Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694819123415.pdf (Australia)
Submission No.

153 AUTHORISED.

~ ~ australian breastreeding association Submission by the Australian Breastfeeding Association The Australian Breastfeeding Association (ABA) (fonnerlythe Nursing Mothers’ Association of Australia) welcomes the opportunity to make this submission to the future direction for the health of our children.

The health of Australia’s children should be a priorityfor all governments.
A significant bodyof research demonstrates that nutrition in infancyhas a significant influence on health outcomes throughout life.

Not breastfeeding or premature weaning from breastfeeding is known to be a significant indicator for poorer health outcomes later in life, including obesity.

Australia is currentlyburdened with the health costs associated with poor breastfeeding practices of the past.

Investing in breastfeeding is an investment in the health of our children.
The Association would like to see policythat addresses this issue thnugh the promotion, protection and support of breastfeeding.

Since its’ founding by six mothers in 1964, the Association has spread to all Australian states and territories to become one of the country’s largest women’s non-profit organisations and Australia’s leading source of breastfeeding information and support.
The Association aims to support and encourage women who desire to breastfeed their babies, and to raise community awareness of the importance of breastfeeding and human milk Eachyear, we handle more than260,000 counselling contacts, hold more than 90,000 communityevents, and our volunteers contribute more than$16.6 million m community support.

The Association is also a recognised authority on breastfeeding management and training.
Our Lactation ResourceCentre (LRC) provides a scientific basis for the Association’s breastfeeding policies and provides training and education for health professionals, complementing the practical experience of breastfeeding mothers with one of the most comprehensive collections of breastfeeding infonnation in the world.

Please do not hesitate to contact me if you would like furtherinformation about the Australian Breastfeeding Association or this submission.
Yours sincerely Margaret Grove Nationalpresident Australian Breastfeeding Association Submission by the Australian Breastfeeding Association Themes of submission: 1.

2.

2.

3.

4.

5.

Health Issues facing Australian Children and the Importance of Breastfeeding Impact of Breastfeeding on the Health of Mothers Breastfeeding Rates in Australia Economic costs of premature weaning Why are our breastfeeding practices poor?
Breastfeeding, Maternity Leave and Childcare This submission will detail the importance of breastfeeding to health and the risks associated with premature weaning in relation to key health challenges faced by the Australian community.

It will also address some other important considerations for health and wellbeing.

Executive summary To improve children’s health on a population basis it makes sense to workon the foundation of health.
Good health for children begins with breastfeeding; poor health begins with premature weaning from breastfeeding.

Breastfeeding is important in preventative healthbehaviour with implications for infant and maternal health, national healthcosts and the environment The public health benefits of breastfeeding are well documented and continue to accumulate.
Artificial formula feeding substantially increases the nsk of gastrointestinal illness, respiratoryillness and infection, eczema, and necrotizing enterocolitis, with increasing scientific evidence of its links with chronic or senous illnesses or conditions such as childhood diabetes, urinaiy tract infection, certain types of cancers, diseases of the digestive system such as coeliac disease and Crohn’s disease, liver disease and cot death.
Breastfeeding is known to promote cognitive development and higher IQ, central nervous system development and visual acuity, and speech and jaw development.

Breastfeeding also helps protect mothers against breast cancer and other cancers of the reproductive organs, and osteoporosis.’ Breastfeeding rates in Australia are wellbelow levels recommended by health authorities.
Very few Australian infants are exclusivelybreastfed to 6 months and one in two is alreadyweaned by 6 months despite NHN’IRC recommendations for exclusive breastfeeding to 6 months and health targets for 80 breastfeeding at that age.

Poor infant feedingpractices increase ill health of mothers and babies, and significantly raise communityand family health costs.

of babies to be atleast partly Recommendations The protection, promotion and support of breastfeeding are important public health needs.
While most Australian mothers begin breastfeeding but theyneed support to continue.

Breastfeeding is not a responsibilitythat lies just with mothers.

Mothers need the support of their families, peers, communities, workplaces, health professionals and 1 See for example Gartner LM, Morton J, Lawrence RA, Naylor AJ, O’Hare D, Schanler RI, Eidelman Al, American Academy of Pediatrics Section on Breastfeeding 2005, Breansfeeding and the use ofhuman milk.
Pediatrics 115(2): 496-506. governments to continue breastfeeding.

We propose a multi sector partnership approach, Governments and the community working together2.

This Plan proposes actions in four strategic areas: 1.

Establish policies, legislation and institutions protective and supportive of breastfeeding.

2.

Develop a Breastfeeding Friendly Healthcare System - hospitals, health professionals, and pharmacies 3.

Promote Breastfeeding Friendly Workplaces and Childcare Services 4.
Strengthen Breastfeeding Friendly Families and Communities We urge the current government, and indeed future governments, to consider including a strategy to protect, promote and support breastfeeding as part of its health policy because, as we will demonstrate the dumtion of breastfeeding and whethera child is prematurely weaned from breastfeeding impacts many health issues.
2 Anr~ij~ Breassfeeding Association Leadership PlanAugust 2004 HEALTH ISSUES FACING AUSTRALIAN CHILDREN AND THE IMPORTANCE OF BREASTFEEDING Foetal origins of disease are well establishedin the research literature.

Earlynutrition and care has a profound impact on the health and development of children.

Human milk provides infants with nutrients that are essential for normal growth and with immune factors that support infants’ abilityto fight illness.
Babies are born with an immature immune system, and are extremelyvulnerable to infection.

However, their breastmilk acts as an external immune support system.

~1aenbabies are prematurely weaned their external immune support is removed from them and theyare more likely to become ill and theyhave more difficultyin recovering from illness.

Low birth weight babies An increasing number of babies are born in Australia with a low birth weight.

Often these babies were born prematurely.


These babies are particularly vulnerable and breastfeeding is particularly important to their health outcomes.

NEC is a common disease of the intestinal system seen almost exclusively in low birth of low birth weight babies develop NE& resulting in a weight babies.

Between 5-10 high risk of surgical complication and morbidity.

It has been estimated that 20-35 of babies who develop NEC will die as a result of the infectionl-5.
However, babies who are fed breasimilk are not equally vulnerable to NEC; babies who are fed breastmilk substitutes (infant formulae) are at 500-1000 developing NEC and babies fed a mixture of breastmilk and bivastmilk substitute are at a 200 components of humanmilk assist in the maintenance of intestinal health in premature babies and preventthe development of NEGs.

increased risk of developing NEC3.


It is thought that increased risk of Premature babies fed breastmilk substitutes are also at greater risk of all infection related events including: late onset sepsis, urinarytract infection, diarrhoea and upper respiratory tract symptoms7.

In very small babies anyinfection can be life threatening.

Other conditions such as retinopathy of prematurity and chronic lung disease are more common in premature babies fed breastmilk substitutes5.
Children who as premature infants did not receive breast milk display intellectual deficits of an average of 8 IQ points.

Breastmilk is essential for normal brain development8.

Mothers whose babies are born prematurely are in need of increased support for breastfeeding.

Prematurity or having spent time in a special care nurseryis a risk factor for not breastfeeding in Australia9.
In addition, providing sufficient milk can be a challenge even for mothers who strongly wish to do so (especially when there are medical ~Loh M, Osborn DA, Lui I( (2001).

Outcome ofvetypsematuse infants withneceotising entecocolitis cased for in centres with or without on site surgical facilities.

Anthives of Disease in Osildisood Foetal Neonatal edition 85: F114-F118.

4 Landers 5 (2003).

Maximisingthe benefits of hunssn milk feeding for the peeterminfant.

Psediatric Annals 32: 298-306.


Lucas A, Cole TJ (1990).

Bresatmilkand neonatal neceotising enteivcolitis.

The Lancet 336, 1519-1523.

6 Cisplan MS. AmerM, Jilling T (2002).

The mieof human milk innecastizing enterocolicis.

Advances in Experimental Medicine and Biology503: 83-90.

7 Schanler RJ, Lau Q Hurst NM, Smith EO (2005).

Randonsised trial ofdonor human milkversus pretems formula as substitutes for mothers’ own milkin the feeding ofextremelypremature infants.

Pediatrics 116: 400-405.


8 Lucas A,MorleyR, Cole TJ, ListerG,Leeaon-Payne C(1992).

Breast milkand subsequent intelligence quotientincbildren bom precems.

Lancet 339: 261-264.

9 Scotej.A, Lenders MCXI, Hughes RM, finns CW(2001).

Factors associated with breastfeeding at discharge and dumtion of breastfeeding.

Joumal of Poediatric Osild Health 37:254-261 complications that led to the preterm birth such as pre~eclampsia)10.
It is important that medical staff and managers prioritise assisting mothers to provide milk for their babies.

Lactation support programs in NICUs have been successfully implemented and can result in breastfeeding success rates above those of the ambient population demonstrating that prematurityis not an inherent ban-ierto breastfeedingll.
Human Milk Banks In those circumstances where mothers are unable to provide milk, human milk banks can provide the most vulnerable babies with the nutritional support theyneed.

Prof Peter Hartmann and Dr Karen Simmer in Perth have recentlyset up a Human Milk Bank at King Edward Memorial Hospital with the assistance of private funding.
(Prof Hartmann’s research group is also developingprotocols forprocessing of human milk so that fortification of milk for premature babies can be provided without the risks associated with fortifiers based on animal milk) Dr Howard Chilton is seeking to set up a bank in Sydney and midwife Maera Ryan is similarly raising funds to provide human milkto sick babies on the Queensland Gold Coast.
Human milk banks are a cost effective intervention because low birth weight babies who are not provided with breastmilk are not only less likely to survive but will require more interventions in hospital and have longer hospital stays12.

However, governmental and departmental support is required to make human milk available to all babies who need it.
Overseas experience indicates that the costs associated with banked donor milk are more thanoffset by the savings to the hospital system resulting from decreased costs due to illness when babies are providedwith human milk13.

Children born with a disability Breastfeeding assists children to reach their full potential.
In instances where a child’s disability involves a cognitive impairment early nutritioncan be particularly important because premature weaning causes a 3-8 point IQ deficit.”’ 15 16 A deficit of this magnitude atthe lower end of function increases the need for resources in special education at a population level and at, an individual level, may make the difference between living independently or being in need of intensive support.
Lester et al17 provides a detailed description of the additional health and educational costs flowing from the average 3 point IQ deficit caused by cocaine exposure in utero.

When a child is born with special needs of any kind the development of the mother-child relationship is impacted’8.

However, breastfeeding can assist in the development of the 10 Gorenendaal F, Sauer PJJ (1991).

Breasemilk and neceotising enteancoliris.

The Lancet 331: 435-436 ~ SpatzDL (2004).


Ten steps for peomoting and prvtecting breastfeeding for vulnemble infants.Joumal of Perinatal and Neonatal Nursing 18: 385-396.

12 Schanler RJ, Shulman RJ, Lau C (1999).

Feedingstmtegies for premature infants: beneficialoutcomes of feeding fortifiedhuman milkversus pretemt fonmla.

Pediatrics 103: 1150-1157.

LD (2002).

The Cost-effectiveness ofUsing BankedDonor Milk in the Neonatal Intensive Cam Unit: Prevention of Neceotizing Entemeolitis.
Joumal ofHuman Lactation, 18(2); 172-177.

14 Mortensen El.

Michacisen KF; Sanders SA.

Reiniach JM (2002).The Association BetweenDuretion of Breastfeedingand Adult Intelligence.

Obstetrical &Gynsecological Survey.

57(10): 659-661.

15 Daniels MQ AdairLS (2005).

Breast-feeding influences cognitive development in Filipino children.Joumal of Nutrition 135: 2589-2595.

A (2001).

Bresatfeeding and brein development.

Psediatric Clinics of North America 48:159-171.

17 LesterBM, La Gasse, Seifer K. (1998).


Cocaine exposure and children: the meaning of subtle effects.

Science 282.5389: 633. t8 Blscherj Meyers CE (1983).

A review of anachment fonnation and disorder in handicapped children.

American Joumal of Mental Deficiency87: 359-371.

I I mother-child relationship because hormonal and mechanical aspects of breastfeeding promote maternal responsiveness’9.

Mothers of babies born with a disability need additional support to breastfeed.
Some disabilities prevent direct breastfeeding and mothers need additional support to express milk for their babies.

Some disabilities may make children more vulnerable to the impact of premature weaning.

For example, childrenborn with a cleft palate have a eustachian tube dysfunction that makes them extremelyvulnerable to otitis media (at a 300 iisk)20.
Children with cleft palates fed infant formula rather than breast milk are much more likelyto suffer from otitis media and the shorter duration of breastfeeding the greater the incidence18.

However, children with clefts are often difficultto feed, most cannot be breastfed directly, prior to cleft repair18.

Some babies are unwilling to breastfeed after repair.
Thus, babies with clefts often receive breast milk for a shorter length of time than non-cleft affected babies’8 despite their increased health needs due to their disabilityand surgical intervention.

Geft affected babies provide just one example of the impact infant feeding has on the health of children with disabilities and demonstrate the need for increased assistance to maintain breastfeeding for children with disabilities.
greater Sudden Infant Death Syndrome (SIDS) While it is not possible to identify which babies are will fall victim to SIDS, this tragic event is not completelyunpredictable.

Rather, it is much more prevalent in socioeconomicallydeprived populations2122 and these populations are those least likely to breastfeed their babies.
Background epidemiological characteristics of SIDS victims and their families include low birth weight, short gestation, young maternal age, high parity, sole parent caregiver, parental smoking, parental alcohol consumption and bottle- feeding.
Every study looking at SIDS has found that babies that are not breastfed are on average twice more likely to die23 and even after statistical adjustment this relationship often remains2” 25~ However, since not breastfeeding is also associated with socio-economic deprivation the impact of breastfeeding on SIDS sometimes disappears in statistical adjustment for socio-economic background.2126 Nevertheless, there are some reasons whybabies not breastfed might be more vulnerable to SIDS.
Children who are not breastfed sleep more deeply and mayhave higher arousal thresholds than breastfed infants, impairing their abilityto respond to the life-threatening situation that results in SIDS.2~ Breastfeeding also provides protection against some 19 Gribble K (2006).

Mental health,attachment and breastfeeding: implications for adopted childrenand their mothers.

Intemacional BreastfeedingJoumal 1:5.

20 Amansson G, Avensson H, Becker H, Ingvarsson L (2002).
Otitis media and feeding with breast milk ofchildren with a cleft palate.

Scandinavian Joumal of Plastic and Reconstmctive Sur~eryand Hand Surgery 36: 9-15.

21 Blair PS, Sidebotham P, BerryPJ, Evans H, Flernming PJ (2006).

Mejor epidemiological changes in sudden infant death syndrome: a20-yearpopularion-based scudyinthe UK.

Lancet 367 (9507): 314-319.

22 FlemingPJ, Blair PS, Ward PM, TrippJ, Smith IJ (2003).
Sudden infant death syndeome and social deprivation: assessing epidemiological factors after pose-matching for deprivation.

Paediarric and Perinatal Epidemiology 17: 272-280.

23 McVeaKL, Tuner PD, PepplerDK (2000).

The role ofbreastfeeding in sudden infant death syndrome.

Journal ofHuman Lactation 16: 13-20.

24 Fredrickeon DD, Sorenson JR. Biddle AK, Kotelchuck (1993).

Relationship of sudden infant death syndrome to breast-feeding duretion and intensity.
American Joumal ofDiseases of Coildren 147: 460.

25 AIm B, Wennergren C, Norvenius SC, Skaerven R, Lagercrantz H, Heiweg-Larsen K, Irgens on behalf of the Nordic epidemiological aids study (2002).

Breast feeding and the sudden infant death syndrome in Scandinavia.

1992—95.

Archives of Disease in Childhood 86:400-402.


26 Flemiuig PJ,Blair PS, Platt MW, Tripp J, SmithIJ, CESDI SUDI Research Group (2003).Sudden infant death syndrome and social deprivation: assessing epidemiological factors after post-matching for deprivation.

Psediatric and Perinatal Epidemiology17: 272-280.

27 Home RS, ParslowPM, FerensD, Watts AM, AdamsonTM (2004).

Comparison of evoked arousabilityin breast and fonnula fed infants.
Archives ofDisease in Childhood 89: 22-25. pathogens implicated in SIDS such as S. aui~mand C pe?fii~e~.28 Infants who die of SIDS are also more likelyto have recentlysuffered from illnesses (the most common being respiratory infection)29 to which non-breastfed babies are more vulnerable.

Asthma Research has generally found that premature weaning from breastfeeding results in increased risk of development of asthma in children.
A meta-analysis of well-designed studies from around the world found that children weaned before 3 months of age had a 25 increased risk of developing asthma as comparedto children who were breastfed beyond 3 months.

In a specifically Australian context, research has found that introduction of milks other thanhuman milk before 4 months of age resulted in a 25 increased risk of asthma, an earlier diagnosis of asthma, a 31 increase in wheeze and earlier onset of wheeze30.
Encouraging exclusivity of breasifeeding, avoidance of breastmilk substitutes and increasing total duration of breastfeeding should be an important part of any strategy aimed at decreasing asthma incidence.

The increased incidence of asthma in children who are notbreastfed maybe due to increased vulnerability in children not breastfed to respiratory infections and allergy.
As will be discussed, children who are not breastfed are at an increased risk of suffering from multiple episodes of upper respiratory tract illness and this may make children more vulnerable to developing asthma.
An Australian study found that lower respiratoryillness with associated wheeze, in the first year of life, particularlywhere there are multiple episodes, increases the risk of asthma in children from between 300 (where a familyhistoryof allergy).3’ Adose dependent history of allergy) and 800 association between antibiotic exposure in infancyand the development of asthma has been identified32 and children who are not breastfed have been found to spend twice as much time on antibiotics as children who are breastfed.33 Children who are prematurely weaned from breastfeeding are also more likely to develop allergic symptoms and this is also associated with increased asthma risk29 There are other defence mechanisms against asthma associated with breastfeeding that are yet to be elucidated.29 (where no family The discussion paper notes that the ALP plans to liase with ProfessorFiona Stanley on these issues.
Professor Stanley is a co-author on some of the papers cited here in relation to early nutrition, asthma and allergies and is cognizant of the importance of breastfeeding in the health of children.

Allergy Infants fed infant formula (cow’s milk based or soy) have a higher incidence of allergy than babies who are breastfed.3435 Eczema is a t~e of allergic manifestationthat has 28 Cordon AE, Saadi AT, MacKenzie DA, Molony N,James VS, WeirDM, Burunil A, Blackwell (X1~(1999).
The protective effect of breast feeding in relation to sudden infant death syndrome (SIDS): III.

Detection of IgAantibodies in human milkthat bindto bacterial toxins implicated in SIDS.

FEMS Immunologyand Medical Microbiology2s: 175-182.

29 PIan~~BlairPS,Fle~gPJ, Smith IJ, Cole TJ, Laach CEA,BerryPJ, ColdingJ, CESDI SUDI Reseseth Croup.

A clinical comparison of SII)S and explained sudden infant deaths: how healthyand how normal?

Archives of Disease in Childhood 82:98-106.


30 Oddv~, Hole PC, SIyPD, Read AW, Landau LI, SesnleyFJ, Kendall CE, Burton PR (1999).

Association between breastfeeding and asthmain 6-year-old children: findings ofa prospective birth cohort study.

British MedicalJoumal 319: 815-819.

31 OddywH, KlerkNH, SIyPD, Hole PC (2002).

The effects of respiratoryinfections, atopyand breastfeeding on childhood asthma.

European ReapiretoryJoumal 19: 899-905.


32 Macca F, Lynd L, Coombes H, Richardson K, Lagal H, FiszCersldJIvL Mama CA (2006).

Does antibiotic exposure during infancy leaden development of Asthma?

A systematic review and metranalysis.

Chest 129: 610-618.

~ Flores MS, FairehokMP (2004).

The relationship of breastfeeding to antimicrobial exposure in the first year oflife.

Clinical Pediatrics 43: 631-636.

34 Friedman NJ, ZeigerR5 (2005).


The role of breast-feeding in the development of allergies and asthma.Joumal ofAllergyand Clinical Immunology ilS: 1238-1248. been studied in relation to early nutrition.

Kull et al36 exan’.ined the development of eczemain children whose families had a history of allergy and those who did not.
It was found that where there was no family history of eczema the risk of developingeczema was increased by 20 in children exclusively breastfed for less than 4 months and by in children with a family history of eczema.34 Children not exclusively breastfed for ~ atleast 4 months were also found to be 43 more likely to develop allergic rhinitis than children exclusively breastfed for 4 months or more.37 Finally, children who were not exclusively breastfed for 4 months or more were 43 more to suffer from multiple allergic diseases.35 Oddyet al38 found that children who were not exclusivelybreastfed were 30 more likely to show a positive skin prick test to atleast one common aeroallergen.
Exclusive earlybreastfeeding (for around six months) is particularly important in preventing allergy~ Australia’s exclusive breastfeeding rates are very poor39.
It is thought that children who are not breastfed are more likelyto develop allergy because: 1) Breastfed children are less exposed to foreign dietary antigens 2) Human milk contains factors that promote gastrointestinal mucosa maturation therebyallowing early“closure” of macromolecular absorption 3) Children not breastfed have increased incidence of infection and breastmilk substitutes alter the gut microflora in such a way that can act as to act as a adjuvant for ingested food proteins, increasing the risk of sensitisation 4) Human milk has functional immunomodulatory and anti-inflammatory factors that reduce macromolecular intake.
~ Thus, bottle-feeding provides regular exposure to many microbial products and foreign proteins that may cause sensitisation and other.
problems in infants, especiallyin those who are at high risk for development of allergic symptoms.41 As mentioned in the discussion paper, babies can be exposed to antigens via their mother’s milk however, the incidence of allergy as a result of this exposure is verylow and it is possible that this low level exposure mayinduce tolerance rather thansensitisation.42 Nevertheless, in cases where there is a strong family historyof allergyit maybe advisable for mothers to avoid consuming common dietary allergens.
It is not uncommon for babies to be exposed to cow’s milk protein via infant formula in the first few days of life in hospital.43 It is possible that this may initiate sensitisation to this protein in susceptible individuals so that subsequent exposures maythen result in ~ OddyWH,Peat 1K (2003).

Breasrfeeding, asthma, and atopic disease: an epidemiological review of the litereture.

Joumal of Human Lactation 19: 250-261.

36 Kud I, Bohme 24 Wahlgren CF, Nordvall L, Pershagen C, Wecleman M (2005).
Breast-feeding reducer the riskfor childhood eczema.Joumal ofAlleegy and Clinical Immunology 116: 657-681 37 Kull I, Wrckman M, Lilja C, NordvallSL, Pershagen C (2002).

Breast feeding and allergic diseases in infants a prospective birth cohort study.

Arehives of Diseases in Childhood 87: 478-481.

38 OddyWH~ Hole PC, SIyPD, ReadAW, LandauU, StanleyFJ, Kendall CE, Burton PR (1999).

Associatian between bresatfeeding and asthma in6-year-old children: findings ofaprospective birth cohort study.
British MedicalJoumal 319: 815-819.

~ Donath SM, Amir I.H (2005).

Breastfeeding and the introduction of solids inAustrelian infants: data from the 2001 National Health Survey 29: 171- 175.

40 Oddy (2004).A review of the effects ofbreasefeeding on respieamry infections, atopy, and childhood asthma.Joumal of Asthma 41: 60S-621.

41 Peat JK, LiJ (1999).

Reversing the trend: reducing the prevalence of asthma.Joumal of Allergy and Clinical Immunology 103:1- 10.
42 Oddy(2004).A review of the effects of breasefeeding on reapiretoryinfections, atopy, and childhood asthma.Joumal ofAsthma 41: 605-621.

~ Hose A (1994).

Cow’s milkprotein allergy and intolerence in infancy.

Some clinical, epidemiological and immunological aspects.

Psediatric Allergyand Immunology 5 Suppl: 5-36. allergic responses”0.

The use of banked human milk where a mother’s o~ milk is unavailable would entirely remove this risk factor.
Type 1 Diabetes There is some evidence that the likelihood of developing Type 1 diabetes may be related to early nutrition.

It is thought that sensitisation and development of antibodies to a cow’s milk protein may be the initial step in the aetiology of Type 1 diabetes.” A relationship between diarrhoeal disease due to rotavirus infection and Type 1 diabetes has also been identified~5and as will be discussed, children who are not breastfed are more vulnerable to diarrhoeal illness.
Thus, a meta analysis of high quality studies that looked atinfant feeding and the development of Type 1 diabetes found that children exposed to cow’s milk in the first 3 months of life or not breastfed for at least 3 months have a 63 increased risk of developingType 1 diabetes.
It appears that the relationship between infant feeding and development of Type 1 diabetes is strongest where children develop the condition young, thus, children not breasifed for at least 3 months have a 280 to breastfed children.
increased risk of developingType 1 diabetes before the age of 4 years as compared It is worth noting that reseaich in this area is conflicting (certainly some studies do not indicate that early nutrition has a role in the development of Type 1 diabetes) and it has been recognised for some time that a large-scale prospective study is required to elucidate the impact of earlynutrition in this condition.
Unfortunatelysince human milk is not a product that can be sold for profit this poses an obstacle to the consideration of the role of non-exclusive breastfeeding or premature weaning from breastfeeding in the development of a disease.

There is currently an extremelylarge trial operating in 70 centres, including 3 in Australia, testing whether infant formula that does not contain cows milk protein is less likelyto result in children developingType 1 diabetes than children fed a standard infant formula.
The study design includes supporting women to breastfeed.

However, women are provided with free infant formula, which, it has been argued is an inducement to wean.
Indeed, results published so far indicate that a large proportion of women inthe study breastfeed for a short time only.46 Any study examining the impact of early diet on the development of Type 1 diabetes should include an exclusivelybreastmilk control as reconunended bythe WHO”7 but this study is funded at least partiallyby an infant formula manufacturer who was involved in developingthe study design.48 Currently, the environment is such that in Australia it is difficult to gain researrh funding for a projects that do not have potential for commenzialisation.
Howevei the situation with the TRIGR studyhighlights the need for government to be involved in funding reseaich that is in the public good, reganllessof commenzial opportunities.

The results from the TRIGR study are already promising that the “special” infant formula may have an impact and there is little doubt that pressure will be placed on the Australian government to subsidise the cost of this formula for the purposes of reducing the incidence of Type 1 diabetes.
It is however, deplorable that the impact of exclusive breastfeeding on the development of Type 1 diabetes is not being considered because if effective this would be a far more cost effective intervention.

“~ Villalpando and Hamosh 1998 Villalpando 5, Hasnosh M (1998).

Early and late effects of breast-feeding: does breast-feeding really maner.

Biologyof the Neonate 74:177-190.

~ CouperJJ (2001).

Environmental triggers of type 1 diabetes.Joumal ofPrediatrica and ChildHealth 37:218-220.
46~ rhlom IlK, Virtanen SM, IlonenJ, Savilahti E, Vaarela 0, Reunanen A, Teremo K, Hamalainen AM, ParonenJ, Riil~ae-v MA, Ormisson A, Ludvigason J, Doach 1-ilvI, Halsulinen T, Knip 24 National TRICRStudyCroupa.

Diabetologia.

200S May,48(5): 829- 37 47 deOnis (2006).

Poreword.

Acta Psediatrica 450: 5-6.


48 heep://erigr.epi.usf.edu/ahnue.hemi I’’ It is worth noting that women who suffer from diabetes themselves may have a delay in lacto genesis 2 post-birth49, which often necessitates supplementing their babies with other milks.
Given the suspected link between earlynutritionand Type 1 diabetes, and the possibility of a genetic susceptibility it would be advisable that these babies be provided with donor humanmilk from a milk bank until their mothers’ milk is sufficient.

The primarycause of Type 2 diabetes is obesity and the involvement of infant feeding in the development of obesity will be discussed later.
Childhood cancers As put forward in Labour~s discussion paper, the reasons why some children develop cancer are not well understood.

Nevertheless a number of factors have been implicated in increasing the risk of development of cancers in childhood including early nutntion.
to a Thus, research indicates that children who are not breastfed are at between a 75 increased risk of developing any cancer5051 Research has found that artificial 600 feeding increases the risk of developingHodgkin’s disease, non-Hodgkins lymphoma, acute lymphoblastic leukaemia and acute myeloblastic leukaemia49 a lot of variation in research results.

Nonetheless, studies have generally found that breastfeeding duration is important.
Cancer risk is greatest in babies not breastfed at all compared to those breastfed for the longest duration.54 Childhood cancer has been associated with immunodeficiency and infection.55 Since human milk is protective against infection and stimulates the early, normal development of the immune system this may explain whybabies who are not breastfed are at greater risk of developing cancer56 53However, thereis 52 Obesity Research has consistently found that children who are not breastfed are more likelyto be overweight in childhood and adolescence.
The relationship appears to be dose dependent.

A recent meta-analysis of research found that children breastfed for less than 1 month have a 32 breastfed for 4-6 months and have a 47 compared to children breastfed for more than9 months.57 increased risk of being overweight as compared to children increased risk of being overweight as There are several possible reasons for this relationship.
Firstly, babies who are breastfed are able to regulate their own intake (self regulate) based on internal satietycues58 and ‘~ ReaderD, FranzMJ (2004).

Lactation, diabetes,and nutrition recommendations.

Corrent Diabetes Repoets 4: 370-376.

50 Davis MK (1998).

Reviewof the evidence for an association between infant feedingand childhood cancer.

Interoational Joumal of CancerSupplement 11:29-33.

51 Smulevich VB, Solionova LC, Belyaltova SV (1999).
Parentaloccupation and other factors and cancer riskin childrere I Study methodologyand non-occupational factors.

Intemational Joumal of Cancer 83: 712-717.

52 Kwan ML, Buffler PA, Abram, B, Kiley VA. 2004.

Breasefeeding and the risk of childbood leukemia: a meta-analy,is.

Public HealthRep 119:521-535.

~ Shu xO, Linet MS. Steinbuch 24 Wen WQ, BuckleylD, NegliaJP, PonerJD, Reaman CH, Robison 11(2004).

Breast-feeding and riak of acute Leukemia.

Joumal ofthe National CancerInstitute 91: 1765-1772.
54 Davis MJI (2001).

The evidence for breastfeeding: breastfeeding and chronic disease in childhood and adolescence.

Pediatrics Clinics inNorth America 48.

~ Davis MK (2001).

The evidence for breasefeeding: breastfeeding and chronic disease in childhood and adolescence.

Pediatrics Clinics inNorth America 48.

56 Davis MK (1998).

Reviewofthe evidence for an association betweeninfant feeding and childhood cancer.

IneemationalJoumal of CancerSupplement 11: 29-33.


57 Hatder T, Beegmann B, KallischniggC, Plagemmn A (2005).Duration ofbreastfeeding and risk of overweight: a meta-analysis.

AmericanJournalof Epidemiology 162: 397-403.

58 DeweyKC (2003).

Is breascfeedingprotective against child obesity?

Jouroal of Human Lactation 19:9-18. maternal milk productionis driven by infant demand.59 Overfeeding is therefore unlikely in exclusively breastfed babies, if not impossible.
In contrast, babies that are bottle-fed maybe encouraged to finish bottles so as not to waste milk or to meet parental expectations of consumption.

It has been speculated that this may impede the later ability to self regulate energy intake.56 In addition, mothers who continue to breastfeed their child for 12 months or more are less controlling of theirtoddler’s eating habits and, perhaps as a result of this, their children eat a greater variety of foods and are leaner60.
There may also be physiological differences between breastfed and non-breastfed infants that leads to a greater likelihood of overweight in those not breastfed.

It is known that bottle fed babies consume more milk and gain weight more rapidlythan breastfed babies.6’ Over feeding in infancymay result in increase in the number and fact content of aclipocytes (cells that store fat)62 potentially making such children more vulnerable to obesity.
There may be differences in insulin metabolism in formula fed infants that contribute to increased risk of overweight.56 Levels of, and body’s response, to the appetite regulatory hormone leptin may also be affected by earlynutrition increasing the risk of overweight in non-breastfedindividuals.63 It may also be that familial factors may modify the relationship between infant feeding and obesity so that “unhealthy” families maybe less likely to breastfeed.64 Nonetheless, when studies have adjusted for factors associated with infant feeding choice the relationship between formula feeding and overweight is still apparent.65 While the impact of infant feeding on obesity is relatively small compared to other factors such as parental overweight, dietary practices and physical activity, infant feeding is still a significant factorand worthy of consideration in obesity prevention programs.
Smoking Labour’s health policy addresses the use of drugs by children and adolescents.
However, children born to smoking parents (mothers particularly) should also be considered.. Women who smoke are less likely to initiate breastfeeding and tend to breastfeed for a shorter duration than non-smokers.66 This maybe at least partially because educational materials about breastfeeding often undermine women’s confidence in their breastmilk such that they feel that if their diet is not perfect, if they smoke or drink even a little, they feel that infant formulawould be a better choice fortheir babies.
However, while it is true that nicotine moves easily into breastmilk (one of only a small group of drugs to do so) the milk of a smoking mother nevertheless provides nutrition that is far superior to infant formula.67 68lndeed, it may be more important forthe children of smokers to ~ DeweyKC, Lonnerdal B (1986).

Infant self-eegulation of breast milk intake.

Acts Paediatrica Scandinivica 75: 893-898.


60 FiaherJO, Biath 11, Smidildas- Wright H~ Picciano MF (2000), Beeastfeeding thanugh the firet year protects maternal control in feeding and subsequent toddler energyintakes.

Journal ofthe AmericanDietetic Association 100: 641-646.

61 De~yKG (1998).

Growth chamcteristics of breast-fed as compared to fomaula-fed infants.

Biology of the Neonate 74: 94-105.

62~ GjI~ HQ Mots GE, Lewia D5, MeMahan CA, Jackson EM (1996).
Earlydetenninants of adult metabolic regulation: effects of infant nutrition on adult lipid and lipoprotein metabolism.

Nutrition Review 54: 531~540.

63 Locke R(2002).

Preventing obesity the breast milk-leptin connection.

ActaPaediatrica 91:891-896.

64 Burke V, Beilin U, SimmerK, OddyWH, Blake KV, DohertyD, Kendall GE, NewnhamJP, Landau LI, StanleyFJ (2005).

Breastfeeding and overweight: longitudinal analysis in an Australian birth cohort.

Journal of Pediatrics 147: 56-61.

65 DeweyKG (2003).
65 DeweyKG (2003).

Is breastfeeding protective against child obesity?

Journal of Human Lactation 19: 9-18.

66 Amir LI-I, Donath SM (2003).

Does maternal smoking have a negative psychological effect on breastfeeding?

The epidemiological evtdence.

Breastfeeding Review 11: 19-29.

67 D~t,~m A, Eberajd B, Lundell ONicotine exposure in breastfed infants.

Acta Paediatr.
Acta Paediatr.

2004; 93(6): 810-816. breastfeed because breastfeeding may mitigate the increased vulnerability of their children to illnesses caused by exposure to cigarette smoke.69 Smoking mothers need additional support to breastfeed their children if theycannot give up smoking.

Oral and Dental Health Breastfeeding is important for the normal development of the oral cavity.

In infants the palate is soft and malleable.
Breasts are also soft and malleable and during breastfeeding the breast applies an even and dispersed pressure to the palate via the normal peristaltic movement of the tongue as it massages rather thansucks milks out of the breast.70 This results in individuals who breastfed were more likely to have a healthy, broad palate, without malocclusions or improper alignment of teeth.71 In contmst, bottle teats are hard and a piston-like suckling with negative pressure is used to obtain milkfrom a bottle.
The relatively strong and concentrated pressure associated with bottle-feeding can deform the infant’s palate leading to a greater risk for poor alignment of the teeth and malocclusions.72 Dummy and finger sucking are associated with restrictedbreastfeeding and with premature weaning from breastfeeding.73 They are also associated with malocclusions such as crossbite, reduced arch width, open bite and tongue thrust.74 In addition, when the palate is nanowed and heightened bybottle- feeding it may infringe on the upper airway.72 It has been found that a high and narrow palate is a good predictor of snoring and obstructive sleep apnoea, both of which contribute to significant health problems in adulthood.75 Research has found that babies fed formula reconstituted using tap water containing fluoride may consume amounts of fluoride far in excess of the recommended intake of fluoride.76 77 These excessive levels of fluoride may cause dental fluorosis in the permanent teeth of children.74 Antibiotic use in the first 6 months of life (more common in babies who have been weaned from breastfeeding) can also cause enamel defects in the permanent teeth of children.78 Preventable accidents, injury and child abuse Epidemiological research in the US has looked atthe impact of infant feeding on post- neonatal mortality.
It has been identified that babies who are never breastfed are 27 68 My~R (2004).Promoting, protecting, and supportingbresatfeeding ina communitywith a high rate of tobacco use.

Journalof Human Lactation 20: 415-416 69 Nafatad P,JaaldeolaJJ, HaganJA, Botten C, KongemdJ (1996).Breast feeding, maternal smoking and lowerrespiratoxytrace infections.

European RespiratoryJournal 9: 2623-2629.

70 Palmer B (1998).

The influence of bresatfeeding on the development ofthe oral cavity a commenesay.
Journal of Human Lactation 1493-98.

71 Lanson EF, Dahlin KC (1985).

The prevalence and the aetiologyofthe initial dumrny~ and finger-sucking habit.

American Journal of Orthodontics 87:432-435.

72 LabbokMH, HenderahotC (1987).

Does breast-feeding protect against rnalocclusion?

Ananalysis ofthe 1981 Coild Health Supplement to the National Health Interview Survey.

American Joumal of Preventative Medicine 3:227-232.

LarasonEF, Dahlin KC (1985).


The prevalence and the aetiologyofthe initialdurnmy~ and finger-sucking habit.

American Journal of Orthodontics 87: 432-435.

74 PalmerB (1998).

The influence of bresatfeedingon the developrnent of the oral cavity~ a commentary.Joumal ofHurnan Lactation 1493.98.

‘~ Kushida GA, EfronB, Cuilleminault G (1997).

A predictive moephometric model for the obatnictive sleep apnoeasyndrome.

Amals of Internal Medicine 127: 581-587.

76 Andenon WA, Pratt I, Ryan MR. Flynn A (2004).


A probabilistic estimation offluoride intake by infants up to the age of4 months frorn infant fomnila reconstituted with tap waterin the fluoridated regionsof Ireland.

Codes Resesach 38: 421-429.

77 NHIVIRC (1999).

Review of Water Fluoridation and Fluoride Intake fromDiscretionary Fluoride Supplements.

NI-IMRQ Melbourne.

78 Hong L, LavySM, WarrenJ, Dawson DV, Bergus CR, WefelJS,James 5(2005).
Association ofamoxidillin use during early childhood with developmental tooth enamel defects.

Asehives of Psediatric and Adolescent Medicine 159: 943-948. more likelyto die in their first year than babies who are ever breastfed79 Some of the reasons for the increased death rate in never breastfed infants are related to increased rates of illnesses in non-breastfed babies.
However, an examination of cause of death foundthat babies who had never been breastfedwere at 69 increased risk of death from accidents.77 The relationship between not breastfeeding and increased mortality from accidents has been found before80 and may be relatedto the absence of physiological and physical factors associated with breastfeeding that help prevent accidents.
Breastfeeding women are physiologically different from women who are not breastfeeding and hormones that are released in response to breastfeeding act on the central nervous system of mothers to promote maternal behaviour818283 and reducetheir response to physical and emotional stress.84 This enables breastfeeding women to be more responsive to their babies and to want to be closer to them8586 breastfeeding encourages maternal care giving and closer maternal-childproximity and this may directly decrease the risk of accidentthitwgh increased adult supervision88 and increased maternal-child attachment.89 Because of the potential for breastfeeding to promote maternal-child attachment90 there is also the potential for breastfeeding to reduce child abuse amongst vulnerable populations such as where children are born prematurely~1 92 or where there is a history of intergenerational relational trauma.88 87 Thus It is worth noting that there is a dose dependent relationship between post neonatal death and breastfeeding and babies who were never breastfed are at a 61 of death as compared to babies who were breastfed for 3 months.86 Since research has only examined whether death due to accidentis affected by infant feeding it is not possible to sate with certainty whether non-fatal accidents are also more likely in babies who are not breastfed, however, it seems reasonable to surmise that this would be the case.
increased risk ~ Chen A, Rogan WJ (2004).

Bresatfeeding and the riskof post neonatal death inthe United States.

Pediatrics 113: e435-e439.

80 carpenter RG, Gardner A, McWeeny PM, Emery JL (1977).

Multistage scoring system for identiBying infants at risk of unexpected death.

Archives ofDiseasesin childhood 52: 606—661 81 Bartels A, Zeki S(2004).

The neural correlates ofmaternal and romantic love.

Neuroimage 21:1155-1 166.

82 MannPE, Felicin LF, Bridges RS (1995).


maintenance of maternalbehaviour in rats.

Honnones and Behaviour 29:392-406.

83 Neuman ID (2003).Brain mechanisms underlying emotional alterations in the peri partuin period in rats.

Depression and Anxiety 17:111-121.

84 Croer MW, Davis MW, Hemphill J (2002).

Postpartum stress: current concepts and the possible protective role of bresatfeeding.

Journalof Obstetrics, Cynaccology andNeonatal Nuraing 31:411-417.
Investigation into the role ofcholecystokinin (CCK) inthe induction and 85 NewtonN, Peeler D,Rawlins C (1968).

Effect of lactation on maternal behaviour inmice with comparative data on humans.

Journalof Reproductive Medicine 1:257-262.

86 yp~sabtromAM, Wahlbeig W, Matthiesen AS (1990).

Short-term effects ofearly suckling and touch of thenipple on maternal behaviour.

EarlyHuman Development 21:153-163 87 Feldman R, Weller A, Lackman JE, Kuint J, Eidelman Al (1999).
The nature of the mothes~s tie to her infant: maternal bonding uoderconditions orproxisnity, separation, and potential loss.

Journalof Child Psychologyand Paychiatry40:929-939.

88 (len A, Rogan ‘4~ (2004).

Breasefeeding and the riskofpost-neonatal death inthe United States.

Pediatrics 113: e435-e439.

89 Anisfeld E, Casper V,Nozyce M, Csnningham N (1990).

Does infant canying promote attachment?

Anexperimental atudyof the effects of increased physical contact on the development of attachment.
Osild Development 61:1617-1627.

90 Cribble K (2006) Mental health, attachment and breastfeeding2 implications for adopted children and their mothera.

International BreasefeedingJoumal 1:5.

91~ s~ey’rJ, Harmon RJ, Easterbrooks MA.

(1987).

Impact of premansee birth on the development ofthe infant in the family.

Journalof Consulting and Clinical Psychology55: 846-852.

92 Field T (1987).

Interaction and attachmentin normal and atypical infants.Journal of Consulting and Clinical Psychology55: 853- 859.
The link between breastfeeding, premature weaning and later mental health is one that has received little attention from scientist (although there has been a small amount of work in this area93) and more research is needed in this area.

yandleing born into affluence... Itisalni~tfbk~theirfant Indigenous health Breastfeeding may be more important to the health of indigenous children because of the overall poorer health of aboriginal children.
As stated byJames Grant the former Director of UNICEF “Breas~feeding is a natural “safrty ~“ against the ~o~st~ts the d,ildssn’rJz~ thefirst nvnth cf4/~ (the n~t arigenws ~ childhax~) then/or the r~tfa~r nwdz or so, e~dusiw b~vas~f~zkngg~ a k~w~ tounrd cancellingait the health d~event~ hetzeeen lang mi cwt cfpozertyfor thc~efirstfew nvnths inorder togize the childafaimr start in1~ and wn~’ensatefor the irdustice qCthe uorldinto ~hichit wzs hem” Traditionally aboriginal people breastfed their children for several years and in remote areas of Australia this continues.94 However, in urban and non-remote rural areas of Australia breastfeeding rates amongst aboriginal mothers are as pooras those of non-indigenous mothers.9596 However,that aboriginal mothers breastfeed for as long or longer than mothers in the general population and that there is a strong cultural historyof long-term breastfeeding provides a positive basis from which to build health promotion programs in aboriginal communities.
jpxe7~y If Gastroenteritis Gastroenteritis is common disease in young children.
In 1993- 1996 there were approximately20 000 hospital admissions in children under 5 years in Australia.97 Rotavirus infection is thought to account for half of all hospital admissions for severe diarrhoea and in Australia the cost of hospitalisation for each case is estimated at$1700 per episode per child and cost of care in the community is estimated at $440 per child.98 Children who are not breastfed have been found to be 3 times more likelyto contract rotavirus infection99 and children who are not breastfed will also be sicker thanbreastfed children who contract rotavirus.97100 One study found that babies who were not breastfed had an 800 increased risk of being sick enough with rotavirus to require a doctor’s visitY’1 Other research has found that babies who are not breastfed have a 200- risk of developing gastroenteritis caused by non-viral pathogens.102 Breastfeeding 500 provides protection against infections such as gastroenteritis because human milk ~ Soremen I-n, Mortemen EL, lleinischJM, MednickSA (2005).
Bresatfeeding and risk of schizophrenia 112: 26-29.

94 ZubrickSR, LawrenceDM~SilbumSR,BlairEM~ ilroyH~Wdltea T, Fades 5,D’Antoine H~ ReadA, Ishiguchi &Doyle S (2005).

The Western Australian Aboriginal Child HealthSurvey2 The Health of Aboriginal Children and Young People.

Curtin Universityof Technology, Perth.

95 ZubrickSiz, Lawrence DM,SilbumSKBlairEM, MilroyH~ Wilkes T, Eades S,D’Ansoine H~ Read A,Ishiguchi&Doyle S (2005).
The Western Australian Aboriginal Child HealthSurvey~ The Health of Aboriginal Children and Young People.

Curtin Univeraityof Technology, Perth.

96 Hohnes W, Thorpe L, PhillipsJ (1997).

Influences on infant-feeding beliefs and practices in an uthan aboriginal community.

Australian and New Zealand Journal of Public Health 21: 504-510.

~ Carlin JB, Chondros P. MasendyczP, Bugg Ij Bishop EF, Bames CL (1998).
Rocavirus infection and rates of hospisalisatian for acute gastroenteritis in ynung children inAustralia.

MedicalJournal ofAustralia, 1993-1996.

MedicalJournal ofAustralia 169: 252- 256.

98 Elliot EJ,Dalby~Payne JR (2004).

Acute infectious diarrhoea and dehydration in children.

MedicalJoumal ofAustralia 181: 565- 570.

~ Cianino P. Mastretta E, Longo P, Laccisaglia A, Sartose M, Russo 11, MazzaccareA (2002).
Incidence of nosocomial rotavims infections, synsptomatic and asymptomatic, in breast-fed and non-breast-fed infants.

Journalof Hospital Infection 50:13-17.

100 DuffyLQ Bycra YE, Riepenhoff-TaltyM, LaScoles U, ZieleznyM, 0gm PL (1986).

The effects of infant feeding on rotavirus- induced gastroenteritis: a prospective study.

AmericanJournal ofPublic Health 76: 259-263.

101 SethiD, Cumberland P, Hudson MJ, Rodrigues LC; WheelerJC, Roberts JA, Tompkins DS, CowdenJM,RoderickPJ (2001).
A atudyofinfectious intestinal disease in England: riskfactors associated with group A rotavirus in England 126: 63-70.

102 ColdingJ, Emmett PM, Rogers IS (1997).

Does breasefeeding protect against non-gastric infections?
Early Human Development 49: S105-S 120. contains seve~1 specific and non-specific anti-infective factors and because it may preventthe mucosal attachment of potential pathogens.’03 Currently, the government is being lobbied by manufacturers of a rotavirus vaccine to add theirvaccine to the immunisation schedule at great cost to the government.

However, serious illness due to rotavirus is largely preventable by breastfeeding.
Since breastfeeding is also protective against mmy other illnesses it makes economic sense to place resources into breastfeeding promotion to reduce the need for expensive medical intervention.

Respiratory infections Early feeding affects the incidence and severity of respiratory illness.
Australian research has identified that in the first year of life babies not exclusively breastfed for 2 months or at leastpartiallybreastfedfor6 months are 1.4 times more likely to have 4 or more hospital or doctors visits because of upper respiratorytract infections.104 Babies not exclusively breastfed for 6 months are 2 times more likelyto have two or more hospital or doctors visits and 2.6 times more likely to be hospitalised for wheezing lower respiratory illness (bronchiolitis or asthma).’ months is associated with a 60 lower respiratory illness.102 increased risk of 2 or more hospital visits for wheezing Cessation of breastfeeding before 12 02 Breastfeeding is protective against respiratory illness because breastmilk contains antibodies that neutralise some pathogens associated with respiratory infection.105 Children not increased risk of developing otitis media107108109 The shorter Otitis media Research has consistentlyfound that babies who are not breastfed are atincreased risk of suffering from otitis media, otherwise known as middle ear infection.’ breastfed have between 60 and 100 and at about double the risk of suffering from recurrent otitis media.’ the duration of breastfeeding, the greater the likelihood of otitis media.111 Recurrent otitis media particularlyproblematic because of the impact that it canhave on hearing.
Recurrent otitis media is associated with mild, fluctuating hearing loss.112 Since the first fewyears of life are critical for language development recunent otitis media in infancy and toddlerhood can negativelyaffect children’s language acquisition.

Research has found that up to 70 of children with a history of recurrent otitis media exhibit a language delay”3 resulting in an increased need for speech therapyservices.

Hearing loss 07110 06 103 Hanson LA, HofvanderY, Lindquist B, Zenerasroro R(1985).
Breast-feeding as a protection against gastroenteritis and other infections.

Acts Psediatrica Scandinavica 74: 641-642.

104 OddyWli SlyPD, de KlerkNH, Landau LI, Kendall CE, HoltPC, SsanleyFJ (2003).

Breast feeding and respiratoty morbidity in infancy” a birth cohortstudy.

Arthives ofDiseases in Childhood 88: 224-228.

105 Downham IvIA, Scott B., Sima DC, Webb JXC (1976).

Breast-feedingprosects against respiratotysyncytial virus infections.

British MedicalJournal 2: 274-276.


106 ColdingJ, Emmett PM, Rogers IS (1997).

Castroenteritis, diarrhoeaand breastfeeding.

Early Human Development 49: S83- 103.

107 DuffyLC Faden H,Wasielewald B. Wolf J, Ks-ystofikD (1997).

Exclusive breastfceding protects against bacterial colonization and day care exposure to otitis media.

Pediatrics 100: e7.

108 Duncan B, EyJ, Holberg CJ, Wright AL, Martinez FD, Taussig LIvI(1993).

Exclusive breast-feeding for at least 4 months protects against otitis media.
Pediatrics 91: 867-872.

109 Teele DW,Klein JO, RosnerE (1989).

Epidemiologyofotitis media during the fisat seven ycass of life of children in greater Boston: a prospective cohort study.

Joumal of Infectious Diseases 160: 8-94 110 Fosarelli PD, Deangelis Q WrnkelsteinJ, Mellits ED (1985).

Infectious illnesses in the first two ycars oflife.

Psediatric Infectious Diseases 4:153-159.

111 Allan OP, Koivu M, Sorri M (1990).

Riskfactors for recurrent acute otitis media and sespiratotyinfection in infancy.
International Joumal ofPsediatric Ororhinolaayngology 19: 151-161.

112 Schlieper A,KisilevskyH, MareinglyS, Torke L (1985).

Mild conductive hearing loss and language development: a one ycar follow-up study.

Joumal of Developmental and Behavioural Pediatrics 6: 65-68.

113 Friel-PaniS, Finitzo-HiebcrT, Conti C, Brown KC (1982).

Language delayin infants associated with middle ear disease and mild, fluctuatinghearing impairment.
Pardiatric Infectious Disease 1:104-109. and language delayearlyin life have a flowon effect on academic learning in the early years of school.

Children with a historyof recurrent otitis media are also at an increased risk of having difficulties with learning to read in middle childhood”4 necessitating an increase in the need for remedial education programs.

This is anotherexample of the impact of earlynutrition on later heathand wellbeing.
Breastfeeding may provide protection against otitis media because babies are often held in a more upright position when breastfed, or because of anti-infective and anti- inflammatoryagents present in breastmilk”5 Urinary tract infection Babies who are not breastfed are 5 times more likely to suffer from urinarytract infection in infancythan children who are breastfed.”6 Theyare also more likelyto sufferfrom urinarytract infections up until atleast 6 years of age.
It is thought that breastfeeding is protective because the urine of breastfedinfants contains substances that inhibit the adhesion of pathogens such as E. aii to uroepithelial cells and also because breastfed infants may have more stable and less pathogenic intestinal flora.”7 Other conditions Some research has found an increased risk of developing ulcerative colitis, Crohn’s disease and coeliac disease in individuals who were formula fed as infants.”8 Long term impacts of breastfeeding The impact of breastfeeding continues beyond weaning.
Children weaned earlier continue, for 2 or more years after weaning, to suffermore ill health than children who were breastfed for longer.”9 This finding supports the idea that breastfeeding supports the normal development of the immune system and conversely that premature weaning from breastfeeding retards the development of the immune system.
It has been foundthat children who were not breastfed are more likely to require antibiotic treatment at 18 and 30 months at least 3 times in the preceding 6 months as compared to babies’ breastfed (not exclusively) for at least 4 months’17.

Antibiotic medication is commonlyused to treat respiratory illness and otitis media.

The duration of exclusive breastfeeding is significant in determining the likelihood of a child developing these conditions.
One recent studyfound that children who were fully breastfed (meaning breastfed without supplementation with other milhs) for 4 to 6 months were 4 times more likely to suffer from pneumonia and 2 times more likely to suffer from recurrent otitis media up until the age of 2 years than those breastfed for 6 months or more 120 I~4 Colz A, NetzerA, Westeswaan ST, Cilbert DA,Joachims HZ, Coldenberg D (2005).

Reading pesforosance in children with otisis media.

Otolar~gology Head and NeckSurgery 132: 495-499.


115 DuncanB,EyJ,HolbergCJ,Wright AL, Martinez FD, Taussig 1.M(1993).

Exclusive breast-feeding forat least 4 months protects against otitis media.

Pediatrics 91: 867-872.

116 Pisacane A, Craziano L, Mazzarella C, Scarpellino B, Zona C (1992).

Breastfeeding and urinsaysract infection.

Joumal of Pediatrics 120: 87-89.

117~ 4~2Jd 5, Jodal U, Hanson LA (1990).Breastfecding and urinary tract infection.

Lancet 336: 942.

118 Villalpando 5, HamoshM (1998).


Early and late effects of breast-feeding:does breast-feeding really matter.

Biologyofthe Neonate 74: 177-190.

119 Dubois L, Cirard M (2005).

Breast-feeding,day~care anendance and the frequency ofantibiotic treatments from 1.5 to 5years: a population-based longitudinal study in Canada.

Social Science and Medicine 60: 2035-2044.

120 ChantryCi, HowartlCR, AssingerP (2006).

Full bresatfeeding duration and associated decrease inrespiratorytract infection in US children.
Pediatrics 117: 425-432.

IMPACT OF BREASTFEEDING ON THE HEALTH OF MOTHERS Breastfeeding also has an impact on the health of mothers and has been found to reduce the incidence of hip fracture, breast cancer, rheumatoid arthritis, ovarian cancer and diabetes.

Hip fracture Hip fractures are common in elderly women and have a high mortality and morbidity.

However, women who breastfeed their children have a reduced risk of hip fracture.

The reduction of risk is dependant on duration ofbreastfeeding.
One study of Australian women who had breastfed each oftheir children for9 months or more reduced their risk as compared to women who had not breastfedtheir children.121 of hip fracture by 72 There is evidence that the risk of hip fracture continues to decrease with breastfeeding beyond 9 months perchild.’22 Breast Cancer Breast cancer is the most common type of cancer and cause of cancer deathin women in Australia.
Breastfeeding reduces the risk of a woman developing breast cancer in a very strong dose dependent relationship.
It has been estimated that each 12 months of breastfeeding reduces the risk of breast cancer development by 4•3123 impact of breastfeeding on breast cancer reduction increases with long-term breastfeeding such thatwomen who breastfeed each of their children for 2 years or more up to halve their risk of developing breast cancer.124 A recent meta-analysis concluded “the k~a1e oforshort l~fetin~ duration Icr*oitri~ m~tk&~ a mijor contribution to the hz~h incidence ofbreast cancer in thee countries” (Collaborative Group on Hormonal Factors in Breast Cancer, 2002).
It is thought that breastfeeding may reduce the riskof breast cancer because it reduces the exposure to the cyclic hormones of reproductive life, it induces physical changes in the breast that associated with breastfeeding maybe protective, breastfeeding reduces concentration of toxic o~anochlorins in the breast and because breastfeeding may activate factors that suppress the growth of breast cancer cells.’22 a4eeding t~piad j~wv2 in de and that the Rheumatoid arthritis Hormonal factors are involved in the development of rheumatoid arthritis and since breastfeeding can impact the hormonalmilieu of women in the long term125 it is not suxprising that lactation history can affect the likelihood of women developing rheumatoid arthritis.
Avery large prospective study found that women who had a lifetime breastfeeding duration of 12 months had a 20 decreased risk of developingthe condition and women who had a lifetime breastfeeding duration of 2 years or more had a 121 Chroming RC, Klineberg RJ (1993).

Breastfeeding and otherreproductive factors and the riskof hip fractures in elderlywamen.

Insemational Joumal of Epidemiolngy22: 684-691.

122 Hun D, Lauderdale DS, Liming L (2003).


Influence of reproductive factors on hip fracture riskin Chinese women.

Osteoporosis Insemational 14: 694-700.

123 Collabotative Croup on Hormonal Factors in Breast Cancer (2002).

Breast cancer and hreassfeeding~ collaborative reanalysis of individual data from47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease.

The Lancet 360: 187- 195.


124 Zheng T, Duan L, Liu Y, ZhangB, Wang Y, Chen Y, Zhang Y, Owens PH (2000).

Lactation redures breast cancer risk in Shandong Province, China.

American Joumal of Epidemiology152: 1129-1135.

125 Lanltarani-Fard A, Kritz-Silveratein, Barrete-Counor E, Goodman-Croen D (2001).

Cssmulative duration ofbreast-feeding influences cortisol levels inpost-menopausal women.
Joumal ofWomen’s Health and Cender-Based Medicine 10: 681-687. decreased (i.e halve4) risk of developing rheumatoid arthritis as compared to 50 women who had breastfed for 3 months or less.126 Ovarian Cancer Breastfeeding also impacts the likelihood of women developing ovarian cancer.
Reseatch has found that breastfeeding for 2-7 months results in an average 20 incidence of ovariancancer (studies have found up to a 50 relationship being dose dependent).’27 reduction with the reduction in Diabetes A recent study found that each year of breastfeeding reduces the risk of developing Type 2 diabetes by 15 factors are controlled for.’28 It is thought that this may be because breastfeeding improvesthe stabilityof glucose levels in women.126 in young and middle aged women even when BMI and other risk BREASTFEEDING RATES IN AUSTRALIA The Australian National Health and Medical Research Council’s (NHMR~ Dietary Guidelines for If ant Feeding reflect the World Health Oi-ganisation (WHO) recommendation that infants be exclusively breastfed for the fhst six months of life’29, with ongoing breastfeeding until two years and beyond with appropriate complementary foods.
Despite this policysupport, Australia has a poor reconi when it comes to exclusive breastfeeding and breastfeeding duration.

of infants breastfed for at least six months of age.130 Breastfeeding The NHMRC has set breastfeeding targets for Australia.

It recommends a 90 rate and 80 initiation rates in Australia are very close to the NI-IMRC goal.

87 breastfeeding.13l This suggests that the overwhelming majorityof women want to breastfeed their babies.
However, less thanhalf of babies continue to be breastfed at 6 of children breastfed at 2 years months of age, 23 of age.’29 are breastfed at a year and only 1 of women initiate initiation Figures from the latest National Health Survey (NHS) in 2001129, showed that exclusive and sustained breastfeeding rates remain very low, with fewer thanone in three of all babies aged less thansix months being exclusivelybreastfed.
In particular, there has been little if anyimprovement in the number of mothers and babies breastfeeding exclusively for the minimum recommended six months.

That is, less than half of Austmlian babies reach the normal standard for human nutrition.

126 Kaabon EW, Mandl LA, Hankinson SE, Crodatein F (2004).

Do breast-feeding and other reproductive factors influence future riskof theumatoid arthritis?

Arthritis and Rheumatism 50: 3458-3467.

127 LahbokMH(2001).
127 LahbokMH(2001).

The evidence for breastfceding: effects ofbreastfeeding on the mother.

Pediatric Clinicsof North America 48: 143-158.

128 Stuebe AM~ Rich-Edwards JW~ Willett WQ MansonJE, Micheis KB (2005).

Duration of lactation and incidence of type 2 diabetes.Joumal ofthe American Medical Association 294: 2601-2610.

129 World Health Assembly(FiftyFourth) 2001, Infant and Young Child Nutrition: Resolution 542.

~ Binns CW(2003).

Encourageand support hreastfeeding.


DietaryGuidelines for Childsen and Adolescents in Australia.

Commonwealth of Australia.

pp.

1-19.

31 ‘ Aust~an Bureau of Statistics (2003).
Bsuss#iiaa~inAeeerali4 Elrts,o cDe/isery Retrieved online from hnp://www.ahs.gnvau/Ausstaes/absal) .nsf/0/8E65D6253F10F802CA256DA40003A0700pen# Links ECONOMIC COSTS OF PREMATURE WEANING The cost attributed to the hospitalisation of prematurely weaned babies alone is around $60- 120 million annually in Australia for just five common childhood illnesses.’32 Conversely, any decline in breastfeeding from current levels has substantial and adverse cost implications for the public health system.
Premature weaning from breastfeeding results in an unnecessarydisease burden on our health care system.

There is a limited amount of research that had quantified this burden.
One study (US) looked atjust three illnesses (lower respiratory tract illness, middle ear infection and gastrointestinal illness) and found that for every 1000 babies never breastfed as compared to 1000 babies exclusively breastfedfor 3 months there were 2033 extra visits to the doctor, 212 extra days of hospitalisation and 609 extra prescriptions in the first year of life.’33 It is therefore not surprising that increasing breastfeeding rates has been shown to decrease the frequency of illness at a community level.’34 Breastfeeding is something that belongs to women.
There is no commercial interest in fostering increased breastfeeding rates.

Therefore breastfeeding has been largelyignored in terms of its economic contributions and is not currently included in the national product statistics whilst formula and its products are.

Breastfeeding curventlyhas a negative impact on the economy.

Ifnvre ni&vhe~s h~s~ the national actrxints nv.asure this as wnm~tial ijantfax1sa1~ a/all in nationalfxxlaitpit and GDP, b~ra~e nvre ~ngloue~ and reduce spending on health azm’135.
Byincluding breastmilk production and consumption in the national food output and GDP there are substantial economic gains from a resource that costs so little to produce and the follow-on effects of good health which reduces public expenditure on health.
It had been earlier suggested that if the WHO targets for breastfeeding were achieved in Australia the economic value of breastfeeding would increase by $3.4 billion per annum136 A farmer can currentlymilk a cow and feed that to his baby and be included in the gross domestic product and food statistics.

So while a farmer can claim exemption forthe GST for expenses related to millting machinery, a mother with a baby who has a cleft palette and needs to use a breast pump cannot!
This inconsistencydoes not value the contribution made bywomen and breastmilk WHY ARE OUR BREASTFEEDING PRACTICES SO POOR?

Low breastfeeding continuation and exclusivity rates are of public health importance.

The normalisation of bottle-feeding results in a lack of confidence in mothers in their ability to breastfeed.

Most health care professionals gain the majority of their knowledge about breastfeeding from their own infant feeding experiences.
Experience of successfullybreastfeeding their 132 SmithJ, Thompson J, Eliwood D 2002, Hospisal systemcosts of artificial infant feediar Estimates for the Australian Copital Territosy.

ANZPublirHealth26(6): 542—551 133 Ball TM, Wright AL (1999).

Health C~re costs of formula feeding in tbe first year of life.

Pediatrics 103: 870-876.

134 Wright AL, Bauer M, NaylorA, Sutcliffe E, Clark L (1998).

Increasing breastfeeding rates to reduce infant illness at the communirylevel.

Pediatrics 101: 837-844.


135 SmithJP, Ingharo LH (2001).

Breastfeeding and measurement of economic progress.Joumal ofAustralian Political Economy 47:S1-72 136 Clshuang A, Botten C (1994) Human milkon food supplystatistics.

Food Policy19(5): 479-482. own children for a physiologicallynormal length of time greatly increases the ability of health care providers to assist their patients with breastfeeding.
However, where theydo not successfullybreastfeed this negatively impacts their abilityto support their patients in breastfeeding.

Unfortunately, health care professionals breastfeeding duration rates reflect those of the surrounding population’37and unfortunately manywomen are pressured to prematurelywean by health care professionals.
In addition, while doctors usually receive only one or two hours of breastfeeding education during their training theyare repeatediyprovided with education about infant feedingfrom the manufacturers of baby foods and breast milk substitutes (formula).
Marketing of infant formula to health care professionals and women undermines their confidence in breastfeeding.’38 Research overseas has found that doctors’ beliefs and practices surmunding breastfeeding mirror the ambient beliefs and practices in the society inwhich they operate.’39 Infant formula manufacturers are somewhat restrictedin their abilityto market directly to parents however, theyhave no restriction on marketing to health care professionals.
They actively do so by sponsoring conferences, wooing with freebies and providing advertising that is targeted to health care professionals as parents rather than as medical professionals.Sponsorship: A recent child health conference held in NSW had no breastfeeding content but 5 infant formula or bottle manufacturers that were invited to sponsor the conference.
They gave out misleading information about infant feedingto the health care professionals who attended this conference.This conference had NSW Health as a major sponsor!

While health care professionals can be educated about breastfeeding and bottle-feeding by those with commercial interests in encouraging premature weaning from breastfeeding we have a problem.

Similarities can also be draw with the marketing of cigarettes.
It would not be appropriate to invite cigarette manufacturers to sponsor a respiratory conference!

Many health care professionals are completelyunaware that the health and developmental impact of breastfeeding continues for years of breastfeeding rather than months or weeks.

Generallythere is community support for positive parental health behaviours.
So parents are commended for having a hat on their baby or child, or taking their child to sport but breastfeeding women often experience pressure to wean from family, friends and even health care providers (research has found thatthe attitudes of health care professionals re breastfeeding reflects the social norm).

Hence there is a very real need for a public health campaign promoting the importance of breastfeeding.
Women who have successfullybreastfed their children for physiologically nonnal durations have usually had towi~~d often verysignificant pressure from family, friends and health care providers to wean.

This is despite the fact that theyare doing something good for their children and themselves.”~~’ 137 Mh~, CR, Saenz,RB., &Replogle, W.H.

(2003).

Personal breast-feeding behavioursof female physicians in Masissippi.

Southem MedicalJournal., 96(2), 130-135.

138 SmithY(2006).
138 SmithY(2006).

Sellingsickness to mothers and bahies: historical perspectives in infant food advertising and breasefeeding practices inAustralia.

Inaugural Conference on Disease Mongering.

Newcastle, Australia.

11,h~13,h April2006.

139 Arthur CR, SaenzRB, Replogle WH (2003).

Personal breastOfeeding behaviours of female physicians in Mississippi.

Southern MedicalJournal 96:130-135 140 Cribble, K. (2005).

Breastfeeding into toddlerhood and beyond: the experience of mothers and children.
Breasefeeding the NaturalState.

Australian Breastfeeding Association Internatinnal Conference.

28th-30th September, Hobart.

BREASTFEEDING, MATERNITY LEAVE AND CHILD CARE We currently have a vigorous debate about childcare.

However, it has been identified that m order to provide the sort of care that babies need the cost is so high that providing paid maternity leave is comparable in cost.
“The Suealsh a~seis zely rewaling - there teas quality i73Fant ca,vazuilaNe to alland heazilysz&idised It wts niddy usedinthe ZOs and 80s, but in the early 90s, parental leaze zeus increasedandnowthere is remzikably little use qCchildcare under 18 nwths.

Parents zdedzeith theirfeet~ “~141 Babies need the responsive care of a small number of adults.

Where paid maternityleave is provided,the need for childcare for children under 2 years is almost non-existent.
Paid maternity leave allows women choice in the early months of their child’s life and makes it easier for women to continue breastfeeding.

In Norwaywith 12 months paid leave, breastfeeding rates are 92 are still breastfeeding 12 — 15 exclusively breastfeed for 3 months and still 40 months.’42 Children in daycare are more vulnerable to infection143 and therefore it is very important for working mothers to be supported in continuing to breastfeed/provide breastmilk for their babies.
In addition, the increased illness in non-breastfed babies result in decreased productivity and increased absenteeism amongst parents in the paid workforce.
Thus, a large employer in the US who instigated a lactation program that supports employees continuing to breastfeed once they have returned to work found that over a one year of bottle fed babies of employees were sick enough to require a doctors visit period 93 of breastfed babies.1” Since bottle fed babies were not onlysicker compared with 50 but also sicker for longer the parents of bottle bed babies had an absenteeism rate that was 7 times higher thanparents of breastfed babies.’34 In addition, some research has found that women who are supported in breastfeeding their babies by their employers are more likely to return to work after their baby is born.’~5 CONCLUSION We are sure that you can see that there are compelling reasons for including a breastfeeding componentin Labour’s health strategy.
Breastfeeding belongs to women, it is not something that makes anyone any moneyand therefore is not seen as a valuable resource in terms of competing in international markets with large corporations that manufacture infant formula.

These companies have the resources to spend large amounts on research and in marketing their product because there is profit involved.

It is clear that the health consequences associated with premature weaning from breastfeeding are manifold and serious.
Breastfeeding is an investment in the future health of our children 141 Manna, A (2005).

Motherhood: Howshould we care for our children?

Allen &Unwin 142 Cevoed, C 1999 BorstvoeinginNoorwegen.

2000; No.1:: 3 extracted fusm the WHO ClobalDataBankon Breastfeeding and ComplementaryFeeding: www.who.int/reseaach/ 143 DdfyLQ Faden 1-1, Wasielewald R, WolfJ, KryatofikD (1997).

Exclusive breastfeeding pmeects against bacterial colonization and day care exposure to otitis media.

Pedintrics 100: e7.
Pedintrics 100: e7.

144 Ceisel J (1994).

Lactation pmgrarnyields multiple benefits.

BusinessImurance 28:12.

145 Katcher AL, Lanese MC (1985).

Breast-feeding by employedmothers: a reasonable accommodation in the workplace.

Pediatrics 75: 644-647.