Lengthy pacifier use can lead to speech problems

Questions on whether a baby should be given a pacifier or allowed to thumb-suck have existed for generations. The concerns center on whether sucking habits will impact tooth alignment and speech development. The latest evidence, published today, suggests that long-term pacifier use, thumb-sucking and even early bottle use increases the risk of speech disorders in children.

The study looked at the association between sucking behaviors and speech disorders in 128 children, ages three to five, in Chile. Delaying bottle use until at least 9 months old reduced the risk of developing a speech disorder, researchers found. But children who sucked their thumb, fingers or used a pacifier for more than three years were three times as likely to develop speech impediments. Breastfeeding did not have a detrimental effect on speech development.

The authors of the study noted that other research suggests that use of a pacifier or thumb-sucking for less than three years also increases the risk of a speech problem. The sucking motion may change the normal shape of the dental arch and bite. Breastfeeding, however, seems to promote positive oral development.

"The development of coordinated breathing, chewing, swallowing and speech articulation has been shown to be associated with breastfeeding. It is believed that breastfeeding promotes mobility, strength and posture of the speech organs," the authors wrote.

The study is published in the open access journal BMC Pediatrics.

- Shari Roan

Photo credit: Los Angeles Times

Breastfeeding moms: Want lovely bones? Do some exercise

Breastfeeding mothers do a lot for their babies, but the process of breastfeeding can shortchange moms when it comes to bone mineral density.

During pregnancy and lactation a woman's body can show bone mineral loss even greater than what the average woman experiences after menopause. While bone mineral density usually returns to normal levels when lactation stops, it doesn't return to pre-pregnancy levels in all women.

But exercise, according to a new study, may help shore up that bone loss. Researchers from the University of North Carolina at Greensboro recruited 20 breastfeeding women, randomly assigning half to an exercise intervention group, and half to a control group that did no exercise. Neither group changed their diet.

The 16-week exercise program consisted of aerobic activity three days a week (brisk walking) and resistance training three days a week that emphasized increasing core strength. Individual exercises included squats, bench presses, push-ups, abdominal planks and dead lifts and were done at home with handheld weights and a stability ball. Since all study participants were sedentary at the beginning of the study, time and intensity of the exercises increased gradually.

All that exercise paid off--the workout group showed significantly less bone mineral density losses in the lumbar spine compared with the control group. The intervention group also showed greater muscular strength and improved endurance over the control group. That group also lost substantially less lean body mass than the control.

The study concluded: "Additional research is needed to determine whether these beneficial effects of exercise continue after weaning, resulting in higher [bone mineral density] and decreasing the risk of osteoporosis in later life."

The study appears in the October issue of the journal Medicine & Science in Sports & Exercise.

-- Jeannine Stein

Photo credit: Barbara Peacock/CORBIS

WIC program gets its first overhaul -- to include fresh produce

There is rejoicing today at agencies that work with recipients of food vouchers through the Women, Infants and Children program.

"We're in seventh heaven," said Laurie True, executive director of the Cal WIC Assn., based in Sacramento.

Starting Thursday, WIC recipients -- more than 8 million of them -- will be able to use vouchers to buy fresh fruit and vegetables, under a program revision that has been years in the making.

"We're extremely excited," said Pina Hernandez, outreach manager for the Public Health Foundation Enterprises WIC Program, which provides WIC services to 316,000 people in Los Angeles and Orange counties.

"It's a much-needed change," said Elizabeth Pivonka, president of the Produce for Better Health Foundation, a nonprofit behind a national public health initiative to get people to eat more fruit and vegetables.

"That's the one food group consumers are eating so little of," she said.

When WIC was devised more than 30 years ago, hunger and vitamin deficencies were problems, and the WIC foods reflected that -- eggs, cheese, protein, milk, juice. Today, of course, obesity is the top food-related health problem.

WIC also provides education to recipients, and Pivonka said the emphasis on the reasons people need fruit and vegetables might help families develop good eating habits. And for families who might have felt that fresh produce was too expensive, the targeted funds will "give them permission to eat fruits and vegetables," she said.

The provision is $6 a month for children, $8 for pregnant women and mothers of children 5 and under, or $10 for mothers who are exclusively breast-feeding.

"Is it sufficient? No, but it's just a supplemental program," Pivonka said.

-- Mary MacVean

Breastfeeding may benefit women with a family history of breast cancer

Women who have watched a mother, sibling or child battle breast cancer can become understandably preoccupied, if not obsessed, with trying to reduce their own risk of the disease. One possible way to do that? Breastfeed.

In a study published online today in the Archives of Internal Medicine, researchers at Brigham and Women's Hospital and Harvard Medical School analyzed information on 60,075 women who had given birth and who had provided information about, among many other things, their breastfeeding practices.

Earlier studies had hinted that breastfeeding might lower a woman's chance of developing the disease, but those results were far from conclusive.

This study seems somewhat clearer. It found that women who had a so-called first-degree relative with breast cancer were less likely to develop pre-menopausal breast cancer if they had ever breastfed. Duration of breastfeeding didn't affect risk, the study said, nor did whether the women supplemented with formula, nor did whether the women experienced a cessation of menstruation. Just the act of breastfeeding.

No such connection was found in women who didn't have a family history of breast cancer.
 
Here's a synopsis of the study; more on the risk factors for breast cancer, from the American Cancer Society; and a roundup of information on breastfeeding, from the National Institutes of Health's Medline Plus.

(As for the women in this study, if you hadn't guessed already, they were participants in the Nurses' Health Study. Some years ago, thousands upon thousands of nurses answered detailed questions about seemingly every health factor imaginable. Researchers have been mining their answers ever since, and the possible connections between health and lifestyle gleaned from those participants just keep coming.)

In this study, the researchers conclude: "The observed 59% reduction in risk compares favorably
with hormonal treatments such as tamoxifen for women at high risk for breast cancer. Moreover, breastfeeding is associated with multiple other health benefits for both mother and child. These data suggest that women with a family history of breast cancer should be strongly encouraged to breastfeed."

-- Tami Dennis

Photo: Los Angeles Times

A nipple, a cellphone camera -- and a diagnosis

Cellphone cameras are so handy, aren't they? In a bizarre little article in the British Medical Journal, doctors describe how a woman, by taking quick snapshots of her nipple, was able to provide clear evidence of the symptoms she was experiencing -- and as a result, a diagnosis was made.

The article, "Lesson of the Week: An underdiagnosed cause of nipple pain presented on a camera phone," described a 25-year-old breast-feeding woman who was experiencing extreme transient pain in the nipples. The nipples, in addition, changed color:

--First white, with tingling,
--Then blue, with a burning pain,
--Then red, with the pain fading away.

(We kid you not.)

The patient carefully took photographs of her nipples in each of these states, presented them to her doctor, and a diagnosis of "Raynaud's phenomenon of the nipple" was made. What happens is this:

WHITE -- blood vessels constrict (cut-off in blood supply leads to whiteness)
BLUE -- remaining blood in the nipples turns blue because it becomes deoxygenated, and that's the color blood turns when the oxygen in it is used up
RED -- the vessels dilate, and fresh, oxygenated blood re-enters the nipple.

This occurs when the temperature drops below a certain key level, one that depends upon the patient in question.

As the paper explains, the patient should: Avoid exposure to cold. Breast-feed in warm environments. And wear warm clothes.

--Rosie Mestel

* Poor women receive less support for breastfeeding

Breastfeeding has substantial benefits for infants in terms of promoting healthy weight, reducing infections and boosting cognitive ability. The American Academy of Pediatrics recommends that mothers breastfeed exclusively for the first six months of life, and organizations such as the World Health Organization and U.S. Centers for Disease Control and Prevention have urged hospitals to implement policies to promote the exclusive breastfeeding of newborns.

In California, however, there is wide disparity in how well hospitals support breastfeeding, according to a new report from the UC Davis Human Lactation Center and the California WIC Assn. The report rates nearly every hospital in the state on two measures: the average number of women breastfeeding their newborns while in the hospital and the average number of women who are breastfeeding exclusively (that is, with no supplemental formula or other fluid). Breastfeeding exclusively in the hospital creates the best chance for sustained breastfeeding at home. The report found a concentration of low-performing hospitals in Southern California compared with elsewhere in the state and showed the breastfeeding gap is greatest at hospitals serving ethnic, low-income women and babies.

"Breastfeeding should not depend on where you are born," says Karen Farley of the California WIC Assn. "Our report shows that virtually all of the hospitals with the lowest exclusive breastfeeding rates reported here serve low-income and minority women -- the very population most affected by poor health outcomes such as diabetes and obesity."

Overall, 87% of new mothers in California start breastfeeding during the hospital stay but less than half of them leave the hospital exclusively breastfeeding. The report cites Coastal Communities Hospital, in Orange County, where 88.4% of women initiate breastfeeding at birth but only 2.4% leave the hospital breastfeeding exclusively. Other low-performing hospitals on the exclusive breastfeeding measure include: Pacific Alliance Medical Center in L.A., Pacifica Hospital of the Valley, Bellflower Medical Center, Los Angeles Metropolitan Medical Center, Valley Presbyterian Hospital, Beverly Hospital in Montebello, St. Francis Medical Center in Lynwood, Garfield Medical Center in Monterey Park and California Hospital Medical Center. All those hospitals are in Los Angeles County.

Hospitals that performed well have policies in place to support breastfeeding women, according to the report. For example, the staff is trained to help nursing mothers, the hospitals prohibit free formula samples and mother and baby are allowed to stay together to promote nursing. High-performing hospitals in Southern California include St. John's Hospital, which has a breastfeeding exclusively rate of 68.7%; St. Joseph's Hospital in Orange, at 63.8%; St. John's Pleasant Valley Hospital in Ventura County, at 72.4%; and Rancho Springs Medical Center/Tenet in Riverside County at 71.6%.

The full report and county by county statistics can be accessed at the WIC website.

- Shari Roan

Photo credit: Spencer Weiner/Los Angeles Times

* Updating this blog item: Under the state labor code, employers are required to provide a break time and space to accommodate an employee who wants to express breast milk for her baby. A training session entitled "The Business Case for Breastfeeding" will be held on Sept. 22 in Los Angeles to help employers establish worksite lactation programs. The training session is offered by the Breastfeeding Task Force of Greater Los Angeles and the Los Angeles Collaborative for Healthy Active Children.

For more information on the training session, see this website at the L.A. County Public Health Department. You can find information on breastfeeding in the workplace at this site.

-- Shari Roan

The not-so-good news on breastfeeding

More women than ever are breastfeeding, according to a report released last week by the Centers for Disease Control and Prevention. The survey of mothers and infants taken in 2005 and 2006 showed that 77% of all infants were breastfed at least once.

However, breastfeeding advocates say the real picture isn't so positive. They say that breastfeeding rates are lower in racial and ethnic groups, compared to whites, and lag among lower-income women, younger women and those who work.

The Numbers Guy, writing for the Wall Street Journal blog, notes that the CDC's statistics on women who breastfeed for a substantial length of time, such as six months, are also unimpressive.

"...looked at another way, the CDC numbers show that breastfeeding is flat - and the rate of long-term acceptance of the practice is declining among those who try it. The latest available rate of breastfeeding for six-month-old infants barely cleared 30%, well short of a federal-government goal of 50% by 2010, and barely budged from a decade earlier."

These numbers suggest that women know breastfeeding is best for their babies and would like to nurse but can't manage the task long-term. Health experts say that although breastfeeding for even a short time is good, the most potent health benefits come from nursing six months or more. That evidence continues to pile up. But until the U.S. workplace is more accommodating to new mothers, the six-month rates are unlikely to improve.

- Shari Roan

Photo: Ricardo DeAratanha / Los Angeles Times