55 Comments

Dr Offit, I have great respect for your important work. But please don't call breastfeeding cheap! The cost of breastfeeding is the opportunity cost of women's active participation in the workplace. Whatever the quality of the evidence on infection prevention, to call breastfeeding "cheap" and "readily available" is to ignore the many social and physiological barriers to breastfeeding which must be taken into account.

Expand full comment

Rubbish. I breast fed my two children and have had a very satisfying career. I just didn’t work when they were tiny. I went back when they were older.

Expand full comment

Thanks for making this excellent point.

As you note, the costs of and barriers to breastfeeding for many women are substantial. In this sense, it is far from cheap and readily available.

These costs and barriers are one reason that socio-economic status is a widely recognized confound in the literature linking (often weak, mixed) correlational benefits with breastfeeding. Starvation when breastfeeding is insufficient is another such possible confound, along with maternal and infant health.

Expand full comment

Your education is an ABJECT FAILURE.

"opportunity cost of women's active participation in the workplace"?

Are you kidding? So you are clueless about the value of even YOUR OWN child's health. And YOU, of all people, work in "public health"?

With such incompetent clowns, is it any wonder that "public health" is public enemy #1?

Expand full comment

My wife did it while working as an RN for 3 children... she would take time out during the day to pump, and then we would freeze that breast milk... she would generate an oversupply early, and then the babies would catch up to it as they got bigger....

or... you can take your chances with the latest potions from the always trustworthy and reliable FDA & CDC.

Expand full comment

Breasfeeding if the mother has been covid "vaxxed" can be deadly yhtru the transmission of the spike protein to the child. Not recommended. Breasfeeding in a non vaxxed mother is the best thing ever.

Expand full comment

Your information is pretty well jaded. Only elements of the spike protein are reproduced in mRNA vaccines. The spike is not a conserved element, and the spike protein alone cannot cause infection. Your information source is suspect, at best.

Expand full comment

You are completely clueless. The spike is plasmid mediated in the shots and has been shown to persist indefinitely in at least 50% of individuals who were injected. It is of course the pathologic element . Amazing nonsense that you spew.

Expand full comment

I'd recommend reviewing a few articles.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9021367/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9968612/

https://scopeblog.stanford.edu/2023/07/31/mrna-vaccine-spike-protein-differs-from-viral-version/

https://www.nature.com/articles/s44161-023-00222-0

Yes, S protein does persist for weeks in most cases and is eliminated by immune binding or excretion. Longer persistence indicates other issues, including a potential humoral immune response dysfunction or an increased cytokine response to the initial exposure to antigen. Overall, the literature I've found today is consistent with the literature I've seen in the past suggesting the duration of S protein is on the order of weeks. We know there's passage of humoral-mediated antibodies across the placental barrier.

https://www.sciencedirect.com/science/article/pii/S2589004223016267 suggests that "We observed minimal uptake of mRNA vaccines in placental explants by in situ hybridization and quantitative RT-PCR. No specific or global cytokine response was elicited by either of the mRNA vaccines in multiplexed immunoassays. Our results suggest that the human placenta does not readily absorb the COVID-19 mRNA vaccines nor generate a significant inflammatory response after exposure."

Expand full comment

If you read garbage and have no medical education it's probably better for you to stop reading. You can easily find the 2 critical points above mentioned.

Expand full comment

You are describing yourself.

Expand full comment

Says the fake Doctor. Lol. Still trolling and pretending?

Expand full comment

Bullshit!

Expand full comment

Both my kids were breast fed and had zero respiratory infections in their first few years.

Expand full comment

So important to facilitate breast feeding for all mothers, both those who work and those who are at home.

Expand full comment

Dr Offit, I respect you a lot but this article is tough to read. My baby was very breastfed and still had RSV which landed her in the NICU for a full week. It's an awful illness and mothers shouldn't feel like it's their fault if they cannot breastfeed and being unable to do that was a contributing factor to their child having RSV. Not being able to breastfeed is a complicated and personal choice.

Expand full comment

If you’re not able to, it isn’t a choice, surely?

Expand full comment

Too many people don't understand that not every mother can produce adequate milk for their infant. I'm not an expert on this (my wife, a Board-certified Lactation Consultant, is, however), so my thoughts are anecdotal but she treated a number of women in her practice as a Certified Nurse Midwife in a busy Central Texas Ob/Gyn practice who were unable to nurse. Many felt like it was their fault, and some tried to solely feed their kids that way even when they were falling behind in new-born and well-baby pediatrics checks on the growth charts. This is a serious problem of misunderstanding.

Expand full comment

Thanks for sharing your personal experience. Having a baby in the NICU with RSV sounds terrifying. I'm sorry you both experienced that, and glad she was alright.

Your point that mothers shouldn't feel guilty for their limitations is valid. But, as my original comment noted, evidence does not establish a causal link between breastfeeding and RSV prevention. So it would be incorrect to inform mothers that not breastfeeding was a contributing factor in the event that their children got RSV.

In fact, "exclusive breastfeeding" as it's currently promoted by the medical mainstream may causally contribute to common and preventable harm including increased infant infection risks when breastfeeding insufficiencies cause starvation, which has numerous medical sequelae of possible clinical significance. Then, it may look like breastfed babies fare better in numerous ways when moms for whom it doesn't work so well eventually listen to their hungry babies and switch to formula. However, that could be not because breastfeeding is necessarily protective (although maybe it is when it works!) -- but because starvation is risky. Available data cannot distinguish this possible causal story from the alleged breastfeeding benefits that most experts incorrectly assume are established.

At the same time, the potential negative impact on mothers that you describe here, from medical and social pressures to breastfeed, is quite real. I was not able to breastfeed my son, and received poor medical advice resulting in accidentally starving him for over a month under the auspices of "exclusive breastfeeding." Still numerous medical practitioners told me that I could do it, that every woman can, and how important it was for my child - when all the data said it did not work. It took realizing that I had been wrong, including in my pregnancy readings of peer-reviewed science like PROBIT (famous breastfeeding RCT) results - and digging down into the literature using the knowledge gleaned from my difficult personal experience - to understand what had happened. The resulting critique (published in my 2021 article also linked above, https://www.cureus.com/articles/68847-breastfeeding-insufficiencies-common-and-preventable-harm-to-neonates) suggests that current infant feeding guidelines conflict with the available evidence.

Expand full comment
Comment removed
Expand full comment

Your comments are erroneous and dangerous.

Expand full comment

Oh my god, its just a title Dr Schenk get a life. Dr Offitt thanks for your time, ignore the Woke l google users please, i appreciate getting the facts. The act of breastfeeding is free, are their opportunity costs with breastfeeding? Yes ,but there are opportunity costs with vaccination. This is a Medical site, not an economics site. Given this reality vaccines cost ~$500, breastfeeding $0. Therefore breastfeeding is Free! Some people are just unhappy and complaining is part of their DNA, ignore them please Dr Offitt!

Expand full comment

To the contrary, new moms hear quite a bit that "breast is best." But a causal link between breastfeeding and benefits including infection prevention as argued here is inadequately supported by available data. Meanwhile, the exclusive breastfeeding paradigm risks common and preventable harm to newborns, including in terms of permanent neurodevelopmental harm. See, most recently, Merino-Andrés et al's Oct. 2023 review of "Neonatal hyperbilirubinemia and repercussions on neurodevelopment" in *Child: Care, Health and Development* (https://onlinelibrary.wiley.com/doi/full/10.1111/cch.13183), as well as my articles (https://pubmed.ncbi.nlm.nih.gov/?term=vera+wilde) and related talk (slides 7-9, https://docs.google.com/presentation/d/17fLcUdMTzc1aEWuXX54pQ_OGJCnQGeHiw7c8fhy_d_0/edit#slide=id.g23c8339bb0e_2_75). Possible selection effects threaten relevant causal inferences, including in available experimental data.

It's a sexy story that corrupt corporations keep women from breastfeeding despite innumerable health benefits for mother and child. But that's not what the evidence suggests. Women who can, do report switching to formula for many valid, empirical reasons including insufficient milk -- a reality medical researchers and professionals tend to deny without evidence. And starvation isn't any better for human babies than it would be for puppies or kittens. Healthier animals tend to have healthier metabolic processes like breastfeeding, and less healthy animals shouldn't suffer starvation when those metabolic processes don't work so well. Especially when those animals happen to be newborn babies.

Expand full comment

The fact that some women cannot breast feed does not argue against the benefits.

Expand full comment

The fact that breastfeeding insufficiencies are common and have serious possible medical consequences suggests an alternative causal story. The dominant narrative is that breastfeeding causes benefits. An alternative interpretation of the same evidence is that healthier mothers and babies may be better able to breastfeed, accidental starvation from exclusive breastfeeding may do preventable harm (e.g., by causing or worsening jaundice), and these effects may explain associations between breastfeeding and better health outcomes. That is, these associations may not be because breastfeeding causes benefits -- but, rather, because current exclusive breastfeeding norms cause preventable harm to infants whose mothers realize it's not working and switch them to formula.

Expand full comment

Breastfeeding can be incredibly challenging for an employed mother or in someone whose milk production, baby latching, and breast discomfort/injury prevent this option from working in the real world. Yet I think the evidence for RSV protection is there, similar to the 80% reductions noted above:

“Ip et al. [3]. reported the risk of hospitalization for lower respiratory tract infections during the first year of life is reduced by 72% if infants are exclusively breastfed for more than 4 months.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170789/#:~:text=Ip%20et%20al.,for%20more%20than%204%20months.

If I were a woman I might by default try to breastfeed but keep reassessing how that’s going in reality for me and the baby, get the vaccine as close to 36 weeks as possible if delivering into RSV season, or have my child get Beyfortus later if they were born into a low RSV prevalence time of year. Thoughts on that?

Expand full comment

As a well known researcher has said, there are no solutions, only trade offs.

Expand full comment

Time to engage a good Boards-certified Lactation Consultant (IBCLC) to support the women who have difficulties with breast-feeding, as they are trained and can recognize when it's time to switch to another approach for the benefit of Mom and Baby, and can also work with Mom to understand it's a physical process and not a failure on her part.

Expand full comment

Also, don't you think it's a little weird that you prefaced your proposal with "If I were a woman"? You're not. Maybe your expertise is limited by perspective in important ways here. What if you were a woman who had been sexually assaulted and worried breastfeeding might be triggering (a reported phenomenon)? What if you were a woman with mental health problems that could be exacerbated by inadequate sleep (as most of them can), and formula made your baby sleep more (as it does)? The evidence is just not here for sweeping recommendations that affect all mothers and babies in ways that can have far-reaching implications for their health and quality of life. Many of them bad.

Expand full comment

Points well taken, Vera. I meant to say "If I were a woman" more from an acknowledgement that I'm not, and that blanket recommendations are not helpful for many individual women. Or men with blanket recommendations. But if no one recommends anything for fear of unique contraindications, then it's just chaos.

You may find this offensive, but I mean it in the best way possible: I just watched Barbie with my very feminist wife and daughter, and I can take the well-deserved heat. I loved it, besides the meta-commercialism. And I'm sorry that medical advice can come across as wrong and cruel in certain situations. We need a lot more compassionate disclaimers. thanks for speaking up with you point of view, it's helpful.

Expand full comment

I'm glad you like Barbie. Now please address the substance of my main argument: No evidence of causal benefit from breastfeeding versus evidence of common and preventable harm means Offit and the "breast is best" consensus are dangerously wrong.

Expand full comment

I don't know if you can access this UpToDate Article:

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding

I won't cut and paste the whole thing here. I will only cut and paste the parts relevant to what I think is your sincere request regarding benefits in terms of infection prevention. Women should never feel shame or guilt if breastfeeding does not work for them, or is physically/emotionally painful. Love, protection, and nurturing cannot be reduced simply to breast feeding... It's just an optional part. But the consensus you refer to is thusly derived:

"Prevention of illnesses while breastfeeding

In both resource-abundant and resource-limited settings, human milk, compared with infant formula, decreases the risk of acute illnesses during the time period in which the infant is fed human milk. Most of these benefits are related to protection from infectious diseases [1,39]. In one study, breastfeeding was associated with fewer serious infections requiring hospitalization during the first year of life, with a 4 percent reduction in hospitalization for every extra month of any breastfeeding [39].

The protective effect includes:

●Gastroenteritis and diarrhea – Breastfeeding lowers the risk of gastrointestinal infections and diarrhea in many populations, but this is particularly important in resource-limited settings [40-42]. In a meta-analysis that included studies from both resource-limited and resource-abundant settings, the risk of diarrhea in infants <6 months was lower in those who were breastfed (pooled relative risk 0.37, 95% CI 0.27-0.50) [40]. In a study in the United Kingdom, infants who were breastfed exclusively for six months had a decreased risk of severe or persistent diarrhea compared with infants who breastfed exclusively for less than four months [41]. The protective effects are greater for infants living in resource-limited settings, likely because formula-fed infants are more likely to be exposed to pathogens through improperly prepared formula and also because they tend to have worse nutritional status than breastfed infants.

●Respiratory disease – Breastfeeding lowers the risk of respiratory disease in the infant, based on results of studies from several different types of populations. As examples, in an study from the United Kingdom, infants who were exclusively breastfed for six months had a decreased risk of lower respiratory tract infections than infants who exclusively breastfed for less than four months [41]. In another study conducted in the United States and Europe, breastfeeding reduced the risk of respiratory infections in three- to six-month-old infants by approximately 20 percent [42]. Optimizing breastfeeding in the United States to current recommendations has been estimated to prevent almost 21,000 hospitalizations and 40 deaths for lower respiratory tract infections in the first year of life [43].

●Coronavirus disease 2019 (COVID-19) – Vaccination of pregnant people against COVID-19 is recommended, and vaccine-generated antibodies to the causative virus cross the placenta and into breast milk to confer passive immunity to newborn infants. Although antibodies persist in breast milk for at least several months, there is no definitive evidence regarding how much protection this confers on the infant or how long it might last [44,45]. (See "COVID-19: Overview of pregnancy issues", section on 'Vaccination in people planning pregnancy and pregnant or recently pregnant people'.)

●Otitis media – The incidence of otitis media and recurrent otitis media are reduced in breastfed compared with formula-fed infants, primarily for those younger than two years [42,46,47]. The incidence of two or more episodes of otitis media was reduced in infants breastfed for one year compared with infants fed formula (34 versus 54 percent) [48]. Feeding directly at the breast appears to be more beneficial than feeding expressed human milk [49].

●Urinary tract infection – In a case-control study conducted in Sweden, there was a significantly higher risk of urinary tract infection for infants who were not breastfed compared with those who were. Longer duration of exclusive breastfeeding reduced the probability of urinary tract infection, especially in females up to seven months of age [50]. A separate case-control study found that human milk feeding was associated with a lower risk of urinary tract infection in premature infants in the neonatal intensive care unit [51]. A mechanism for this protection has been suggested, based on observations that breastfed infants have greater contents of oligosaccharides, lactoferrin, and secretory IgA in their urine compared with formula-fed infants [52]. (See 'Biologically active components of human milk' above.)

●Sepsis – Early institution of exclusive breastfeeding decreases the risk of developing neonatal sepsis [53-56]. (See "Clinical features, evaluation, and diagnosis of sepsis in term and late preterm neonates".)

●Sudden infant death syndrome (SIDS) – Any breastfeeding is associated with a decreased risk of SIDS [57-59]. Exclusive breastfeeding and longer duration of breastfeeding confers the greatest protection [60,61]. (See "Sudden infant death syndrome: Risk factors and risk reduction strategies", section on 'Protective factors'.)

Mortality and hospitalization — In low- and middle-income countries, breastfeeding substantially decreases the risk of childhood mortality [62-64]. In a meta-analysis of 13 studies conducted in these populations, children exclusively breastfed through five months had lower risk of all-cause and infection-related mortality compared with those only partially or not breastfed [62]. Children aged 6 to 23 months who were not breastfed had higher risk of all-cause and infection-related mortality than children who continued breastfeeding. A separate systematic review showed that initiation of breastfeeding within one hour of birth decreased neonatal mortality compared with later initiation [63]. It has been estimated that improving global breastfeeding could prevent 823,000 annual deaths in children younger than five years [46].

Breastfeeding also reduces the risk of infant mortality in high-income countries. In a study of more than 3 million births in the United States, breastfeeding initiation was associated with reduced risk of mortality during the late perinatal period (7 to 28 days; adjusted odds ratio [AOR] 0.6, 95% CI 0.54-0.67) and the post-perinatal period (28 to 364 days; AOR 0.81, 95% CI 0.76-0.87) [59]. Significant effects were seen across different racial/ethnic groups and across all gestational age and birth weight groups, as well as for deaths due to infection, SIDS, and NEC. (See "Sudden infant death syndrome: Risk factors and risk reduction strategies", section on 'Protective factors' and "Neonatal necrotizing enterocolitis: Prevention".)

These data confirm and extend the findings from earlier smaller studies that also found a beneficial effect of breastfeeding on mortality [46,65,66], as well as associations between breastfeeding and lower rates of hospitalization and outpatient visits during the first year of life [46,67-70]. These findings suggest that severity of illness is reduced in the breastfed infant [48]."

Expand full comment

I’m sure I’ll be painted as misogynist for saying this. But not being a particular gender, race, etc, doesn’t preclude one from having an opinion.

Expand full comment

Oh prove your a woman!

Expand full comment

As I described, possible selection bias plagues existing research including the classic Ip et al article that you cite. There is ample evidence that poor maternal health can adversely impact both breastfeeding success and child health. There is no causal evidence establishing breastfeeding benefits. And that makes telling women that there is, given the challenges you acknowledge, both wrong and cruel.

Expand full comment

So, I have a number of questions:

1. Your first link on hyperbilirubinemia , it is common in newborns. It also have other causes but breastfeeding is not listed nor in your link. https://www.verywellhealth.com/bilirubin-definition-and-description-1759872

2. The Mammalians have evolved this system of feeding their youngs eons ago.

3. From my limited knowledge in this area, Colostrum is enormously important in establishing gut microbiome as well as other immunizing effects.

4. Autism? In your powerpoint talk? Really?

5. Are there challenges for breastfeeding? Absolutely and too numerous to list.

6. Not a binary as to breastfeeding or "formulas", you can do both. I have a story for you!

Expand full comment

I'm sorry my reply to you yesterday was not in the tone to which I aspire.

You raised reasonable issues, which this reply addresses in the order in which you raised them.

1. The first article I linked above does indeed cite my peer-reviewed 2022 article on neonatal jaundice, autism, and breastfeeding (also linked to in my original comment). I think anyone challenging (as well offering) citations needs to read them carefully before saying they do or do not contain some claim or result.

That said, hyperbilirubinemia does have other causes, as you note. However, jaundice severity predicts damage, and formula supplementation prevents jaundice progression and helps treat it by enhancing bilirubin clearance through excretion. There is no other treatment that does this, including breastfeeding.

2. In the late 1970s, well-intentioned modern Western reformers created a new mythology around "exclusive breastfeeding." It included this origin myth you are presuming, of an infant feeding Garden of Eden where mammal mothers always exclusively breastfed their infants. But this story reflects ignorance of a great deal of variety across the animal world, including human societies.

For instance, anthropologist Sarah Hrdy synthesized early infant feeding approaches in different societies documented in the Human Relations Area Files database in her book *Mothers and Others* (https://www.hup.harvard.edu/catalog.php?isbn=9780674060326). She noted the Efe and Aka tribes have an already lactating woman feed newborns in the first full 48 hours before a new mother's mature milk typically comes in. If there's not one around, they send to a neighboring tribe for a wetnurse.

My synthesis of parts of the extensive eHRAF database is consistent with Hrdy's suggestion that feeding newborns differently than we do today has long been part of many societal traditions. There's a lot we don't know about the rich cultural tapestry of human societies; but what we do know here documents a lot of variation and collaboration, and a lot of early supplemental and complementary feeding practices — as opposed to the modern Western myth that a particular form of exclusive breastfeeding involving one mother:child pair from birth was universal prior to the advent of formula.

3. It's possible that, as you suggest, colostrum (the thin first milk most mothers make in the days before mature milk comes in) may offer health benefits. But it's not known. In fact, the modern Western emphasis on feeding newborns colostrum bulldozes a wide array of cross-cultural traditions of prohibiting the practice. So we also don't know what benefit, if any, accrues in relation to what cost of this change.

While colostrum taboos have been widely interpreted as examples of maladaptive culture, it's possible that they had important functions including protecting infants against the rare risk of life-threatening Sudden Unexpected Postnatal Collapse (SUPC; https://pubmed.ncbi.nlm.nih.gov/23518795). This would make them a Chesterton's fence (https://fs.blog/chestertons-fence) - something we should not have bulldozed, without first understanding its purpose. Colostrum taboos may have also helped new mothers rest before initiating breastfeeding after their milk came in, and improved the chances that newborns were adequately fed in their first days from a different source.

At the same time, the health benefits of probiotics are increasingly well-established including in protecting infants against serious infections like NE (https://pubmed.ncbi.nlm.nih.gov/?term=probiotics+necrotizing+enterocolitis). This is one plausible mechanism whereby your suggestion that colostrum offers important health benefits could work. However, probiotic supplementation may offer a more reliable delivery method, given the common nature of dysbiosis.

4. As previously mentioned, I gave an invited talk on the basis of my two related peer-reviewed articles on preventable harm from the exclusive breastfeeding paradigm at the University of Kent this May. Due to a technical failure, I regret that the slides but not video are available, and these are linked in my previous comment.

The connection between breastfeeding and autism is that breastfeeding insufficiencies in the first days of life are near-universal. They cause starvation. Starvation worsens neonatal jaundice. And hyperbilirubinemia can do permanent brain damage including possibly substantially increasing the risk of neurodevelopmental disorders like ASD.

5. It's reasonable to acknowledge that there are numerous challenges to breastfeeding.

6. You're absolutely right that breastfeeding is not a binary variable! That's a chief flaw in current infant feeding guidance that promotes exclusive breastfeeding, where supplemental feeding at least in the first days of life makes more sense as a harm prevention norm.

I've heard from so many moms who combi fed. Theirs are success stories. But the option isn't widely taught in prenatal classes. Universal infant feeding guidelines promote exclusive breastfeeding instead, and many medical practitioners advise their patients accordingly.

Hopefully this reply better addresses your questions and invites further discussion should more arise.

Expand full comment

The first article I linked to does indeed cite my peer-reviewed 2022 article on neonatal jaundice, autism, and breastfeeding (also linked to in my original comment).

And yes, really, I gave an invited talk on the basis of my two related peer-reviewed articles on preventable harm from the exclusive breastfeeding paradigm at the University of Kent this May.

But hey, people are going to be wrong on the Internet. Happy to hear your story. Would be nice if you'd reciprocate the basic norms of civil discourse by actually reading the references I cited if you're going to argue about them, though.

Expand full comment

You work for Emfamil dont you? Or a Bot! Breastfeeding is as good as the vaccine or monoclonal is the point. Well actually the vaccine is worse than breastfeeding unless you want dead babies. Read the Study Dr Offit is and quit flooding this discussion with cra..

Expand full comment
Nov 6, 2023·edited Nov 6, 2023

https://cks.nice.org.uk/topics/jaundice-in-the-newborn/background-information/risk-factors/

Note the word significant.

“ Factors associated with significant neonatal hyperbilirubinaemia include:

Decreased gestational age/preterm delivery.

Low infant birth weight.

Development of jaundice within first 24 hours of life.

Male sex.

Visible bruising.

Cephalhaematoma.

Maternal age older than 25 years.

Maternal diabetes mellitus.

Asian, European, or native American ethnicity.

Sibling born with jaundice requiring phototherapy/other treatment.

Dehydration.

Poor caloric intake/increased neonatal weight loss.

Breastfeeding.”

https://www.nhs.uk/conditions/jaundice-newborn/

“Jaundice is caused by the build-up of bilirubin in the blood. Bilirubin is a yellow substance produced when red blood cells, which carry oxygen around the body, are broken down.

Jaundice is common in newborn babies because babies have a high number of red blood cells in their blood, which are broken down and replaced frequently.

Also, a newborn baby's liver is not fully developed, so it's less effective at removing the bilirubin from the blood.

By the time a baby is about 2 weeks old, their liver is more effective at processing bilirubin, so jaundice often corrects itself by this age without causing any harm.

In a small number of cases, jaundice can be the sign of an underlying health condition. This is often the case if jaundice develops shortly after birth (within the first 24 hours).”

https://www.nice.org.uk/Guidance/CG98

https://cks.nice.org.uk/topics/jaundice-in-the-newborn/background-information/complications/

“The level at which bilirubin is likely to cause neurotoxicity is variable and may be affected by a number of factors, such as prematurity, postnatal age, the rate of serum bilirubin increase, and co-existing illnesses (particularly if associated with sepsis, acidosis, and hypoxia)”

“ Neurological complications in neonates with jaundice are rare. A prospective surveillance study found a UK incidence of bilirubin encephalopathy of 0.9 per 100,000 live births [Manning, 2007]. In high resource countries, studies suggest that in the absence of risk factors such as sepsis or Rhesus haemolytic disease, chronic bilirubin encephalopathy or kernicterus occur in around 1 in every 200,000 live births [Academy of Breastfeeding Medicine, 2017].”

Preer GL, Philipp BL. Understanding and managing breast milk jaundice. Arch Dis Child Fetal Neonatal Ed. 2011 Nov;96(6):F461-6. doi: 10.1136/adc.2010.184416. Epub 2010 Aug 5. PMID: 20688866.

Expand full comment

A review of the evidence for a change (?).

Expand full comment

I worked full-time and breastfed for the first three years of my child's life. It wasn't easy, but I made it a priority, and I did so as a solo parent. It is possible. I know other parents who did the same.

Expand full comment

Paul, after hearing your discussion with Vincent on microbe.tv, may I suggest that it would be easier for those mothers who work outside the home to breast feed *IF* their employers provided a private space for lactation. Many employers are recognizing this and accommodating their nursing employees by having a small room available with a comfortable chair and electrical outlets for the pumps.

Expand full comment

Why was rsv virtually unheard of 30 years ago?

Expand full comment

30 years ago? In 1993 I was very busy as a resident b/c of RSV during the winter.

Expand full comment

RSV was not unheard-of 30 years ago. It was recognized as a cause, in infants, of bronchiolitis, in some few cases of croup, and pneumonia. Most people will have had an infection by age 5 (COVID and the lockdowns reduced this during the 2020-2021 "season" meaning the 2021-2022 interval saw more infections than usual. Because most people have been infected conventional wisdom was that adults were immune and it wasn't an issue in the older population. About 10 years ago, testing in older adults revealed that severe respiratory illness during the winter months was often related to RSV, changing the concept, once again, of life-long immunity.

Expand full comment

Well I’d never heard of it when I was a mom vigilantly reading every health related issue on children. And neither had any of my mom friends. It was a non issue and certainly nothing to get vaccinated over🙄 But we didn’t have daycare babies, we took care of ours until they started 1st grade, and even then worked around the kids schedule so they were the priority-so maybe that’s why?

Expand full comment

I was involved in healthcare. It wasn't a non-issue for us.

Expand full comment

Thank you for being a voice of reason and for caring about children.

Expand full comment

always clear and fact-based information from the premier infectious-disease pediatrician

Expand full comment

You don’t hear much about it as it’s not making money for anyone. But I agree, it should be talked about more.

Expand full comment