Breast milk for eye health

The Pediatric Insider

© 2014 Roy Benaroch, MD

 

Supermouse wrote: “Several of my online friends have been talking about putting breastmilk in their babies’ eyes, either to cure conjunctivitis or to deal with runny/goopy eyes that result from a cold.  Is there any benefit to doing this?  Is there any risk?  Why would anyone do that?”

 

A quick Google search shows a whole lot of posts that suggest mother’s milk as an eye drop—and a whole lot of other things, too.  This post claims that breast milk is a “…sterile liquid packed with antibodies giving it countless other uses, some of which you may not be aware of.” Listed uses include not only eye infections, but teething, minor wounds, bug bites, diaper rash, and dry skin. Another site encourages breast milk for the entire family, claiming it helps everything from ear infections to organ transplantation.

 

Breast milk is certainly a wonderful thing for babies to drink. It is a good source of passive antibodies, especially the earliest milk (colostrum.) Those are infection-fighting molecules made by mother that can transfer into the GI tract of babies, preventing the initial steps of invasion of germs from the environment. That’s different from antibodies made by the baby himself, triggered by disease exposure or vaccinations. Both kinds of antibodies help, and they complement each other.

 

There’s a lot of other stuff in breast milk, too. Water, mostly; plus fat and protein and carbohydrate (mostly lactose). And: human breast milk is teeming with bacteria, the healthy-good kind that populates the baby’s gut to aid digestion. Breast milk is far from sterile (which for babies, is a good thing)—but maybe it’s not such a good thing for immunocompromised people after an organ transplant, for example. For most of the uses proposed, the idea is to apply breast milk topically into places like the eye or mouth or ear canal, places that aren’t sterile to begin with. So the presence of bacteria in breast milk isn’t really a problem, though the site that called breast milk a sterile liquid isn’t accurate.

 

Sites that suggest breast milk for eye conditions lump together a few different conditions that can cause a gunky eye. There are three that are common:

 

Blocked tear ducts are very common, usually presenting in the first several weeks of life with one or both eyes collecting a gunky discharge. The whites of the eyes are white, and there are no symptoms other than goo in the eye. This condition is almost always “self-limited”—it goes away on its own, whatever you do about it one way or the other. My typical advice is it leave these eyes alone.

 

Gunk can also accumulate in the eyes of a child with a common cold. The nose gets snotty, and some of that snot tracks backwards up the tear duct into the eye. Gross, yes, but it goes away without any specific therapy.

Conjunctivitis means inflammation of the eye, though for practical purposes in babies this usually means an eye infection, typically with bacteria. This is often called “pink eye”, though in truth there are many other reasons for eyes to turn pink. Conjunctivitis causes goo, but also redness to the eye itself. In newborns this can be very serious—some eye infections can lead to permanent vision loss or infection that can spread throughout the body. Bad newborn eye infections are very rarely seen in the United States, in large part because it’s standard care for all newborns to get antibiotic eye drops or ointments shortly after birth. Outside of the newborn period, “pink eye” in an otherwise well-appearing child is rarely anything super-important, and is typically first treated with antibiotic eye drops.

 

OK, so three causes of gunk eye in a baby. The first two, blocked tear ducts and gunk from a common cold, go away on their own without treatment. The third, bacterial pink eye, is pretty benign in older babies though can be devastating in newborns, especially newborns from the developing world. Keep this in mind when you see what the studies of mother’s milk eye drops have shown.

 

And, believe it or not, there have been studies:

 

Verd, in 2007, published an account of his clinic’s switch from treating blocked tear ducts with antibiotic eye drops to mother’s milk drops. The study is retrospective and more descriptive than quantitative, but at least shows that routinely using mother’s milk is probably safe. Blocked tear ducts, we know, get better without any therapy at all. But if you want to do something, instilling mother’s milk seems safe.

 

In 2012, Baynham and colleagues published a letter in the British Journal of Opthalmology, looking at the in vitro inhibitory effects of donated fresh breast milk against common ocular pathogens. (Translation: they squirted milk into petri dishes of eye germs to see what would happen.) They found that 100% of their donated milk samples contained bacteria (including, in some cases, bacteria that could cause human disease). Though there was some inhibition of bacterial growth against some bacteria, the inhibition wasn’t strong, and the authors concluded that “… human milk is unlikely to be effective against the most common causes of paediatric conjunctivitis.” There was one interesting finding: of all the bacteria tested, human milk was most effective against the bacteria that causes gonorrhea, which is the same bacteria that causes most serious neonatal eye infections, world-wide. Now, it wasn’t as good as an antibiotic, but for resource-poor communities in the developing world, human milk may be much better than nothing.

 

Ibhanesebhor, in 1996, also did an in vitro (in the lab) study looking at the effects of human milk against bacteria. He found that while colostrum had some inhibitory effects, mature milk did not—presumably because colostrum has a much higher concentration of antibodies. In any case, even colostrum was effective against only some bacteria, and it wasn’t nearly as effective as an antibiotic.

 

Finally, the oldest study I found: 1982, Singh, in the Journal of Tropical Pediatrics. The study is really quite wonderfully written, and includes a background quote from the 18^th century, referring to human breast milk: “It is an emollient and cool, and cureth Red Eye immediately.” From November to December, 1977, the mothers in one wing of the All-India Institute of Medical Sciences were told to instill colostrum into their babies’ eyes three times a day, while babies in the other ward had no such instructions. Then “A careful examination, in good day light, was made twice a day to look for any stickiness of the eyes…” The authors also noted that “We did not encounter any difficulty or resistance in motivating mothers to instil colostrum in their baby’s eyes. In fact, most mothers accepted the suggestion rather enthusiastically.” The incidence of sticky eyes or conjuctivitis was 35% in the control (no colostrum) group, and only 6% in the study group.

 

Those results look great—but, honestly, I’m not sure they’re very realistic. A 35% rate of conjunctivitis in the control group is oddly high. And the babies were kept in two separate wards—maybe only one ward had an outbreak of conjunctivitis. Also, the observers (who diagnosed “sticky eyes”) couldn’t be blinded. Still, zero ill effects were noted, and the intervention is very low-cost.

 

To summarize: most conditions that cause gunky eyes in babies (blocked ducts and the common cold) resolve on their own. You can squirt mother’s milk in there, or probably coconut water or contact lens soaking solution—any of these will “work”, because it would have gotten better anyway. For actual bacterial pink eye, what evidence there is shows that mother’s milk is unlikely to be effective for the bacteria that cause this infection. And certainly, in a newborn, genuine pink eyes need to be evaluated by a physician—don’t fool around with home treatments with mother’s milk or anything else.

 

Apologies, this post got away from me a bit—it came out too long! But the question was good, and I had fun digging up those old studies. I don’t say it often enough, but I really appreciate everyone’s questions and comments. The best posts, I think, come when they’re inspired by you guys. Keep the questions coming, and I’ll keep reading and writing!

Vitamin K can save your newborn’s brain. Get it.

The Pediatric Insider

© 2013 Roy Benaroch, MD

Some topics I enjoy writing about. Some give me no satisfaction whatsoever. Still: I never want to read about another baby going through a completely avoidable catastrophe again. So pay attention, especially those of you about to have a baby, or those of you who might someday have a baby, or those of you who ever talk to couples who are having a baby. Just all of you, pay attention here.

Hemorrhagic disease of the newborn is a real thing. Newborns aren’t born with good stores of Vitamin K, so they can’t make their own clotting factors well. Sometimes—rarely, but it does happen—they develop spontaneous bleeding. It might be from their umbilical cord, or in their gut, or in their brain. If the bleeding isn’t treated quickly, the baby will bleed to death or suffer brain damage.

Hemorrhagic disease of the newborn, you say? You’ve never heard of that? You’ve never heard of it because it’s rare to begin with, about .24-1.7 cases per 1000 live births, and because there is a nearly 100% effective way to prevent it. The AAP has recommended that all babies receive vitamin K shortly after birth since 1961, and multiple studies have confirmed that this is completely safe and just about 100% effective in preventing hemorrhagic disease.

There is no other way to prevent hemorrhagic disease of the newborn. It doesn’t matter how much vitamin K mom has—it doesn’t cross the placenta. It doesn’t matter whether baby nurses—vitamin K is not present in human milk. Commercial formulas do contain vitamin K, but not enough to “fill up the tank” when babies are born.

The best, most effective, and safest way to give vitamin K to a newborn is by injection. Though oral vitamin K is used in some countries, oral vitamin K fails to prevent all hemorrhagic disease, leading to about 1.2-1.8 cases per 100,000 births, versus zero cases after injected vitamin K.

There are no known side effects of vitamin K. There are no downsides to any baby getting this injection, which prevents death and brain damage.

Still, some parents choose to NOT allow their babies to get this injection. Their worry is based on completely unfounded internet hoopla, but that’s the way it is. Random internet stupidity trumps science, pediatricians, and the recommendations of public health agencies worldwide. Apparently it’s becoming trendy to skip the vitamin K injection.

The internet, as usual, exaggerates the freaky and uncomfirmable stories, and fails to tell the boring stories about the millions of babies who do great after receiving good routine care. Parents are tricked into worrying about the wrong things. Instead of protecting their babies, they place them in harms way. That’s a tragedy we all need to fight.

New baby! Does sibling need to stay home?

The Pediatric Insider

© 2013 Roy Benaroch, MD

I’m a-busy editing and polishing a big project—details later—so for a little while, I’m going to try to stick to short questions and news stories. It’s a fun-sized-blogging summer! Feel free to send in a brief question from the links on the right. I won’t be able to answer all of them, but I’ll get to the ones I think are most interesting. Thanks!

Marianna wrote: “We currently have a 2 1/2 year old and a newborn who arrived last week. Our pediatrician here advised to keep our 2 year old out of daycare for two months (explaining the procedures necessary if he gets a fever before 2 months old). I was wondering your opinion about the risk reward of spreading germs to a newborn vs. keeping our two year old in a somewhat routine schedule.”

First, congratulations! I hope you’re feeling good and getting some sleep. Please, remember to take a nice long shower at least once a day. You deserve it!

Now: I see what the ped is saying. A 2 ½ year old in group care may well bring something home, and I don’t mean a clay walrus or a picture frame made of macaroni. You do want to keep germs out of your house. But the 2 ½ year old is part of the family, too, and I’m not so sure it’s fair to put newborn concerns so far ahead of the sibling’s needs.

What I’d suggest: keep the older child away from the baby if he’s sick. Newborns aren’t crawling around and mouthing everything (yet), so unless someone touches baby’s face with germy hands or sneezes right on him, the risk of transmission isn’t very great. It’s the summer, so there aren’t tons of respiratory viruses around right now. If it were winter, I’d suggest getting flu shots for everyone in the house over 6 months of age.

But keep the 2 year old home for two months? That doesn’t seem like it will be very enjoyable for the child. Or mom. Or, even, the newborn. Older Junior, if he’s used to day care and likes it, would rather be there with his buddies; and Junior Junior, he’d rather be home snuggling with mom for a few hours while she’s not chasing another child around the house. Mom is going to need a break, and I don’t think she’s likely to get it by keeping her toddler home.

Farts don’t hurt: The truth about gas

The Pediatric Insider

© 2012 Roy Benaroch, MD

“My baby seems gassy. Should I use Mylicon drops? My doctor says they don’t work, and I don’t want to give medicine unnecessarily. What else can I do?”

I wrote about this recently, though the post was a little bit silly. I’ll try again, seriously this time.

Little babies do seem gassy a lot. They squirm and fart and kind of ball up, and sometimes getting pretty upset. But one thing I know for sure: farts don’t hurt. They just don’t. They don’t hurt me, and they don’t hurt you, and I can’t imagine why they would actually cause pain in a little baby.

Though farts don’t hurt, they might feel kind of weird. To a little baby, all sorts of sensations are new: the feel of air on the skin, breathing, seeing, stretching out little legs– all of that’s new, and all of that might feel weird and surprising. I’m surprised, honestly, that newborns aren’t more upset, more of the time. Think about how you’d feel with all of this new stuff going on. Add on to that the perfectly normal (but new) feeling of gas burbling around and passing out, and you might get one worried little baby.

When little babies get upset, parents wonder what’s wrong, and what they ought to do about it. No one likes to see a baby cry! Drug companies know that, and are happy to provide a remedy. In this case, it’s a product called “simethicone”, the so-called “active ingredient” in Mylicon and dozens of other “gas medicines.”

Simethicone has been around a long time, as an anti-foaming agent. Add simethicone to a sudsy bath, and all of those little bubbles coalesce into a few larger bubbles. It can’t make the gas actually disappear or go away. But it can reduce the surface tension on the little bubbles, turning them into fewer, larger bubbles. (Simethicone, you’ll be happy to know, is used in industrial applications as an agent to reduce foaming from some soaps and detergents.)

But think about it: what possible good would it do to turn a bunch of foamy, little bubbles into a few larger bubbles? Are larger bubbles easier to pass? Would one large bubble “hurt” less than 100 small bubbles?

There are no human studies– none, ever– that have shown that simethicone helps with any symptoms in any people of any age. It does seem to help, some, with endoscopy procedures by reducing the little foamy bubbles that might make it hard to see through a scope. But that’s it. That’s the only situation in medicine where it might conceivably help in any way.

Simethicone does seem safe. There are no reported side effects, though at least one report suggests that giving simethicone to a baby might interfere with the absorption of other medications. Other than that, though, since it doesn’t do much of anything, it’s not surprising that there are no side effects. (As an aside: any ‘real’ medicine that has real, genuine biologic effects must have at least some side effects. If any sort of herb or homeopathic stuff is promoted as being free of any side effects, it’s because it has no biologic effects whatsoever.)

If it’s safe, why not try it? I suppose it’s OK to try, but my biggest problem with simethicone (and other placebos) is that it sends the wrong message to parents, and seems to contribute to a long-term philosophy of health and illness that I think is a big mistake. Gas,  farts, and most cases of newborn fussiness are not a medical problem. Babies with these symptoms should be evaluated to make sure there is nothing medically wrong, and then parents should be reassured and taught good soothing techniques. By encouraging the use of medicine for gas (and other benign, normal things humans put up with), we’re perpetuating the idea that all symptoms need medicine, and all problems need a medical approach. This is wrong, wrong, wrong. Parents shouldn’t be taught that their kids need medicine for every problem. What parents need is to make sure their kids are OK, and how to help them feel better when they’re upset, and the warning signs to look for that might mean the doctor needs to be contacted. What we don’t need is more parents relying on the medicine cabinet to solve their problems.

What about herbal and other more “natural” cures for gas? Those are, at best, just different placebos, and possibly something worse. Since there’s essentially no regulation of the market for “supplements”, parents have no idea what’s in those bottles. It’s probably just a nothing-safe-placebo, but who knows? If you’d like a placebo, at least choose one you know is safe. How about plain water? That’s exactly what homepathic products are.

Better yet, save your money. Stay away from Mylicon, and stay away from the “alt-med” cures too.

If you’ve got a fussy baby, your first step is to try to figure out if there’s a medical problem that needs to be addressed– I’ve written about that before. As long as there’s no medical issue, your best bet is calm, soothing things to help your baby relax. Often a tight swaddle, gentle rocking, a pacifier, and/or a white noise machine can be a big help. You’ll also need to make sure you get some rest and have someone else who can help give you a break during those long evenings! If mom (or dad) is having an especially hard time handling baby fussiness, they ought to talk to their own doctors about their own health problems—postpartum depression is very real, and can certainly contribute to making babies fussy and difficult. Fortunately, the weird feelings of “gas” go away by the time babies are about 3 months old, once they’ve gotten used to the normal sensations of their bodies. Until then, gentle & calm reassurance is the best “medicine.”

A fussy newborn

Amanda wrote, “My son is 9 weeks old and he cries all the time! He cries throughout the day and night. The Dr. keeps saying that it is colic but I thought that was normally at the same time everyday. This is all day everyday. I have tried gas medicine, Zantac because they said he could have acid reflux and now I have changed his formula that is specifically for colic but there have been no changes. Please help!!! I feel like tests are something should be ran what can you recommend?”

Although some people use the word “colic” to refer to any sort of excessive crying in babies, to most pediatricians colic refers to a very specific pattern of crying. Babies with colic cry at a set interval each day, almost always in the evenings. Many parents will say they can set their clocks by the crying, it’s so regular. The crying peaks at about 4-6 weeks, and goes away by the time the baby is three months old. Although colic can be exhausting, in a way it can be reassuring if your baby only cries excessively during a set time each evening. After all, there is no medical problem that only occurs in the evening. This is sort of crying is not caused by any medical issue, and the main way to treat it is to learn good soothing techniques and provide a way for parents to get some rest and take a break once in a while.

It sounds like your baby, who is fussy all of the time, doesn’t have what I would call “colic.” Excessive fussiness can be caused by many different things, some related to the baby, and some related to the family:

• Reflux, which you mentioned, can lead to pain and heartburn. There are no simple and easy tests for reflux, but if it seems clear from the history that reflux is occurring many physicians will try to treat it.
• Food allergy—either formula intolerance or a problem with something in mom’s breast milk—can cause frequent fussiness at all times of day.
• Temperamental fussiness refers to babies who have a hard time settling down, are anxious, and cry a lot. These babies need extra reassurance, and their parents need extra support.
• Constipation is not common in little babies, but if your child is having firm and painful stools that needs to be addressed.
• Maternal health problems, including post-partum depression, can cause or be caused by excessive baby crying.
• Unusual medical problems in a baby can include urinary tract infections, glaucoma, a broken bone from birth trauma, or really almost anything else. There is no way to “test for everything,” but a careful history and physical exam will reveal almost any sort of problem like these. Rarely, specific directed tests like a urinalysis or an x-ray might be needed.

Your first step is to get yourself some respite care. If you’ve got a very fussy baby, you especially need time to unwind and get some rest. If you don’t have family in town, you may need to rely on a neighbor, close friend, or a hired nursery helper. Do it! No matter what the underlying cause of the fussing, you’ll be able to deal with it better if you have a chance to catch your breath once in a while.

Then, make sure that your pediatrician gets the whole story and a good complete physical exam. Bring notes with a log of the fussiness—when is it? How does it relate to meals and bowel movements? What have you tried that has helped? In my experience the answer to the mystery of a fussy baby is much more likely to be found in clues the parents provide than in any sort of medical tests.

Best of luck, and I hope you get some rest soon!

Holiday twofer: Bananas, constipation, and corn syrup

I’ve got two short questions in the hopper, and I’ve come up with a fairly lame segue to tie them together. So let’s see how it works out: for the first time ever, two questions answered in one blog post! It’s like getting something free for half-price!

First, Claire asked: “Dr. Roy, can a child consume too many bananas to the point it is harmful? My son is a darling toddler who refuses to eat (literally) but he loves bananas. Less than 36 hours ago I bought 13 bananas and he ate them all. He seriously consumes at least 4 or 5 bananas a day (this is with me limiting the bananas-he would eat more if I let him). Every time he sees our bananas in the pantry he freaks out and wants them. Should I be worried? He only weighs 20 pounds so it seems like so much for him to be consuming but when offer other foods he just doesn’t eat. He has always been on the tiny side so sometimes I just want to eat anything.”

I’m not worried about a mostly-banana diet. The monkeys at the zoo look pretty healthy to me.

More seriously: You could try to broaden his diet a little by offering dips or spreads. A banana might be even more yummy smeared with peanut butter or Nutella. You could cut it into little rounds and top them with cottage cheese, or make little banana and cream cheese sandwiches.

As for his overall growth, review this with your pediatrician to make sure he’s tracking along an appropriate percentage. As long as he’s growing normally, I wouldn’t worry about his calorie intake. You should though ensure he’s getting enough calcium, vitamin D, and iron—these are not found in a limited diet. A daily multivitamin is probably a good idea.

The only problem I can foresee is that a diet rich in bananas might be constipating….which brings us to the second question of the post!

A question from Brad: “What is your opinion on using Karo syrup for baby’s constipation?”

Karo is a brand of corn syrup, useful for baking pecan pies. It’s safe and tastes sweet, and is often used to treat constipation in babies. I could find only one study looking at the effectiveness of this approach, lumping in corn syrup with other dietary modifications. It found that this approach relieved constipation about 25% of the time.

Keep in mind that the stooling patterns of babies can be quite variable. At about six weeks of life, breast fed babies may start to have especially infrequent stools, maybe just once a week or even fewer. The stools continue to be soft, and the babies are thriving and happy. Because the frequency of poops is so variable, it’s best to consider constipation only present if the stools are hard and uncomfortable. Infrequent stools, as long as they’re soft, are not constipation.

If your baby is having hard stools, one reasonable step to try is corn syrup. Check with your pediatrician on the exact dosing and how to use it. Keep in mind that corn syrup and honey are not the same thing– never give raw honey to a baby less than one year of age.

Don’t use the car seat as a crib

Here’s a sleep question from Kathryn: “Just wondering about the safety of infants sleeping in the car seat (in the crib). My 8 week old sleeps beautifully in the car seat but only naps for 45 minutes at a time in the crib. This is my 3rd child and this is new to me – my others were great sleepers once I “figured them out”. It appears that this one just does better sleeping like that -what are your thoughts? Thank you!”

In the short run, car seat sleeping might save you some trouble, but in the long run it can lead to more serious problems. Best to stop this habit now, before it’s really ingrained.

To circ or not to circ

Jennifer asked about the medical evidence for and against circumcision: “A family doctor friend said there is new evidence (based on studies in S. Africa and New Zealand) suggesting that circumcisions for boys can reduce chances for HIV by 50%, and that uncircumcised men had 3x the incidence of STDs between the ages of 18-25. He said there is also strong evidence that circumcising males lowers the risk for UTIs, genital ulcer disease, penile cancer and HPV. Has the medical community changed their minds recently on recommending circumcisions as a preventative measure based on recent (limited) evidence?”

The current recommendation of the American Academy of Pediatrics (AAP) is that there is not sufficient evidence to support routine circumcisions on all baby boys. They acknowledge that cultural and religious factors are important and should be considered when making recommendations to parents. In other words, while the AAP agrees that there are medical benefits to circumcision, these don’t clearly outweigh the risks of the procedure. In the opinion of the AAP, it’s not a slam-dunk to circumcise.

Nursing multiple siblings

Nancy posted a question about nursing two siblings at once: “I am not sure if this is more of a question but for OB or a pediatrician but I thought I might ask anyways I am pregnant and still breastfeeding my now 13 month old. If I was to continue to breastfed once her younger sister was born would my newborn get all the nutrients she needs? My daughter only nurses twice a day so of course the newborn would nurse a lot more but I am very concerned my body wouldn’t make enough nutrients for a vulnerable newborn. Please any information you can give me would be wonderful. I am less concerned about my older child’s nutrients because he takes vitamins and eats tons of regular food. Thank you!”

At The Pediatric Insider, we’re happy to tackle the occasional OB question! Nursing multiple siblings is called “tandem nursing.” Here is an article from an experienced mom addressing some ways to address some of the challenges that may arise. The bottom line is that you can successfully and safely nurse both of your children. Your body will be able to make enough milk for both of them, and both kids will do fine. Usually the quality of the milk will change to match the needs of the newborn, and in fact sometimes the older child weans shortly after baby is born, perhaps because the milk begins to taste different.

Tandem nursing may be a little harder on mom. Make sure you’re getting plenty of fluids and enough calories, as well as enough calcium, vitamin D, and iron. Your newborn should take a vitamin D supplement as well.

Taking a newborn outside

A post from Steve: “I have a newborn baby girl and I was wondering how long after birth does she need to stay in the house. I have heard everything from 1 month to three. If we do take her out what places should we avoid?”

If your daughter is healthy– born at or near term, with no problems—she can go outside any time the weather is nice.