Correct Answers: The answer is D
IABLE Comment by Anne Eglash MD, IBCLC, FABM
Curr Allergy Asthma Rep. 2016 Sep;16(9):68. doi: 10.1007/s11882-016-0647-0.
The Role of Breastfeeding in Childhood Otitis Media.
Lodge CJ1,2, Bowatte G3, Matheson MC3, Dharmage SC3,4.
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PURPOSE OF REVIEW:
The purpose of this review is to summarize the recent literature, both systematic reviews and recently published original studies not included within those reviews, on the relationship between breastfeeding and childhood otitis media (OM).
RECENT FINDINGS:
There is clear evidence that breastfeeding is associated with a reduced risk of OM in childhood with sound biological plausibility to support that the association is likely causal. Any breastfeeding reduces OM risk in early childhood by 40-50 %. Systematic reviews also support a further reduced risk for continued breastfeeding. Recent studies have estimated burden of disease savings if breastfeeding within countries and globally approached WHO guidelines. Cost savings per year for reduced cases of OM by increasing ever and exclusive breastfeeding rates are estimated to be millions of pounds or dollars for UK and Mexico. Breastfeeding reduces OM in children. The burden of disease and economic impact of increasing breastfeeding rates and duration would be substantial.
A visit with a silly, slobbery child pulling on his ears can be the best comic relief for a family physician swamped with a packed schedule of patients with complicated, no-quick-fix problems. Within 5-7 minutes, after examining, laughing, and cooing with the tot, the doctor writes the prescription and waves goodbye, not worried about the consequence of that visit. Ear infections are considered normal in a typical office practice.
But wait- what if the doctor counseled the family on prevention? Let’s say that the doctor asked the parent about infant feeding, more specifically how long the child breastfed, and is the child still nursing? Hopefully the physician is discussing prevention for a child exposed to tobacco smoke, since passive smoke exposure increases the risk of ear infections. That is a modifiable factor, meaning that the family can stop the cigarette smoke exposure. However, a non-breastfeeding child either already weaned or was never breastfed, rendering infant feeding a non-modifiable factor at that point. So if infant feeding is non-modifiable, is asking about breastfeeding simply guilt-inducing?
Ideally during the prenatal period, families learn the risk of ear infections associated with not breastfeeding. Yet a reminder down the road could be instructional, and can be done without creating an atmosphere of guilt. There is a good chance, based on many studies, that the ear infections started after weaning. A gentle comment might be an educational moment, such as ‘oh you weaned Freddie at 6 months? Often I notice that infants don’t develop a first ear infection until after weaning’. That one statement might change a family’s plan for time of weaning a subsequent child, or at least segue into a conversation about mom’s barriers to breastfeeding duration. If we don’t talk about it, rates of ear infections related to premature weaning may not change.
