & Experimental Allergy
Volume 33 Issue 3 Page 312 - March 2003
Breastfeeding and the prevalence of symptoms of allergic disorders in Japanese adolescents
===========================================
Also, I thought this was a good critical overview of the suggested breastfeeding-asthma risk:

Breastfeeding and Asthma

Sept 27, 2002
A study by Malcolm Sears and others, recently published in the September 21, 2002 issue of the British medical journal, The Lancet concluded that "breastfeeding does not protect children against atopy [allergic diseases] and asthma and may even increase the risk." The Massachusetts Breastfeeding Coalition has reviewed this study and finds it to be flawed, because the study states that "many newborns who were breastfed received a nightly formula feed while in hospital to allow the mother to sleep."

There have been numerous studies showing a reduction in asthma in children who were exclusively breastfed, that is, they did not receive any formula at all. This suggests that early exposure to formula may increase the risk of asthma. For example, recent study by Wendy Oddy and others, out of Australia, studied twice as many children as The Lancet study, and found a significant reduction in the risk of asthma in 6 year old children who were exclusively breastfed. (see the Public Health section of our website for references).

An unspecified, significant number of the children in The Lancet study were not exclusively breastfed - and in fact received formula in the early newborn period when their immune systems were the most vulnerable and immature, and when their guts were most permeable. Even one bottle of supplemental formula has been shown to alter the pH of the gut. Two bottles may be all it takes to sensitize an already allergy-prone baby. As with the relationship between breastfeeding and other diseases, it is clear that exclusive breastfeeding should be the reference standard.

The Massachusetts Breastfeeding Coalition believes the study in The Lancet by Malcolm Sears and others does not contradict the numerous earlier studies in which exclusive breastfeeding is linked to significant reductions in the risk of asthma in later life.

[bobthebaby]

Thanks all, esp. Zebra - fantastic job!

ds has never ever had formula because I believed that even one bottle could be harmful. I also restricted my diet as soon as we knew what he was allergic to, and I am very strict about this and won't eat anything unless I can read the label myself.

I wish someone had used me in a study, I would think that exclusive breastfeeding for 25 weeks (he grabbed a chip in week 26, scuppering my attempts at 6 months)with no supplemental formula was quite unusual. Moreover I didn't give him anything except breastmilk for 3 months (no gripewater, calpol, water etc). It's a bit depressing that being so pig headed hasn't prevented it completely, but I am sure it is less severe because of my efforts.

[tamum]

I hate to say it, but there have been a load of recent studies suggesting that breastfeeding increases the risk of eczema. The second one zebra posted, and this one, for example:
Clin Exp Allergy. 2002 Feb;32(2):205-9.
Breastfeeding duration is a risk factor for atopic eczema.

Bergmann RL, Diepgen TL, Kuss O, Bergmann KE, Kujat J, Dudenhausen JW, Wahn U;
MAS-study group.

Department of Obstetrics, Charite, Virchow University Hospitals, Augustenburger
Platz 1, 13353 Berlin, Germany. [email protected]

BACKGROUND: The results of numerous studies on the influence of breastfeeding in
the prevention of atopic disorders are often contradictory. One of the most
important problems is confounding by other lifestyle factors. OBJECTIVE: The aim
of the present study was to analyse the effect of any breastfeeding duration on
the prevalence of atopic eczema in the first seven years of life taking into
account other risk factors. METHODS: In an observational birth cohort study 1314
infants born in 1990 were followed-up for seven years. At 3, 6, 12, 18, 24
months and every year thereafter, parents were interviewed and filled in
questionnaires, children were examined and blood was taken for in vitro allergy
tests. Generalized Estimation Equations (GEE)-models were used to model risk
factors for the prevalence of atopic eczema and for confounder adjustment
RESULTS: Breastfeeding was carried out for longer if at least one parent had
eczema, the mother was older, did not smoke in pregnancy, and the family had a
high social status. The prevalence of atopic eczema in the first seven years
increased with each year of age (OR 1.05; 95% CI 1.01-1.09 for each year), with
each additional month of breastfeeding (1.03; 1.00-1.06 for each additional
month), with a history of parental atopic eczema (2.06; 1.38-3.08), and if other
atopic signs and symptoms appeared, especially specific sensitization (1.53;
1.25-1.88), and asthma (1.41; 1.07-1.85). Although breastfeeding should be
recommended for all infants, it does not prevent eczema in children with a
genetic risk. CONCLUSION: Parental eczema is the major risk factor for eczema.
But in this study, each month of breastfeeding also increased the risk.

I looked on Pubmed aiming to find lots of stuff that you could use to back up your choice (since I'm very pro-bf) but everything I found from this year was at best inconclusive or concluded that it increased the risk. As others have said, there are going to be lots of confounding factors like exclusive bfing vs the odd bottle, so I would just do what you think best, but I think the doctors were actually basing what they said on real data, to be honest.

[zebra]

But let's not forget that breastfeeding definitely reduces the risk for lots of other things, including incidence of ear infections, colds, diabetes, leukemia (that one is a massive risk reduction), and I'm sure loads of things I've forgotten. Plus the long-chain fatty acids are still good for brain development. If you've ever had a toddler with a vomitting bug, you'll know that breastmilk is usually the only calorie laden food they can keep down. And the main health benefits to mother come with extended rather than short-term br'feeding. So it's a risk trade-off situation, really.

[mears]

What utter pish bosmum!

[mears]

Sorry, on the wine

[mears]

Bobsmum

[tamum]

Oh absolutely zebra, as I say I'm very pro long-term breastfeeding. It's just worth knowing, IMHO.

[zebra]

I just wanted anybody reading this thread, weighing it up, to remember that eczema isn't the only thing to think about.

[JJ]

bobthebaby, my guess is that they (wrongly!) think you are not managing your diet properly... even if you've told them you are. If you weaned your son, they'd know more about his diet (by being able to disregard yours, iyswim). If it comes up again, you might try asking them if that's the case then offering to do an "inclusion" diet -- ie, only eat certain things (rice, most veggies or whatever they suggest) for a couple of weeks or whatever. Obviously, the easiest thing is just to blow them off (that's what I'd do, fwiw).

Tamum, do you think that could be the reason for the breastfeeding = more eczema? With formula, it's fairly easy to switch to a less allergenic one, but managing an exclusion diet is difficult. (BTB, that's not to say you're not doing it -- I'm just wondering about an alternative explanation to the study results.)

[bobthebaby]

I had considered doing a couple of weeks of just eating what I know my son can eat and feeding him the same in addition to breastmilk whilst taking a calcium supplement, to see if it really made a difference. I agree JJ that the doctors probably think I am cheating on the diet - but what would be the point of that? I think the next sensible idea may be a dietician rather than another doctor.

Zebra's point is a good one - I don't think I could cope with ear infections or colds on top of eczema. DS has actually started to sleep quite well this week, despite the hospital etc. Maybe it looks worse than it is for him IYSWIM.

Tamum, I hate to think that every month I am bfing is increasing the risk more. It's weird, because in countries where they breastfeed for years not months they don't have allergies. Or possibly they don't notice them because of all the other stuff they have to cope with.

[bobthebaby]

Also, Tamum's study did not say whether the infants had formula and or cow's milk as well as breastmilk. Maybe there is a relationship there (clutching at straws...)

[wilbur]

I think you've done a fantastic job, bobthebaby, and I'm sure your ds's skin is far better than it would be if you had not stuck with b/f. I have an anecdotal back up to zebra's brilliant post (which I am going to print out and give to anyone who asks me why I b/f again). When I was a baby I had a huge allergic/intolerance (not sure which as no notes remain) to cows milk, and even though my mother was b/feeding, but not exclusively, I ended up in hosp for 3 months v. ill, gastric probs and so on. I then had bad eczema as a child (cleared up eventually) and now have mild asthma which has been bad on and off, but responds brilliantly to accupuncture. When I was preg with ds I told the obstetrician this and she said not to give ds any cows milk formula, do not try it as it could sensitise him. When he was born we were referred to paedatric immunologist who told me that my pattern is a classic one and that we were entirely right in what we were doing - exclusive b/f until weaning and then if we wanted to do mixed feeding to use soya formula until ds was at least one year and preferably 18 months. He also mentioned that ds being at nursery part-time was good as the colds he picked up would help his immune system - any socialising is good for allergic kids, apparently. So we did this and so far, ds is not an allergic boy, although I realise he may become so because of so many allergies in my family. Anyway, long ramble sorry, just trying to say that even though we cannot prevent our kids getting these things, we can do our best to lessen the effects and I think that is exactly what you are doing and you should keep on going until you feel the time is right to try and introduce these foods again.

[tamum]

Oh bobthebaby, I am SO sorry, I really didn't want to make you feel bad. I'm sure there are all sorts of things that affect these studies, it must be impossible to control for maternal diet and odd bottles of formula and all the rest of it. You are doing the right thing, you are helping him in all sorts of ways. If this was me and my baby, even after all I read I would carry on. As zebra says there are so many other reasons to keep breastfeeding. Even if you stopped and he got better straight away he would be missing out for other reasons. I just thought in some ways it was quite a hopeful thing, that at worst the eczema is a necessary evil for now but will improve eventually.

I'm so sorry., as if you didn't have enough to cope with

[Eulalia]

bobthebaby - have the doctors not considered there may be another reason why your ds's eczema has flared up? why do they automatically assume it is to do with breastfeeding?

I think you are right to highlight the study tamum (I am all for balanced views) but it is only one study and we've not seen the whole paper. One thing that wasn't mentioned was the extent to which the mothers stuck to a diet. Also I would have to see stronger evidence to see how stopping breastfeeding reduces eczema. How is this measured and how do they know it is not breastfeeding that is accountable for this.

In any case I have found this paper ....

Here is an article which is a review of ALL the literature on the subject which indicates that breastfeeding is best for protection of atopic manifestations .

Allergy
Volume 58 Issue 9 Page 833 - September 2003
doi:10.1034/j.1398-9995.2003.00264.x


Review article
Breastfeeding and allergic disease: a multidisciplinary review of the literature (1966-2001) on the mode of early feeding in infancy and its impact on later atopic manifestations
J. van Odijk1, I. Kull2, M. P. Borres3, P. Brandtzaeg4, U. Edberg5, L. Å. Hanson6, A. Høst7, M. Kuitunen8, S. F. Olsen9, S. Skerfving10, J. Sundell11, S. Wille12

Background: Strategies to prevent children from developing allergy have been elaborated on the basis of state-of-the-art reviews of the scientific literature regarding pets and allergies, building dampness and health, and building ventilation and health. A similar multidisciplinary review of infant feeding mode in relation to allergy has not been published previously. Here, the objective is to review the scientific literature regarding the impact of early feeding (breast milk and/or cow's milk and/or formula) on development of atopic disease. The work was performed by a multidisciplinary group of Scandinavian researchers.
Methods: The search in the literature identified 4323 articles that contained at least one of the exposure and health effect terms. A total of 4191 articles were excluded mainly because they did not contain information on both exposure and health effects. Consequently, 132 studies have been scrutinized by this review group.
Results: Of the 132 studies selected, 56 were regarded as conclusive. Several factors contributed to the exclusions. The studies considered conclusive by the review group were categorized according to population and study design.
Conclusions: The review group concluded that breastfeeding seems to protect from the development of atopic disease. The effect appears even stronger in children with atopic heredity. If breast milk is unavailable or insufficient, extensively hydrolysed formulas are preferable to unhydrolysed or partially hydrolysed formulas in terms of the risk of some atopic manifestations.

[zebra]

I wonder about these "other countries" studies, too, bobthebaby. Allergies must be massively under-reported. And there aren't that many "other" countries that can qualify, any more! Even in places like Nigeria, Mexico, India -- breastfeeding rates are falling.

I know I would keep br'feeding my baby, if it were me. Overall, definitely a net benefit. I just can't accept that it's superior to give your child fake human milk, instead.

[Eulalia]

bobthebaby - I also didn't give anything else to my dd till she was 6 months .. no water or anything. I tried to give her some Calpol after her 2nd lot of jabs but she spat it out. I kept her off wheat till around 8 months and no dairy till a year and her skin is lovely. ds (aged 4) has eczema on his legs, not bad but I wonder if it was down to a few bottles of formula in the early weeks... so I was determined to keep dd away from milk...

Not an expert on this but to reiterate there is more to just method of feeding/diet that affects eczema which would explain the differences with other countries, I mean things like atmospheric pollutants, plastic packaging, exposure to sunlight and so on....

Anyway just to say you are doing a great job to be so considerate and careful for the sake of your ds after all this time and good for you to stick to your guns.

[tamum]

The problem is Eulalia, that the paper you mention says at the end (note added in proof sort of thing) that since they did the survey a further large study has now come out that now suggests that breastfeeding has a negative impact on eczema. That's the one I cited. It changes the conclusions quite a lot unfortunately. I don't understand it, and I wish it was wrong, but there you are.

[Eulalia]

I knew it couldn't be that simple, what about this? ...

A caesar drawback? Could caesarean births increase the risk of children's food allergies?

[tamum]

Yes, I read that, it's really interesting. Makes you wonder about all sorts of things that are on the increase really, doesn't it, not least autism. It's just so hard to study all these kinds of things properly, I think we should take it all with a pinch of salt.

[JJ]

I have to say that I can very easily believe the sweeping statement "breastfeeding is a risk factor for atopic eczema". Breastfeeding mothers with children who have garden variety eczema probably don't even consider modifying their diet many times and just treat the symptoms. And those who do modify their diet, eg by excluding cow's milk probably don't do it completely. It is very hard to do and, as bobthebaby mentioned, it involves knowing every ingredient of every piece of food you put in your mouth. So, what the study might actually highlight is the need for better dietary information for breastfeeding mothers about what to do for eczema and minor allergies.

With formula, it's easy enough to switch to a hypoallergenic one. The dietary trigger is removed. I don't mean it in a "so we shouldn't encourage breastfeeding" way, just in a "this is probably why they said what they did" way.

I can't access the articles without paying, but it'd be interesting to read the details.

(None of this was meant in an argumentative way -- it's just interesting to me.)