The global recommendation of the World Health Organization (WHO) to give "exclusively breastfeeding during the first six months of life" is considered by mothers and health professionals a nutritional goal suitable for any mother who can and wants to make it. It is important to point out that the so-called "Third World", with millions of disadvantaged people, was and is the fundamental objective of the dissemination and implementation of a very broad WHO health program, which includes this recommendation. The socioeconomic and cultural circumstance in our western area is different and with a history, well established with recommendations from the ESPGHAN, which have made compatible said WHO recommendation with the introduction of complementary feeding since 4 months. Therefore, this recommendation should be applied with flexibility in our pediatric field and monitor the risks of iron deficiency that may result.

Breast feeding provides the infant with fresh mother’s milk in natural condition. When expressed breast milk has to be used, there is a risk of contamination and deterioration of the milk. Careful expressing, assuring the cold chain during storage and transport and proper handling are essential if its properties are to be maintained.

Since industrial revolution, rickets has been an endemic disease. Since the discovery of vitamin D and its supplements, above all in milk formulates, practically it was disappear, but in the last few years it seems to
be again a public health problem. Vitamin D deficiency contributes, not only to bone problems, but also to an important increase in the risk of cardiovascular, autoimmune, infectious diseases and cancer.
We communicate a case of neonatal hypocalcemic tetany secondary to a vitamin D deficiency that appeared in a neonate before the second day of life. The precocity of its appearance and its clinical severity are exceptional. It also warn of the emergent problem that it suppose the vitamin D deficiency and the necessity of set up the supplementation with this vitamin, following the last recommendations of the Spanish Paediatrics Association.

Usually complementary feedings include, at least temporar­ily, pureed foods or spoon foods until infant is able to grasp food and feed herself. In daily practice time for chewable foods has delayed is this is a cause of eating problems in late infancy.

Baby-led weaning (BLW) is an alternative approach for introducing complementary foods that emphasises infant self-feeding rather than adult spoon-feeding. In this way infants early joins family meals and share familial menu. Some small observacional studies suggest that this approach enhances eating patterns, although benefits for health are still to be probed. Its diffusion is according to the recommendations from the WHO to delay complementary feedings till 6 months of age. Many of the considerations of these phylosophy could be applied to most infants, although it is difficult to agree in some radical aspects (opposition to pureed foods).

Main unanswered questions are: do infants following BLW obtain sufficient nutrients, including energy and iron? Are iron deficiency, choking and growth faltering real concerns for those following BLW approach? Is the technique suitable for all infants?

Up to date, it seems important that pediatricians know about BLW approach, its benefits and risks.

Introduction: Breast milk should be the only food for babies up to six months, but complementary feedings may be necessary between 4-6 months.

Aim: Clinical evaluation of the use of a new cereal porridge made with water, in infants 4 months of age with breastfeeding.

Material and methods: 30 healthy infants being breastfed up to 6 months of age were recruited. At 4 months, a daily intake of these cereals in place of the breast milk intake was prescribed for 4 weeks. The composition was prepared with 25% water providing 106 kcal/100 g. The average intake was 190 kcal slurry/day. A significant difference was found in the Z-score (p

Conclusion: The new preparation is a great alternative for starting a complementary feeding of infants exclusively on breast milk, who want or require the start of the process without adding formula.

Introduction: Synthetic oxytocin (Oxt) is the most commonly used drug to induce or augment labour contractions. The objective of the study is to evaluate the effect of Oxt used during labour on exclusive breastfeeding.

Patients and methods: This job is part of an observational descriptive study which primary objective is to investigate the effect of intrapartum oxytocin administration on primitive neonatal reflexes. Twenty women with their first term pregnancies were studied. Inclusion criteria were: healthy primiparae with a single gestation at term and vaginal delivery induced or augmented with Oxt. Three months following the birth all mothers were contacted by telephone to assess feeding.

Results: Women breastfeeding exclusively had received a significantly lower average dose of Oxt than those women who were not exclusively breastfeeding at 1 and 3 months postpartum (p

Conclusion: Synthetic Oxt used during labour may have negative influence on breastfeeding.

Objective: To know the incidence and importance of breastfeeding during the first six months of life, and to relate it to the variables that predispose to the beginning of breastfeeding and maintenance, the most frequent difficulties and the motives for abandoning it and/or introducing other kind of food early. We aim to compare hospital practice recommended by the World Health Organization and the importance of breastfeeding at the beginning.

Material and method: Transversal descriptive study with retrospective data gathering, telephonically surveying to mothers of babies 15, 30, 90 and 180 days old and maternity infirmary registries about newborns feeding.

Results: 81.2% decide to breastfeed at the moment of birth, 76% after hospital leave. It descends progressively 73.6% after 15 days of life, 72.5% after one month, 56.9% after three months, 37.8% after 6 months. Mothers that hare "touched skin to skin" right after birth and hare initiated breastfeeding during the first hour hare a higher prevalence of full breastfeeding against partial breastfeeding after 15 days is a 86.6 and a 86.3%, against 56.3 and 55%, respectively. The association disappears after the first month, and there is no direct relation between the practice of getting in contact of "skin with skin" during de first hour and the early cessation of breastfeeding. The age of the mother is not associated with the type of lactation according to the gathered data. 79.3% of women who are university students keep on breastfeeding for 3 months, compared to 62.2% in other studies, after 6 months they all do it in a similar way.

The critical moments of abandonment are around first month, and between the 4th and 5th month of life.

The reasons for partial breastfeeding during the first month are primarily 75.64% crying, hunger, puts on little weight, insufficient milk. The reasons for partial breastfeeding between 3 and 6 months is a 60.6% professional recommendation, a 18.2% because of working or studying and 18.2% insufficient milk, crying or hunger.

Conclusions: Rates of breastfeeding in the Hospital Son Llàtzer health sector are similar to those obtained in other studies and those of the 2006 National Health Survey. Appropriate hospital practices improve the prevalence of breastfe­eding in the beginning, after that there are a lot of other factors involved. To improve the prevalence of breastfeeding during the subsequent months, health care and measures that protect it should be improved.

Objectives: To evaluate an intervention program devised in 1997 to promote breastfeeding in the Nazaret Health Center in Valencia, Spain. The program consisted in distributing and explaining a leaflet designed for that purpose.

Methods: Demographic and anthropometric data and information on the approach to infant feeding was collected from the medical records of children born in 1995 and 1996 (control group) and from 1998 to 2000 (intervention group).

Results: In all, 52.4% of the control group and 56.0% of the intervention group were breastfed for a mean duration of 3.5 months (95% CI, 3.3-3.8) and 3.8 months (95% CI, 3.3-4.3), respectively (log rank test: nonsignificant). There were no differences between the groups with respect to the reason why breastfeeding was not initiated or was discontinued. The age and marital status of the mother and number of previous children had no affect on the decision to initiate or continue breastfeeding in the intervention group.

Conclusions: This intervention program did not change the percentage of mothers that initiated breastfeeding or prolong its duration.

The benefits of breastfeeding for the infant, the mother, the family, the healthcare system and society in general are well documented in numerous scientific publications. The medical advice for weaning a child without a justified reason is an act of irresponsibility from an ethical point of view. More than 90% of women might need to take some type of medication while breastfeeding their babies at any time, this being a commonly alleged reason for weaning. However, only a few drugs have been shown to represent a real hazard: phenindione, amiodarone, ergot derivatives, antineoplastic agents, iodides and drugs of abuse. Seemingly, only six maternal diseases are considered to contraindicate breastfeeding or make it nearly impossible. By exercising common sense, applying basic knowledge of Pharmacology and Pediatrics and using updated guidelines (e.g. books, journals and web resources), we should be able to adequately advise those lactating mothers who require medication. Therefore, healthcare givers are committed to offering them proper assistance since mothers will ultimately reject misinformation or recommendations based on prejudices or released by the industry, like that contained in the Physician's Desk Reference. A website, www.e-lactancia.org, an easy-to-use resource in both Spanish and English, will help us make appropriate decisions concerning more than 1,400 options that a lactating mother may have to confront.

Breast pain and other breast problems are frequent among breastfeeding mothers. They cause significant distress, undermine the mother's self-confidence in her ability to feed the baby and often contribute to early cessation of lactation. However, more than often, health professionals do not have the necessary knowledge for prevention or resolution of these specific problems as, in general, these topics are not included in preservice or in-service training. The purpose of this review is to provide all professionals in charge of the health of the mother-infant dyad with a practical tool based on present scientific knowledge.

Breastfeeding is the best way to feed infants as the properties of breast milk confer many short and longer-term benefits. As recommended by the World Health Organization, exclusive breastfeeding should continue throughout the first 6 months of life and, after this time, be accompanied by complementary feeding for as long as the mother and infant want. Data from our general population show that the mean duration of breastfeeding does not exceed 3-5 months, early cessation during the first month occurs in 30% of cases and only 10%-20% of the mother-infant dyads maintain it up to 6 months. We review the risk factors for the initiation and continuation of breastfeeding, the best moments to promote breastfeeding on the part of health institutions and the most effective actions. At the same time, we present the PALMA project, the purpose of which is to evaluate the effectiveness of a multidisciplinary intervention program to promote breastfeeding at the primary care level, comparing a group of infants with a control group.

Breast milk is the ideal form of nutrition for infants. Among its many advantages is the prevention of allergic diseases. The incidence of hemorrhagic proctocolitis, a manifestation of cow's milk protein intolerance, is currently increasing, especially among exclusively breastfed infants. It should be considered in the case of infants with blood-streaked stools despite good general health, in whom the presence of anal fissures and infectious colitis has been ruled out. Diagnosis is mainly based on the clinical response to an exclusion diet. A definitive diagnosis is rarely achieved because the good prognosis and outcome make it unnecessary to perform invasive tests. An endoscopic evaluation and biopsy may be necessary only if the bleeding persists. The treatment is the elimination of cow's milk proteins from the diet. The management of formula-fed infants with rectal bleeding is easy. However, in the case of exclusively breastfed infants, there are questions that need to be clarified.

Developmental care was introduced in many neonatal care units some time ago. The aim of this initiative is to improve preterm outcomes through comprehensive interventions that consider the newborn infant and his or her family as a closed unit. Kangaroo mother care, which is included among these interventions, is defined as mother and infant skin-to-skin contact as early as possible, as continuously as possible and as long as possible, together with breastfeeding, which will benefit both mother and infant. Kangaroo mother care should be offered to all preterm or sick newborns as an alternative to care in an incubator as it is effective in terms of temperature control, reduces the risk of infections and episodes of apnea, favors breastfeeding, enables and strengthens mother/father-infant bonding, restores the predominant role of the family in infant care and reduces hospital stays.

Objective: To determine the prevalence of breastfeeding (BF) in our setting and evaluate the efficacy of a program to promote its initiation and prolongation.

Method: A descriptive, retrospective study based on the review of the medical records of infants born in our health area during 2005.

Results and conclusions: The prevalence of BF is low and its duration short with respect to the recommendations of the World Health Organization. The program to promote BF has little influence on the decision to undertake and continue this practice.

Introduction: Exclusive breastfeeding is the best method during the first six months of life of the infant, and is recommend­ed by the majority of organizations and institutions. However, the number of women who start and the duration are still very limited, and are easily influenced.

Material and methods: Mothers who gave birth in the hospital between the years 2001 and 2003 were interviewed after the birth of their children to ask about their choice of feeding method. The breastfeeding mothers were followed for the first six months to establish the duration of breast feeding and main causes for discontinuing it.

Results: In all, 69.9% of the 1166 mothers (1,185 live infants) intended to breastfeed, whereas 31.5% of 1,170 babies were bottle-fed with formula; 17.4% gave up breastfeeding during the first week; 3.8% gave it up between the first and fourth weeks; 12.7% between the fourth and twelfth weeks; and 13.8% continued breast feeding after week 24. The main causes for discontinuing were the failure of the breastfeeding technique (45.2%), natural causes (22.1%), return to work (11%) and diseases in the mother (8.6%). The main cause for discontinuing within the first 4 weeks was an incorrect technique (58.1% versus 41.3%), followed by diseases in the mother (17.4% versus 6%) and diseases in the infant (9.8% versus 2.4%).

Conclusions: Breastfeeding is influenced by many external factors, which could be modified through proper education of mothers and those around them, and through the introduction of institutional measures that support it.

Objective: To study the prevalence and duration of maternal breastfeeding (MB) in the Region of Murcia.

Methods: Cross-sectional study (June, 2007). Mothers of infants under 24 months old were surveyed in immunization centers. The study was conducted through the 77 health zones of the 6 health areas of the Region. The sample size was proportional to the number of newborns in these areas. Breast-fed baby, mother and child feeding social and health data were collected. The MB prevalence was calculated in accordance with the categories defined by the World Health Organization (WHO) and the reasons for not starting and for stopping MB were studied.

Results: Data from 1,836 infants (response rate of 95.2%) has been obtained. Upon hospital discharge, the percentage of children fed with MB was of 89.7% (1,643), 76.7% (1,405) of which were breastfed without nourishing supplements. 44.4% of infants exclusively MB at 3 months and 36.3% at 6 months. The median duration of exclusive MB was of 75 days and of 129 days for partial MB. The reasons for not being fed by MB were: disease/admission (46.7%), lack of milk (28.6%), and mother's decision (19.3%). The reasons for discontinuing breast¬feeding were: hypogalactia and insatiable appetite (29.3%), and not to put on weight (11%). The variables that showed statistically significant association (p < 0.05) regarding MB were child weight, type of childbirth, and health area, and, regarding the mother, age, parity, occupation, place of origin, and education.

Conclusions: The MB figures in the Region of Murcia are similar to those in our environment, but are far from those recommended by the WHO.