©August 2007

An appropriate public health message for a Neanderthal human living 150,000 years ago would look strikingly different from a public health message appropriate to a human living today.  The message for primitive humans might include ways to recognize clean water, where to safely build a shelter and information about how to clean assorted bite wounds.  Conspicuously absent would be advice to exercise thirty minutes each day and encouragement to breast feed.  The reasons for these different priorities may seem obvious, but it may help to remind us how profoundly we have meddled with our natural machinery.

In fact, the trend to replace breast milk with substitutes is a relatively recent development.  Prior to the availability of infant formulae, a “wet nurse” or lactating community member was occasionally employed to breast feed an infant in the absence of the biological mother.  In the last century, careful chemical analysis of breast milk led ambitious laboratories to develop breast milk substitutes using the milk of other mammals mixed with various combinations of proteins, nutrients and vitamins to approximate the components that were identified in human milk.  The products then required special engineering to develop powdered formulations and packaging to prevent contamination during transport, and finally to design bottles that would as closely as possible accommodate the mouth of the infant and simulate the natural action of the human breast.

Regardless of our scientific brilliance, modern humans have failed to improve upon the human breast.  The American Academy of Pediatrics points out that there is considerable evidence that breast feeding decreases the incidence of a wide range of infectious diseases in infants, and reduces the occurrence of subsequent diabetes, lymphoma, leukemia, high blood cholesterol, asthma and obesity in the infant.  Breastfeeding mothers also reap considerable rewards, including a more rapid return to prepregnancy weight, decreased risk of breast cancer, decreased risk of ovarian cancer, and possibly decreased risk of hip fractures and osteoporosis in the postmenopausal period.  The boundless benefits of warm, human touch needs no further expansion.

The purpose of World Breastfeeding Awareness month is to reaffirm confidence and appreciation for our natural machinery.  Current recommendations seek to encourage all mothers to exclusively breastfeed their infants for at least the first six months after birth, and to continue breastfeeding through the first year of life.  When our natural inclinations are diverted by the allure of clever merchandising, such as the illusion of the convenience of baby formula, it is worthwhile to look carefully at the machinery we are replacing.  Our own bodies can often boast of features that science and industry can only hope to approximate.  Just ask a Neanderthal.

©October 2008

One of the great joys of being present at the delivery of a newborn is witnessing what ensues immediately thereafter, at the head of the delivery bed.  The quiet moments during which mother and father carefully study this new creature are inspiring.  Almost unconsciously, an inventory is completed during which parents fill their cerebral file cabinet with images of the infant – blinking eyes, pointy head, pouty lips, groping fingers and all.  As the next hours, days and years pass, mother and father become familiar with every sound and facial expression emitted by their child, thus preparing them perfectly for the responsibility of recognizing when important needs arise, such as deficiencies of sleep or excesses of sewage.  Any variation from what has been established as “normal” behavior becomes cause for parental investigation.  The most common cause for parental anxiety and unscheduled visits to clinics at this point in an infant’s life is a respiratory infection, begging the question, “when is an infection more than a common cold?”

There are a number of viruses which are regular visitors to our respiratory tracts throughout the year, going by such family names as adenovirus, enterovirus and rhinovirus.  The most famous virus is, of course, the influenza virus which prefers to visit during the winter months.

During the first year of life, there is evidence that most infants experience nine different respiratory infections.  Each virus has a different method of tying itself to the dock at it’s preferred port-of-entry.  Once in port, the virus enters the cells lining our nose, throat or lower airway.  The virus then begins duplicating itself and causing general havoc, not unlike pirates who have been too long at sea.  Some viruses are able to travel deeper into the respiratory tract where they may disrupt general operations.

Shortly after irritation develops, our bodies respond with an outpouring of mucous in an effort to wash away the troublemakers and, presumably, to assist the soldiers of our immune system as they confront the infection.  Thus, the production of yellow or green mucous is a common development.  At this point, an elevated temperature is often noted.

There are two signs that may indicate a need for a clinic visit for an infant with a respiratory infection.  One is a disruption of the job of the respiratory machinery, usually resulting in shortness of breath, excessive irritability or an unwillingness to eat.  The second sign is a fever.

A fever is an elevated temperature.  According to the American Academy of Pediatrics, pediatricians the official threshold for what constitutes a fever is above 100.4°.  Body temperature will typically vary from 97° to 100.4° F during the day, a little higher in the afternoon.  People should not use mercury thermometers any more because of concern for the toxicity of mercury, and because new digital thermometers used properly are quite accurate.

Temperatures should be taken for infants under 3 months of age with a rectal thermometer by placing the thermometer ½ to one inch into the anus for one minute, or until the thermometer beeps.  Any temperature over 100.4° in an infant under three months should be reported to your health care provider.  For children three months to three years of age, a temperature may be taken under the arm (axillary temperature) or in the rectum, but it should be remembered that axillary temperatures are not nearly as accurate (they tend to be at least one degree lower).  Beginning at fours years of age, you may instead take a child’s temperature under the tongue (an “oral” temperature).

New ear thermometers (“tympanic” thermometers) may also be used, although they are a little trickier and some children with ear wax may not show an accurate temperature.  For infants or children with symptoms like shortness of breath or significant irritability you should always use the most accurate method to take their temperatures.

The small airways of an infant do not need to accumulate much mucous to create an impressive amount of racket.  Thus, after first noting that the little one appears irritable and may not be eating quite normally, snorting, sputtering and sneezing often becomes a full time occupation.  Talk to your pediatrician about how to manage such congestion, but be aware that cough medicines or so-called “cough suppressants” are not to be used for infants these days.

Finally, be aware that antibiotics are not often necessary for common upper respiratory infections in the pediatric population.  In addition to vaccinations, there are many alternatives that your health care provider can suggest which will do just as well to return your little one to his/her usually entertaining self in a matter of a week or so.

©August 2007

An appropriate public health message for a Neanderthal human living 150,000 years ago would look strikingly different from a public health message appropriate to a human living today.  The message for primitive humans might include ways to recognize clean water, where to safely build a shelter and information about how to clean assorted bite wounds.  Conspicuously absent would be advice to exercise thirty minutes each day and encouragement to breast feed.  The reasons for these different priorities may seem obvious, but it may help to remind us how profoundly we have meddled with our natural machinery.

In fact, the trend to replace breast milk with substitutes is a relatively recent development.  Prior to the availability of infant formulae, a “wet nurse” or lactating community member was occasionally employed to breast feed an infant in the absence of the biological mother.  In the last century, careful chemical analysis of breast milk led ambitious laboratories to develop breast milk substitutes using the milk of other mammals mixed with various combinations of proteins, nutrients and vitamins to approximate the components that were identified in human milk.  The products then required special engineering to develop powdered formulations and packaging to prevent contamination during transport, and finally to design bottles that would as closely as possible accommodate the mouth of the infant and simulate the natural action of the human breast.

Regardless of our scientific brilliance, modern humans have failed to improve upon the human breast.  The American Academy of Pediatrics points out that there is considerable evidence that breast feeding decreases the incidence of a wide range of infectious diseases in infants, and reduces the occurrence of subsequent diabetes, lymphoma, leukemia, high blood cholesterol, asthma and obesity in the infant.  Breastfeeding mothers also reap considerable rewards, including a more rapid return to prepregnancy weight, decreased risk of breast cancer, decreased risk of ovarian cancer, and possibly decreased risk of hip fractures and osteoporosis in the postmenopausal period.  The boundless benefits of warm, human touch needs no further expansion.

The purpose of World Breastfeeding Awareness month is to reaffirm confidence and appreciation for our natural machinery.  Current recommendations seek to encourage all mothers to exclusively breastfeed their infants for at least the first six months after birth, and to continue breastfeeding through the first year of life.  When our natural inclinations are diverted by the allure of clever merchandising, such as the illusion of the convenience of baby formula, it is worthwhile to look carefully at the machinery we are replacing.  Our own bodies can often boast of features that science and industry can only hope to approximate.  Just ask a Neanderthal.