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Study objectiveTo describe sleep duration and quality in the first month postpartum and compare the sleep of women who exclusively breastfed at night to those who used formula.MethodsWe conducted a longitudinal study in a predominantly low-income and ethnically diverse sample of 120 first-time mothers. Both objective and subjective measures of sleep were obtained using actigraphy, diary, and self-report data. Measures were collected in the last month of pregnancy and at one month postpartum. Infant feeding diaries were used to group mothers by nighttime breastfeeding behavior.ResultsMothers who used at least some formula at night (n = 54) and those who breastfed exclusively (n = 66) had similar sleep patterns in late pregnancy. However, there was a significant group difference in nocturnal sleep at one month postpartum as measured by actigraphy. Total nighttime sleep was 386 ± 66 minutes for the exclusive breastfeeding group and 356 ± 67 minutes for the formula group. The groups did not differ with respect to daytime sleep, wake after sleep onset (sleep fragmentation), or subjective sleep disturbance at one month postpartum.ConclusionWomen who breastfed exclusively averaged 30 minutes more nocturnal sleep than women who used formula at night, but measures of sleep fragmentation did not differ. New mothers should be encouraged to breastfeed exclusively since breastfeeding may promote sleep during postpartum recovery. Further research is needed to better understand how infant feeding method affects maternal sleep duration and fragmentation.CitationDoan T; Gay CL; Kennedy HP; Newman J; Lee KA. Nighttime breastfeeding behavior is associated with more nocturnal sleep among first-time mothers at one month postpartum.

Some of the molecules and cells in human milk actively help protect against infection. Infants who are breastfed therefore contract fewer infections than those who are given formula. UNICEF and the World Health Organization advise breast feeding to two years and beyond since a childs immune response does not reach its full strength until after approximately five years. All babies receive maternal antibodies through the placenta before birth but breastfed infants receive extra protection from antibodies other proteins and immune cells in human milk. Once ingested the molecules and cells help to prevent microorganisms from penetrating the bodys tissues. This assistance is particularly important during the first few months of life when an infant cannot effectively defend itself against foreign organisms. Some of the molecules bind to microbes in the lumen of the gastrointestinal tract blocking microbes from attaching to and crossing through the mucosa which line the digestive tract and other body cavities. Other molecules lessen the supply of particular minerals and vitamins which harmful bacteria need to survive in the digestive tract. Certain immune cells in human milk are phagocytes which attack microbes directly while another set produces chemicals which boost the infants own immune response. The author describes breast milk antibodies and the general immune benefits of breast milk.

Breastfeeding is a natural physiologic process upon which human survival has depended for uncounted generations. Natural selection over millions of years has ensured that breastmilk contains all the nutritional requirements of the newborn period and beyond. In order to prevent problems for the few, modern management of labour, delivery and the postpartum period has subjected most mothers and infants to routines which are contrary to the physiologic principles underlying successful breastfeeding. The early introduction of bottles may render suckling less effective or may result in breast refusal, thus paving the way for failure to thrive, hyperbilirubinemia, "colic" and crying, prolonged and frequent feedings, sore and cracked nipples for the mother, and it may contribute to the onset of plugged ducts and mastitis. Alternatives to bottles can be used when supplementation is thought to be indicated. They include using a lactation aid, finger feeding, or feeding with a cup, spoon, or eyedropper.

Recently, some of my patients were instructed not to breastfeed for 24 to 48 hours after magnetic resonance imaging scans. Is this based on scientific evidence?No. On the contrary, evidence indicates unequivocally that the contrast media used for both magnetic resonance imaging and computed tomography scans are excreted into breast milk in such small quantities that there is no concern at all for nursing babies.

Children suffering from mild to moderate (3 to 6%) dehydration likely caused by viral gastroenteritis are often hospitalized because they are unable to tolerate oral fluids. We studied 17 such children, aged one to six years, who were otherwise healthy. All had isonatremic dehydration and were treated with 30 ml/kg of 3.3% dextrose and 0.3% saline over a period of three hours in the emergency department before being discharged. No patient required admission to the hospital. Only one patient required another course of rapid intravenous rehydration and subsequently improved without hospitalization. Although all our patients experienced vomiting before treatment, 65% had no vomiting after treatment. Rapid intravenous rehydration is an effective treatment, for children with mild to moderate dehydration secondary to presumed viral gastroenteritis, that obviates the need for hospitalization.

Dehydration and poor weight gain in breastfed infants are common but potentially preventable problems. Serious consequences are severe hypernatremic dehydration, severe weight loss, and severe hyperbilirubinemia with possible irreversible damage to the baby's brain or other vital organs. The dangers of dehydration have been emphasized by recent media reports of severe cases. These reports have resulted in increased, but often inappropriate, intervention in breastfeeding. On the basis of our experience at the Hospital for Sick Children, and the Doctors Hospital (Toronto), we have developed a decision tree and management protocol to assess breastfeeding, intervene effectively, and prevent such problems. If all breastfeeding mothers and babies are evaluated by qualified staff before discharge using this tool, it is expected that the serious consequences associated with babies leaving hospital appearing to be breastfeeding, but in fact not breastfeeding at all, will be prevented. Application of this approach, however, will require considerable upgrading of nurses' and physicians' skills and knowledge with regard to breastfeeding. A case report is presented.

To the Editor.— Cronenwett et al1 have jumped to a completely unwarranted conclusion from the data they present in their article on bottle use, that "no support was found for the nipple confusion hypotheses" Rather, there is no support to make such a statement. There seems to be confusion in the minds of the authors by what is meant by "nipple confusion" or "nipple preference." In the first place, those of us who handle breast-feeding problems on a daily basis would not argue that the occasional bottle, introduced once breast-feeding was well underway and both mother and baby were doing well, would cause serious problems in most instances.

1. 2 - [1 - 14C]Butyryl - 10 - [3 - (4 - methylpiperazin - 1 - yl)propyl]phenothiazine (butaperazine) was synthesized and its metabolism, excretion and distribution studied in rats and dogs.2. A specific fluorescent method for butaperazine is described, and blood levels have been determined in dogs and humans following oral dosing.3. Two compounds, resulting from hydroxylation of the phenothiazine ring and N-demethylation, are the major metabolites. The sulphoxide, sulphone and a reduction product of the butyryl side chain carbonyl group are minor metabolites.4. The drug appears to be rapidly absorbed, undergoes biliary excretion and is excreted primarily in the faeces of rats and dogs.

Six instances of subluxation of the radial head ("nursemaid's elbow, pulled elbow") in babies in the first 6 months of life are presented. In four cases, the pulled elbow was produced in a previously unreported fashion.

HUMAN factor VIII contains at least two biological activities, antihaemophilic factor (AHF) and von Willebrand factor (VWF). When highly purified, factor VIII is estimated to have a molecular weight of over 1.12 × 106, as determined by gel chromatography or sedimentation equilibrium centrifugation1–4. Some investigators2–4 consider factor VIII a single glycoprotein with a number of covalently linked subunits. Since factor VIII can be dissociated in certain conditions, others5–7 consider it to be a two-molecule complex consisting of a multi-subunit high molecular weight protein (> 106) with VWF activity that acts as a carrier molecule for a lower molecular weight (2.4 × 105) subunit with AHF activity. A third model suggests that both AHF and VWF are high molecular weight, separate proteins consisting of disulphide linked subunits8,9.