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Foster Breastfeeding

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Compiled by Dusty Copeland 2004

I. What is foster breastfeeding/ wet nursing?

1.(Abejide et al in Nigeria, 1997 ), and (Banapurmath 1993) and Seema (Seema 1997) in India, identified the childs health as the principle motivating factor for mothers and foster mothers. ( to relactate). The infants were already ill when relactation was suggested by a health care provider. In Papua New Guinea (Nemba 1994), foster mothers who requested prescriptions for a feeding bottle were motivated to relactate when the hazards of bottle feeding were explained to them. In these situations, the amount of milk produced and the extent of relactation were important outcomes. ( WHO, 1998)

2.Over time, many changes have evolved in adoptive and foster care policies. For ages, motherless infants had to be placed with lactating women in order to insure their survival. Once formulas could be made from relatively safe animal milk, artificial feeding allowed institutions to care for babies until more formal arrangements could be made. Today emphasis is placed on uniting children with their adoptive family as quickly as possible to insure positive emotional bonding. Foster placement may allow for reunification or alternative permanent living through adoption. (Sutherland, Ann H, Breastfeeding: An Adoption Option, A Foster care Workers Review,  ISBN#0 96559 20-6-5)

3.Grandmothers in Africa (Slome 1956) produced milk when they put infants to their breast to soothe them in the absence of their mothers, without any intention to relactate.

4. Wet nursing was the norm among European based cultures for centuries and was seen in all cultures throughout recorded history. Before technology and milk surpluses created the mass production of, and market for, artificial baby foods, wet nursing was the only option for infant survival if the birth mother was unable to nurse. ( Wight, 2004)

B. Foster breastfeeding in America

1. Cross-nursing is breastfeeding of a child by a woman other than their mother. In the West, prior to the 20th century a form of cross-nursing called wet nursing (where a woman is paid to breastfeed a child) was common( Golden 1996)

. 2. The decline in cross-nursing in the West paralleled a general decrease in breastfeeding resulting from the ready availability of artificial infant milks. ( Golden 1996 )

3. However, the situation is different in many non-industrialized societies where breastfeeding is ubiquitous and it is relatively common for children to be breastfed by other than their mother. ( Riordan 1999)

4. In 2001 there were 542, 000 children in foster care in the United States ( US Dept of Health and Human Services, the AFCARS Report www.acfhhs.cov/programs/cb. ). All of these children have emotional special needs and a proportion also have physical special needs ( Halfon 1995) (McIntyre 1986) 23, 000 were babies under a year of age10. Despite breastfeeding being universally recognized as the desired form of nutrition for babies, providing breast milk and/or breastfeeding for babies in foster care is usually not considered.

II. Who can foster nurse?

A. County Regulations

1. Each state and county has differing regulations, many or perhaps even most do not address the issue of foster breastfeeding. You must have the consent, in writing preferably, of your social worker in order to protect yourself, the infant, and the foster family agency.

B. State regulations

1. I have copied the Wa state code here : What I have found is that most states follow this protocol, if any at all. WAC 388-148-0395 What requirements must I meet for feeding babies? You must meet the following requirements for feeding babies:
(1) In group care settings, all formulas must be in sanitized bottles with nipples and labeled with the child's name and date prepared if more than one child is bottle-fed.
(2) You must refrigerate filled bottles if bottles are not used immediately and contents must be discarded if not used within twenty-four hours.
(3) If you reuse bottles and nipples, you must sanitize them.
(4) If breast milk is provided by anyone other than a baby's biological mother, approval must be obtained from the child's social worker.


(5) Infants who are six months of age or over may hold their own bottles as long as an adult remains in the room and within observation range. You must take bottles from the child when the child finishes feeding or when the bottle is empty.
[Statutory Authority: RCW 74.15.030. 01-18-037, 388-148-0395, filed 8/28/01, effective 9/28/01.]

 

C. Foster moms should/must meet these criteria: (suggested by Piatak,)

1. Be HIV negative. The only definite exception to the above is HIV infection in the mother. Until we have further information, it is generally felt that the mother who is HIV positive not breastfeed, at least in the situation where the risks of artificial feedings are considered acceptable. There are, however, situations, even in Canada, where the risks of not breastfeeding are elevated enough that breastfeeding should not be automatically ruled out. The final word is not yet in. Indeed, recently information came out that exclusive breastfeeding protected the baby from acquiring the HIV better than formula feeding and that the highest risk is associated with mixed feeding ( breastfeeding + artificial feeding). This work needs to be confirmed. ( Newman 2003)

2.Be hep b and c, syphilis and recreational drug negative

3.Be otherwise healthy and committed.

 

 

Siskiyou County has suggested the following protocol, written by Patty Shackleton, PHN: This is included for discussion only and has not been approved by Siskiyou County Council.

 

HUMAN MILK AND BREASTFEEDING FOR FOSTER BABIES

Philosophy: Breastfeeding has been widely over-looked in foster care. Some
California counties have been practicing and advocating breastfeeding in foster homes for a few years, hence precedent and standards have been developed. Some foster mothers have believed that it was not permitted or would complicate reunification. There are no laws or licensing policies opposing breastfeeding by caregivers. Breastfeeding should be encouraged and training made available to foster parents, social workers, and biological mothers. Basic to the responsibilities of foster care are modern health care and nutrition; breastfeeding is the best single source of nutrients and prophylaxis against many illnesses.
Human milk is uniquely suited for human infants. As we see more high-risk infants becoming the responsibility of the courts, it is very important to provide these children maximum opportunity to thrive. Mother's milk or banked breast milk are options that shall be accommodated when conditions exist to do such.
Purpose: The purpose of the protocol is to allow distribution of a county wide standard to foster family agencies, licensing authorities, social services, and the courts regarding health and safety measures to be taken by foster families that are able to use human milk or breastfeed foster babies. Public Health nurses will be responsible for maintaining and updating this protocol which will incorporate guidelines and recommendations from the American Academy of Pediatrics ( AAP) and the California Department of Health Services (DHS)


AAP and DHS currently promote the following:

. Human milk is easy to digest and contains all the nutrients that babies need in the early months of life.
. Factors in breast milk protect infants from a wide variety of illnesses.
. Fatty acids, unique to human milk, may play a role in infant brain and vision development.
. In several large studies. Children who had been breastfed had an advantage over those who had been artificially fed when given a variety of cognitive and neurological tests, including measures of IQ
. Infants who are exclusively breastfed for at least four months, are half as likely to have ear infections in the first year of life.
. Breastfeeding reduces the incidence, and lessens the severity of a large number of bacterial infections, including meningitis.
. Breastfeeding protects against a variety of common illnesses, such as diarrhea and infant botulism.

. Lack of breastfeeding is a risk factor for sudden infant death syndrome (SIDS)
. Human milk may protect premature infants from life-threatening gastrointestinal diseases.
> Breastfeeding has recently been identified as an intervention for infants at risk for reactive attachment disorder.



Wet nursing has been almost unheard of in this country. In other cultures it has been assumed that women of the community should nurse a child whose mother is unable to nurse him. Through most of human history, childcare has included breast-feeding by the women of the community. Foster care is a natural place for breastfeeding and wet nursing. The many benefits to child and parent are all in accordance with the principles of foster care. The risks to the infant are minimal and can be eliminated by screening of the foster mother.

FOSTER FAMILIIES WHO ARE APPROVED TO BREAST -FEED FOSTER BABIES MUST ADHERE TO THE FOLLOWING:
1. The foster homes' licensing agency must have acknowledged the parents intent to breast-feed. A statement in the service plan for the foster family should clearly state that breastfeeding is available to the babies placed in their home.

2. The foster mother will have on record testing results for HIV Hepatitis B and C, syphilis and recreational drugs current every two years.

3. The foster mother 's physician must agree that this mother is suitable for breastfeeding.


4. The health care provider for the child must be aware of the use of breast milk and assist with direction of quality, frequency and duration.

5. The foster home must follow safe and appropriate sanitary practices.


Foster homes willing to feed foster babies breast milk from other sources may receive milk from:

1. The biological mother. *


2. A licensed breast milk bank.

3. A source determined to provide screened milk that is recognized by the family's health care provider, and approved for the baby by the family's social worker.**
* follow rule #4 above

III. Why should we have foster nursing moms?

A. World Health Organization, UNICEF, AAP, American Dietetic Association, American College of Obstetrics and Gynecology, and the Department of Health Services for California. all recommend breastfeeding an infant for the first year .( see Welcome to California, http://www.wicworks.ca.gov/breastfeeding/resourcedocs/dhs_bfpolicy.html )

1. Where it is not possible for the biological mother to breastfeed, the first alternative, if available, should be the use of human milk from other sources. Human milk banks should be made available in appropriate situations. ( WHO, 1998)

2. WHO recommends exclusive breastfeeding for at least the first 4 and if possible the first 6 months of an infants life, and continued breastfeeding with adequate complementary food for up to two yeas of age or more. Yet many infants stop breastfeeding in the first few weeks or months and, as a result, are at increased risk of illness, malnutrition and death.( WHO, 1998)

3. In emergency situations, for infants who are unaccompanied; those who were artificially fed before the emergency; and those for whom breastfeeding has been interrupted. As many infants as possible should be enabled to resume or continue breastfeeding to help prevent diarrhea, infection and malnutrition. A woman can relactate to feed one or more unaccompanied infants. ( WHO, 1998)

4. Breast milk is the normal food for babies. The World Health Organization and Unicef1 state that where it is not possible for the biological mother to breastfeed, the first alternative, if available, should be the use of human milk from other sources." Given the precarious physical and emotional health of some babies in foster care it is possible that breast milk/breastfeeding might assist many children ( Gribble, 2003)

5.Throughout the WHO and UNICEF documentations one can find referrals to foster mothers in the same context as the breastfeeding mother, no differences or discriminations seem to appear.

B.. Health of the infant

1.The general calming effect of breastfeeding is well known and has been measured in reduced heart and metabolic rates of breastfeeding children (Blass, 1994).

2. Two other factors to consider are the provision of breast milk through breastfeeding and foster breastfeeding. We have considered the emotional benefits of breastfeeding a child at risk of attachment issues, however, the unique properties of breast milk also confer positive immune and growth factors to the breastfeeding child obtaining breast milk. This will be of benefit to all children but may be especially significant to medically fragile infants (Arnold et al, 1993).

3. the lack of breastfeeding as one of the risk factors for serious RSV ( Piatak, 2003)

4. Many foster babies may benefit from breast milk/breastfeeding however, the risk of disease transmission must be minimized. Provision of breast milk to all medically fragile foster babies is desirable. Breastfeeding by the foster mother may be applicable in cases where the child is likely to be in care long term, has been previously breastfed or the childs mother desires that s/he be breastfed. However, for breastfeeding of foster babies to become more common social barriers must be overcome. ( Gribble, 2003)

5. Cases where the child is physically ill or emotionally damaged or in localities where milk banks do not exist to supply donor milk might place a higher imperative on breastfeeding than would otherwise be the case. (Gribble 2004)

C. Reunification of mom and breastfeeding infant

1. The first priority is to ensure that maternity and child care services in health facilities and in the community provide mothers with the help that they need to initiate, establish and sustain breastfeeding. ( WHO, 1998)

2. breastfeeding may be appropriate where a mother desires her child to be breastfed. Some mothers, as part of the process of working towards regaining custody of their child, may even maintain their milk supply with the intention of breastfeeding their child on reunion and a breastfeeding foster mother may assist in this (although this may seem far fetched the author is aware of one case in which this has occurred).( Gribble 2004)

D. Attachment disorders

1. Though it is likely that the skin to skin contact involved in breastfeeding may of itself be comforting to the child and aid the transition to sleep, hormonal influences are also involved as suckling stimulates the release of the hormone cholecystokinin in the gastrointestinal tract of breastfeeding children, inducing sleepiness (Uvnas-Moberg, 1987).

2. Although adoptive breastfeeding has been the focus of breastfeeding a child at risk of attachment issues, it is worth note that foster breastfeeding is also practiced, sometimes with the permission and support of the relevant authorities, sometimes without. The possibility of gaining permission to breastfeed a foster child varies widely between locations, however, for those who are considering breastfeeding a foster child without approval they should be aware that children have been removed from foster families because of breastfeeding. (Gribble,2003)

3. Thus, a child unable to be breastfed by their mother due to work arrangements, illness or death may be breastfed by another woman. In these cases, cross-nursing is a convenient way to nourish and comfort a baby when their mother is not immediately available or a pragmatic necessity in cases where alternative feeding methods are unacceptably risky. (Slome 1956)

4. An insecure attachment (of which foster children are already at risk) results in difficulties with self-regulation, relationships and negatively impacts many areas of development ( Drury-Hudson 1994)

E. Necrotizing enterocolitis and other health issues

1. Conversely, though it is widely unacknowledged, not breastfeeding results in retardation of babies potential. ( Cunningham 1995)( Wiessinger 1996)( Polan 1994)

2. However, it is possible to envisage that foster babies not be further disadvantaged and that prescription of donor breast milk, might become common. Moves towards more routine use of donor milk has begun and some US states (California for example), the government reimburses the cost of milk bank donor milk for foster babies with medical needs via Medi-Cal . (personal experience).

F. Benefits to the foster mother

1.Certainly mothers have described that the act of breastfeeding helped them feel closer to their adopted child which may be at least partially due to the release of oxytocin during breastfeeding which promotes the development of maternal behavior (Uvnas-Moberg, 1996).

2.Alternatively it may be because breastfeeding requires mothers to maintain physical proximity to their child and to interact with them on a regular basis in a positive and intimate manner (Epstein, 1993).

3.Moreover, breastfeeding may help the mother cope with stress better as suckling at the breast has been associated with relaxation responses that have been measured via electroencephalograph (Cervantes et al 1992) and in decreased blood pressure and cortisol levels (Amico, 1994).

G. Benefits for Foster Family Agency and Child Protective Services

1. Financial cost to government and families is dramatically decreased with breastfeeding. The cost to supply artificial baby milk to one child is between $1,160 and $3,915 per year in 1998. Medical expenses are an increase of $331 to $475 per never-breastfed infant during the first year of life ( 1999 costs) (Ball, 1999). Compared to formula feeding, breastfeeding each infant enrolled in WIC saved $478 in WIC costs and Medicaid expenditures during the first 6 months of the infants life.( Montgomery 1997)

2. If you breastfeed for at least 4 months, your child will experience one third the risk of hospitalization for lower respiratory disease, the protection seems to last for the first year of life. ( Dr. Virginia Bachrach, Palo Alto, Ca.)

3. A pre-publication study by the Wisconsin State Breastfeeding Coalition estimated the following health care savings in Wisconsin if Breastfeeding rates were at 7;5% at discharge and 50% at six months.

$4,645,250/yr Acute Otitis Media

$437,120/yr Bronchitis

$6,699,600/yr Gastroenteritis

$262,400/yr Allergies

$ 758,934/yr Asthma

$578,500/yr Type I Diabetes

$30,984,432/yr Total Health cost savings

4. Listed in Outcomes of Breastfeeding Versus Formula Feeding are 19 pages of scientific studies that prove the superiority of breast milk over formula in both economic and health issues. Every agency and breastfeeding foster mom should obtain a copy of this for references. Most recently updated Mar 2001 by Ginna Wall, MN, IBCLC gwall@u.washinton.edu

IV. When is foster nursing applicable or desirable?

A. Drug babies

1. For the foster child it can be an extra emotional benefit as well as offer superior nutrition to help overcome poor prenatal care. ( see article- naturalchild.com/guest/george_wootan.html from Breastfeeding New Discoveries)

2.Drug babies are often colicky or cry a lot babies. These infants are at high risk for shaken baby syndrome. Breastfeeding foster mom can relieve the stress on the biomom, encouraging her to continue to breastfeed and keep the infant breastfeeding until the bio-mom can get it together or overcome depression.

3. Irritability and high pitched crying is not uncommon in drug exposed infants and infants with CNS damage. ( Archer 2003)

B. RAD

1. Reactive attachment disorder . At the top of the list of interventions recommended for infants at risk for RAD is Breastfeed, if possible ( Piatak 2003)

C. Formula intolerance

1. The risk of Necrotizing Enterocolitis is so high in the premature infant, all NICU babies at risk should have a prescription for human milk, if mother cant supply or breastfeed, then milk bank milk should be supplied. ( Wilson-Clay 2002)

2. Some babies can not tolerate any type of formula.

D. Reunification with breastfeeding mom

1. Remember that stopping breastfeeding for a week may result in permanent weaning since the baby may then not take the breast again. On the other hand, it should be taken into consideration that some babies may refuse to take a bottle completely, so that the advice to stop is not only wrong, but often impractical as well. On top of that it is easy to advise the mother to pump her milk while the baby is not breastfeeding, but this is not always easy in practice and the mother may end up painfully engorged. ( Newman 2003)

E. Adoptive placement

A breastfeeding foster mother can ease an infants struggles to handle crisis and help a transition to a permanent location. (see article- naturalchild.com/guest/george_wootan.html from Breastfeeding New Discoveries)

F. Premature infants

1. AAP guidelines acknowledge that human milk also is beneficial in the management of premature infants. ( Pediatrics 1997)

2. Babies who are preterm are at risk of developing Necrotizing Enterocolitis, which may be prevented by breast milk/breastfeeding. ( Wilson-Clay, 2002) In this article she lists numerous benefits of human milk for preterm infants, and suggests ALL infants discharged form the NICU should have a prescription for breast milk or be breastfed.

3. Kangaroo care for these infants. Improves thermoregulation, regulation of heart rate, better oxygen saturation, improved weight gain, improved bonding issues, increases in milk volumes. ( Wilson-Clay 2002)

4. Mild- and moderate-preterm birth infants are at high relative risk for death during infancy and are responsible for an important fraction of infant deaths ( Kramer 2000)

V. What are some barriers to foster breastfeeding?

A. The woman's motivation

1. "Sometimes mothers or foster mothers are self-motivated. . . More often, mothers or prospective foster mothers need to be counseled, informed, encouraged and supported by health care providers before they are sufficiently motivated to relactate for an infant. This requires time, skill and patience from the counselor." (WHO 1998)

B. Some Physicians and Lactation consultants!

1.Physicians were the least supportive people and were also sometimes openly hostile. ( WHO 1998)

2.The other barrier that needs to be overcome is the view of breastfeeding special and as being best for babies, rather than being a normal part of child care. While this attitude remains, many will deny foster children who would benefit from breast milk/breastfeeding the opportunity because it is an added extra rather than a basic need. Breast milk/breastfeeding may not be for every situation but lactation experts have a role to play in raising the possibility with social workers and other health care professionals responsible for foster children. ( Gribble 2004)

3. Doctors, LLLLs and LCs are in a perfect position to provide accurate, evidence based information and support regarding relactation. They can make or break a foster nursing relationship, so it is extremely important that they be well-informed and up to date on this topic.

 

B. Social Workers

1. Social workers may have concerns about foster breastfeeding as it is uncommon in our country. This may include that it is somehow strange or perverted, or that foster breastfeeding would interfere with the bond between the child and the birth mother, or that foster breastfeeding represents a hidden agenda to adopt the child. ( Piatak, 2003)

2. Social workers may not be familiar with the laws and codes as they relate to breastfeeding. Health and Safety Code Section 1647 states The procurement, processing, distribution, or use of human milk for the purpose of human consumption shall be construed to be, and is declared to be for all purposes, the rendition of a service by each and every nonprofit organization and its employees participating therein, and shall not be construed to be, and is declared not to be, a sale of the human milk for any purpose or purposes.

3. The belief that breastfeeding creates a special bond that may cause trauma if broken (e.g. if a child is reunited with birth family) does not appear to be borne out by those who have cross-nursed. Rather, women frequently express that breastfeeding anothers child gave them warm feelings towards the child and the childs mother. ( Krantz 1981) (Gaskin 1989) ( NMAA 1994)

4. while women have observed that some babies appeared initially surprised at being breastfed by another woman, it has not been reported that breastfeeding interfered in any way with a childs return to maternal care. ( Krantz 1981) ( Gaskin 1989) (NMAA 1994)

 

C. Family members

1. In countries where breastfeeding is the norm, women usually receive more support from their families and friends, making relactation easier. Health workers, too, may be more supportive in these settings, and may both suggest the procedure and help her to carry it out: (Neema 1994, Abejide 1997 )

WHERE TO OBTAIN INFORMATION ABOUT ADOPTIVE/FOSTER BREASTFEEDING.

World Health Organization booklet on Relactation- the most complete summary of relactation/adoptive breastfeeding available (also available for purchase directly from WHO)

http://www.who.int/child-adolescent-health/New_Publications/NUTRITION/Relactation_EN.html

Other websites

http://www.fourfriends.com/abrw/

http://www.kellymom.com/relactation.html

http://www.asklenore.com

Email lists

http://groups.yahoo.com/group/1ABSupportGroup/

References

Abejide OR, Tadese MA, Babajide DE, Torimiro SEA, Davies-Adetugbo AA, Makanjuola ROA. Non-puerperal induced lactation in a Nigerian community: case reports. Annals of Tropical Paediatrics 1997; 17: 109-114.

Amico J, Johnson JM, Vagnucci AH: Suckling induced attenuation of plasma cortisol concentrations in postpartum lactating women. Endocrinology Research 20:79-87, 1994

Alarcon PD, Tressler R, Corner GM. Gastrointestinal tolerance of a new infant milk formula in health babies: a multicenter study conducted in Mexico. Int Pediatr 2001;16:150-154.

Archer D, Breastfeeding the Special Needs Infant with Cleft Palate, Comforting Issues for Colic and GERD, Area 1 Perinatal Council, Sept 2003.

Arnold LDW. Use of donor human milk in the management of failure to thrive: case histories. J Hum Lact 1995;11:137-140.

Arnold L. trends in donor milk banking in the United States. In: Newberg DS, ed. Bioactive Components of Human Milk. New York: Kluwer Academic Publishers: 2001;pp509-517.

Ball TM, Wright AL. Health care costs of formula-feeding in the first year of life, Pediatrics 1999 Apr;103 (4 Pt 2):870-6.

Banapurmath CR, Banapurmath S, and Kesaree N. Successful Indured Non-puerperal Lactation in Surrogate Mothers. Indian J. Pediatr. 1993: 60: 639-643.

Blass EM: Behavioral and physiological consequences of suckling in rat and human newborns. Acta Paediatrica Supplement 397:71-71, 1994

Cervantes M, Ruelas R, Alcala V: EEG signs of relaxation behavior during breast-feeding in a nursing woman. Archives of Medical Research 23:123-127, 1992

Cunningham AS. Breastfeeding; Adaptive behavior for child health and longevity. In; Stuart-Macadam P, Dettwyler KA, eds. Breastfeeding; Biocultural Perspectives. Hawthorne: Aldine de Gruyter; 1995;pp243-264.

Dozier M, Stovall KC, Albus KE, Bates B. Attachment for infants in foster care: the role of caregiver state of mind. Child Dev 2001;72:1467-1477.

Drury-Hudson J. Some effects of attachment disturbance on child behavior. Children Australia 1994;19:17-22

Epstein K: The interactions between breastfeeding mothers and their babies during the breastfeeding session. Early Child Development and Care 87:93-104, 1993

Gaskin IM. Babies, Breastfeeding and Bonding. Massachusetts: Bergin and Garvey Publishers; 1989.

Golden JL. A Social History of Wet Nursing in America: From Breast to Bottle. Cambridge: Cambridge University Press; 1996.

Gribble K, Breastfeeding of a medically fragile foster child, submitted Journal of Human Lactation 1-12-03

Gribble K Post-institutionalized adopted children who seek breastfeeding with their adoptive mothers. Journal of Developmental and Behavioral Pediatrics 2003, Submitted.

Gribble K Breastfeeding adopted children at risk for attachment issues. Journal of Human Lactation 2003

Halfon N, Mendonca A, Berkowitz G. Health status of children in foster care. Arch Pediatr Adolesc Med 1995;149:386-392.

Johnson K, Gerada C, Greenough A. Treatment of neonatal abstinence syndrome. Arch Dis Child Fetal Neonatal Ed 2003;88:F2-F5.

Kerner JA. Formula allergy and intolerance. Gastroenterol Clin North Am 1995;24:1-25.

Kramer M, Demissie K, Yang H, Platt R, et al: The Contribution of Mild and Moderate Preterm Birth to Infant Mortality, JAMA 2000, 284:843-849.

Krantz JZ, Kupper NS. Cross-nursing; wet nursing in a contemporary context. Pediatrics 1981;67:715-717.

Marcus RF. The attachments of children in foster care. Genet Soc Gen Psychol Monogr 1991;117:365-394.

McIntyre A, Kessler TY. Psychological disorder among foster children. J Clin Child Psychol 1986;15:297-303.

Montgomery DL, Splett PL. Economic benefit of breastfeeding infants enrolled in WIC, J Am Diet Assoc 1997 Apr;97 (4):379-85.

Nemba K. Induced Lactation: A Study of 37 Non-puerperal Mothers. J. Trop Paediatr 1994: 40: 240-242.

Newman J, You Should Continue Breastfeeding (2)(Illness in the Mother of the Baby). Revised 2003 handout #9b. www.BreastfeedingOnLine.com

NMAA. Wet nursing, Nursing Mothers Association of Australia Newsletter 1994;30:13-18.

Oddy WH. The impact of breast milk on infant and child health. Breastfeed Rev 2002;10:5-18.

Piatak R, Does Wet Nursing Have a Place in the USA Today?, Breastfeeding Update: SDCBCs quarterly newsletter, http://www.breastfeeding.org/newsletter/v2i3/page5.html

Polan HJ, Ward MJ. Role of the mothers touch in failure to thrive: a preliminary investigation. J Am Acad Child Adolesc Psychiatry 1994;33:1098-105.

Riordan J. The cultural context of breastfeeding . Breastfeeding and Human Lactation 2nd Edition. Sudbury: Jones and Bartlett; 1999;pp29-52.

Ruff AJ. Breastmilk, breastfeeding and transmission of viruses to the neonate. Semin Perinatol 1994;18:510-516.

Seema AK, Patwari L, Satyanarayana. Relactation: An effective Intervention to Promote Exclusive Breastfeeding. J Trop Paediatr 1997: 43: 213-216.

Stovall KC, Dozier M. Infants in foster care: an attachment theory perspective.Adoption Quarterly 1998;f2:55-88j.

Uvnas-Moberg K, Widstrom AM, Marchini G, Winberg J. Release of GI hormones in mothers and infants by sensory stimulation. Acta Paediatr Scand 1987:76:851-860.

Wight NE, Foster Breastfeeding: Another Perspective, Breastfeeding Update: SDCBCs quarterly newsletter, http://www.breastfeeding.org/newsletter/v2i3/page5.html

Wilson-Clay B. Transitioning the Preterm Infant to Full Breastfeeding: www.lactnews.com 2002.