Contaminantes químicos y lactancia materna: tomando posiciones / Chemical pollution and breast milk: Taking positions

La contaminación química alcanza todos los ecosistemas del planeta. La leche materna se ha utilizado como marcador biológico de la contaminación ambiental ya que, por los procesos de bioacumulación en tejido graso, muchos compuestos químicos alcanzan concentraciones fácilmente medibles en la leche materna. Con relativa frecuencia la información sobre la presencia de contaminantes en la leche materna salta a los medios de comunicación, creando confusión en los padres y en los profesionales de la salud, y en algunos casos abandono de la alimentación al pecho. En este documento, el Comité de Lactancia Materna de la Asociación Española de Pediatría subraya la importancia de promover la lactancia materna como la opción más saludable, ya que sus beneficios superan claramente cualquier riesgo para la salud asociado a los contaminantes químicos presentes en la leche materna. La leche materna contiene factores de protección que contrarrestan los efectos potenciales relacionados con la exposición prenatal a contaminantes ambientales. Se resumen las principales recomendaciones para reducir el nivel de contaminantes químicos en la leche materna y se destaca la importancia de que los gobiernos desarrollen programas para eliminar o reducir la contaminación química de los alimentos y el medio ambiente y prevenir de esta manera los efectos negativos para la salud infantil que se pueden derivar de la exposición a estos compuestos tóxicos a través de la placenta y la leche materna (AU)

Chemical pollution affects all ecosystems of our planet. Human milk has been used as a biomarker of environmental pollution as, due to bioaccumulation processes in fat tissue, many chemical compounds reach measurable concentrations that can be readily tested in breast milk. Quite frequently information about the presence of contaminants in breast milk appears in the media, leading to misunderstanding among parents and health professionals, and in some cases breastfeeding the child is stopped. In this article, the Breastfeeding Committee of the Spanish Association of Paediatrics stresses the importance of promoting breastfeeding as the healthiest option, because its benefits clearly outweigh any health risks associated with chemical contaminants in breast milk. Breast milk contains protective factors that counteract the potential effects related to prenatal exposure to environmental pollutants.This article summarises the key recommendations to reduce the level of chemical contaminants in breast milk. It also highlights the importance of government involvement in the development of programs to eliminate or reduce chemical contamination of food and the environment. In this way, the negative effects on child health resulting from exposure to these toxic compounds through the placenta and breast milk may be prevented (AU)

[Chemical pollution and breast milk: Taking positions]. / Contaminantes químicos y lactancia materna: tomando posiciones.

Chemical pollution affects all ecosystems of our planet. Human milk has been used as a biomarker of environmental pollution as, due to bioaccumulation processes in fat tissue, many chemical compounds reach measurable concentrations that can be readily tested in breast milk. Quite frequently information about the presence of contaminants in breast milk appears in the media, leading to misunderstanding among parents and health professionals, and in some cases breastfeeding the child is stopped. In this article, the Breastfeeding Committee of the Spanish Association of Paediatrics stresses the importance of promoting breastfeeding as the healthiest option, because its benefits clearly outweigh any health risks associated with chemical contaminants in breast milk. Breast milk contains protective factors that counteract the potential effects related to prenatal exposure to environmental pollutants. This article summarises the key recommendations to reduce the level of chemical contaminants in breast milk. It also highlights the importance of government involvement in the development of programs to eliminate or reduce chemical contamination of food and the environment. In this way, the negative effects on child health resulting from exposure to these toxic compounds through the placenta and breast milk may be prevented.

El colecho favorece la práctica de la lactancia materna y no aumenta el riesgo de muerte súbita del lactante. Dormir con los padres / Bed-sharing favours the practice of breastfeeding and does not increase the risk of sudden infant death syndrome. Sleeping with parents

La práctica de los padres de dormir junto a sus hijos ha sido una constante en la humanidad. Con el aumento en la prevalencia y duración de la lactancia materna, se ha observado paralelamente un aumento de esa práctica, que posiblemente se dé con más frecuencia que la reconocida en las encuestas. Los estudios han demostrado interrelación y mutua potenciación entre lactancia materna y colecho. Las asociaciones y organizaciones pediátricas recomiendan evitar el colecho, por relacionarlo con la muerte súbita del lactante. Se basan, sin embargo, en estudios en su mayoría no controlados, bajo la influencia de factores de riesgo no tenidos en cuenta. Los autores, tras una revisión exhaustiva sobre colecho, lactancia y muerte súbita del lactante, encuentran el colecho como una práctica beneficiosa para la lactancia y concluyen que, bien practicado, evitando factores de riesgo, no guarda relación con la muerte súbita del lactante (AU)

The practice of bed-sharing by parents and their offspring has been a common behaviour among humans. In parallel with the increase of breastfeeding rates, a higher frequency of bed-sharing has been observed worldwide. And, it is probable that it occurs more frequently than what appears reflected in surveys. There seems to be an interrelated and mutually enhanced effect between breastfeeding and bed-sharing. Pediatric associations and health organizations have warned against the practice of bed-sharing based on studies that describe a link between this practice and Sudden Infant Death Syndrome (SIDS). However, many were non-controlled studies that did not include other potentially risky circumstances. After a thoroughly review of the available literature, the authors have found the practice of bed-sharing to be of benefit on the basis of a warm and close-up infant care approach and calls for recognition and avoidance of risky situations that could represent a threat for infant life (AU)

Uso del chupete y lactancia materna / Use of pacifiers and breastfeeding

El uso del chupete se encuentra muy arraigado en las sociedades desarrolladas, ya que calma el llanto del bebé, ayuda a conciliar el sueño, y reduce el estrés y el dolor en procedimientos desagradables. Su uso se ha relacionado con una menor duración y exclusividad de la lactancia materna, aumento de otitis media, problemas dentales y riesgo de accidentes. Además, estudios recientes relacionan su uso, particularmente durante el sueño, con disminución del riesgo de muerte súbita del lactante. Otros beneficios demostrados son su efecto analgésico y el estímulo de la succión no nutritiva en niños pretérmino y a término. El debate sobre su utilización o no es actualmente motivo de controversia, pero es importante que los profesionales de la salud y los padres conozcan los riesgos y beneficios que conlleva el uso del chupete. Dada la controversia actual, el Comité de Lactancia Materna de la Asociación Española de Pediatría ha realizado, a la luz de las pruebas disponibles actualmente, una revisión del tema en relación con la lactancia materna (AU)

Pacifiers are widely used in developed societies. They are used for soothing infants, reducing their stress and pain during procedures and to help them sleep. The use of pacifiers has been associated, however, with a shorter duration and exclusivity of breastfeeding, with higher rates of otitis media and dental problems, as well as a higher risk of accidents during infancy. Recent studies have also described a relationship between pacifier use and SIDS, especially when used during infant is sleep. Other described benefits are analgesia and stimulation of non-nutritive sucking in preterm and term infants. There is, at present, wide debate and controversy on whether or not to recommend its use; thus it seems important for professionals and parents to be aware of the risks and benefits associated to its use, particularly related to breast feeding. Due to the existing controversy of scientific findings, the Committee on Breastfeeding of the Spanish Paediatrics Society, publishes this review, trying to summarise present evidence with the objective of, after analysing scientific results and recommendations, making recommendations regarding the use of the pacifier in the breastfed infant (AU)

[Use of pacifiers and breastfeeding]. / Uso del chupete y lactancia materna.

Pacifiers are widely used in developed societies. They are used for soothing infants, reducing their stress and pain during procedures and to help them sleep. The use of pacifiers has been associated, however, with a shorter duration and exclusivity of breastfeeding, with higher rates of otitis media and dental problems, as well as a higher risk of accidents during infancy. Recent studies have also described a relationship between pacifier use and SIDS, especially when used during infant́s sleep. Other described benefits are analgesia and stimulation of non-nutritive sucking in preterm and term infants. There is, at present, wide debate and controversy on whether or not to recommend its use; thus it seems important for professionals and parents to be aware of the risks and benefits associated to its use, particularly related to breastfeeding. Due to the existing controversy of scientific findings, the Committee on Breastfeeding of the Spanish Paediatrics Society, publishes this review, trying to summarise present evidence with the objective of, after analysing scientific results and recommendations, making recommendations regarding the use of the pacifier in the breastfed infant.

Migraña y mujer / Migraine and female

No disponible

Medicamentos, plantas, tóxicos, enfermedades y lactancia: una ayuda en español en Internet / Drugs, plants, toxins, diseases and breastfeeding: ana aid in Spanish on the Internet

Los beneficios de la lactancia materna, para el niño y la madre, su familia, el sistema sanitario y la sociedad en general, están muy bien documentados en múltiples publicaciones. Suprimir una lactancia sin un motivo de peso es una grave irresponsabilidad desde el punto de vista sanitario. Más del 90% de las mujeres pueden tener que tomar medicamentos o productos de fitoterapia durante el periodo de lactancia, lo que constituye un motivo clásico de cese de la lactancia, pese a no estar demostrado su peligro real más que en un pequeñísimo porcentaje de productos: fenindiona, amiodarona, derivados del ergot, antineoplásicos, y oduros y psicodrogas de abuso. Del mismo modo, sólo 6 enfermedades de la madre contraindican o hacen prácticamente imposible la lactancia. Con sentido común, unos conocimientos básicos de farmacología y pediatría y buenas guías (libros, revistas y páginas web), podemos asesorar a las mujeres que lactan, deben tomar remedios para alguna dolencia o sufren una enfermedad. Las madres huirán de informaciones erróneas, basadas sólo en prejuicios o en el Vademécum. Una página web(www.e-lactancia.org), en español y de sencillo manejo, nos ayudará a tomar decisiones acertadas antemás de 1.400 opciones diferentes implicadas en la lactancia materna

The benefits of breast feedingf or the infant, the mother, the family, the health care system and society in general are well documented in numerous scientific publications. The medical advice for weaning a child without a justified reason is an act of irresponsibility from an ethical point of view. Moret han 90% of women might need to take some type of medication while breastfeeding their babies at any time, this being a commonly alleged reason for weaning. However, only a few drugs have been shown to represent a real hazard: phenindione, amiodarone, ergot derivatives, antineoplastic agents, iodides and drugs of abuse. Seemingly, only six maternal diseases are considered to contraindicate breast feeding or make it nearly impossible. By exercising common sense, applying basic knowledge of Pharmacology and Pediatrics and using up dated guidelines (e.g. books, journals and web resources), we should be able to adequately advise those lactating mothers who require medication. Therefore, healthcare givers are committed to offering them proper assistance since mothers will ultimately reject misin formation or recommendations based on prejudice so rreleased by the industry, like that contained in the Physician's Desk Reference. A website, www.e-lactancia.org, an easy-touse resource in both Spanish and English, will help us make appropriate decisions concerning more than 1.400 options that a lactating mother may have to confront

[Iatrogenic botulism: a complication to be taken into account in the treatment of child spasticity]. / Botulismo yatrógeno: una complicación a tener en cuenta en el tratamiento de la espasticidad en la infancia.

INTRODUCTION: During the last decades the use of botulinum toxin for management of muscular disorders and spasticity associated to cerebral palsy has become a widespread practice. CASE REPORT: A 6-years female suffering of cerebral palsy secondary to a partial agenesis of the corpus callosum who was receiving bolulinum toxin since October 2001. One week after the last dose (Dysport 46 U/kg/dose) she started high grade fever, malaise, food refusal, choking, constipation, eyelid ptosis, absence of deep tendon reflexes, and abundant mucous discharge. Such features were so progressively severe that ventilatory support became mandatory. After a previous dose five months before, she developed similar features but they were less severe and thought to be related to a respiratory infection. CONCLUSIONS: At the present, there are two forms of botulinum toxin commercially available: the British brand Dysport and the American brand Botox. Bio equivalences are 1 U Botox to 2 or 6 U Dysport. Dosing (U/kg per session) has been established as follows: 5 U for Botox, 35 U for Dysport. Safety limits are a wide range with a therapeutic toxic index rate of 1:10. Generalized side effects after diffusion to blood of locally injected botulinum toxin are rare.

Botulismo yatrógeno: una complicación a tener en cuenta en el tratamiento de la espasticidad en la infancia / Iatrogenic botulism: a complication to be taken into account in the treatment of child spasticity

Introducción. En las últimas décadas se ha generalizado la terapia con toxina botulínica para el tratamiento de diferentes trastornos musculares, así como de la espasticidad asociada a parálisis infantil. Caso clínico. Niña de 6 años diagnosticada de parálisis cerebral secundaria a agenesia parcial de cuerpo calloso, que recibía tratamiento con toxina botulínica desde octubre de 2001. A la semana de recibir la última dosis de Dysport (46 U/kg/dosis) inició un cuadro de fiebre alta, decaimiento, rechazo del alimento, crisis de atragantamiento, estreñimiento, ptosis palpebral, ausencia de reflejos osteotendinosos y mucosidad abundante, todo ello progresivo, que obligó a aplicar medidas de soporte ventilatorio. En la dosis que recibió cinco meses antes presentó un cuadro de características clínicas similares pero de menor intensidad, que se atribuyó a un proceso infeccioso respiratorio. Conclusiones. Actualmente, hay dos tipos de toxina botulínica comercializada, la británica Dysport y la estadounidense Botox; la bioequivalencia clínica de 1 U de Botox es de 2 a 6 U de Dysport, y las dosis habituales máximas (U/kg por sesión) son de 5 U unidades para Botox y 35 U para Dysport. Los límites de seguridad son amplios, con una relación dosis terapéutica y tóxica de 1:10. Los efectos secundarios generalizados debidos a la difusión de la toxina a la sangre son raros (AU)

Introduction. During the last decades the use of botulinum toxin for management of muscular disorders and spasticity associated to cerebral palsy has become a widespread practice. Case report. A 6-years female suffering of cerebral palsy secondary to a partial agenesis of the corpus callosum who was receiving bolulinum toxin since October 2001. One week after the last dose (Dysport 46 U/kg/dose) she started high-grade fever, malaise, food refusal, choking, constipation, eyelid ptosis, absence of deep tendon reflexes, and abundant mucous discharge. Such features were so progressively severe that ventilatory support became mandatory. After a previous dose five months before, she developed similar features but they were less severe and thought to be related to a respiratory infection. Conclusions. At the present, there are two forms of botulinum toxin commercially available: the British brand Dysport and the American brand Botox. Bio-equivalences are 1 U Botox to 2 or 6 U Dysport. Dosing (U/kg per session) has been established as follows: 5 U for Botox, 35 U for Dysport. Safety limits are a wide range with a therapeutic-toxic index rate of 1:10. Generalized side effects after diffusion to blood of locally injected botulinum toxin are rare (AU)

[Intoxication by diphenoxylate (author's transl)]. / Intoxicación por difenoxilato

Two cases of intoxication by diphenoxylate, inespecific antidiarrheal, depressor of the intestinal motility, are presented. Diphenoxylate is chemically related with meperidine. One case was caused by hipersensitivity and the other one by overdose. Both had a favourable outcome. Existent bibliography was reviewed and clinical signs of this intoxication pointed-out. It is suggested that diphenoxylate should not be prescribed to children under thirty months.