Breastfeeding

Breastfeeding a newborn on a mother's breast that has been swollen due to milk production . The infant is held so that he can continue to breathe through his nose.

An already older infant will continue to be breastfed from the mother's breast.

As breastfeeding or breast nutrition the diet of is infant and toddler at the breast of a mother or a nurse or other nursing capable woman called. More generally, when is mammals natural supply of the young with milk from the mammary glands also suckling called.

Word origin

Since Old High German in the 8th century AD, breastfeeding and Middle High German breastfeeding in the sense of "silence" or "calm down" can be proven as a synonym for "suckle" and is thus based on a shift in meaning , perhaps as a cover word . Stillen is probably a derivation from the adjective / adverb " still " - which could possibly be a regression of the verb itself (since the latter is better comparable outside of Germanic). In New High German, "breastfeeding a child" was used instead of "suckle" until the 16th century. Both words are still used synonymously, but the word breastfeed more often than suckle .

Physiological perspective

On the part of the mother

Colostrum from the breast of a pregnant woman just before the due date

Milk flow

Even during pregnancy, the breast begins to prepare for the production of milk ( lactation ). If breastfeeding is not breastfed from the beginning or if breastfeeding is interrupted, milk production will decrease. The milk that is still in the breast is absorbed by the body, which can take several months.

Since men also have rudimentary mammary glands, milk can in principle also develop in men. In 1799, Alexander von Humboldt reported on a Venezuelan farmer who is said to have breastfed his child for months after the death of his wife. More recently, the phenomenon of milk production has been shown to occur in men who are treated with female hormones, such as prostate cancer . Even in babies of both sexes often occurs in the first days of life, caused by placental hormones, a milk-like liquid (colloquially witch's milk ) from the breast off.

Oxytocin release

During breastfeeding, the hormone oxytocin is released in the breastfeeding woman's body . Oxytocin increases the flow of milk and causes the uterus to contract ( after labor ). This accelerates the weekly flow and the regression of the uterus . The breastfeeding mother can experience this “contraction” of the uterus as very strong and uncomfortable in the first few days. This feeling sets in immediately when breastfeeding, but subsides after a short time. In addition, breastfeeding and the associated hormone release promotes the closeness of mother and child. The thesis that breastfeeding also promotes secure bonds in the sense of Mary Ainsworth has not been confirmed in empirical studies.

Relactation

If a mother has weaned, she can resume the breastfeeding relationship with her baby / child months later ( relactation ). However, it is very difficult and can only be accomplished with great effort (for example, by regularly pumping out / putting on every two hours for weeks ). In addition, by then the infant may have forgotten the correct suction technique for the breast, which is difficult to train again.

Breastfeeding an unrelated or not directly related child

A woman need not have been pregnant to breastfeed. Milk production can also be started without a previous pregnancy, but this requires quite time-consuming preparation. This process is called "induction of milk production" .

Basically, every mechanical stimulus on the nipple (and somewhat less on the breasts as a whole) quickly leads to the release of the “milk production” hormone prolactin . Regular, long-lasting irritation ultimately leads to the expansion / growth of the mammary gland tissue and ultimately to milk secretion. How quickly milk production starts depends to a large extent on the intensity, but also on other factors such as the physical abilities of the woman, psychological influences and her age. Under the most favorable conditions and intensive induction, milk production can begin after three days and under unfavorable conditions only a few drops are achieved even after months.

The baby should be laid as often as possible, even (or especially) when there is little milk at first. This can be supported with a breast feeding set, which consists of a bag filled with breast milk or artificial baby milk and a fine, flexible tube, the end of which is attached to the nipple (= nipple) so that the baby sucks on the breast and extracts milk in the process the bag receives. This stimulates milk production and the child remains motivated to continue sucking on the breast.

On the part of the child

Milking the breast is a complex process in which many muscle groups work together in a coordinated manner.

A healthy newborn baby usually begins looking for the mother's breast within the first two hours of life. The newborn's strong sense of smell and its ability to recognize light-dark contrasts make it easier for them to find the nipple and suck in on the smell of the nipple and the pigmentation of the areola, which has been darker since pregnancy.

On the part of the infant, breastfeeding begins with the search reflex . The infant reacts involuntarily to touching his lips or cheeks by turning his face towards the stimulus (the nipple), opening his mouth and sticking out his tongue. Efficient breastfeeding requires that not only the nipple but also a whole piece of breast, i.e. H. roughly the entire areola is absorbed into the mouth. In order to create enough space for the tongue, the lower lip is folded outwards.

Grasping the areola triggers the sucking-swallowing reflex , which consists of powerful, rhythmic milking movements of the tongue and lower jaw ( masticatory muscles ). The double task of the tongue here is to alternately close the mouth towards the areola and towards the throat so that the nipple and areola are milked by the periodically changing internal pressure in the mouth and at the same time carry portions of food peristaltically into the throat. The jaw supports these rhythmic processes through complex synchronous movements in order to enlarge the oral cavity (opening, pushing back) to build up pressure and in order to (closing, pushing forward) push milk out of the areola. Other muscles that play a coordinated role in these processes are the lips ( orbicularis oris muscle ), which seal the mouth from the areola, the cheeks ( buccinator muscle ), which generate pumping pressure, and all the muscles involved in swallowing and nasal breathing involved.

Breastfeeding Practice

Advantages of breastfeeding over bottle feeding

Overdosing on breast milk is not possible; There are no preparation errors (such as not boiled bottles) or problems such as dirty water when breastfeeding, so breastfeeding makes breastfeeding more independent of external factors.

The taste of breast milk depends on the mother's diet. The child thus experiences a wide range of different tastes at an early age and is better prepared for porridge and family meals.

Breastfeeding positions

Breastfeeding mother in Madonna with the green pillow by Andrea Solario . The position of the mother's upper hand shows how it helps the nipple go into the baby's mouth and keeps the baby's nostril clear.

The so-called cradle hold, in which the child lies in the mother's arms, is known as the classic breastfeeding position. Especially with newborns, it is important that the baby's face is fully turned towards the mother and is level with the nipple. The child can be supported by pillows, for example, so that the mother's arm and shoulder muscles are relaxed. Pillows or a large U-shaped nursing pillow are used for this purpose . Armrests of a chair can also serve this purpose. A rocking chair or nursing chair has an additional swaying effect.

There are a number of other breastfeeding positions. The child can be breastfed sitting, lying down or standing. When back handle sitting the child's feet are aligned with the back of the mother; the support is usually provided by a nursing pillow. A tandem breastfeeding of twins for example, is possible in that both children are both in the back handle. Breastfeeding while lying down allows the mother to relax completely and even sleep. A change of breastfeeding position during the day is considered to be helpful in order to evenly empty the mother's breast and thus prevent milk congestion. It is common to alternate between two breasts for the same purpose when breastfeeding. Whether or not a breastfeeding meal consists of drinking on both sides differs individually and culturally, and also depends on whether the mother wants to increase or reduce the amount of milk.

Nursing clothes

Many breastfeeding women wear special breastfeeding bras that allow only one breast to be exposed for breastfeeding. Nursing pads are often used to keep clothes and bra dry .

Increase in the amount of milk

The following measures can increase the amount of milk the breast produces:

• Frequent laying of the baby, at least every two hours, possibly with a slightly longer break at night
• Pay attention to effective sucking and a correct breastfeeding position. The child should not twist its head sideways or overstretch it, but rather lie belly to belly close to the mother
• changing breastfeeding positions
• Change silences. To do this, the child is placed on one side until it lets go of the breast by itself. It is then placed on the other side until it stops sucking. Now it is put back on the first page, then again on the second, etc.
• Breast massages to relax and to trigger the milk donation reflex
• As much rest as possible for the mother, elimination of stress factors
• Extended body contact by being carried in a baby carrier and sleeping together promotes milk production and the baby's willingness to suckle

Agents such as milk production oil and milk production tea have no proven effect on the amount of milk. Fluid intake - whether in the form of water, tea, or other beverages - is necessary to meet the mother's increased fluid needs and to prevent dehydration . However, drinking alcohol reduces the amount of milk (see below ), and the alcohol passes into breast milk and is harmful to the health of the baby.

Tandem breastfeeding

Tandem breastfeeding is the simultaneous breastfeeding of two or more children of different or the same age (twins). Typically, babies are weaned before a new baby is born. However, this is not necessary as the older child can also continue to drink at the mother's breast. The breast adapts to the increased demand.

Breastfeeding types

According to the findings of the American pediatrician GR Barnes, five different breastfeeding types ( procrastinator , connoisseur or gourmet , dreamer and excited or less effective , barracuda ) can be distinguished in infants , which already reveal personality traits and character traits through their behavior on the breast.

Breastfeeding and Contraception

Breastfeeding is only a reliable method of contraception under very limited conditions. After lengthy studies in various countries in the 1980s, the exact framework conditions under which safe contraception can be assumed were published under the name Lactational Amenorrhea Method . Under these conditions, a Pearl Index of 1 to 2 was determined, which means that out of 100 women who do not use any other methods of contraception for 6 months after giving birth, one or two will become pregnant again.

However, the security of the method is only guaranteed:

• if the birth was not more than six months ago,
• if the woman has not had menstrual bleeding after giving birth ,
• if the infant is breastfed every four hours during the day and at least every six hours at night and then for at least 20 minutes. If there are longer breaks in breastfeeding, for example if the child sleeps longer at night, the concentration of the hormone prolactin, which is responsible for contraception, drops to such an extent that it is no longer effective as a contraceptive.

During breastfeeding, common methods of contraception are sometimes more, sometimes less suitable; see: Contraception during breastfeeding .

Breastfeeding obstacles and problems

Only a few women (less than 5%) cannot or only partially breastfeed. If problems arise, the breastfeeding mother should contact a breastfeeding advisor or a midwife with experience in breastfeeding in order to be able to continue the breastfeeding relationship with as little stress as possible for mother and child. In Germany there is a right to midwifery help during the entire breastfeeding period.

On the part of the mother

• The greatest obstacles to breastfeeding are incorrect or insufficient information from mothers, lack of support or the lack of willingness to breastfeed. The importance of the father's benevolent support when breastfeeding should not be underestimated. The duration of breastfeeding depends largely on its approval, as various studies and surveys have shown.
• Breastfeeding problems occur particularly often when the infant is breastfed according to a schedule or a minimum interval between hours rather than as needed.

Pain

• Pain when starting breastfeeding from sore nipples. If the pain does not subside on its own in the first few days of breastfeeding, this may be due to an attached tongue ( ankyloglosson ) in the newborn. A severing of the tongue frenulum can help. An Italian study has pointed out in 2015 that the use of nipple shield made of silver can help to heal sore nipples; Nipple shields made from other materials were not even tried in this study. Nipple shields also hinder efficient drinking because they do not allow the areola to be milked (see above ).
• Milk congestion is when the breast is not emptied sufficiently and this leads to (temporary), sometimes painful, indurations in the overcrowded breast. A milk blockage can develop into an inflammation of the breast (glands) , which can be treated with breastfeeding-compatible antibiotics. It is also said that drinking sage or mint tea lowers milk production. A breastfeeding break or even weaning, on the other hand, is a hindrance to overcoming a milk congestion or breast inflammation, because in both cases the focus is on emptying the overcrowded breast and setting the amount of milk actually required by the child. The use of lecithins is also recommended to prevent recurring milk congestion or mastitis . In addition, care must be taken to ensure that it is clean : the breast should be washed once a day with clear water and the breastfeeding woman should only touch her breast with clean hands; this is particularly important with sore nipples. For a baby of crawling age, the baby's face and hands should also be clean when breastfeeding so that bacteria from the floor and objects do not get onto the breast.
• A painful whitish discoloration of the nipple while breastfeeding can indicate Raynaud's syndrome . In milder cases, taking magnesium can bring relief.
• Since teething starts around the 6th month after birth, children who have been breastfed for longer can bite the nipple. This can also happen with toothless jaws.

Shape of the nipples; Piercing

• The shape of the nipples does not affect whether or not a woman can breastfeed. In the case of special features (very large nipples, flat or inverted nipples), however, in most cases a little more patience and the support of a consultant with breastfeeding experience are required. In the case of flat or inverted nipples, a kind of gentle reshaping can be attempted during pregnancy in order to make breastfeeding easy. In the case of inverted or inverted nipples, you can counteract this in advance by using niplettes .
• In the case of a nipple piercing (see nipple piercings when breastfeeding ), the jewelry should be removed beforehand to make it easier for the baby to suckle and to prevent the jewelry from being swallowed. In addition, the piercing must be well cared for and healed to avoid infection. If milk ducts were injured when the piercing was stabbed, the milk may jam because the milk cannot be properly emptied. However, if the piercing was done professionally and healed properly, no breastfeeding problems are expected.

Problems with the amount of milk

• If hypogalactia (too little breast milk) is actually present and not caused by incorrect breastfeeding , the infant can be fed through breast milk donation or dual milk feeding without the mother having to stop breastfeeding.

Problems with milk quality

For the milk quality with tobacco and alcohol consumption etc. see below: Proven or suspected risks for the child

• If you need to take medication while breastfeeding, it may be necessary in rare cases to take a break from breastfeeding or, in very rare cases, to wean. Doctors and breastfeeding women can obtain information on breastfeeding tolerance from research institutes (see web links ). Most medications, however, are compatible with breastfeeding or there is an alternative that is compatible with breastfeeding.
• There are some medical conditions that limit breastfeeding, such as: B. psychoses and due to the risk of infection tuberculosis or AIDS . The relatively common postpartum depression can be treated with breastfeeding tolerance (see web links ), but many antidepressants pass into breast milk and should not be used by breastfeeding women.

On the part of the child

Rejection of the chest

• In some cases, babies “strike” for a few hours or a few days and do not want to breastfeed . This is referred to as a breastfeeding strike , which in no way means weaning on the part of the infant. A silent strike can u. It can be triggered by a food ingested by the mother (e.g. garlic in some infants). The milk takes on this taste and the baby does not like it. In such a case, the breastfeeding strike can be quickly eliminated by pumping out this milk and pouring it away.

Disorders of the milking ability

• In the case of dual milk feeding, in which the bottle is fed in addition to breastfeeding, nipple confusion can occur. Drinking from a bottle demands a less differentiated sucking behavior from the child, so that it may forget how to drink correctly from the breast. The milk runs out of the bottle almost by itself, drinking only requires a sucking-swallowing movement. The child has to exert itself more on the breast, breastfeeding requires a sucking-chewing-swallowing movement. Alternative feeding methods should be used here, e.g. B. the gift with a spoon, from a cup or by means of a breast feeding set. Nipple confusion can also be caused by using pacifiers too early, when the infant is not yet confident in how to suckle the breast.
• In the case of very small premature babies , the often associated weak sucking needs to be taken into account. However, the composition of the mother's milk is very well adapted to the needs of a premature or deficient baby. If breastfeeding is not immediately possible due to a suckling weakness, the baby should be pumped and the milk obtained in this way fed to the baby using an alternative feeding method (cups, Haberman feeders, etc.) in order to prevent nipple confusion.
• Infants with cleft palate cannot be breastfed or can only be breastfed to a very limited extent. After the operational union of the sail, breastfeeding can sometimes still be successful.
• Disabilities of the child, such as B. malformations in the digestive and respiratory tract , heart defects or brain damage can make breastfeeding difficult.

Breast milk intolerance

• In very rare cases, lactose intolerance is already present in infancy , e.g. B. Galactosemia .

If breastfeeding is not possible, the infant or toddler is generally supplied with a feeding bottle , which is also referred to as a bottle- fed child .

Breastfeeding advice

Midwives provide breastfeeding advice in the context of childbirth and aftercare in the puerperium and is therefore also a service provided by health insurance companies. Also so-called lactation consultants, mothers with their own breastfeeding experience and appropriate training and further education. They offer mother-to-mother counseling at breastfeeding meetings and in breastfeeding groups on a voluntary basis .

The working group of independent breastfeeding groups e. V. (AFS) and the La Leche League Germany e. V. (LLL) offer voluntary breastfeeding advice and breastfeeding group work and organize training for breastfeeding consultants. The main goal of these two self-help organizations is to promote breastfeeding culture in Germany and to disseminate well-founded information on the subject of breastfeeding. The La Leche League is close to Attachment Parenting , a scientifically controversial doctrine developed by William Sears , according to which needs-based breastfeeding, constant carrying of the child and co-sleeping should prevent disorders of the mother-child bond.

Furthermore, there are also professional breastfeeding and lactation consultants (" International Board Certified Lactation Consultant ", IBCLC , English for "internationally certified lactation consultant") who practice a medical profession and have well-founded training in breastfeeding and breastfeeding advice. The consultation is chargeable for breastfeeding women, but in many cases the health insurance company pays for this consultation.

Willingness to eat complementary foods, weaning, weaning age

→ Main article : Weaning

As the infant gets older, usually between the sixth and ninth months, the willingness to consume complementary food will become apparent. A baby is ready for complementary feeding when:

• the tongue reflex, which automatically pushes solid food out of the mouth, has disappeared
• he is interested in the food and can bring it to his mouth himself
• it can sit alone
• it shows an increased need for breastfeeding that does not return to normal after a few days and is not due to other reasons, such as B. teething , illness , stress , growth.

However, the introduction of Bei kost ( i.e. not instead of kost) is no reason to stop breastfeeding, because breastfeeding offers many advantages well beyond the first six months. If the infant is breastfed as required and is allowed to determine the time of weaning himself, the time of weaning is often only after the second or third birthday. A real weaning on the part of the child in the first year almost never happens. If one considers the behavior of mammals and adjusts the data to humans, the weaning age would be between 2.5 and 7 years. The comparison of the weaning age of 64 traditional cultures, as made by Katherine Dettwyler and Stuart McAdam in "Breastfeeding: Biocultural Perspectives", 1995, comes to a curve, the apex of which is shortly before the third birthday. The earliest weaning time of the cultures examined is shortly before the first birthday, the latest around 5 1/2 years.

The WHO recommends exclusively breastfeeding for up to six months and partial breastfeeding for up to two years or more. From an allergological point of view, to prevent atopic diseases, breastfeeding should be carried out for at least the fourth month.

The timing of the introduction of complementary foods varies from region to region. While between 2000 and 2006 45% of all babies in South Asia and 43% in East Asia and the Pacific region are exclusively breastfed in the first six months, the proportion in Sub-Saharan Africa is 30%. In North Africa and the Middle East it is 28% and in Central and Eastern Europe and the Commonwealth of Independent States 19% of all babies. Between 1996 and 2006, the proportion of infants nourished exclusively by breastfeeding in the first six months of life increased in all regions of the world mentioned with the exception of North Africa and the Middle East.

In any case, a gentle, i.e. H. treacherous weaning should be sought, regardless of whether this originates from the child or the mother. This avoids fear of loss in the infant and health problems - such as milk congestion in the mother. With natural weaning according to the needs of the child, the child will want to be breastfed less and less frequently as development and maturity increase. In the case of weaning initiated by the mother, one breastfeeding meal after the other should only be slowly replaced by a complementary meal over a period of weeks.

Benefits and Risks

→ See also: Maternal health: breastfeeding

Proven or suspected benefit to the child

The health benefits of breastfeeding (vs. feeding bottled food) for children in rich countries in the Western world mainly consist in supporting the immune system and in promoting and stimulating the mouth muscles, which cause certain anatomical and motor deficiencies such as e.g. B. prevents jaw malformations or accustomed mouth breathing.

Many older studies on the benefits of breastfeeding were methodologically flawed and systematically neglected possible other factors (such as education or the mother's sociocultural environment) that not only determine the child's health but also the type of feeding. Statistical correlations were confused here with cause-and-effect relationships, with the result that the health benefits of breast milk were greatly exaggerated or, as artifacts, actually did not exist and could not be proven in methodologically sound studies.

Immune protection

Little research has been done on the development of the immune system in the fetus and the infant. Although there are indications that children already have their own T-lymphocytes ready for defense immediately after birth , many authors assume that newborns do not yet have a functioning immune system of their own. It is undisputed that fetuses and newborns receive antibodies , enzymes and leukocytes from the mother. Before birth, this happens through the placenta , immediately after birth through colostrum and finally - to a much lesser extent - through breast milk .

The transplacental antibodies are only broken down slowly in the newborn's blood and protect the child from many viruses, bacteria and fungal spores for a few weeks . The maternal immune protection against whooping cough and Hib is lost the fastest, which is why children are now vaccinated against these diseases as early as two months after birth . Colostrum and breast milk are not a substitute for vaccinations, but can increase the “ nest protection ” that the child received through the placenta.

Breastfeeding offers the greatest immunological benefit to infants in poor countries who, when fully breastfed, are significantly less likely to develop life-threatening diarrhea than bottle-fed children. But breastfed children also develop otitis media and respiratory infections somewhat less often than bottle-fed children. A Spanish study in 2006 came to the result that of the children who had been fully breastfed in their fourth month of life, 4.2% had been hospitalized for an infectious disease during their first year of life. In the comparison group, this was the case for 6.6% of the children.

Oral motor skills, speech development

Breastfeeding by no means forces the infant to suckle, but rather to a complex, milking movement pattern of all of its mouth muscles (lips, tongue, soft palate, cheek and jaw muscles). Bottle drinking, on the other hand, only uses the cheek and circular muscles of the lips . Because the other muscle groups in bottles drinkers may stimulate insufficient and be trained early weaning favors proven mistakes of the oral motor with consequences such angewöhnter mouth breathing, unusual resting position of the lips and tongue, false formations of the dental arch and palate , malocclusions , teeth grinding , excessive Saugdrang, impaired Chewing, sucking or swallowing, up to articulation disorders . The popular opinion that is often expressed that breastfeeding promotes an early start to speech or leads to better speaking has not yet been proven in methodologically sound scientific studies.

Infant mortality

There are hardly any studies from rich countries in the Western world that deal with the possible influences of infant nutrition on infant mortality . An exception is the study published in 2004 by a team of researchers at the National Institute of Environmental Health Sciences in North Carolina, in which it was found that children who are not breastfed are slightly more likely to die in infancy than breast-fed children, particularly as a result of accidents. In poor countries, only well-nourished mothers are often able to breastfeed their child, so that the reduced infant mortality of breastfed children is more a result of their overall better living conditions than the type of feeding alone.

Also, sudden infant death syndrome occurs in non-breast-fed infants slightly more common than breast-fed. Sudden infant death syndrome is a rare occurrence - in 2005 for example. B. hardly more than 1 in 2100 infants died in Germany - so that scientific studies on this topic have to work with very low case numbers. Far more powerful risk factors than bottle-feeding have also been described for sudden infant death : namely single parenting , motherhood of minors , poor education and poverty. Mothers in these risk groups often do not breastfeed because they are overwhelmed or have to go back to work soon after giving birth.

Body weight, blood pressure, cholesterol level, type 2 diabetes

Women who generally value a healthy diet are particularly likely to choose breastfeeding. Since they also teach their children healthy eating, they are less likely to be overweight than bottle-fed children, even in adulthood.

Also, slim mothers are more likely to breastfeed than overweight mothers, with the latter's children more likely to become overweight than the former. A direct effect of breastfeeding on the body weight of the child appears in many studies (which ignore maternal nutritional education) as a measurement artifact, but could not be proven in methodologically sound studies.

In many studies, breastfeeding has also been said to have a long-term antihypertensive effect. Adults who were breastfed as children have been shown to be less likely to have high blood pressure than people who are not breastfed. Since high blood pressure is one of the natural side effects of overweight and obesity, one must assume that here too, breast milk is not the decisive factor, but maternal nutritional education. The same applies to the supposedly beneficial long-term effects of breastfeeding on cholesterol levels and the development of type 2 diabetes .

Asthma, allergies, eczema

More recent, methodologically flawless studies have not confirmed the - often formulated - assumption that breastfeeding protects against asthma , allergies or eczema in the long term .

Intelligence development

Breastfeeding is far more common among educated mothers than among less educated mothers; they also breastfeed their children much longer. Although these facts have been known since the 1980s, many researchers have attempted to demonstrate a positive association between breastfeeding and intelligence development , without taking into account that the breastfed children they studied (and who were significantly more intelligent than the non-breastfed children), had a disproportionately high number of educated mothers. However, some studies that considered this source of error found a link between intelligence and length of breastfeeding. In contrast, a more recent study of 8,000 Irish families found no connection between the duration of breastfeeding and the cognitive abilities of children examined at the age of three and five.

Proven or suspected risks to the child

In the overall assessment of the benefits of breast milk, it should not be overlooked that harmful substances accumulate in breast milk. Fortunately, DDT, which was found in the 1970s, is now only slightly or not at all detectable in breast milk. But other pollutants, for example flame retardants or currently (June 2015) glyphosate, are found to a considerable extent.

Tobacco and cannabis smoking

Women smokers decide to breastfeed significantly less often than non-smokers and breastfeed less long. While numerous clinical studies have looked at the presumed benefits of breastfeeding, the consequences of smoking for breastfeeding - in particular the transfer of ingredients and combustion products from cigarettes and cannabis products into breast milk - have only been investigated sporadically to date.

A study carried out in Italy in 2003 showed that the nutritional composition of breast milk from women who smoked before pregnancy differs from that of non-smokers. It contains less HDL and more triglycerides , cholesterol and LDL .

Nicotine passes into breast milk very quickly after smoking . A 2007 study in Philadelphia showed that infants slept significantly less after breastfeeding if their mother smoked before (an average of 53.4 minutes; compared to 84.5 minutes if the mother hadn't smoked before breastfeeding). The half-life of nicotine in breast milk is 97 minutes, which means that 97 minutes after smoking the breast milk still has 50% of its initial nicotine content, 194 minutes after it still has 25%, etc. Breast milk produced after smoking smells characteristic of tobacco own flavors and flavors added to tobacco. Some researchers suggest that children get used to it and thereby become susceptible to smoking themselves later. In male infants, feeding breast milk with nicotine also decreases the adaptability of the heart rate . Nicotine replacement therapy has similar consequences as smoking before breastfeeding: transdermal patches with 21 mg nicotine pass the same amount of nicotine into breast milk as 17 cigarettes a day. Experiments showed that the amount of milk in mothers who used nicotine patches was reduced by around 17%. In older studies, differences in the amount of milk and the duration of breastfeeding among smokers and non-smokers were often attributed to the assumption that nicotine interfered with prolactin formation; However, this thesis has not been confirmed experimentally. Rather, psychosocial factors seem to be at play. Nor has it been proven that nicotine in breast milk leads to developmental disorders in infants.

Not only the neurotoxin nicotine, but also highly carcinogenic polycyclic aromatic hydrocarbons such as B. Benzo (a) pyrene pass into breast milk. On the question of whether the breast milk of smokers also contains significant amounts of genotoxic substances such as B. contains ethylene oxide , there are no studies to date.

Studies are also not yet available on the THC content in the breast milk of women who smoke cannabis products such as marijuana or hashish . The only indisputable fact is that THC, because it is fat-soluble , easily passes into breast milk. Until now, however, proof of quantities has only been provided in animal experiments.

alcohol

Drinking alcohol does not, as an urban myth suggests, increase the amount of milk; on the contrary, it actually decreases it. Also, infants do not like the milk fortified with alcohol and in the first 3–4 hours after the mother has had a drink they ask for the breast particularly often, but drink a good 20% less milk than when the mother is empty. Drinking large amounts of alcohol can disturb the milk ejection reflex.

Alcohol that a woman drinks is immediately excreted into breast milk in the same amounts as is found in her blood. The alcohol does not accumulate in breast milk, but is broken down at the same rate as in the blood. There is no need to pump out and dispose of the milk produced after drinking alcohol.

Alcohol is broken down only half as quickly in the organism of newborns as in adults. One study found that breastfed children of mothers who drink small amounts of alcohol sleep less. Another showed that the mother's daily drinking can delay the development of the child's gross motor skills.

Caffeine

Caffeine only passes into breast milk in very small amounts (0.06–1.5% of the amount taken by the mother) and reaches its peak in the child 1–2 hours after drinking coffee. Caffeine is also given to premature babies as a medication - in significantly higher doses than would be obtainable through breast milk - to strengthen breathing. Different children react differently to the caffeine in breast milk; younger ones usually stronger than older ones, sick ones possibly stronger than healthy ones. The half-life of caffeine is 2–5 days in newborns, but only 3–7 hours in 6-month-old infants - as in adults. A small study has shown that moderate coffee drinking by the breastfeeding mother (500 mg caffeine per day) has no measurable effects on the pulse and sleep times of breastfed children. The American Academy of Pediatrics has classified caffeine that is not consumed in unusually large amounts as safe for breastfeeding.

Vaccinations

According to current recommendations from the Robert Koch Institute responsible for this in Germany , vaccinations are generally possible without restrictions during breastfeeding. Furthermore, vaccinations against dead substances are not a reason to postpone a (further) pregnancy. If another pregnancy is planned, only vaccinations with live vaccines (such as against measles , mumps and rubella ) are contraindicated from three months before (and then during the entire) pregnancy .

HI virus

25–30% of children of HIV- positive mothers become infected with the virus during pregnancy or childbirth; through new treatment methods such as B. the early administration of zidovudine , this risk can be reduced to 8.3%. However, infection is also possible through breast milk. A study carried out in Malawi has shown that 9.7% of the children who were not yet infected at birth became infected by their HIV-positive mothers while they were breastfeeding, with 87.4% of the cases only occurring after the first six months happened. In another study, however, an even distribution of cases of infection was observed over the entire period of breastfeeding.

Proven or suspected benefits and harm to the mother

The most significant maternal health benefit of breastfeeding shown in studies is a lower risk of developing ovarian cancer . Breast cancer is also slightly less common among women who breastfeed than women who bottle-feed. Further health benefits for the mother, which are often attributed to breastfeeding, have not been proven in methodologically sound studies. Breastfeeding does not pose any health or cosmetic risks for women.

Ovarian cancer

The lifetime risk for women to develop ovarian cancer is 1.37%. In women who did not give birth ( nulliparous ), it is around 30% higher than in women who gave birth. An Australian study found that women who breastfeed for more than 13 months in their lifetime cut their risk of ovarian cancer by more than half. Other studies have shown that even a short period of breastfeeding significantly reduces the risk.

Breast cancer

Every year breastfeeding (white boxes) only lowers the risk of breast cancer by a few percentage points. The number of births (pillars) has a significantly larger effect.

As has been shown in many studies, breastfeeding lowers the risk of breast cancer, but only to a very small extent. The lifetime risk of breast cancer is around 10% for women, 30% higher for nulliparous women than for women who gave birth, i.e. a good 11%. The risk of breast cancer decreases by 7% with every birth and by an additional 4.3% every year that a woman breastfeeds. To cut her risk of breast cancer in half , a woman would have to breastfeed a child for twelve years; with five children, she would have to breastfeed for a total of five years.

Loss of shape of the breast

An urban myth says that breastfeeding causes the female breast to lose its original, firm shape and begin to sag. The actual cause of the increasing sagging of the chest ( mastoptosis ) lies primarily in the loosening of the connective tissue , especially the Cooper ligament, which is associated with aging . At what age and how much the breast sinks depends on various other factors, especially the weight of the breast before pregnancy, the body mass index , genetic factors, the number of pregnancies and whether the woman smokes. There is no evidence from research that breastfeeding has any influence on the process. The only possible prevention is to avoid excessive weight gain during pregnancy.

osteoporosis

The incidence of osteoporosis in women is estimated to be 9–38%, depending on the examination method. The lifelong risk of women suffering from a bone fracture caused by osteoporosis is less controversial : it is 46%. In nulliparous it is 11% (for fractures of the pelvic bones even 44%) higher than in women who gave birth. Some researchers have suggested that breastfeeding further reduces the risk, but scientific studies have not yet proven such a link. In rare cases, however, breastfeeding can lead to pregnancy-associated osteoporosis .

Body weight, metabolism, cardiovascular health

Women who were overweight before pregnancy were 16% more likely than women of normal weight to choose to feed their child industrial bottled food. Breastfeeding women are therefore disproportionately often women of normal weight. In many older studies, which were supposed to examine the possible benefit of breastfeeding for maternal health, the body mass index (BMI) of women before pregnancy was not taken into account, with the result that the effects of factors including the BMI of the Women determine - e.g. B. Diet and exercise habits - were systematically misinterpreted as the effects of breastfeeding .

An example of this is the studies that found that breastfeeding women lose weight faster after giving birth than women who bottle feed. Other examples include studies showing that breastfeeding women are less likely to suffer from high blood pressure , diabetes , hyperlipoproteinemia, and cardiovascular disease than bottled food .

distribution

Germany

So far, only a few surveys have been carried out on the prevalence of breastfeeding in Germany. The KiGGS study, funded by the Robert Koch Institute , was published in 2006 and showed that 81.5% of the children born in Germany in 2005 were breastfed at least temporarily. The most important determinant that this study found for the willingness of mothers to breastfeed was their social status. Of the mothers with high social status, 90.5% had breastfed, of the mothers with medium social status 80.0% and of the mothers with low social status 67.3%. Mothers with high social status had also breastfed longer (average 8.45 months) than mothers with medium (6.81 months) or low social status (6.19 months). The most frequent and longest breastfeeding women were those who had given birth in the 4th decade of life (younger than 20: 69%, 5.49 months; 20–29 years: 75.1%, 6.21 months; 30–39 years: 80 , 0%, 7.85 months; 40+: 69.6%, 7.69 months). Children from East Germany (81.6%) were more likely to breastfeed than children from West Germany (75.7%), but the duration of breastfeeding was shorter on average (East Germany: 6.3 months, West Germany: 7.0 months; nationwide: 6, 9 months). Mothers with a migration background (79.1%, 7.75 months) breastfeed somewhat more frequently and for longer than non-migrant women (76.2%, 6.73 months). Full breastfeeding recommended by the WHO in the first half of life was mainly practiced by West German women with a high social status who were between 30 and 39 years old.

A study from Berlin showed that two months after birth, 73% of the children were still breastfed there; after six months it was about 56%. In a study in Bavaria it was 70% after two months and around 50% after 6 months. The proportions of children who were exclusively breastfed were even lower.

The most important comprehensive study on breastfeeding in Germany was carried out in 1997/98. This SuSe study had shown that the high breastfeeding rate of 91%, which was found in the participating hospitals immediately after the birth, fell sharply within the first few weeks. After four months, 33% of the children were still exclusively breastfed; after six months it was only 10%.

United States

Although gynecologists and paediatricians generally strongly advocate breastfeeding in the USA , the proportion of breastfeeding mothers there falls from 70.9% to 36.2% after birth by the end of the 6th month. After 12 months, 17.2% of the mothers were still breastfeeding, after 18 months it was 5.7%. In 2003, 54% of mothers of babies were employed. There is no paid maternity leave in the United States .

Breastfeeding is more common in white families than in African American families . Of white babies born in 2010, 79% were breastfed immediately after birth and 62% of African-American babies. Six months later, 52% of the whites were still breastfeeding, compared to 36% of the Afro-American ones. Breastfeeding is particularly widespread among academics; in 2014, 88.7% of college-educated mothers breastfed; the proportion of mothers who exclusively breastfed for six months was 21.8% among academics, also more than in all other comparison groups.

International breastfeeding statistics

In some poor countries, e.g. B. Eritrea , many infants are only breastfed for a very short time because their mothers are malnourished and therefore do not have enough breast milk.

country	ever breastfed (in percent)	exclusively breastfed (in percent)			Sources and Notes
		3 months	4 months	6 months
Germany	81.5		34	22nd	Average length of breastfeeding: 6.9 months, average length of full breastfeeding: 4.6 months
Austria	93.2	60		10	After three months, 72% of the children are at least partially breastfed, after six months 65%, after 12 months 17% (1% fully breastfed).
Switzerland	88	48	32	14th
Egypt	95			53
Albania				39
Algeria	93			7th
Ethiopia				52
Australia	56	46
Armenia				35
Azerbaijan				12
Bangladesh	97			64
Bahrain	97
Belgium	66	34	26th
Belize	90			15th
Benin	97			33
Bhutan				49
Bolivia	97			60
Bosnia and Herzegovina				18th
Brazil	93			40
Burkina Faso	99			25th
Burundi				69
Costa Rica				19th
Denmark	98	48	51
Dominican Republic	93			8th
Djibouti				1
Ecuador	95
El Salvador	94			31
Ivory Coast	100			12
Eritrea	98
Finland	93	51	34	15th
France	74	10		11.5	74% of mothers try breastfeeding once in the hospital. 39% of the children are still breastfed after three months, 23% after six months. After one year, 9% of all children are still breastfed.
Gambia				36
Georgia				11
Ghana	99			46
Greece	86
Great Britain	69	12
Guatemala	96			50
Guinea				21st
Guinea-Bissau				38
Guyana				33
Haiti	96			40
Honduras	96			30th
India	96		46	33
Indonesia	96			32
Iraq				20th
Iran	98			28
Ireland	34		15th	1	81% of mothers breastfeed their baby at least once, but only 34% breastfeed when they leave the hospital; after two months, 15% of children are still fully breastfed
Iceland	97	69	46
Israel	78.5
Italy	85	20th	19th	32
Japan	96	38	37	35
Yemen	97
Jordan	95			22nd
Cambodia				74
Cameroon	97			20th
Canada	84		38	19th
Cape Verde				60
Kazakhstan	96			32
Kenya	98			32
Kyrgyzstan	95			32
Colombia	95			43
Comoros	96
Congo, Dem. Rep.				37
Congo, Republic				21st
Cuba	99			48.6	17.1% of children are still breastfed at the age of two.
Laos				26th
Lesotho				54
Latvia				29
Lebanon	88			17th
Liberia				29
Madagascar	97			51
Malawi	97			71
Maldives				48
Mali	95			34
Morocco	95			15th
Marshall Islands				27
Mauritania	95			19th
Mauritius	72
Macedonia				16
Mexico	92	18th	10	3
Mongolia				59
Montenegro				19th
Mozambique	95			41
Namibia	95			24
Nauru				67
Nepal				70
New Zealand	88	56	39
Netherlands	75	35	35	25th
Nicaragua	92			31
Niger	97			10
Nigeria	97			15th
North Korea				89	No infant formula is industrially manufactured in North Korea. Some wealthy parents buy imported products from South Korea.
Norway	99	63	46
Oman	99
East Timor				52
Pakistan	94			40
Panama				14th
Paraguay	94			24
Peru	97			71
Philippines	88			34
Portugal	93	55
Rwanda	97			85
Romania	91			34
Russia	98.7
Solomon Islands				74
Zambia	98			61
Samoa				51
Sao Tome and Principe				51
Sweden	97		60	15th
Senegal	97			39
Serbia				14th
Sierra Leone				32
Zimbabwe	99			31
Slovakia	87	63	55
Slovenia	97
Somalia				5
Spain	91	41
Sri Lanka				76
Sudan	96			41
South Korea	81	50	40.5	11.4
Suriname				2
Swaziland				44
Syria	92			29
Tajikistan				25th
Tanzania	97			50
Thailand	97			15th
Togo	97			63
Trinidad and Tobago				13
Chad	98			3
Czech Republic	94	61
Tunisia				9
Turkey	95			42
Turkmenistan				11
Tuvalu				35
Uganda	98			63
Ukraine				18th
Hungary	96	96
Uruguay				57
Uzbekistan	96			26th
Vanuatu				40
Venezuela				12
United Arab Emirates	93
United States	74	31		12
Vietnam				17th
People's Republic of China	98.3	46	30th	13
Belarus				9
Central African Republic	97			23
Cyprus	78	52	15th

Sources, unless otherwise noted: OECD, LLL and WHO

Social, cultural and ideological history of breastfeeding

19th and 20th centuries

As 1894 L. Emmett Holt , a pioneer of Pediatrics ( Columbia University ), his standard work The Care and Feeding of Children published, was rampant in New York City , the infant mortality rate ; Holt tried to combat them by applying scientific knowledge to child care and feeding. In his book he recommended monitoring the child's weight gain by weighing weekly and later monthly. Because he assumed that the child needed digestion time after the meal, Holt stubbornly held regular breastfeeding a basic requirement of good child care. He was a strong advocate of full breastfeeding; Only in the last quarter of the first year of life should the child gradually be weaned and used to cow's milk and other foods. However, since many mothers had to wean earlier because they were working, he also gave detailed instructions on how to make bottle-fed formula.

John B. Watson succeeded Holt as the leading author of infant care guides . Watson had founded classical behaviorism in the 1910s and was convinced that human beings could be shaped at will. In his work Psychological Care of Infant and Child , published in 1928, he warned - in keeping with his mechanistic conception of the infant - against petting children and spoiling their characters, and identified the main culprits as the mothers who, he observed, kept kissing their toddlers. Watson's ideal was to replace sentimental pampering with rational practice of good habits. Regular feeding by the clock, which Holt had recommended for physiological reasons, became Watson's use of sensible parenting techniques, and to minimize physical contact between mother and child, Watson recommended bottle-feeding.

In the German Empire , based on the first laws on maternity protection , breastfeeding benefits were also paid out. During the National Socialist era , the nursing allowance was increased, and in 1944 it was finally paid to all mothers, including those to whom the Maternity Protection Act did not apply.

21st Century: Breastfeeding Controversy

In English-speaking countries, where not only the slogan Breast is best , but also William Sears ' breastfeeding- friendly attachment parenting has found widespread use, some of the theses of breastfeeding advocates and the social pressures that non-breastfeeding mothers face today often exposed, have recently been repeatedly criticized. For example, the journalist and author Hanna Rosin reports on how she undertook the experiment to announce to befriended mothers that she would soon wean her one-month-old baby: “The reaction was always the same: affiliations were redefined, so that I ended up in a class of mothers who, to put it bluntly, would be willing to feed their baby pureed Chicken McNuggets. ” In Great Britain, the sociologist Ellie Lee published a study on this subject in 2005. The Zeit author Jeannette Otto noted that in Germany, too, it takes courage to be an “avowed non-silent woman”.

In 2013, the sociologist Joan B. Wolf ( Texas A&M University ) described how health issues had such a high priority in social discourse and how the question of what constitutes a responsible mother had attained such a level of dogmatism that the quality of studies made the superiority of breastfeeding versus bottle feeding prove that it is hardly questioned. The most serious allegation that has been made against almost all previous studies is that they did not compare breast-fed children with non-breast-fed children, but rather children from breastfeeding families with children from non-breastfeeding families, i.e. This means that potential socio-economic factors were not systematically excluded. In 2014, Cynthia G. Colen ( Ohio State University ) circumvented this problem by examining only those families in which at least one child was breastfed and at least one other bottle-fed diet. In this study, she was able to show that the bottle-fed children did not differ significantly from their breastfed siblings in terms of physical, emotional and intellectual development. A comparable study carried out by Eirik Evenhouse and Siobhan Reilly in 2005 at Mills College had come to similar results. In Belarus , Michael S. Kramer conducted a true randomized study in 2008 by urging the mothers in one of the two comparison groups to breastfeed longer and more exclusively than they had originally planned. In this case, too, the children showed only very few significant differences in terms of health. Hanna Rosin, who has systematically examined the medical literature, comes to the conclusion that breastfeeding does indeed have small health benefits compared to bottle-feeding, but that these are not significant enough to justify the doctrinalism that is currently shaping the social discourse on breastfeeding .

Cultural, social and political perspective

Breastfeeding corset with detachable breast access (around 1880)

Breastfeeding in Public (Europe and US)

Breastfeeding in public is widely accepted, at least in the European cultural area. A nursing bra that can be opened on one side allows the mother to breastfeed and to be largely clothed. The chest can largely be covered by clothing and the child's head. The child can lie under the outer clothing; conversely, the clipping of the clothing can also be opened or moved. "Nursing tops" are also available as items of clothing specially designed for breastfeeding.

In the US , breastfeeding is not universally accepted in public. According to polls by the American Dietic Association , 57% of Americans oppose breastfeeding in public. The German Foreign Office points out that breastfeeding in public in almost all states of the USA is now expressly excluded from penal regulations against exhibitionism, but advises that it should be "at least in restaurants and bars or in less 'liberal' areas" to stop.

Promotion of breastfeeding in Germany

In 1994 the federal government founded the National Breastfeeding Commission to promote breastfeeding in Germany .

The National Breastfeeding Commission consists of scientists, paediatricians, representatives of the breastfeeding associations, midwives and obstetricians as well as pediatric nurses. The management of the commission is based at the Federal Institute for Risk Assessment (BfR).

The task of the National Breastfeeding Commission is to advise the federal government on breastfeeding. She comments on a variety of topics related to breastfeeding and gives recommendations. Furthermore, one of their tasks is to support initiatives to remove existing obstacles to breastfeeding.

Breastfeeding and employment

In Germany, every mother who works while breastfeeding is legally entitled to breastfeeding breaks and other special regulations. A professional activity is therefore no reason to wean (see the Maternity Protection Act ).

The revision of the European Social Charter of May 3, 1996 also contains in Article 8 the obligations for the contracting parties to “ensure that mothers who breastfeed their children have the right to adequate work breaks for this purpose”.

Breastfeeding can be combined with care from another person. This is easier the older the child is, as the number of breastfeeding meals usually decreases. If the mother's place of work is nearby, she can interrupt her work to breastfeed, possibly at the request of the carer; otherwise it may be useful to express breast milk or the child will eat different foods during the day. Breastfeeding in the evening, at night and in the morning can remain part of the mother-child relationship .

Many day nurseries support breastfeeding in every way and allow mothers to visit the facility to breastfeed as needed. In some cases, a corresponding regulation has been institutionalized: for example, in 2002, by decree, breastfeeding was allowed in all day care centers in Paris.

See also

• Swiss Foundation for the Promotion of Breastfeeding

literature

• Hanna Neuenschwander, Cornelia Hebeisen-Welle; La Leche Liga International (ed.): The manual for the nursing mother. 3. Edition. La Leche League Switzerland, Zurich 2010, ISBN 978-3-906675-02-2 (title of the original 1981 edition: The Womanly Art of Breastfeeding ).
• Breastfeeding and breastfeeding. Basics, experiences and recommendations. (PDF) Publication by the Federal Center for Health Education, ISBN 3-933191-63-7 , free of charge (shipping costsapply)
• B. Koletzko, F. Lehner: Beer and breastfeeding. In: Advances in Experimental Medicine and Biology . 2000; 478, pp. 23-28. (English)
• S3 guideline breast infections during breastfeeding: Therapy of the German Society for Gynecology and Obstetrics (DGGG). In: AWMF online (as of February 2013)
• S3- guideline allergy prevention of the German Society for Gynecology and Obstetrics (DGGG). In: AWMF online (as of July 2014)
• Jürgen Kleinebrecht [Welcoming], Klaus Friese, Klaus Mörike, Gerd Neumann, Adolf Windorfer: Medicines in Pregnancy and Breastfeeding - A Guide for Doctors and Pharmacists , Wissenschaftliche Verlagsgesellschaft Stuttgart 2016, 8th completely revised edition, also appears as an online Edition: Medicines in Pregnancy and Breastfeeding, ISBN 978-3-8047-2948-3 .

Social and cultural history of breastfeeding

• Antonia Charlotte Freiin Teuffel von Birkensee: The breastfeeding behavior of academics in the period from 1950 to 1990 . Dissertation. Düsseldorf 2014, 148 pages, 2.5 MB, DNB 1063085063/34
• Luisa Heininger: On the change in breastfeeding behavior in the FRG between 1950 and 1990. An oral history study . University and State Library of Heinrich Heine University Düsseldorf 2014, DNB 1056035811 (Dissertation University Düsseldorf 2014, 130 pages, referee : Thomas Höhn. Supervisor: Jörg Vögele full text online PDF, free of charge 130 pages, 6.66 MB).

Web links

Commons : Breastfeeding  - collection of pictures, videos and audio files

Wikibooks: Baby book: Breastfeeding  - learning and teaching materials

Wiktionary: breastfeeding  - explanations of meanings, word origins, synonyms, translations

• Breastfeeding - feeding the baby - kindergesundheit-info.de: information offered by the Federal Center for Health Education (BZgA)
• Familienplanung.de - For fathers: Why breastfeeding is good. Information portal of the Federal Center for Health Education (BZgA)
• Website of the WHO and UNICEF initiative "Baby-Friendly Hospital"
• Recommendations of the National Breastfeeding Commission

Individual evidence

1. ↑ Kluge Etymological Dictionary of the German Language , 24th edition.
2. ^ Duden language advice, Duden newsletter of July 15, 2005.
3. ↑ Alexander von Humboldt: The research trips to the tropics of America. In: Darmstadt edition. Volume II, Part I, Darmstadt, Wissenschaftliche Buchgesellschaft, 2008, p. 241ff.
4. ↑ Entrez Gene - Gen-ID: 5020 (Oxytocin)
5. ↑ Oxytocin.  In: Online Mendelian Inheritance in Man . (English)
6. ↑ John R. Britton, Helen L. Britton, Virginia Gronwaldt: Breastfeeding, Sensitivity, and Attachment . Pediatrics, Volume 118, Issue 5, November 2006 ( abstract )
7. ↑ ^{a b c} F. CB Neiva, DM Cattoni, JLde Araujo Ramos, H. Issler: Early weaning: implications to oral motor development , Jornal de Pediatria (Rio de Janeiro), Volume 79, Issue 1, 2003, p. 7– 12.
8. ↑ Strengthening breast milk.  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. In: Kleinesonne.de.  
9. ↑ Breastfeeding Positions. ( Memento of the original from February 15, 2008 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. In: stillbaby.info. Retrieved February 2, 2008. 
10. ↑ Breastfeeding, yes, but right. ( Memento of the original from October 20, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. In: stillen.de. Retrieved February 2, 2008. 
11. ↑ still-lexikon.de
12. ↑ Planned Parenthood: "Breastfeeding as Birth Control at a Glance" .
13. ↑ The influence of expectant fathers on the decision to breastfeed ( Memento of December 28, 2005 in the Internet Archive )
14. ↑ Fathers and Breastfeeding ( Memento of the original from January 23, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF). 
15. ↑ Breastfeeding shouldn't be painful. (PDF; 142 kB) In: Deutsche Midammen Zeitschrift. 1/2007, pp. 52-55.
16. ↑ JL Ballard et al. a .: Ankyloglossia: Assessment, Incidence, and Effect of Frenuloplasty on the Breastfeeding Dyad. In: Pediatrics. 2002; 110, p. E63 pediatrics.org (English)
17. ↑ Adriano Marrazzu, Sanna Maria Grazia, Francesco Dessole, Giampiero Capobianco, Maria Domenica Piga: Evaluation of the Effectiveness of a Silver-Impregnated Medical Cap for Topical Treatment of Nipple Fissure of Breastfeeding Mothers . In: Breastfeeding Medicine . tape 10 , no. 5 , May 19, 2015, ISSN  1556-8253 , p. 232–238 , doi : 10.1089 / bfm.2014.0177 ( liebertpub.com [accessed October 18, 2016]).
18. ^ Carol Green: Maternal Newborn Nursing Care Plans. 2011, Jones & Bartlett, ISBN 978-0-7637-7742-5 , p. 357. (English).
19. ↑ Elaine Stillerman: The Danger of Mastitis. In: Massage Today. June 2008, Volume 8, No. 6. (English).
20. ↑ Birgit Laue: The Baby 1x1. Gräfe Und Unzer, 2012, ISBN 978-3-8338-3374-8 , p. 27 ( limited preview in the Google book search).
21. ↑ Breastfeeding With Nipple Piercings. In: breastfeeding.asn.au. Australia Breastfeeding Association (English).
22. ↑ Nipple Piercing: Is It Compatible with Breastfeeding? ( Memento of the original from June 4, 2012 in the web archive archive.today ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. In: La Leche Liga . 
23. ↑ who.int
24. ↑ S3 guideline allergy prevention. (PDF).
25. ↑ United Nations Children's Fund [UNICEF] (Ed.): Progress for Children: A World Fit for Children Statistical Review (No. 6) . UNICEF, New York 2007, ISBN 978-92-806-4194-3 , pp. 10 ( unicef.org [PDF; 4.0 MB ; accessed on December 20, 2012]).
26. ↑ Immune system of newborn babies stronger than previously thought. Retrieved April 23, 2015 . 
27. ↑ How long do babies carry their mother's immunity? Retrieved April 23, 2015 . 
28. ↑ S. Arifeen u. a .: Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. In: Pediatrics. Volume 108, Issue 4, October 2001, p. E67, PMID 11581475 . LM Lamberti et al. a .: Breastfeeding and the risk for diarrhea morbidity and mortality. In: BMC Public Health. Volume 11, Suppl. 3, 2011, p. S15 ( Review )
29. ↑ otitis media: B. Duncan u. a .: Exclusive breast-feeding for at least 4 months protects against otitis media. In: Pediatrics. Volume 91, 1993, pp. 867-872; KG Dewey, MJ Heinig, LA Nommsen-Rivers: Differences in morbidity between breast-fed and formula-fed infants. In: J. Pediatr. Volume 126, Issue 5, Part 1, 1995, pp. 696-702; J. Golding, PM Emmett, IS Rogers: Does breast feeding protect against non-gastric infections. In: Early Hum Dev. Volume 49 (Suppl.), 1997, pp. S105-S120; Respiratory diseases: AL Wright et al. a .: Breast feeding and lower respiratory tract illness in the first year of life. In: Group Health Medial Associates. BMJ. Volume 299, 1989, pp. 946-949; A. Pisacane et al. a .: Breast feeding and acute lower respiratory infection. In: Acta Pediatr. Volume 83, 1994, pp. 714-718; AH Cushing et al. a .: Breastfeeding reduces risk of respiratory illness in infants. In: Am J Epidemiol. Volume 147, 1998, pp. 863-870; V. Bachrach, E. Schwarz, LR Bachrach: Breastfeeding and the risk of hospitalization for respiratory disease in infancy: a meta-analysis. In: Arch Pediatr Adolesc Med. Volume 157, 2003, pp. 237-243.
30. ↑ JM Paricio Talayero u. a .: Full Breastfeeding and Hospitalization as a Result of Infections in the First Year of Life. In: Pediatrics. Volume 118, Issue 1, July 2006, pp. E92 – e99, doi: 10.1542 / peds.2005-1629 ( abstract )
31. ↑ RT Pivik, A. Andres, TM Badger: Diet and gender influences on processing and discrimination of speech sounds in 3- and 6-month-old infants: a developmental ERP study . In: Dev Sci , Volume 14, Issue 4, July 2011, pp. 700-712, PMID 21676091
32. ^ ^{A b} Aimin Chen, Walter J. Rogan: Breastfeeding and the Risk of Postneonatal Death in the United States. In: Pediatrics. Volume 113 No. 5, May 2004, pp. E435 – e439.
33. ↑ ^{a b} Ulrich Ladurner: Who's going next? In: The time. No. 2, January 7, 2016, p. 6 f.
34. ↑ Centers for Disease Control and Prevention: Sudden infant death syndrome. United States, 1980-1988. MMWR Morb Mortal Wkly Rep., Vol. 41, 1992, pp. 515-517; Centers for Disease Control and Prevention: Sudden infant death syndrome. United States, 1983-1994 . MMWR Morb Mortal Wkly Rep., Vol. 45, 1996, pp. 859-863; HJ Hoffman, K. Damus, L. Hillman, E. Krongrad: Risk factors for SIDS. Results of the National Institute of Child Health and Human Development SIDS Cooperative Epidemiological Study . Ann NY Acad Sci, Volume 533, 1988, pp. 13-30; HJ Hoffman, LS Hillman: Epidemiology of the sudden infant death syndrome: maternal, neonatal, and postneonatal risk factors . Clin Perinatol., Vol. 19, 1992, pp. 717-737.
35. ^ ^{A b} Bernardo L. Horta, Cesar G. Victora: Long-term effects of breastfeeding. A systematic review. (PDF) p. 13 , accessed on October 13, 2015 . 
36. ↑ Bernardo L. Horta, Cesar G. Victora: Long-term effects of breastfeeding. A systematic review. (PDF) pp. 28f, 31 , accessed on October 13, 2015 . 
37. ↑ Bernardo L. Horta, Cesar G. Victora: Long-term effects of breastfeeding. A systematic review. (PDF) pp. 41, 43, 51, 53. , accessed on October 13, 2015 (English). 
38. ^ MC Matheson, KJ Allen, ML Tang: Understanding the evidence for and against the role of breastfeeding in allergy prevention . In: Clin Exp Allergy , Volume 42, Issue 6, June 2012, pp. 827-851, PMID 22276526 .
39. ↑ DL Yeung et al. a .: Breastfeeding: prevalence and influencing factors . Can J Public Health, Volume 72, Issue 5, Sept./Oct. 1981, pp. 323-330. E. McNally, S. Hendricks, I. Horowitz: A look at breast-feeding trends in Canada (1963-1982) . In: Canadian Journal of Public Health , Volume 76, 1985, pp. 101-107. L. Colodro-Conde et al. a .: Relationship between level of education and breastfeeding duration depends on social context: breastfeeding trends over a 40-year period in Spain . In: J Hum Lact. , Volume 27, Issue 3, August 2011, pp. 272-278, PMID 21788656 . Bilkis Banu, Khurshida Khanom: Effects of Education Level of Father and Mother on Perceptions of Breastfeeding. In: Journal of Enam Medical College. Volume 2, Issue 2, 2012.
40. ↑ G. Der, D. Batty, I. Deary: Effect of breast feeding on intelligence in children. In: British Medical Journal. November 2006; 333 (7575), p. 945; Breastfeeding doesn't make you smart . Focus reception.
41. ↑ EL Mortensen, KF Michaelsen, SA Sanders, JM Reinsch: The association between duration of breastfeeding and adult intelligence . In: Journal of the American Medical Association (JAMA), Volume 287, Issue 18, May 8, 2002, pp. 2365-2371. MS Kramer u. a .: Breastfeeding and child cognitive development: new evidence from a large randomized trial . In: Arch Gen Psychiatry , Volume 65, Issue 5, May 2008, pp. 578-584.
42. ↑ L.-C. Girard, O. Doyle, RE Tremblay: Breastfeeding, Cognitive and Noncognitive Development in Early Childhood: A Population Study . In: Pediatrics , March 2017, online ; explanatory Breastfeeding 'doesn't boost children's intelligence' PubMedHealth article.
43. ↑ Glyphosate detected in breast milk. In: Süddeutsche Zeitung. June 26, 2015, accessed June 28, 2015 . 
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93. ↑ United States Breastfeeding Rates
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95. ↑ Maternity Leave (PDF).
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112. ↑ LLLI Center for Breastfeeding Information. (No longer available online.) Archived from the original on May 19, 2015 ; Retrieved April 24, 2015 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  
113. ↑ World Health Staticists 2013. (PDF) Retrieved November 16, 2015 . 
114. ↑ L. Emmett Holt: The Care and Feeding of Children. A Cathechism for the Use of Mothers and Children's Nurses . 2nd Edition. D. Appleton and Company, New York 1900, pp. 21, 27, 30, 33, 34 ff., 56 ff . ( limited preview in Google Book search). .
115. ^ John B. Watson: Psychological Care of Infant and Child . WW Norton Company, New York 1928.
116. ^ Maria Mesmer: Births / Control: Reproductive Policy in the 20th Century . Böhlau, Vienna, Cologne, Weimar 2010, ISBN 978-3-205-78320-6 , pp. 168 ( limited preview in Google Book search).
117. ↑ It's Time to End the 'Breast Is Best' Myth. In: Time. May 15, 2014.
118. ^ ^{A b} The Case Against Breast-Feeding. In: The Atlantic. April 1, 2009.
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122. ↑ Cynthia G. Colen, David M. Ramey: Is breast truly best? Estimating the effects of breastfeeding on long-term child health and wellbeing in the United States using sibling comparisons. In: Social Science & Medicine. 2014, doi: 10.1016 / j.socscimed.2014.01.027 ; Breast-feeding Benefits Appear to be Overstated, According to Study of Siblings. ( Memento of the original from April 18, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
123. ↑ PMC 1361236 (free full text) Improved Estimates of the Benefits of Breastfeeding Using Sibling Comparisons to Reduce Selection Bias.
124. ↑ A Randomized Breast-feeding Promotion Intervention Did Not Reduce Child Obesity in Belarus.
125. ↑ Outrage over the cover picture with a nursing woman. In: Der Tagesspiegel. August 4, 2006 (accessed February 2, 2008).
126. ↑ Travel advice USA. Federal Foreign Office, March 14, 2011, accessed on March 23, 2011 . 
127. ↑ Recommendations of the National Breastfeeding Commission ( Memento of the original from June 15, 2006 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
128. ^ European Social Charter (revised), 1996 , Council of Europe (accessed December 12, 2007).
129. ↑ Travail et allaitement: en garde . ( Memento of April 30, 2009 in the Internet Archive ) In: Allaiter Aujourd'hui , No. 53, La Lèche Lique France, 2002 (French), accessed on December 12, 2007.

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