|Beri-Beri and breast-feeding|
|Breast-feeding and Beri-Beri||Ritsuko Aikawa + M. Golden||18.02.99|
|Re: Breast-feeding and Beri-Beri||George Beaton||18.02.99|
Date: Thu, 18 Feb 1999 12:33:58 +0000
Subject: Breast-feeding and Beri-Beri
I have received a question from a nurse working in Cambodia. I am forwading it . I appreciate NGONUTS help.
Japan International Cooperation Agency, Medical Cooperation Department
How are you?
Many of the women are beriberi. After nutritional intervention on women, eating more pulses and vegetables, a mother began to produce her milk, however, her child suddenly died 2months old. The medical doctor suspected that a deficiency of thiamine made the baby die because the milk produced by the mother did not contain enough thiamine.
When a mother in the village does not produce any milk, she always gives her baby hot water with sugar.
They do not have a money to buy powder milk. Many cambodian mothers breast feed for more than one year without giving additional food.
Now I have a question;
*When a mother does not produce any milk and she is poor, how to feed the new born baby?
*Is it true that when a mother is beriberi, her milk does not contain enough thiamine for the baby survive?
Thank you for your help in advance.
Note added by M.Golden
Breast milk thiamine can certainly drop to levels where the infant gets one of the syndromes of infantile beri-beri (aphonic beri-beri, acute cardiac failure, meningo-enchephalitis like) which were described in a message some time ago (2nd May 1997) and is available from the archives. If the mother has beri-beri the infant is at grave risk - it is even more important to appreciate that, because the infant's requirements are proportionately much higher than the mother's, the fully breast fed child can have infantile beri-beri without the mother having any symptoms at all - in this situation the correct diagnosis is rarely made, but we should all be aware of this.
If there are those who want the original message and do not have access to WWW then let me know and I will send it to them "off-line".
I have heard from Nick White (Wellcome Trust Units - Thailand and Viet Nam) that he has data on magnitude of the problem of deaths from unsuspected thiamine deficiency in young children and that it could be up to 10% of deaths in some regions - perhaps he would care to comment on this (smile - please).
Date: Thu, 18 Feb 1999 15:23:37 EST
From: George Beaton <g.beatonatutoronto.ca>
Subject: Re: Breast-feeding and Beri-Beri
There is a well-documented literature concerning infantile beriberi in southeast Asia and the Philippines. Infantile beriberi was associated with suddent deaths in infants (1-3 m old) from acute beriberi while the mother might exhibit clinical signs of only marginal beri beri. The development of beri beri in the infant was seldom noticed until a sudden acute and often fartal episode developed. The probable explanation is that thiamin levels in milk are not "regulated" like some other micronutrients and reflect dietary ntake and circulating blood levels. The thiamin levels in the milk secreted by the thiamin-depleted mothers was simply inadequate to prevent beriberi in the suckling infant.
It sounds as though there may be urgent need for thiamin supplementation (creal fortification or direct supplements or, if feasible, change to parboiled or brown rice if polished rice is the staple) of mothers and probably the general population in the area in which you are working.
Date: Fri, 19 Feb 1999 11:40:45 +0000
From: "Patrick Kolsteren" <pkolsterenatitg.be>
Subject: Ngonut: beri-beri
Further to the excellent answer of George Beaton I wanted to share some personal experiences with beri-beri in the region of south-east Asia.
Beri-beri is still very frequent in south-east Asia. In the North-east of Thailand where I worked a number of years, we saw lots of beri-beri in young men and only very occasionally in infants. The signs and symptoms of infantile beri-beri appear and progress so fast that by the time the mother sees something is wrong with the infant there is very little time left to arrive at the hospital. Infants often expire on the way to the hospital. We did however, see many cases of infantile beri-beri in the refugee camps in the north east of Thailand (when symptoms develop the mothers reached in time the hospital) which was due to the relative lack in the diet of fruits and vegetables and the exclusive use of white rice. Since thiamine is not really stored in the body infants will depends very much on the daily intake of B1 which in poor rural areas will be fluctuating highly. We never saw infantile beri-beri after giving daily supplements to lactating women. This seems to me the best immediate solution. In southeast Asia, traditional communities have sometimes post-natal practices where the mother is put on a bamboo bed above hot charcoal. Thsi can be even for a few days. This produces a sauna effect. he women is given little food and water and a mixture of chilis with salt. An important degree of dehydration can be found with this practise. The newborns are given water during these first days. I would look for this type of practice as a cause for a low breast milk output (dehydration of the mother and non-stimulation of the breast). It is only when the nutritional status of the mother is exceptionally low that milk output will decrease.
Hope this is of some use to you.
Nutrition and Child Health Unit, Institute of Tropical Medicine Antwerp
Nationalestraat 155, 2000 Antwerpen, Belgium
tel 32-3-2476389 Fax 32-3-2476543