Monday, October 31, 2016

Human milk – as a topical treatment?

Not too long ago, a participant in one of my research studies asked me if I had heard of using breast milk as a treatment for ear or eye infections and skin rashes. A friend had recommended treating a recent episode of conjunctivitis on the baby with human milk. About a year earlier, another participate had informed me that she was putting milk in her baby’s ear to treat an infection.  So here’s the question . . .does it actually work?

Figure 1: Much like Gus Portokalos found that Windex cured everything, is it possible that human milk can treat topical infections?

Ear Infections
First off, there is good evidence that the act of breastfeeding reduces the risk of ear infections in infants. It is unclear if this benefit is related to the milk itself or to the actual act of suckling at the breast, as no studies have been conducted on infants receiving only pumped milk. Abraham and Labbock do hypothesize that the mechanical act of suckling, with its distinct pattern of suck, swallow, breathe and the may increase aeration of the eustachian tube, while the differences in pressure associated with bottle feeding may instead increase the risk of eustachian tube dysfunction from the negative pressure transmitted from the bottle (Brown and Magnuson 2000). Importantly, these pressure differences are only found in unventilated or partially ventilated bottles – fully ventilated bottles showed no such pressure changes. Human milk also contains numerous antibodies and immune factors that will serve to protect the infant from infection.
However, the use of breast milk as a topical treatment for ear infections has not been similarly studies. No one has ever published the results of a randomized control trial – or even an observational study – on the topical application of human milk as a treatment for ear infections. And there is a pretty good reason why:

Most ear infections clear up on their own without the need for further treatment.

In fact, the American Academy of Pediatrics recommends against using routine antibiotics in the case of milk to moderate ear infections, instead reserving them for severe or chronic infections. Further, the majority of ear infections are middle ear infections, on the inside of the ear drum. In this instance, the ear drum will block the milk from entering the ear and maintain a barrier between the milk and the infection.  The majority of personal accounts reporting breast milk as curing the ear infection? The mostly likely explanation is that the ear infections resolved from a combination of immunological support from the mother’s milk during normal breastfeeding practices and the infant’s immune system, not from the external application of the milk.  

Skin conditions: rashes, eczema
Okay, so what about breast milk as a treatment for other, topical conditions, such as skin rashes, eczema, or diaper rash? In these instances, the milk will be in direct contact with the infection, possibly allowing the immunological agents in the milk to work directly on the infection. And certainly, we know from studies exposing different pathogens to human milk that exposure is associated with increased pathogen death.
A recent study by Farahani, Ghobadzadeh, and Yousefi actually conducted a randomized clinical trial or hydrocortisone 1% ointment compared to freshly expressed human milk in study of 141 breastfeeding infants. All infants in the study were breastfeeding, and they were randomly assigned to one of the two treatment groups: freshly expressed human milk or topical application of the 1% hydrocortisone ointment. Treatment lasted for 7 days, with clinical assessment of the diaper rash at baseline, 3 and 7 days. There were no differences between the two groups with regards to severity scoring of the rash at recruitment and no difference in severity between the two groups at day 7. Most importantly, both groups had shown significant declines in severity from the baseline assessment.  So, for mild diaper rash, human milk applied a minimum of three times a day has been shown to reduce severity of diaper rash. 

Eye infections
The history of using human milk as a treatment for eye infections is a very old one, going back to some of the earliest known medical texts. However, not much is known about the effectiveness. A recent study by Baynham and colleagues (2013) looked at the effectiveness of fresh human milk against several species of bacteria that commonly cause eye infections in infants. The researchers tested milk against Escherichia coli, Haemophilus influenzae, Neisseria gonorrhoeae, Pseudomonas aeruginosa, Streptococcus pneumonia, Staphylococcus aureus, Moraxella catarrhalis, coagulase-negative Staphylococcus and viridans group Streptococcus. Of these bacteria, three were inhibited following exposure to human milk: three were significantly inhibited by human milk relative to the negative control: N. gonorrhoeae, M. catarrhalis and viridans group Streptococcus. Human milk was as effective as polymyxin B sulfate/trimethoprim ophthalmic solutions against N. gonorrhoeae; less so but still effective against M. catarrhalis and Streptococcus.  In the typical American infant, the common causes of conjunctivitis are H influenzae, Streptococcus pneumonia and M catarrhalis. However, this pattern is unique to developed countries – in developing countries the most common pathogen causing eye infections is N. gonorrhoeae.
So how does human milk stack up as a topical treatment? Pretty well based on the limited clinical evidence and there is certainly no data to suggest that using milk as a first line intervention will have any negative consequences. 


Abrahams, Sheryl W., and Miriam H. Labbok. “Breastfeeding and Otitis Media: A Review of Recent Evidence.” Current Allergy and Asthma Reports 11, no. 6 (August 11, 2011): 508. doi:10.1007/s11882-011-0218-3.

Baynham, Justin T. L., M. Allison Moorman, Catherine Donnellan, Vicky Cevallos, and Jeremy D. Keenan. “Antibacterial Effect of Human Milk for Common Causes of Paediatric Conjunctivitis.” The British Journal of Ophthalmology 97, no. 3 (March 2013): 377–79. doi:10.1136/bjophthalmol-2012-302833.

Brown, C. E., and B. Magnuson. “On the Physics of the Infant Feeding Bottle and Middle Ear Sequela: Ear Disease in Infants Can Be Associated with Bottle Feeding.” International Journal of Pediatric Otorhinolaryngology 54, no. 1 (August 11, 2000): 13–20.

Farahani, Leila Amiri, Maryam Ghobadzadeh, and Parsa Yousefi. “Comparison of the Effect of Human Milk and Topical Hydrocortisone 1% on Diaper Dermatitis.” Pediatric Dermatology 30, no. 6 (December 2013): 725–29. doi:10.1111/pde.12118.


Friday, September 23, 2016

Podcast with Hold That Thought

Just a podcast about how awesome I find milk AND high altitude research. Oh, and there are stem cells in human milk!!!!

Sunday, May 1, 2016

Follow us in the field!

We're gearing up for our next field season . . .which starts tomorrow!

There is a possibility that we may have cell phone access in Nubri! A few villages have either wifi or cell service now, and we're preparing to share the research as it happens!

First up: the comparison data from the Nov 2015 - wasting in children under 2 decreased by 21% from May 2013 to November 2015. This represents an increase in mean weight of about 2.5 pounds. And this is despite the earthquake! The figure below is a dramatic representation of us during the calculations and immediately afterward.

If you want to follow us for updates (when we can give them!) there are lots of options! We will try to blog as we can, so check here. You can also follow us on Twitter and Instagram!

Twitter: QQuinnAnthroWman
Instagram: Infancy_at_altitude

and Mallika Sarma, the graduate student from Notre Dame who will be working with us:
Twitter: @MalliGoose
Instagram: MalliGoose

Tuesday, March 1, 2016

I’ll trade you my coffee table for some breast milk . . .buying milk off Craigslist

Recently I was approached by one of our local news channels about a project on online milk buying. The reporter had purchased several samples of human milk online, and I was wondering if I would be willing to be the scientific adviser for the project.

I’ll admit something – I went into this with a motive. I really felt like I was there to protect the milk for poor interpretation, panic arising at the mere presence of bacteria in the samples. Because there are bacteria in milk. These bacteria range from harmless skin bacteria to important bacteria that will colonize the infant’s gut and provide long term benefits to the infant (Marin et al., 2009; Thompson et al., 2012). 

The reporter had 3 samples, after making dozens of inquiries. Two samples were shipped, one arrived seemingly frozen and the other a leaking mess. The third sample was picked up from the mother. The leaking mess was thrown away, and the remaining two samples were tested.

Sample 1: Total bacterial count of 700,000 CFU/gram. This is 7x what is allowed by the dairy industry for pasteurization, and 70x what is allowed by the Human Milk Banking Association of America (HMABA). This included a substantial number of coliform bacteria. Now while many coliforms are not themselves harmful, they are generally used as a measure of bacterial contamination.  

Sample 2: Total bacterial count of <10 CFU/gram. No coliforms.

Compared to the literature, these numbers are not surprising. Earlier, full sized studies of human milk purchased online has found very similar results – Keim et al., (2013) reported that 74% of 102 samples they purchased online had microbial loads >24 CFU/g; comparable data for samples from milk banks are much lower. A second study, purchasing milk online in Canada, also found high levels of bacterial contamination for purchased milk (St. Onge et al., 2015). 
Figure 1: Figure 2 from Keim et al., (2013) showing the distribution of bacteria counts in milk purchased online. Sample 1 would have been placed in the 10^5 group for total bacteria. Image: doi: 10.1542/peds.2013-1687

What seems to be the biggest risk factor for microbial growth in milk? Keim et al., (2013) reported that the amount of time the milk spent in transit was the biggest predictor of microbial growth. Geraghty et al., (2013) reported shipping conditions broke down as follows: 89% of milk samples arrived at a temperature above -20C/-4F (hard frozen) and of those, 45% arrived above 4C/39.2F (or warmer than your fridge). We know milk spoils, and human milk is no exception to the Milk Spoils rule. 

Figure 2: Milk shipping is important, and just because samples look frozen does not mean they are!
What were some other factors? Keim et al (2013) noted that “Information sellers conveyed in their advertisements about their health and behaviors were poor indicators of milk quality.” Donor claims as well (sellers claiming they were milk bank donors) and large volumes were also risk factors. It should be a general red flag that someone claiming to be a milk bank donor but selling thousands of ounces of milk online has something else going on . . .either the bank turned down the milk or the person is not associated with a milk bank despite claims otherwise. 

Keim et al., (2013) also found that the age of milk – that is the interval between when it was expressed and when it was shipped – was also a predictor of bacterial load. They hypothesized that anti-microbial properties of the milk may decline with storage time – and that assumes immediate and appropriate storage. One other potential point of risk may be at the pump itself. There have been several neonatal intensive care unit based outbreaks of bacterial infections linked to improperly cleaned pumps, and one estimate suggests that nearly 1/3 of all pumps may be improperly cleaned and potentially harbor bacteria. 

Figure 3: PSA – maybe give your pump a good scrub down today, just in case. This style of pump is especially problematic because the rubber bulb is extremely hospitable to bacteria. Photo: Etsy
Overall, I was really surprised by this. I expected the Craigslist sample to be a little dodgy, but I genuinely expected that the samples would be safe. Reading the literature, seeing our results, and digging into the online ads has really changed my mind. Buying breast milk online, especially from complete strangers is a risky game. I mean, I wouldn’t buy a dozen cookies off of Craigslist, and the same goes for milk. Both the FDA and the AAP recommend against such practices – and for evidence based reasons as shown in the Pediatrics papers and others. Things in the ads that made me curious: large volumes of milk with a young baby, packages of milk that look too uniform, poor organization of the freezer.

Figure 4: Two things I would never personally buy on Craigslist. Photo:
What about milk sharing? As Aunchalee Palmquist has previously reported (see her blog here) there is something different about milk sharing - it falls more under the auspices of a gift economy, and most studies show that peer to peer milk sharing does not include the same risks of bacterial contamination as milk sold AND shipped. In recent work, Palmquist report that of 867 mothers who completed their survey 100% did not participate in anonymous donation but knew or screened their donors. Almost 30% of mothers only shared with families or close friends, and a similar number (27%) of mothers had serological screening for their donors. This really highlights that we are talking about two very different practices here - milk sharing and milk selling - with possible different underlying motivations and practices.


I had completely forgotten a post on milk selling over at mammalssuck -  worth checking out here!

Geraghty SR, McNamara KA, Dillon CE, Hogan JS, Kwiek JJ, Keim SA. (2013) Buying human milk via the internet: just a click away. Breastfeed Med. 2013 Dec;8(6):474-8. doi: 10.1089/bfm.2013.0048.

Keim SA, Hogan JS, McNamara KA, Gudimetla V, Dillon CE, Kwiek JJ, Geraghty SR. (2013) Microbial contamination of human milk purchased via the Internet. Pediatrics. 132(5):e1227-35. doi: 10.1542/peds.2013-1687.

Keim SA, McNamara KA, Jayadeva CM, Braun AC, Dillon CE, Geraghty SR. (2014) Breast milk sharing via the internet: the practice and health and safety considerations. Matern Child Health J. 18(6):1471-9. doi: 10.1007/s10995-013-1387-6.

Marín ML, Arroyo R, Jiménez E, Gómez A, Fernández L, Rodríguez JM. (2009) Cold storage of human milk: effect on its bacterial composition. J Pediatr Gastroenterol Nutr. 49(3):343-8. doi: 10.1097/MPG.0b013e31818cf53d.

Palmquist AE, Doehler K. 2015 Human milk sharing practices in the U.S. Matern Child Nutr.  doi: 10.1111/mcn.12221. [Epub ahead of print]

St-Onge M, Chaudhry S, Koren G. (2015) Donated breast milk stored in banks versus breast milk purchased online. Can Fam Physician. 2015 Feb;61(2):143-6.
Thompson AL. (2012) Developmental origins of obesity: early feeding environments, infant growth, and the intestinal microbiome. Am J Hum Biol. 24(3):350-60. doi: 10.1002/ajhb.22254.