Search This Blog

Monday, November 1, 2010

Dr. Jay Gordon: Pertussis and iron supplements for breastfed babies

JG Header Complete

Here is an update from Dr. Jay Gordon about the so called Whooping Cough epidemic in California, and the AAP recent recommendation that Breastfed babies should receive iron supplements from age 4 months.
You know, I'd really like to know where the AAP gets it's ridiculous recommendations from?!

Very few of my patients are vaccinated according to the recommended schedules. I support parents' making this decision and have long thought that schedule is not as safe as it could be. The ultimate choice is obviously made by parents, but I share complete responsibility for the decisions they make.

In our office, we have seen quite a few children and adults with long hard coughs as we always do this time of year. Very few of these children and adults actually have pertussis. The media and the California Department of Public Health are exaggerating the threat. This is a miserable long disease, and rarely it can be dangerous to very young infants. But implying that there is a whooping epidemic is inaccurate.

The pertussis epidemic of 2010 is probably very similar to the pseudo-epidemic documented in the New York Times news story linked right here:

Diagnosing pertussis is very difficult and the vast majority of doctors err on the side of making the diagnosis rather than testing for the bacterium. Much of the illness around right now and being reported as whooping cough may be caused by a related bacterium called B. Parapertussis. The vaccine does not protect against this illness; it is rarely dangerous and culture growth confirmatiom for both pertussis and parapertussis bacteria is difficult. RSV and dozens of other respiratory viruses are much, much more common causes of fall and winter coughs. Again, very few coughing children and adults really have pertussis.

The accuracy of the diagnosis of the reported pertussis fatalities is very difficult to confirm. Media emphasis should focus on these deaths being almost exclusively among medically underserved children and families. The reports from public officials are not helpful in a meaningful discussion of the risks of winter illnesses and the condition of our health care system.

Breastfeed babies and toddlers, feed your family well, stay well hydrated, avoid crowds when practical and worry far less. Boring advice but more effective than the panic created by sensationalized media stories.

The AAP recently recommended iron supplementation for breastfed babies at age four months. This report came from the Committee on Nutrition and completely contradicted the statements of real experts on the American Academy of Pediatrics' Breastfeeding Committee. The Breastfeeding Committee is issuing its own report and may demand a retraction of the iron recommendations citing possible harm from supplementing breastfeeding babies. They will soon be publishing a detailed report containing the following paragraph:

"The Clinical Report does not address potential harms nor does it discuss the difference in bioavailability of iron contained in human milk vs. iron-fortified fluids and foods. Given research that has shown potential harm in infant growth and morbidity when iron supplementation is provided to iron-sufficient infants one wonders if universal iron supplementation will be deleterious to the population of developing infants who are breastfeeding exclusively. Furthermore, in a relatively recent US study the prevalence of iron deficiency anemia is low (3%) among unsupplemented breastfed infants in the first 6 months."

Best Wishes for the Fall and Winter Season!